Effectiveness of Mindfulness in Increasing Wellness among Mental Health Professionals

Introduction

Holistic psychology combines psychological theory with traditional transpersonal practices. Current therapeutic approaches utilized in Western society are not enough to truly provide well-rounded treatment. In order for treatment to be effective, the combination of the Western theoretical approaches would have to be combined with the Eastern practices of spirituality [1, 2, 3, 4]. Spirituality does not mean people have to believe in God or practice a religion.

Conceptual Paper

Including Eastern practices of spirituality allows individuals to acknowledge all parts of themselves and not just focus on the mind. This combination allows professionals to provide individuals with holistic treatment. This approach bridges the gaps between the mind, body, and spirit. Counselors are still able to practice ethically and not impose values on clients while providing tools to increase well-being.

Mindfulness is the practice of being aware and conscious of thoughts, behaviors, and feelings in the moment [5].

Mental health professionals work with individuals suffering from various psychological disorders and life stressors that may be impacting these individuals’ functionality and well- being. As a result, these professionals may experience fatigue and burnout unless they practice self-care. Self-care involves doing various activities and practicing ways of taking care of one’s own well-being and happiness when stressed [6]. In this paper, the author will examine the effectiveness of mindfulness in increasing wellness among mental health professionals.

Background

Mental health professionals work with clients with varying issues and may use holistic approaches to help the clients resolve their issues and find clarity. In doing so, mental health professionals may experience times in their personal and professional lives where they are not functioning at their full potential [7]. In other words, the same things mental health professionals may be assisting their clients with could be impacting them as humans. Sometimes stress may be worse for mental health professionals because they are responsible for helping others deal with stress. Mental health professionals could face extreme stress and anxiety without proper boundaries and a work/life balance. This anxiety and stress, if not dealt with in a timely and an appropriate manner, could lead to burnout. Hence, it is important to focus on ways mental health professionals can practice self-care in order to remain effective with their clients.

Work/life balance leads to better mental health. An individual is mentally healthy when he or she is able to successfully function every day, cope with normal stress of life, have fulfilling relationships, and contribute to the community [6]. In other words, the individual has well-being in different areas of his or her life and is healthy mentally, physically and socially. Stress and exhaustion can appear in various ways. The signs can include fatigue, sleeplessness, lack of appetite, stress from overworking, lack of productivity, depression, anxiety, relationship issues, and substance use issues [8]. Hence, there is a mind and body connection in how stress’s impact appears. When the mind is stressed, it also impacts the body and vice versa. There are different ways to improve work/life balance and reduce stress by practicing self-care including: open communication, setting boundaries, time-management, exercising, practicing better sleep hygiene, maintaining healthy eating habits, connecting and socializing with people, and having hobbies.

Self-care looks different for each individual and is dependent on what the individual likes to do and what areas of his or her life needs more attention. Mindfulness is a self- care practice many mental health professionals recommend to their clients because of the positive outcomes including affective, interpersonal, and other intrapersonal benefits [9]. However, when these mental health professionals begin to experience stress, they could potentially ignore it until it turns into burnout where multiple areas of their life suffer. Mindfulness allows individuals to become aware and conscious of their feelings and thoughts in the present moment [7]. This practice trains individuals to reflect on their day and various situations to better understand the impact on their well-being. Hence, it would be beneficial to see if these practices of mindfulness would also be helpful for mental health professionals to take care of themselves in a holistic manner.

Statement of Problem

In the mental health field, it is important to practice what one recommends to others in form of treatment. Genuineness is one of the core factors of the person-centered approach. The person-centered approach is widely accepted as a holistic approach because it accepts clients as they are regardless of culture or values [10]. A person can reach his or her full potential when all parts of his or her life are healthy. It is the complete form of the person. Hence, mental health professionals would be more genuine if they attempted various self-care practices themselves before recommending them to clients. Additionally, mental health professionals must have a healthy well-being in all aspects of their lives in order to provide services to clients. This way, the mental health professionals can avoid causing intentional or unintentional harm.

Mindfulness is a common practice that originated in Eastern society [10]. Mindfulness can be practiced by itself or while doing an activity. For example, when individuals begin to feel anxious they may become mindful with their breathing to slow it down and decrease their heart rate. People who are trying to lose weight could practice mindfulness when eating or exercising. People experiencing stress may not be aware of the cause of the stress and could practice mindfulness regularly as a form of reflection to become more self-aware and conscious of their feelings and thoughts. This allows them to process those thoughts and feelings as they come instead of being oblivious to what is going on with them.

Often, mental health professionals do not take the time to process their own thoughts and feelings allowing them to build up until they reach high levels of exhaustion. Burnout is when an individual becomes emotionally, physically, and mentally exhausted due to prolonged stress that has not been dealt with [7]. Individuals may begin to feel emotionally and mentally drained causing their productivity to suffer. Mental health professionals may work in settings where there could be constant demands and pressure to meet productivity requirements. The environment and the management may be negative and unsupportive. Additionally, there may be a high caseload with clients that are demanding or have issues that can cause the mental health professional to feel even more drained in terms of the energy required to help the client. These professionals could also be dealing with things in their personal lives related to relationships or finances. The psychological impact of the COVID-19 pandemic has affected both mental health professionals and their clients. The pandemic caused an increase in anxiety, fear, isolation, and stress for everyone [3]. Thus, there are additional demands on mental health professionals and those providing behavioral health services. The same stressors that impact clients also impact professionals. All these instances and more could cause mental health professionals to feel overly stressed to where they begin to neglect their well- being. Practicing mindfulness would allow mental health professionals to be more self-aware of their stress through daily reflection. In turn, it could allow them to be proactive in dealing with their stress before it leads to burnout. Further, it could also allow them to practice self-care regularly to enhance their well-being holistically.

This paper will review the effectiveness of practicing mindfulness. Since mindfulness is a common practice recommended to clients by mental health professionals, it would be important to examine its presence among mental health professionals. Specifically, the authors will examine how these practices help reduce anxiety, stress, and burnout among mental health professionals, and promote wellness. There is limited research looking at the impact of mindfulness in decreasing stress and anxiety among mental health professionals. The research that does exist provides beneficial implications but also consists of limitations that could be considered for future research on this topic.

Definition of Terms

The explanation of terms below is provided to help with the understanding of various concepts throughout the paper. Mental health professionals - professionals providing behavioral health services including psychologists, counselors, clinicians, therapists, clinical social workers, psychiatrists, psychiatric or mental health nurse practitioners, and other professionals who diagnose or treat mental disorders[3]. Mindfulness - purposefully paying attention in the present moment without judgment using various techniques such as breathing, yoga, meditation, etc [6]. Burnout - a psychological syndrome that develops in response to chronic emotional and interpersonal stress: emotional exhaustion, depersonalization, and feelings of ineffectiveness or lack of personal accomplishment [7]. Wellness or psychological well-being–characterized by self- acceptance, positive relations with others, environmental mastery, autonomy, purpose in live, and personal growth [11]. The following terms have been adopted from the 5th edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5):

Depression: a mood disorder where people display excessive sadness that negatively affects how you feel, the way you think, and how you act. Symptoms of depression: persistent sad, anxious, or “empty” mood; feelings of hopelessness; irritability; feelings of guilt, worthlessness, or helplessness; loss of interest or pleasure in hobbies and activities; decreased energy or fatigue; moving or talking more slowly; feeling restless or having trouble sitting still; difficulty concentrating, remembering, or making decisions; difficulty sleeping, early-morning awakening, or oversleeping; appetite and/or weight changes; thoughts of death or suicide, or suicide attempts; aches or pains, headaches, cramps, or digestive problems without a clear physical cause. Anxiety: a mood disorder where people display excessive worry that can cause significant problem in areas of their life, such as social interactions, school, and work. Symptoms of anxiety: feeling restless, wound up, or on-edge; being easily fatigued, having difficulty concentrating, mind going blank; being irritable; having muscle tension; difficulty controlling feelings of worry; having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep.

Literature Review

Mindfulness is a practice on how to master the mind, control emotions, and experience spiritual growth. Individuals can have increased mindfulness for overall mental and physical well-being through meditation [5]. Additionally, mindfulness can help maintain and keep the chakras aligned. Chakras, meaning wheels, are center points of energy, thoughts, feelings, and physical body. Imbalances in the chakras can be associated with symptoms, such as anxiety or poor digestion. There are seven major chakras: sahasrara or crown, ajna or third-eye, vishuddha or throat, anahata or heart, manipura or navel, svadhishthana or pelvic, and muladhara or root [12]. Each chakra is associated with specific body parts and emotional focus including wisdom, development, speech, metabolism, heart, compassion, love, digestive system, fear, reproductive organs, base of spine and survival, respectively. Overall, practicing mindfulness enhances physical, mental, and spiritual well-being by improving strength and fitness, memory and concentration, and self-awareness as well as self-esteem.

In a 2015 systematic review and meta-analysis of mediation studies, Gu, Struass, Bond, et al. [13] explored how mindfulness-based cognitive therapy and mindfulness- based stress reduction improve mental health and wellbeing. The studies show that mindfulness-based interventions improved a range of clinical and non-clinical psychological outcomes. With, healthcare professionals Lomas, Medina, et al. [14] found, through systematic review, that mindfulness is generally associated with positive outcomes, most notably burn-outs, but the quality of the studies were inconsistent [15] explored the benefits of mindfulness-based interventions on burnout among health professionals through systematic review and found some studies which reported promising results, but more than half of the studies reviewed did not report a controlled trial design. Cooper, Yap, et al. [16] found through a systematic review and meta-analysis that there is a positive association between mindfulness and some aspects of empathy, but mindfulness-based training did not have a significant impact on empathy among counseling and psychotherapy professionals in these studies. With such limited research on the effectiveness of mindfulness among practicing mental health professionals, future research needs to address existing methodological issues to determine the impact of mindfulness in the mental health profession.

There is limited research on the effectiveness of mindfulness among practicing mental health professionals. Although mental health professionals guide their clients to practice mindfulness, they often fail to do it themselves. Mindfulness can have many benefits for mental health professionals. According to Fulton [4], mindfulness is theorized to increase self-compassion and in turn, lead to increased compassion for others. Using mediation analysis, Fulton [7] confirmed that the practice of mindfulness as a mediator increases self-compassion and compassion for others among counseling interns and leads to counselor development. This was also similar to the findings of Leppma and Young [11]. Leppma and Young [11] found that practicing loving-kindness meditation as a form of mindfulness led to an increase in different dimensions of empathy and perspective taking among master’s-level counseling students. Mindfulness practices are found to be effective concerning mental illnesses such as anxiety, mood disorders, trauma, and stress. Additionally, it can help improve memory and cognitive functioning. When it comes to using yoga as a form of mindfulness to help individuals overcome trauma, the breathing exercises, as well as positions and postures, have to be modified to meet the needs of the individuals. That said, mental health professionals are suggested to resolve their own unfinished business before they begin seeing clients. The unfinished business could include some trauma from their past. Hence, yoga as a form of mindfulness can be beneficial for mental health professionals to be more aware and deal with their own issues. For example, Justice, Brems, et al. [17] found that when yoga was adapted to meet the needs of individuals with trauma, by emphasizing benefits, modifying based on limitations, and avoiding over stimulating the nervous system, it could help individuals deal with the symptoms of trauma in a healthy manner. Furthermore, Ferrera V, Borba P, et al. [18] found that yoga nidra, which is the deepest form of relaxation through seated meditation, helped decrease symptoms of anxiety among college professors.

Mindfulness breathing can also be impactful in reducing stress. Zou, Sasaki, et al. (2018)[19] found, through systematic analysis, that mindfulness and breathing can impact heart rate and the autonomous nervous system leading to stress reduction. This demonstrates that mindfulness practices have a mind-body connection and can be helpful in managing stress and anxiety and possibly be effective across various professions. Mindfulness practices have also been found effective in college students in terms of mindfulness and memory. Srinisha, Priya, et al. [20] conducted a survey experiment with college students and found that physical movement and breath awareness can assist in improving focus and concentration leading to improvement in memory. Since mindfulness can be practiced in many different ways, it can be individualized based on the mental health professional’s need and ability. Rothaupt and Morgan [6], using semistructured interviews with counselors and counselor educators, found that mindfulness has to be practiced regularly in order to be effective. Additionally, they found that mindfulness practice can be individualized where it could include: meditation, walking, and breathing – leading to body awareness, patience, solitude, creating a mindful environment.

Burnout among mental health professionals can impact their cognitive functionality and physical well- being. Mindfulness can allow mental health professionals to maintain healthy performances, both physically and mentally while preventing harm to their total well-being. To support this, Balaji, Varne, et al. [21] found that the practice of mindfulness improved cognitive processes, speed and accuracy during physical performances, and verbal as well as spatial skills among participants. Additionally, they found that various yoga postures, breathing exercises, and meditation reduced fatigue and stress level among participants who practiced yoga for a month. The respiratory system focuses on the lungs and its ability to take in and help with the flow of oxygen along with various other gases. Mindfulness relies heavily on appropriate breathing. As such, it was found to reduce asthma attacks and improve expiratory flow rate Balaji, Varne, et al. [21]. The cardiovascular system focuses on issues related to the heart such as heart rate and blood pressure. Regular practice of yoga reduced basal heart rate, improved cardiorespiratory fitness, reduced blood pressure, and body mass index as well as overall weight in adult participants [21, 22]. It was also found that mindfulness and yoga have also been effective in dealing with the physical and emotional stress from diabetes, obesity, arthritis, cancer, and body immunity as well as improve body image, mindful eating, weight loss and fitness [19, 21, 22]. Overall, mindfulness can effectively lower factors associated with physical diseases and improve factors related to physical health and wellbeing.

Mental health professionals are encouraged to practice using the person-centered approach consisting of skills related to unconditional positive regard, acceptance, and genuineness. Although mindfulness practices are linked to spiritual practices, they allow individuals to better understand themselves and connect their mind, body, and spirit. Mindfulness leads to higher self-esteem, self-reliance, acceptance, and tolerance towards self and others [4, 22]. The practice of yoga can link the body to the mind and the spirit by teaching individuals discipline and patience in coping with stressful life situations. The mindfulness and meditative aspects of yoga permit individuals to be more centered, grounded, and increase self-awareness [4]. This, in turn, can make mental health professionals more competent in their practice with clients.

Conclusion

The research is limited when determining the effectiveness of mindfulness among mental health professionals. Although there are recent research studies, many of the studies are outdated. Additionally, study methodologies have limitations that can impact the results. When conducting a qualitative study, like in the case of Fulton [7], the limitations include using self-report measures that may be influenced by social desirability and knowledge. Additionally, the sample consists of interns who were mostly White women. Further, when conducting groups with mindfulness interventions, the facilitator could influence the outcome based on the his or her teaching and presentation skills, for example in the study done by Leppma and Young [11]. A small sample size used by Rothaupt and Morgan [6] can make results limited to the population and nongeneralizable.

Mindfulness appears to be effective for people in general. It could enhance well-being in the realms of physical, mental, and spiritual health. Although there is limited research in terms of mindfulness practice among mental health professionals, the research that does exist has supported the effectiveness of mindfulness among these professionals. In addition to doing more research with this population, conducting studies using various approaches would also be beneficial. A wider variety of qualitative, quantitative, and mixed methods study to look at the effectiveness of mindfulness across all mental health professionals may be helpful in the future. Holistic practice is important and should not only be suggested to the clients but also practiced by these professionals because it allows for any individual to feel complete and whole.