Mindfulness training assists individuals with moderate mental retardation to maintain their community placements.

The mindfulness procedure Meditation on the Soles of the Feet can help individuals with mild mental retardation control aggressive behavior. In this study, our aim was to teach this mindfulness technique, using a multiple baseline design, to 3 individuals with moderate mental retardation who were at risk of losing their community placements because of their aggressive behavior. These individuals initially found the procedure difficult to comprehend because they could not easily visualize past anger-producing situations, but mastery was achieved when we incorporated recreating-the-scene as a prompt and added a discriminative stimulus on the soles of the participants' feet. Aggressive behavior decreased with mindfulness training, and follow-up data showed that they managed their aggressive behavior in the community for at least 2 years and thus were able to retain their community placements.

Individuals with mental illness can control their aggressive behavior through mindfulness training.

Verbal and physical aggression are risk factors for community placement of individuals with serious and persistent mental illness. Depending on the motivations involved, treatment typically consists of psychotropic medications and psychosocial interventions, including contingency management procedures and anger management training. Effects of a mindfulness procedure, Meditation on the Soles of the Feet , were tested as a cognitive behavioral intervention for verbal and physical aggression in 3 individuals who had frequently been readmitted to an inpatient psychiatric hospital owing to their anger management problems. In a multiple baseline across subjects design, they were taught a simple meditation technique, requiring them to shift their attention and awareness from the anger-producing situation to the soles of their feet, a neutral point on their body. Their verbal and physical aggression decreased with mindfulness training; no physical aggression and very low rates of verbal aggression occurred during 4 years of follow-up in the community.

Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities.

Research shows that after training in the philosophy and practice of mindfulness, parents can mindfully attend to the challenging behaviors of their children with autism. Parents also report an increased satisfaction with their parenting skills and social interactions with their children. These findings were replicated and extended with 4 parents of children who had developmental disabilities, exhibited aggressive behavior, and had limited social skills. After mindfulness training, the parents were able to decrease aggressive behavior and increase their children's social skills. They also reported a greater practice of mindfulness, increased satisfaction with their parenting, more social interactions with their children, and lower parenting stress. Furthermore, the children showed increased positive and decreased negative social interactions with their siblings. We speculate that mindfulness produces transformational change in the parents that is reflected in enhanced positive behavioral transactions with their children.

Mindful staff increase learning and reduce aggression in adults with developmental disabilities.

Aggression by individuals with developmental disabilities may threaten their community placement. In a multiple baseline design across group homes, we provided group home staff with behavioral training and later with mindfulness training to assess the impact on aggressive behaviors and the number of learning objectives mastered by individuals in their care. We also assessed other outcomes including activities engaged in by the individuals, use of restraint by staff, and measures of satisfaction. The effect of varying staff-resident ratios was evaluated on all measures. When compared to baseline, the number of staff interventions for aggression showed some reduction following behavioral training, but decreased substantially only following mindfulness training. There was also some increase in the number of learning objectives mastered by the individuals following behavioral training, but greater and more consistent increases were obtained only after mindfulness training. Improvements also occurred on the other measures assessed after behavioral training, but these were always greater and more consistent following mindfulness training. In addition, consistent gains followed behavioral training only with a high staff-resident ratio whereas the larger gains after mindfulness training occurred with both medium and low staff-resident ratios. Our results suggest that the addition of mindfulness training considerably enhanced the ability of the group home staff to effectively manage the aggressive behavior and learning of the individuals.

Mindful caregiving increases happiness among individuals with profound multiple disabilities.

Happiness is a critical indicator of quality of life in humans. A few studies have measured levels of happiness displayed under different conditions by individuals with profound multiple disabilities. We were interested in determining whether increasing the mindfulness of caregivers would result in increased levels of happiness in adults with these conditions. Using alternating treatments embedded within a multiple baseline across caregivers design, we measured baseline levels of happiness displayed by three adults with profound multiple disabilities when they engaged in leisure activities, each by a different pair of caregivers. Then, we taught mindfulness methods to one of each pair and measured the levels of happiness displayed by the individuals during the 8-weeks training for the caregivers. Finally, we measured the levels of happiness displayed by the three individuals for 16 weeks following the termination of mindfulness training. We found that, regardless of whether the level of happiness was initially observed to be high or low in the presence of a caregiver, it increased markedly when an individual interacted with a caregiver who received training in mindfulness when compared to the control caregiver, who did not receive such training. Our study provides evidence that increasing the mindfulness of a caregiver can produce a substantial increase in the levels of happiness displayed by individuals with profound multiple disabilities.

Mentoring treatment teams to integrate behavioral and psychopharmacological treatments in developmental disabilities.

Individuals with developmental disabilities often have a concomitant psychiatric disorder severe enough to require treatment. The behavioral endpoint of psychiatric disorders may require integrated behavioral and psychopharmacological treatments to stabilize their condition and enhance their quality of life. We used a mindfulness-based mentoring model to facilitate the integration of behavioral and psychopharmacological treatments at the treatment team level. Using a multiple baseline design across treatment teams, we assessed the degree of integration of these two treatment modalities using a 23-item rating scale, and then introduced mentoring successively across the three treatment teams. Following mentoring, six follow-up assessments at monthly intervals were undertaken to assess functioning of the treatment teams in the absence of mentoring. The low levels of integration of behavioral and psychopharmacological treatments occurring during baseline improved significantly within each team commensurate with the mentoring. Further, the enhanced treatment team functioning was maintained during a 6-month follow-up period. Mentoring of treatment teams may be an effective first step in integrating behavioral and psychopharmacological treatments that are deemed essential in the care and treatment of individuals with developmental disabilities and mental illness.

Effects of a mindfulness-based smoking cessation program for an adult with mild intellectual disability.

Smoking is a major risk factor for a number of health conditions and many smokers find it difficult to quit smoking without specific interventions. We developed and used a mindfulness-based smoking cessation program with a 31-year-old man with mild intellectual disabilities who had been a smoker for 17 years. The mindfulness-based smoking cessation program consisted of three components: intention, mindful observation of thoughts, and Meditation on the Soles of the Feet. A changing-criterion analysis showed that this man was able to fade his cigarette smoking from 12 at baseline to 0 within 3 months, and maintain this for a year. Follow-up data, collected every 3 months following the maintenance period, showed he was able to abstain from smoking for 3 years. Our study suggests that this mindfulness-based smoking cessation program merits further investigation.

Peer with intellectual disabilities as a mindfulness-based anger and aggression management therapist.

A young man with intellectual disabilities (ID) and mental illness, who had previously been taught to successfully manage his aggressive behavior by using Meditation on the Soles of the Feet, reported that he shared his mindfulness practice with his peers with ID. When requested by his peers, and without any training as a therapist, he began to teach this procedure to his peers for controlling their anger and aggressive behavior. We tracked the anger and aggressive behavior of three of the individuals he taught and the fidelity of his teaching of the procedure. According to self and staff reports, anger and aggressive behavior of the three individuals decreased to very low levels within five months of initiating training and remained at very low levels for the two years during which informal data were collected. The fidelity of his teaching the procedure was high, if one allows for his idiosyncratic teaching methods. These findings suggest that individuals with mild ID, who have mastered an effective mindfulness-based strategy to control their aggressive behavior, may be able to teach their peers the same strategy to successfully control their anger and aggressive behavior to a level that is acceptable for community living.

Clinical and benefit--cost outcomes of teaching a mindfulness-based procedure to adult offenders with intellectual disabilities.

The effects of a mindfulness-based procedure, called Meditation on the Soles of the Feet, were evaluated as a cognitive-behavioral intervention for physical aggression in 6 offenders with mild intellectual disabilities. They were taught a simple meditation technique that required them to shift their attention and awareness from the precursors of aggression to the soles of their feet, a neutral point on their body. Results showed that physical and verbal aggression decreased substantially, no Stat medication or physical restraint was required, and there were no staff or peer injuries. Benefit-cost analysis of lost days of work and cost of medical and rehabilitation because of injury caused by these individuals in both the 12 months prior to and following mindfulness-based training showed a 95.7% reduction in costs. This study suggests that this procedure may be a clinically effective and cost-effective method of enabling adult offenders with intellectual disabilities to control their aggression.

A mindfulness-based health wellness program for an adolescent with Prader-Willi syndrome.

Individuals with Prader-Willi syndrome have hyperphagia, a characteristic eating disorder defined by a marked delay in the satiety response when compared to controls. This eating disorder has been particularly difficult to control. The authors taught and evaluated effectiveness of regular exercise alone, regular exercise plus healthy eating, and mindfulness-based strategies combined with exercise and healthy eating to an adolescent with this syndrome. Mindfulness-based strategies included mindful eating, visualizing and labeling hunger, and rapidly shifting attention away from hunger by engaging in Meditation on the Soles of the Feet. On average, when compared to baseline levels, there were decreases in weight with regular exercise and exercise plus healthy eating, but the most consistent and sustained changes were evidenced when mindfulness training was added to exercise and healthy eating. The adolescent continued using the mindfulness health wellness program and further reduced his weight during the 3-year follow-up period.

Research briefs reading grade level and readability of printed cancer education materials.

PURPOSE/OBJECTIVES: To analyze cancer brochures to estimate their reading level and assess their readability. DESIGN: Quantitative. SAMPLE: 10 cancer brochures published by various cancer organizations. METHODS: SMOG was used to estimate reading grade level of the brochures; the Readability Assessment Instrument (RAIN) was used to analyze the brochures in terms of 14 variables that affect comprehension. Interrater reliability was computed for reading grade level and readability level. MAIN RESEARCH VARIABLES: Reading grade level and readability. FINDINGS: Reading grade level of the brochures ranged from 9-15. The RAIN analysis showed that the number of variables incorporated across the 10 brochures ranged from 12-14, and the number of variables reaching readability criteria ranged from 6-8. CONCLUSIONS: Cancer education materials are written at levels that may be too high for the average reader. These materials also may be difficult to understand because of the way they are written. Materials need to be written so that they match the reading levels of patients with cancer and the general public and incorporate more of the variables that affect comprehension so that readers can understand them easily. IMPLICATIONS FOR NURSING: Nurses use written education materials to inform patients about their cancer diagnoses. They can conduct a comprehensive analysis of cancer brochures using SMOG and RAIN and then, if needed, use this information to revise the brochures so that they can be understood easily. If possible, patients who are going to be using the materials should be involved in the revision process.