Evaluation of a brief mindfulness-based program on recall and sense of well-being in a sample of older African Americans.
This study examined the effect of mindfulness training, a natural
healthful approach which is consistent with the Rogerian construct of
unitary and inseparable human-environmental field, on recall and sense
of well-being. A number of studies have demonstrated positive benefits
from the practice of mindfulness; however, it does not appear from the
literature review that mindfulness interventions have previously been
studied in older African American populations. Addressing this
understudied population, the sample (N=14) for this preliminary study
was recruited from African Americans 65 years or older who live in a
senior living community. The volunteers were randomly assigned to the
experimental group (n=7) or the control group (n=7). The study examined
the ability of four 30-minute group sessions of mindfulness intervention
to improve recall capacity and sense of well-being when compared to the
control group who did not engage in mindfulness training, but rather
participated in four 30 minute group discussions on aging. Baseline
recall was measured by having each participant listen to a recorded 100
word short story, then asking them to immediately recall verbally all
that they could remember of the story. Participants were also asked to
complete the Well-Being Picture Scale as a base line measure prior to
their participation in the study. Immediately following completion of
the fourth mindfulness training and discussion sessions, both groups
were again measured for recall capacity and sense of well-being. While
no statistically significant differences were found between the
experimental and control groups with regard to recall or sense of
well-being, the tendency toward improvement supports replication of the
study in a larger sample over a longer period of time.
Keywords: Mindfulness, African Americans, Older Adults, Dementia
Senses and sensation (Research)
|Author:||Hubbard, Jabrenta L.|
|Publication:||Name: Visions: The Journal of Rogerian Nursing Science Publisher: Society of Rogerian Scholars Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Society of Rogerian Scholars ISSN: 1072-4532|
|Issue:||Date: Jan, 2011 Source Volume: 18 Source Issue: 1|
|Topic:||Event Code: 280 Personnel administration; 310 Science & research|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
For the first time in American history, older adults age 65 and above outnumber people under the age of 25 years (Spence, 1995). Accounting for 8.3% of the older adult population in 2008, it is anticipated that the number of African American seniors will rise to 11% by 2050 (U.S. Administration on Aging [AOA], 2010). In general, health is expected to decline in the older adult population (Rejeski, 2008). Specifically, research findings predict a higher prevalence of mild cognitive impairment and various types of dementia in the older adult African American population (Doniger, Jo, Simon, & Crystal, 2009; Gurland, et al., 1999). Addressing these concerns, this study tested the ability of a brief mindfulness training program to improve the memory and well-being in a group of older African Americans.
Aging, Memory Decline, and Mindfulness
During the aging process, normal age related declines are apt to occur, and for some, decline in cognition or memory may become problematic. Studies indicate that the African American population is at higher risk for dementia related illnesses as compared to non-African Americans (Doniger, et al., 2009; Gurland, et al., 1999). Memory is affected by the ability to process stimuli, and with age the processing speed decreases (Luo & Craik, 2008). Given the increased risk of dementia in the older African American population, it is important to investigate practices that can aid in reducing cognitive decline in this population.
Research findings have also shown significant links between cognition and the body. One practice that is based on this relationship is that of mindfulness. It is believed that mindfulness connects the mind and body and subsequently aids in the healing process (McBee, 2008). Mindfulness is denoted by "paying attention in a particular way: on purpose, in the present moment, and nonjudgementally" (Kabat-Zinn, 1994, p. 4). This ability to be attentive, to completely experience the present, and to maintain focus has been correlated with improvements in various aspects of life (Raffone, Tagini, & Srinivasan, 2010). Kabat-Zinn (1990) and other mindfulness educators suggest that practicing mindfulness based approaches should foster seven specific features: "non-judging, patience, having a beginner's mind, trust, non-striving, acceptance, and letting go" (p. 32).
The practice of mindfulness began in the Eastern cultures of the world, and key teachings have evolved from Buddhist practices. Being actively aware in the present moment with tolerance, acceptance, and without judgment is being mindful, or as Kabat-Zinn (1994) states, it is "the art of conscious living" (p. 6). For instance, as you eat a meal, you notice each burst of flavor and each unique texture without adhering to the curiosity of whether the meal is appealing or distasteful. The food is just a food. This non-judgmental, present, and accepting practice of living in every moment can be applied to all aspects of life (Sanderson, n.d.).
Mindfulness can be practiced on a daily basis during any daily task. However, the formal practice of mindfulness involves meditation, walking, and yoga. Mindfulness also emphasizes and practices techniques that include mindfully breathing, eating, walking, and being mindfully aware of the body (Berceli & Napoli, 2006). In the professional arena, mindfulness has been developed into various programs. One frequent approach is that of mindfulness-based stress reduction (MBSR), developed by Jon Kabat-Zinn. Kabat-Zinn introduced the MBSR program for patients with chronic pain at the University of Massachusetts Medical Center in 1979.
The idea of accepting, welcoming, and being open to drifting thoughts while remaining focused in each moment and unique experience separates the mindfulness meditation from other meditative techniques (McBee, 2008). With mindfulness meditation, there is nothing that should be expected, there are no goals. This particular practice involves letting go of goals. There is not anything in particular that is being strived toward (Kabat-Zinn, 1990; McBee, 2008).
With no expectations or goals, control is actually gained (McBee, 2008). Learning to focus awareness is often practiced and aided by directing one's attention to their breath (McBee, 2008; Kabat-Zinn, 1990). Focused awareness can be fostered by concentrating on the breath that flows throughout the body, "Just breathe and let go. Breathe and let be" (Kabat-Zinn, 1994, p. 13).
General Health Benefits
Mindfulness has been intensely studied and has been associated with various medical improvements, both physical and cognitive. Regarding physical pain, the work of Baer and Krietemeyer (2006) suggest that mindfulness can be used to reduce the focus on pain and hinder the negative attention and focus placed on the pain (as cited in McCracken, et al., 2007). Mindfulness has also been found to aid one's personal and emotional thoughts and behaviors (Jain, et al., 2007). Specifically, Jain and colleagues observed that participants involved in the MBSR program experienced positive outcomes in regard to distress levels and mood states. In addition, participants resulted in decreased stress, anxiety levels, distraction, rumination levels, and improved attention (Jain et al., 2007). Mindfulness meditation has also been shown to improve cognition and mood, to help access information from working memory, and to aid in "cognitive processing" skills (Zeidan, et al., 2010a, p. 603), as well as to reduce mind wandering (Smallwood, Fitzgerald, Miles, and Phillips, 2009). The practice of mindfulness has also been associated with positive results on well-being (McCracken et al., 2007; Shapiro, Oman, Thoresen, Plante, & Flinders, 2008; Pradhan, et al., 2007; Mayo Clinic, 2009). The central aims in the mindfulness philosophy is to amplify awareness, heighten attention, and intensify focus, thus allowing for the separation from the autopilot, programmed behaviors and tendencies (Brown & Ryan, 2003). It is postulated that through mindfulness interventions, associations exist with positive health outcomes and increased positive feelings, thus indirectly resulting in an improved sense of well-being (Brown & Ryan, 2003; Shapiro, et al., 2008).
An important segment of mindfulness is cultivating and enhancing one's awareness, as well as controlling and focusing attention (Raffone, et al., 2010). To assess whether mindfulness can help increase attention in older adults, Levy, Jennings, and Langer (2001) completed a study with four groups (two mindfulness groups and two control groups) of older adults. The mindfulness intervention was interpreted by the number of distinctions noticed in a set of pictures. The two mindful groups told to notice a specific number of distinctions recalled a larger number of pictures compared to the control groups who did not receive instructions to notice distinctions. Levy and colleagues (2001) found that awareness and action taken to improve attention through the process of mindfulness are able to aid older adults in their recall by opening the mind to novel experiences and stimuli without attending to disturbing and dominating thoughts. These authors stress that in using mindfulness practice to improve attention and thus recall in older adults, it is important to "embrace distraction and let attention wander" (p. 192). Stress and Recall
A number of studies have demonstrated that elevated stress levels are associated with a reduction in the ability to recall certain events (Kramer, Buckhout, Fox, Widman & Tusche, 1991; Schwabe and Wolfe, 2010). Conversely, mindfulness has been shown to aid in the reduction of stress and anxiety (Kabat-Zinn, 1990).
Brief Mindfulness Training in the Older Adult Community
Kabat-Zinn created the mindfulness-based stress reduction (MBSR) program to be completed in 8 weeks. His customary meeting time consists of twenty-six hours, with one class meeting each week for two and a half hours, followed by one six hour class retreat in the sixth week of the program (Carmody & Baer, 2009). In addition to the class assembly time, daily homework assignments are given. It has been noted that although the mindfulness training can potentially become an extremely beneficial program, it may also become an intensely time demanding and strenuous commitment. Carmody & Baer (2009) acknowledge that some individuals may not be able to accommodate their schedules to complete a practice with this intensive time commitment. In the senior adult population, particularly the older population that resides in adult living homes and facilities, various engagements and activities are often required during strictly scheduled time periods.
The findings of several studies suggest that participation in the complete mindfulness program is not mandatory for benefits and positive outcomes, but that a brief period of training may also be effective. Jain et al.'s, (2007) one month program consisting of four one hour and thirty minute sessions resulted in decreased levels of stress, anxiety, rumination, distraction, distress, and increased positive states of mind for the mindfulness group compared to a waitlist control group. Shorter interventions have also been shown to have positive outcomes (Carmody and Baer (2009) Tang, et al., 2007; Zeidan et al, 2010a; Zeidan, Gordon, Merchant, & Goolkasian, 2010b; Zeidan, Johnson, Gordon, & Goolkasian, 2010c).
Purpose of the Study
The purpose of this study was to examine whether recall ability and sense of well-being could be improved through a mindfulness intervention in an older adult African American population. Specifically, the study compared a group of older adults who had never received any training in mindfulness techniques to a group of individuals who were taught and practiced mindfulness on a daily basis for four consecutive days. Each participant's recall ability was assessed and monitored prior to and following the four day intervention. Each participant's sense of well-being was also monitored pre-and-post treatment.
It was postulated that the elders who participated in the mindfulness practice sessions would:
Hypothesis 1: Have improved recall compared to their pre-test recall.
Hypothesis 2: Have better recall than the control group at the time of the final test.
Hypothesis 3: Have an increased sense of well-being, as compared to the pre-test.
Hypothesis 4: Would experience a greater sense of well-being than those in the control group.
Hypothesis 5: Would exhibit a greater level of mindfulness than the control group at the completion of the training.
The sample consisted of 14 older adults from a senior assisted living community located in North Carolina. This facility is unique in that all of the residents are African American, thus the ethnicity of the population consisted of 100% African American. Participants were required to be sixty-five years of age or older and proficient in English. The sample was recruited from persons who had indicated that they were interested in either 1) learning mindfulness or 2) being a part of a discussion group on aging topics. Individuals who had previously practiced mindfulness were not eligible for the study. By completing the informed consent form, each participant was aware that they would be assigned to either a group who would participate in the mindfulness intervention or a group which would discuss aging topics; 7 participants were randomly assigned to the mindfulness group and 7 to the discussion group. The demographics (age, ethnicity, gender) of the population are displayed in Table 1.
Mindfulness Training Group (Experimental Group).
The mindfulness intervention used in this study was patterned after the Mindfulness-Based Stress Reduction (MBSR) program developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center. However, compared to Kabat-Zinn's eight week MBSR program, this intervention was shortened to thirty minute sessions for four consecutive days, based on the findings of studies that reported the success of shorter mindfulness interventions (Jain, et al., 2007; Tang, et al., 2007; Zeidan, et al., 2010a; Zeidan, et al., 2010b; Zeidan, et al., 2010c; Carmody & Baer, 2009).
This mindfulness intervention incorporated formal practice techniques, including mindfully breathing, guided meditation, and silent meditation. Though daily homework is traditionally administered in the MBSR, this intervention did not give homework assignments, nor asked the participants to practice on their own outside of the allotted program time.
The mindfulness intervention was directed by an instructor/facilitator who has studied mindfulness practice for the past sixteen years; the researcher attended each session. At the beginning of the first session, participants were given a brief description of mindfulness. This session began by asking the participants to close their eyes, relax, and focus on their breathing. As thoughts and emotions entered their mind, the participants were told to be aware of these passing thoughts, but to allow them to enter and then pass along by refocusing on the breath. During the last 5 minutes of this session, the participants were introduced to mindfulness meditation. In session 2, the instructor directed the participants to continue working with the breath. The instructor transitioned the breath into practicing mindfulness meditation. During the last 10 minutes, the facilitator presented the class with sitting meditation. The essential theme of accepting thoughts and feelings and allowing them to pass and refocus on the breath was reemphasized. A continuation of the previous two sessions occurred in session 3 and 4. The facilitator instructed the participants to attend to the breath with nonjudgmental moment to moment awareness when thoughts arose, she directed the participants to attend to the breath, and assisted the individuals in their mindfulness meditation. At the beginning and end of each session, participants were asked if they had any questions or comments about their mindfulness and meditation practices. Each session was 30 minutes in length and was held in the facility's conference room at the same time for each meeting.
Discussion Group (Control Group).
A discussion group on various topics such as aging and memories was conducted for individuals in the control group. The control group sessions were held the following week after the experimental group. However, each variable paralleled with the experimental group except for the dates (same day of the week, same time of the day, same conference room, different days of the month--see Figure 1).
Led by the researcher, the control group discussed various topics including childhood memories and hobbies, world travels, and healthy aging strategies. In session 1, the participants were given a brief overview of the topics of discussion for the four sessions. The participants discussed and reminisced about their childhood memories. Session 2 began with a discussion of the group's travels and ended with conversation about each other's hobbies. In Session 3 and 4, discussions about healthy aging strategies occurred. Each session totaled 30 minutes.
Pre-and Post-Intervention Measures
The following measures were administered prior to the start of the respective treatment and control interventions, and again upon completion of the 4-day intervention:
Freiburg Mindfulness Inventory
The Freiburg Mindfulness Inventory (FMI) consists of fourteen questions that assess the individual's familiarity with and understanding of mindfulness (Walach, et al., 2006). The FMI is a reliable test that accurately assesses one's openness to mindfulness thoughts. Each response consists of scaled answers from 1 (rarely) to 4 (almost always); the maximum score possible is 56 and the lowest possible score is 14. The higher the score, the "greater degree of mindfulness", as well as the greater the likelihood of the individual understanding and partaking in the mode or act of being mindful (Zeidan, et al., 2010a, p. 599). This test was administered pre-and-post intervention to determine mindfulness changes that resulted from the intervention. This inventory has been used in studies that have included African American participants, and thus has been validated within this population (Zeidan, et al., 2010a).
Well-Being Picture Scale
The Well-Being Picture Scale (WPS) was also administered to each participant prior to beginning the intervention and again immediately after the intervention was completed (Gueldner, et al., 2005). This scale is described elsewhere in this journal.
Self-Rated Health Scales
The Self-Rated Health Scale was read to each participant involved in the study. The Self-Rated Health Scale was used to determine if correlations existed between self-perceived health, well-being, and ultimately recall ability (Levy, et al., 2001). Each participant was asked to rate both their physical and mental health level on a five point Likert scale, from 1 (excellent) to 5 (poor). The higher the score, the lower the individual's self-perceived physical or emotional health, respectively (Stanford Chronic Disease Self-Management Study, 1996). This scale has been previously validated in studies with African American participants (Lincoln, Taylor, Chae, & Chatters, 2010; Ibrahim, Burant, Siminoff, Stoller, & Kwoh, 2002).
Each individual was also asked to rate their overall vision and their overall hearing ability, and to rate their memory, compared to other people their age. Statements were rated on a five point Likert Scale, from 1 (excellent) to 5 (poor), with higher scores indicating poorer self-perceived vision, hearing, and memory, respectively. This test was administered pre-and-post intervention.
The self-rated health questions of physical health, mental health, vision, hearing, and memory were scored together as each of these items compose the individual's health. Each response was individually rated 1 through 5. The health ratings were totaled at the completion of rating the five questions. The total score ranged from 5 to 25, with higher scores being indicative of lower self-rated health.
Recall Test (Short Story A).
Prior to the start of the program, a recall test was administered to each participant on an individual basis. Each participant was told that they would be asked to listen to a short (100 word) tape recorded story (short story A); after listening to the story, each participant was asked to repeat the story to the investigator to the best of their ability (Joseph, n.d.). This process was used to establish the participant's baseline for comparison at the end of the intervention. At the completion of the study, each participant was again instructed by the researcher to tell all of the short story that they could remember. This test was used to determine if the mindfulness training had affected retrieval, since the story was already encoded prior to the intervention. The Flesch-Kincaid reading level for Story A is 5.3.
The recall test of short story B was only administered one time, at the completion of the intervention.
Recall Test (Short Story B).
A different short story (short story B) was also presented at post testing following the intervention, and recall of this story was also assessed for each participant (Heather916, 2011). This short story was used to further determine any influence of the mindfulness intervention on retrieval capabilities. If members of the mindfulness group were able to recall both stories (stories A and B) better than the control group participants, it would establish that the mindfulness intervention had exerted a positive influence on retrieval. However, if the mindfulness group presented with better recall than the control group only on the second story (story B), then it would indicate that mindfulness effects on encoding would have been obtained by the treatment group. Testing the recall of both short stories A and B at the end of the intervention helped determine whether mindfulness effects encoding and retrieval or only one or the other. Both short stories A and B consist of 100 words each; the Flesch-Kincaid reading level for short story B is 4.2.
Each recall test was scored by marking each detail that was repeated by the participant. Credit was given for each detail from the story, including an accurate or acceptable phrase that was determined to be equivalent to the original story phrase. Equivalent details were considered if they were synonyms for the original word. For instance, the original sentence may have stated, "There once was a sad king who was very ill." If each word was exactly stated, this counted as 10 points. If the participant repeated, "There was a queen who was sick," this was scored as 6 points. The word queen was not given credit, but the word sick did receive credit. Each correct detail or story unit was scored as one point. All details from the story that were mentioned were totaled for the recall score. The lead researcher scored the two stories. However, in order to assess reliability of the scoring, another individual also scored the two stories.
After informed consent forms were signed and the participants were randomly separated into either the experimental or control groups, a day of testing commenced. Pre-testing was initially only completed by the experimental group and was completed one day prior to the start of the mindfulness intervention. The following week, one day before the discussion (control) group intervention, these individuals also completed the testing period. The two programs (the mindfulness program and the discussion group) paralleled each other in that they met on the same day of the week, same time of the day, same room, but different days of the month--see Figure 1.
Pre-Intervention Testing--Day 1 (Experimental Group and Control Group):
In a one-on-one setting with the researcher, each participant in both the treatment and control groups completed the Freiburg Mindfulness Inventory, the Well-Being Picture Scale, the Self-Rated Health Scales, and the recall test of short story A.
Depending on the intervention assigned, the treatment and control groups participated in their respective programs. The experimental group practiced their mindfulness skills that consisted of mindfully breathing and meditation and the control group discussed their memories and travels, as well as aging topics and strategies. Both groups completed a training period totaling 120 minutes (i.e., 30 minutes per day for 4 consecutive days).
Post-Intervention Testing--Day 6 (Experimental Group and Control Group):
Following the intervention, on a one on one basis with the researcher, each participant completed the Freiburg Mindfulness Inventory, the Well-Being Picture Scale, the Self-Rated Health Scales, and again were tested on their recall of the original short story (A) that they had listened to at the beginning of the study. They were also given another recall test on short story B. Recall of short story B involved having participants listen to the recorded story, and then the researcher asked each individual to recall as much as they could remember.
The population's demographics and responses were statistically analyzed using the t-test between two samples assuming equal variances and the chi-square. To test for differences between the experimental group and the control group before and after the interventions, data were analyzed using a 2 X 2 univariate analysis of variance (ANOVA) where pre- and post-test was a within variable and experimental versus control group was a between variable. Cronbach's alpha was used to measure the reliability of the scores from the two raters for the recall tests of short story A and short story B. A significance level of 0.05 was used for all statistical tests.
The demographic of the population and the baseline scores were calculated based on age, ethnicity, and gender. The baseline mean and standard deviation for the demographics of the population were assessed using the t-test (t) and chi square ([chi square]). The age range was from 65 to 93. The mean age of all participants involved was 78, the median age was 77 years of age, and 100% of the older adults were African American. The population demographics are reported in Table 1 and the baseline scores for the self-reported measures and the cognitive tasks can be seen in Table 2. No significant differences existed between the experimental group and the control group in regard to the sample's demographics and baseline measures.
Table 3 presents the pre-intervention and post-intervention changes within both the experimental and control groups. Table 3 displays the mean and standard deviation of the varying results for the Freiburg Mindfulness Inventory (FMI), Well-Being Picture Scale, Self-Rated Health Scales, and recall measures. The univariate analysis of variance (ANOVA) was used to test for effects between the experimental group and the control group before and after the interventions.
The Freiburg Mindfulness Inventory demonstrated that when compared to a control group, the mindfulness levels were not statistically different between the experimental and control groups and between pre- and post-test and experimental and control groups, respectively, F (1, 24) = 0.59, p = 0.45 and F(1, 24) = 0.06, p = 0.81. However, both groups presented with increased levels of mindfulness from pre-test to post-test, F (1, 24) = 4.50, p = 0.04, /72 = 0.16.
The brief mindfulness sessions were not found to significantly increase well-being in this sample, as no significant group differences were found between the experimental and control groups, F (1, 24) = 1.06, p = 0.31; between the two groups from pre-intervention to post-intervention, F (1, 24) = 0.00, p = 0.99; nor between pre- and post-test and experimental and control groups, F (1, 24) = 0.01, p = 0.93.
Nor was a significant difference on self-related health between pre- and post-test, F (1, 24) = 0.67, p = 0.42, nor between pre- and post-test and experimental and control groups, F (1, 24) = 0.10, p = 0.76. Ironically, both the experimental group and the control group reported worse self-rated health. However, the experimental group reported a slightly greater decrease in self-reported health than the control group, F (1, 24) = 5.40, p = 0.03, [h.sup.2] = 0.18.
The recall test scoring for short story A and short story B indicates a high internal consistency and high reliability (see Table 4). Table 3 shows that the effectiveness of this brief mindfulness training on improving cognitive tasks, in particular that of recall, was not statistically significant on either the encoding or the retrieval of the stories administered. The recall of short story A between the experimental and control groups and the interactions between pre- and post-test and experimental and control groups for short story A resulted in no significant differences, respectively, F (1, 24) = 0.03, p = 0.87 and F(1, 24) = 0.03, p = 0.87. However, the change between the groups from pre-intervention to post-intervention was statistically significant, F (1, 24) = 21.31, p = 0.00. The recall for short story B resulted in no significant difference between the two groups, t = 0.649, p = 0.53.
This study evaluated the effectiveness of a brief mindfulness program on older African American adults' well-being and recall when compared to a control group. To date, this is the first study of a brief mindfulness intervention conducted with a 100% African American older adult population. Although no significant effects were seen following the four day (30 minute per day) mindfulness training in increasing well-being or recall scores between the experimental group and control group from pre-intervention to post-intervention, several individual participants expressed their gratitude and personal benefits from the program. A few of the qualitative responses included comments that learning mindfulness and meditation helped in the ability to relax and to be aware of personal thoughts. One of the participants expressed her enjoyment of the intervention as she said, "When you are 91 and you learn something, it makes you feel good."
Though statistically significant changes did not occur within the mindfully treated group compared to the discussion group, it is interesting to note that a significant increase occurred amongst the mindfulness levels for both groups from the pre-test to post-test period. Regarding the mindfulness levels, it can be speculated that the experimental group benefited from their mindfulness intervention in which awareness and presence of mind was learned, while the control group also benefited from the mere interaction and discussions in the group setting. The control group expressed their enjoyment of the discussion sessions. The positive social experience of the control group suggests that the control group also benefited from their experiences.
The failure to achieve significant results of the mindfulness training on the older adults' mindfulness levels and well-being are somewhat surprising. These results tend to contrast prior research which indicates positive associations of mindfulness on well-being (Brown & Ryan, 2003; McCracken et al., 2007; Shapiro, et al., 2008; Oman, Thoresen, Plante, & Flinders, 2008; Pradhan, et al., 2007; Mayo Clinic, 2009). The insignificant results in this study may be partially due to the different interpretations of the administered Well-Being Picture Scale as some individuals tended to point toward a picture rather than a place on the scale.
Previous studies have reported the effectiveness of mindfulness on cognition, particularly in terms of working memory (Zeidan, et al., 2010a). It was predicted that the tranquil and relaxing effects of the mindfulness training, while simultaneously learning to bring wandering thoughts to the present, would aid in improving recall (Zeidan, et al., 2010a). However, this study resulted in unexpected outcomes when testing recall. For the analysis of the short story A and short story B, both recall tests resulted in findings that were not statistically significant between the experimental and control group and their interaction from the pre-test to post-test periods. In both groups, a significantly lower level of recall was apparent from the pre-test to post-test of short story A. Participants recalled less of the story during the post-test as opposed to immediately after the recording was played during the pre-test period. Story B also resulted in no significant differences between the two groups during the post-intervention testing. Limitations
A principal limitation in this study was the small sample size. Associated with the small sample size is the low statistical power to analyze differences in the change over time and the differences between the experimental and control groups. With a larger sample, differences between the two groups from the pre-test period to the post-test period may have been easier to discern. Also, the data collected and studied only apply to a small population of older African Americans of age 65 years of age and older gathered from only one senior living community. These data cannot be generalized to a larger population. Though brief mindfulness has shown to be beneficial in various populations (Jain, et al., 2007; Tang, et al., 2007; Zeidan, et al., 2010a; Zeidan, et al., 2010b; Zeidan, et al., 2010c; Carmody & Baer, 2009), the lack of significant results may possibly be due to the short time frame of this intervention and may have been improved with a longer training period and/or the inclusion of homework assignments. As individuals continue to practice and understand true mindfulness, it would be expected that benefits will inevitably increase (Shapiro, et al., 2008).
Mindfulness can be defined and interpreted in various manners. Although the Freiburg Mindfulness Inventory is able to be generalized, it is largely based on a one-dimensional concept of mindfulness that associates the two factors of presence and acceptance (Kohls, Sauer, & Walach, 2009). Thus, mindfulness could possibly have been measured in another manner that incorporates a broader perspective or meaning. Capturing a broader perspective of mindfulness may possibly be accomplished by testing mindfulness with a multifaceted test (Shapiro, et al., 2008).
Finally, the effect of demand characteristics within the population's answers to their questionnaires is a possibility. As the Freiburg Mindfulness Inventory, the Well-Being Picture Scale, and the Self-Rated Health scales that were administered were physical self-reported handouts, it may have been inadvertently apparent to the participants that awareness, well-being, and evidently health were being tested. This recognition could possibly have caused the participant to respond in a manner that they believed to be appropriate or correct for the specific test. Strengths and Future Studies
Though the study resulted in unexpected outcomes and limitations do exist, this study has the potential to lead to opportunities for subsequent mindfulness studies, particularly in the older adult population. As a unique study that combines the memory and well-being of an aged population with a brief mindfulness intervention, this study serves as a substantive contribution to the current body of literature. Research indicates a higher prevalence of mild cognitive impairments in the African American population (Doniger, Jo, Simon, & Crystal, 2009; Gurland, et al., 1999). Future studies may direct additional investigations that examine mindfulness and its benefits in the older adult African American population. Within this specific population, future investigations might replicate this study in a larger sample, or possibly administer a longer mindfulness intervention with the experimental group. From qualitative comments from participants in the experimental group, in addition to studying mindfulness practices, future research may also study the effects of meditation, relaxation, or even simple discussion group techniques on the older adult African American population.
This controlled study is the first to assess the effects of a brief mindfulness intervention on recall and well-being when administered to a group of older African American adults. In regard to recall and well-being, the findings of this study resulted in no statistically significant difference between participants who received brief mindfulness training and those who do not undergo the intervention from pre-intervention to post-intervention. Although the findings did not achieve statistical significance, it is important to note that positive changes did occur in both the treatment and control groups. Participants in both the experimental and control groups increased their levels of mindfulness from pre-intervention to post-intervention. Therefore, further research should be continued to explore the positive effects of mindfulness in the older adult African American population.
First and foremost, I would not be anywhere near where I am today without the strength, courage, and direction that the Lord has always provided for me. Thanks also to my parents for always pushing me to do my best and for always being by my side. I would also like to express my deepest appreciation for the support of my academic committee members as well as the residents and staff of the facility for their participation and support of the study. Finally, thank you Dr. Sarah H. Gueldner of Case Western Reserve University for allowing me to use your Well-Being Picture Scale, an integral component to this project.
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Table 1. Population's Mean (M) and Standard Deviation (SD) for Demographics Population's Mean (M) and Experimental Control Standard Deviation (SD) Group Group M SD M SD Demographics Age 77 10.65 79 7.99 Gender (Female) 71% - 86% - Ethnicity (African American) 100% - 100% - Education Level (At least high school grad.) 71% - 57% - Population's Mean (M) and Standard Deviation (SD) t/[chi square] Significance Demographics Age 0 41 n s Gender (Female) 0.51 ([chi square]) n.s. Ethnicity (African American) - n.s Education Level (At least high school grad.) 0.69 ([chi square]) n.s. Note: * p < 0.05 t = t-test, ([chi square]) = chi square n.s. = not significant Table 2. Population's Mean (M) and Standard Deviation (SD) for Baseline Measures and Self-Reported Measures Experimental Baseline Mean (M) and Group Control Group Standard Deviation (SD) M SD M SD Self-Reported Measures FMI 41.43 12.74 39.71 7.61 Well-Being Picture Scale 51.43 12.18 56.14 10.04 Self-Rated Health Scale 13.71 2.14 11 43 3.26 Cognitive Measures Recall Ability 8.43 5.91 9.00 6.81 Baseline Mean (M) and Standard Deviation (SD) t/[chi square] Significance Self-Reported Measures FMI -0.31 n.s. Well-Being Picture Scale 0.79 n.s. Self-Rated Health Scale -1.55 n.s Cognitive Measures Recall Ability 0.17 n.s. Note: * p < 0.05 t= t-test, [chi square] = chi square n.s. = not significant Table 3. Population's Pre- and Post-Intervention Mean and Standard Deviation for Mindfulness, Well-Being, Self-Rated Health Scales, and Recall Experimental (a) Mean (M) and Standard Pre-Intervention Post-Intervention Deviation (SD) M SD M SD FMI 41.43 12.74 49 14 5.64 Well-Being Picture Scale 51.43 12 13 51 36 10.61 Self-Rated Health Scale 13 71 2.14 15.00 3.21 Recall Ability Story A 8.43 5.91 0.71 1.25 Story B - - 5.71 3.09 Control (b) Mean (M) and Standard Pre-Intervention Post-Intervention Deviation (SD) M SD M SD FMI 39.71 7.61 45.36 6.84 Well-Being Picture Scale 56 14 10 04 55.36 11.77 Self-Rated Health Scale 11.43 3.26 12 00 3.27 Recall Ability Story A 9.00 6.81 0.71 1.11 Story B - - 6.36 3.49 Note: p < 0.05 (a) n = 7 (b) n = 7 Table 4. Reliability of Short Story A and Short Story B Recall Tests [alpha] Pre test (Short Story A) 0.97 Post-test (Short Story A) 0.96 Post-test (Short Story B) 0.97 Note: [alpha] = Cronbach's alpha Figure 1. Experimental and Control Groups' Intervention Schedules Pre-Test Stimulus Post-Test Experimental 1) Tests: FML Mindfulness 1) Tests: FML Group Well-Being Intervention Weil-Being (Week 1) Picture Scale, Course (4 Picture Scale n = 7 Self-Rated consecutive days 2) Recalled Health Scale for 30 minutes) Story A 2) Listened to 3) Listened to recorded Story A recorded Story B & then tested on & then tested on recall of Story recall of Story A B Control Group 1) Tests: FML Discussion Group 1) Tests: FML (Week 2) n = 7 Well-Being on memories and Weil-Being Picture Scale, aging topics (4 Picture Scale Self-Rated consecutive days 2) Recalled Health Scale for 30 minutes) Story A 2) Listened to 3) Listened to recorded Story A recorded Story B & then tested on & then tested on recall of Story recall of Story A B
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