Coping with depression, anxiety, or insomnia? Research is finding that certain mindfulness practices can help make caregiving a little more manageable.
Research studies on mentalizing imagery therapy are looking to enroll caregivers.
Family members who care for a loved one with dementia often experience chronic stress, anxiety and depression. Psychological research into mindfulness remains a fairly nascent field of study, but mindfulness practices have numerous benefits for care partners.
“Mindfulness is an attitude or a state of being that could pertain to any situation. For example, when caring for a loved one and feeding them or helping them to get dressed when washing dishes or going for a walk, a person can maintain the mindful attitude,” Massachusetts General Hospital psychiatrist Dr. Felipe Jain, the director of Healthy Aging Studies at the Depression Clinical and Research Program, told Being Patient. “Meditation is a specific kind of mindfulness practice, in which you are usually sitting down with your eyes closed and focusing on the sensations that you’re experiencing — and on the mental experiences you’re having in simply observing it for an extended period of time.”
Jain said the current evidence suggests that, with respect to dementia caregivers, mindfulness practices can not only reduce their symptoms of depression, anxiety, stress and insomnia, but also improve positive qualities like resilience, happiness and sense of value.
“Mindfulness in the psychology literature is a relatively new concept that has emerged over the past 15 years or so,” Jain said. “And for a new concept to gain such traction and to show such powerful results … is really surprising, and interesting, and also very promising, particularly for caregivers who might not have grown up with mindfulness or meditative practices.”
Over the years, his team has focused on the development of mentalizing imagery therapy, which involves gentle stretching, breath-focused meditation and guided imagery, or visualization practices.
These techniques, Jain said, can help people in dementia caregiving roles develop a deeper understanding of their reactions toward others — and vice versa.
Mentalizing Imagery Therapy for family caregivers
Those benefits are backed by scientific evidence. In a pilot clinical trial, published in Psychotherapy and Psychosomatics, Jain’s team set out to test the hypotheses that mentalizing imagery therapy for family caregivers would “reduce depression symptoms and improve positive psychological traits more than a support group,” and that there would be material changes to the brain — namely, an improvement in connectivity in the dorsolateral prefrontal cortex, a part of the brain that which orchestrates other brain regions and plays a vital role in executive function — as a result of the mentalizing imagery therapy.
The team randomly split 46 dementia caregivers into two groups: a group that practiced mentalizing imagery therapy and a support group. Both groups attended four weekly, two-hour long sessions facilitated by instructors.
“The main results were that people began to experience increased peace of mind and substantial reductions in depression,” Jain said of the mentalizing imagery therapy group. For instance, the participants reported that they learned ways to comfort themselves and to take a break from the happenings of life, he explained. They also described the therapy they underwent in the study as beneficial to their relationships with others.
Ultimately, Jain’s team found, the mentalizing imagery therapy group significantly outperformed the support group in addressing the mental health issues in question — depression, anxiety, mindfulness, self-compassion and well-being at large. Relative to a support group, participants in the mentalizing imagery therapy group also showed significant increases in connectivity in the dorsolateral prefrontal cortex.
Opportunities to participate in mindfulness research studies
“One of the limitations of our research was that it was delivered in person and so that really limits access,” Jain said. “Even people who live in Boston have a hard time getting to Massachusetts General Hospital or to other specialized sites.”
Building on the recent mentalizing imagery therapy research, Jain’s team will launch a larger trial of 120 dementia caregivers beginning this summer.
Interested parties can sign up for an email list via his website to receive notifications about the upcoming trial.
Subscribers will “be notified down the line when we have a study opening up in work when we’re recruiting participants,” he said. Caregivers will be reimbursed for the time dedicated to participating in the study, and all participants will ultimately receive the therapy.
However, caregivers need not be part of a clinical trial to experience the benefits of mindfulness practices, Jain noted. Here are a few exercises dementia caregivers can practice at home.
Science-backed mindfulness practices to try at home
Mindfulness classes, apps and video tutorials at home and in your community
While developing mindfulness qualities can be done in many ways, Jain said, “the most well studied is to join a local group and receive in person instruction.” Such groups might be found at local libraries, yoga studios and YMCAs.
In the meantime, he said mindfulness and meditation apps like Calm and Headspace — both of which come with paid subscriptions — can be helpful too.
“Headspace, in particular, has been studied within older adults, and has been found to reduce anxiety symptoms in older adults in general,” he noted.
Lastly, one can learn mindfulness techniques through recordings of instructors on YouTube and elsewhere.
“Jon Kabat-Zinn was really the person who brought mindfulness into the mainstream of psychology, and he has recordings online,” Jain said. He added, “Sharon Salzberg is also a very well recognized mindfulness teacher.”
Mindfulness-based Stress Reduction Training
Developed by Jon Kabat-Zinn, Mindfulness Based Stress Reduction (MBSR) involves practices like yoga, noticing one’s thoughts and emotions, and mindfulness of the body and breath, along with visual and body imagery practices, that collectively train a person on how to have a “mindful” mindset.
MBSR teaches “how to sit with oneself, one’s feelings, one’s emotions, and to be able to be present to them without having to run away from them or get ashamed by them,” Jain said. “and also to be able to maintain a mindful attitude in daily life.”
There are barriers to entry, he noted. “Sessions are two- to two-and-a-half hours every week for eight weeks, plus a half-day to a full-day retreat,” he said. “Sometimes that can be challenging for caregivers to do.”
However, certain MBSR classes offer the foundations without such intensive scheduling or rigidity, and in some cases, these are available online, though MBSR generally comes at some cost.
Caregivers can practice this mindful attitude in their routines, whether it be walking, washing the dishes, feeding a loved one and helping them get dressed, Jain said.
According to Jain, MBSR is a well-validated program that has been studied for caregivers.
“There’s very good data for it for reducing depressive symptoms, reducing anxious symptoms and perceived stress,” Jain said of MBSR. “There’s less evidence that it improves positive qualities, such as mindfulness itself, which we demonstrated in our study, or happiness or the sense that the caregiver has something to contribute to others.
“That’s not to say that MBSR doesn’t do those things,” he added. “But researchers typically have not studied it.”
Kirtan Kriya Yoga
One particular tradition of kundalini yoga, Kirtan Kriya, is a go-to for Jain in mindfulness exercises. He walks through the exercise in a YouTube video about meditation and mindfulness approaches.
Kirtan Kriya includes repeating the phrase — “sa-ta-na-ma,” which translates to “beginning-life-death-rebirth” — in three sequential forms: chanting aloud, then whispering, followed by mentally repeating these phrases in silence. This is paired with finger tapping to each syllable and visualizing light shining down on a person.
In clinical practice, Jain said Kirtan Kriya is taught by an instructor in one setting, along with 12 minutes of daily practice at home.
He pointed to the research of Helen Lavretsky from the University of California Los Angeles, whose team has studied its benefits for caregivers. The evidence for Kirtan Kriya in reducing depression is promising, he added, and there is data showing its potential for improving executive functions as well.