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Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries
Abstract
PRIMARY OBJECTIVE: To examine the potential efficacy of a mindfulness-based stress reduction approach to improve quality of life in individuals who have suffered traumatic brain injuries. RESEARCH DESIGN: Pre-post design with drop-outs as controls. METHODS AND PROCEDURES: We recruited individuals with mild to moderate brain injuries, at least 1 year post-injury. We measured their quality of life, psychological status, and function. Results of 10 participants who completed the programme were compared to three drop-outs with complete data. EXPERIMENTAL INTERVENTION: The intervention was delivered in 12-weekly group sessions. The intervention relied on insight meditation, breathing exercises, guided visualization, and group discussion. We aimed to encourage a new way of thinking about disability and life to bring a sense of acceptance, allowing participants to move beyond limiting beliefs. MAIN OUTCOMES AND RESULTS: The treatment group mean quality of life (SF-36) improved by 15.40 (SD = 9.08) compared to - 1.67 (SD = 16.65; p = 0.036) for controls. Improvements on the cognitive-affective domain of the Beck Depression Inventory II (BDI-II) were reported (p = 0.029), while changes in the overall BDI-II (p = 0.059) and the Positive Symptom Distress Inventory of the SCL-90R (p = 0.054) approached statistical significance. CONCLUSIONS: The intervention was simple, and improved quality of life after other treatment avenues for these participants were exhausted.
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“The participating patients suffering from neuromuscular diseases or recovering after TBI were all slightly dissatisfied with their life [23].”
From A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation (2017) · cites this paper as [23]
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“However, a small study of 10 subjects who were included in the MBSR programme for 12 weeks after mild TBI showed significantly improved qualityof-life and decreased depression [40].”
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“Mindfulness-based interventions In a pre-postdesign study with drop-outs as controls, no followup, high attrition rates and no control for medication, an improvement in measures of quality of life was concluded.(53)”
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“2005), borderline personality disorder (Ivanovski and Malhi 2007), brain injury (Bédard et al. 2003), immune system dysfunction (Carlson et al.”
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Traumatic Alterations in Consciousness: Traumatic Brain Injury
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Kangas, M., & McDonald, S. (2011) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2010.540920 · Cited by 133
“In particular, through self-exploration and group discussion, patients were encouraged to view their TBI-related disabilities from a new perspective facilitated by approaching life via acceptance in order to move forward with their life (Bédard et al., 2003).”
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Self-citationSupplements, nutrition, and alternative therapies for the treatment of traumatic brain injury
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Tailoring positive psychology interventions to treat depressed individuals.
Sin, N. L., Porta, M. D. D., & Lyubomirsky, S. (2011) · Cited by 95
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“1998); and practicing emotional skills such as mindfulness and acceptance (Bedard et al. 2003; Grossman et al. 2007).”
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Positive Psychology and Brain Injury Rehabilitation
Evans, J. J. (2011) · Brain Impairment · doi:10.1375/brim.12.2.117 · Cited by 91
“…here and may be particularly important for those who are easily distracted and find it difficult to sustain attention, though there has been mixed results of initial trials of mindfulness techniques with people with brain injury (Bedard et al., 2003; McMillan, Robertson, Chorlton, & Brock 2002”
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Whiting, D. L., Deane, F. P., Simpson, G. K., McLeod, H. J., & Ciarrochi, J. (2017) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2015.1062115 · Cited by 85
“Specifically, the treatments used with TBI have included mindfulness-based stress reduction (MBSR) to improve quality of life (Bédard et al., 2003) and to address mental fatigue (Johansson, Bjuhr, & Rönnbäck, 2012), although the latter sample included people who had experienced a stroke (55% of…”
MethodErnst, S., Welke, J., Heintze, C., Gabriel, R., Zöllner, A., Kiehne, S., Schwantes, U., & Esch, T. (2008) · Forschende Komplementärmedizin / Research in Complementary Medicine · doi:10.1159/000121479 · Cited by 81
Ashman, T., Cantor, J. B., Tsaousides, T., Spielman, L., & Gordon, W. (2014) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000098 · Cited by 83
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“Since then, many other mindfulness studies have appeared (e.g., Bédard et al., 2003; Grossman, Tiefenthaler-Gilmer, Raysz, & Kesper, 2007; Zautra et al., 2008).”
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“…the secondary outcome measures, no differences were found on the measures of depression or psychosocial functioning, although as suggested by Bedard et al. (2003), a substantial period of time following treatment completion would be required to effect significant changes in psychosocial…”
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Purohit, M. P., Wells, R. E., ZAFONTE, R. D., Davis, R. B., & Phillips, R. S. (2012) · PM&R · doi:10.1016/j.pmrj.2012.06.012 · Cited by 75
“In a pilot trial investigating mindfulness-based stress reduction for patients with TBI, the authors noted improvement in patients’ quality of life and depression scores [22].”
Stalder-Lüthy, F., Messerli-Bürgy, N., Hofer, H., Frischknecht, E., Znoj, H., & Barth, J. (2013) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2013.02.013 · Cited by 71
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Lai, S.-T., Lim, K. S., Low, W. Y., & Tang, V. Y. H. (2018) · The Clinical Neuropsychologist · doi:10.1080/13854046.2018.1489562 · Cited by 75
“(Bahrani et al., 2017; Bedard et al., 2013; Bédard et al., 2003; Cash et al., 2016; Grossman et al., 2010; Joo et al., 2010; Paller et al., 2015; Simpson et al., 2017; Tang et al., 2015; Thompson et al., 2015, 2010) and symptomatic related disability in 9/12 (75”
BackgroundMethodInfluentialHadanny, A., & Efrati, S. (2016) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2016.1205487 · Cited by 82
“and high attrition rates, a 10-week MSBR program improved performance on measures associated with improved quality of life and self-efficacy [115].”
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“The participating patients suffering from neuromuscular diseases or recovering after TBI were all slightly dissatisfied with their life [23].”
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Self-citationThe neurological basis of occupation
Gutman, S. A., & Schindler, V. P. (2007) · Occupational Therapy International · doi:10.1002/oti.225 · Cited by 61
“Short, eight-week programmes of mindfulness training have been found to reduce anxiety, elevate mood and increase antibody levels (Antoni, 2000; Bedard et al., 2003; Davidson et al., 2003; Teasdale et al., 2000; Williams et al., 2001).”
BackgroundTraumatic brain injury: future assessment tools and treatment prospects
Flanagan, S. R. (2008) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s1985 · Cited by 63
“Bédard et al (2003) examined the impact of a 12-week mindfulness-based approach to reduce stress and improve quality of life in individuals with TBI.”
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Hardison, M. E., & Roll, S. C. (2016) · American Journal of Occupational Therapy · doi:10.5014/ajot.2016.018069 · Cited by 60
“Common adaptations of the MBSR protocol were to change the number of weeks the MBSR group met (Azulay, Smart, Mott, & Cicerone, 2013; Bédard et al., 2003, 2005) as well as to reduce the group size and session length (Azulay et al., 2013).”
BackgroundInfluentialA transdiagnostic investigation of emotional distress after traumatic brain injury
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“For example, building on a series of pilot studies (Bédard et al., 2003, 2005), Bédard et al. (2014) conducted a randomised controlled trial of a 10-week mindfulness-based group cognitive therapy intervention for people with TBI.”
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“The intervention includes four components: self-registering of mood, changing negative thoughts (Anson & Ponsford, 2006a), undertaking pleasurable activities, and relaxation (Anson & Ponsford, 2006b; Be´dard et al., 2003; Lai et al., 2006).”
BackgroundFinding happiness: Tailoring positive activities for optimal well-being benefits.
Nelson, S. K., & Lyubomirsky, S. (2014) · Cited by 46
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“Furthermore, a small-scale study of 10 mild TBI subjects included in the MBSR program over a 12-week period also showed a significantly improved quality of life and decreased depression rating [53].”
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“A few papers are emerging suggesting the usefulness of ACT and other mindfulness-based approaches for improving quality of life and emotional functioning in people with ABI (Bedard et al., 2003; Kangas & McDonald, 2011; Wong, 2008).”
BackgroundEffects of Mindfulness Meditation on three individuals with aphasia
Orenstein, E., Basilakos, A., & Marshall, R. S. (2012) · International Journal of Language & Communication Disorders · doi:10.1111/j.1460-6984.2012.00173.x · Cited by 45
Gao, J., Lin, M., Zhao, J., Bi, S., Ni, Z., & Shang, X. (2016) · Clinical Rehabilitation · doi:10.1177/0269215515626232 · Cited by 40
Health-related quality of life of individuals with traumatic brain injury in Barranquilla, Colombia
Arango‐Lasprilla, J. C., Krch, D., Drew, A., Aragón, C. J. D. L. R., & Stevens, L. F. (2012) · Brain Injury · doi:10.3109/02699052.2012.655364 · Cited by 36
“Several studies used all eight sub-scales of the SF-36 plus the Physical and Mental Component Summary scores [12, 14, 19, 32, 39], some used only the eight sub-scales [16, 38, 40, 41] and others included only one or both of the component scores or selected sub-scales [33, 36, 37].”
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Iwasaki, Y., & Mactavish, J. B. (2005) · Rehabilitation Counseling Bulletin · doi:10.1177/00343552050480040101 · Cited by 34
“Complementing this suggestion, findings from recent research highlight the importance of behavioral and psychosocial rehabilitation programs for individuals with disabilities in which stress management represents a key component (Afari & Buchwald, 2003; Bédard et al., 2003).”
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The efficacy of community-based rehabilitation programmes for adults with TBI
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“…to meet the inclusion criteria by a narrow margin could lend support to the benefi ts of peer-support groups for TBI clients in facilitating improvements in quality of life and psychosocial functioning (Armengol, 1999; Vandiver and Christofero-Snider, 2000; Bedard et al, 2003; Forman et al, 2006).”
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Mindfulness-Based Versus Health Promotion Group Therapy After Traumatic Brain Injury
Bay, E., & Chan, R. R. (2018) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20180924-03 · Cited by 27
“Various emerging studies about mindfulness-based interventions (MBIs) claim effectiveness with cognitive and depression outcomes and acceptability for individuals with chronic and mild TBI (Azulay, Smart, Mott, & Cicerone, 2013; Bedard et al., 2014; Bedard et al., 2003).”
Suicidality and depression among adult patients admitted in general medical facilities in Kenya
Ndetei, D. M., Khasakhala, L. I., Mutiso, V., & Mbwayo, A. (2010) · Annals of General Psychiatry · doi:10.1186/1744-859x-9-7 · Cited by 27
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“Several researchers have investigated the possibility of preventing depression after stroke [16-19].”
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“…EU R O LO G IC A L C O N D ITIO N S 65 PA U LA L.R O B IN SO N ET A L. TABLE 2 Continued Study Method Participants Intervention Outcome measures Results Bédard et al. (2003) Canada Quality score: Selection∗∗∗ Comparability -Exposure∗ Design: case series, Pre-post design with drop-outs as controls.”
BackgroundMethodInfluentialChanges in Well-Being: Complementing a Psychosocial Approach with Neurobiological Insights
Rickard, N. S., & Vella‐Brodrick, D. (2013) · Social Indicators Research · doi:10.1007/s11205-013-0353-4 · Cited by 27
“positive psychology interventions (PPIs; N = 4,266) including mindfulness (Bédard et al. 2003), positive writing (King 2001) and Well-Being Therapy (Fava et al.”
BackgroundHolden, A. E. C., Shain, R. N., Miller, W. B., Piper, J. M., Perdue, S. T., Thurman, A. R., & Korte, J. E. (2008) · Sexually Transmitted Diseases · doi:10.1097/olq.0b013e31817d7a33 · Cited by 24
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“Psychological interventions, such as CBT, seem promising in terms of effectiveness because they result in fewer side effects than medication and have a stronger effect on preventing relapse of symptoms than pharmacotherapy [20, 26–29].”
BackgroundManagement of chronic traumatic encephalopathy
Cantu, R. C., & Budson, A. E. (2019) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2019.1633916 · Cited by 23
Lovette, B. C., Kanaya, M. R., Bannon, S. M., Vranceanu, A., & Greenberg, J. (2022) · Brain Injury · doi:10.1080/02699052.2022.2109745 · Cited by 24
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“Similar positive findings emerged from the five uncontrolled, pre-post studies (Azulay et al., 2013; Bédard et al., 2003; Bédard et al., 2012; Joo et al., 2010; Moustgaard et al., 2007).”
MethodResultInfluentialShirvani, S., Davoudi, M., Shirvani, M., Koleini, P., Panah, S. H., shoshtari, F., & Omidi, A. (2021) · Annals of General Psychiatry · doi:10.1186/s12991-021-00355-1 · Cited by 21
Hernández, T. D., Brenner, L. A., Walter, K. H., Bormann, J. E., & Johansson, B. (2016) · Brain Research · doi:10.1016/j.brainres.2016.01.025 · Cited by 20
Chan, J., Leung, D. K. Y., Walton, H., Wong, G. H. Y., & Spector, A. E. (2020) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2020.1810571 · Cited by 20
“Significant reduction in overall depression is observed in three MBCT studies [43,44,48] and one MBSR study [49] using BDI-II, and in the cognitive-affective domain of BDI-II in one MBSR study [45].”
BackgroundMethodInfluentialNewer Generations of CBT for Anxiety Disorders
Twohig, M. P., Woidneck, M. R., & Crosby, J. M. (2013) · CBT for Anxiety Disorders · doi:10.1002/9781118330043.ch9 · Cited by 19
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“MBIs encourage the patient to approach life and their disability with a sense of acceptance of their situation, allowing them to move beyond limiting beliefs [6].”
BackgroundKrese, K., Ingraham, B. A., O’Brien, M. K., Mummidisetty, C. K., McNulty, M., Srdanovic, N., Kocherginsky, M., & Ripley, D. L. (2020) · Brain Injury · doi:10.1080/02699052.2020.1776394 · Cited by 18
Kim, S., Mortera, M. H., Wen, P.-S., Thompson, K. L., Lundgren, K., Reed, W. R., Sasson, N., Wright, S. T., Vora, A. J., Krishnan, S., et al. (2022) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000778 · Cited by 18
Can deficits in empathy after head injury be improved by compassionate imagery?
O'Neill, M., & McMillan, T. M. (2012) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2012.691886 · Cited by 18
“(2003) reported that a mindfulness-based intervention improved quality of life following had injury, although this study compared only 10 people with mild to moderate head injury to three drop-out controls and the sample was not demographically representative of head injury, being mostly females educated beyond high s…”
BackgroundHampson, N., King, L., Eriksson, L.-M., & Smee, H. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1554009 · Cited by 17
“The intervention included relaxation training, along with yoga and teaching of mindfulness-based cognitive techniques, and was found to improve quality of life [28] and reduce depression [29] in this population.”
Iqbal, N., & Dar, K. A. (2021) · Child Indicators Research · doi:10.1007/s12187-021-09871-8 · Cited by 19
Ditchman, N., Sung, C. Y. Y., Easton, A. B., Johnson, K. S., & Batchos, E. (2017) · Neurorehabilitation · doi:10.3233/nre-171440 · Cited by 17
“…related interventions with individuals with brain injury, including the use of signature strengths inventories (Andrews, Walker, & O’Neill, 2014), providing cognitive sup-portintandemwithpositivepsychologyinterventions (Rumrilletal.,2016),andmindfulness-basedtech-niques(e.g.,Bedardetal.,2003).”
Overestimated relationships with subjective well-being.
Stones, M. J., Worobetz, S., & Brink, P. (2011) · Canadian Psychology/Psychologie canadienne · doi:10.1037/a0020694 · Cited by 16
Investigating a theatre-based intervention for Indigenous youth with fetal alcohol spectrum disorder
Keightley, M., Agnihotri, S., Subramaniapillai, S., Gray, J., Keresztesi, J., Colantonio, A., Polatajko, H. J., Cameron, D., & Wiseman‐Hakes, C. (2018) · Canadian Journal of Occupational Therapy · doi:10.1177/0008417417719722 · Cited by 16
Social anxiety following traumatic brain injury: an exploration of associated factors
Curvis, W., Simpson, J., & Hampson, N. (2016) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2016.1175359 · Cited by 16
MINDFULNESS AND SELF-DEVELOPMENT IN PSYCHOTHERAPY
Segall, S. R., & Ph., D. (2014) · Cited by 15
Appleton, S., Browne, A. L., Ciccone, N., Fong, K., Hankey, G. J., Lund, M., Miles, A., Wainstein, C., Zach, J., & Yee, Y. (2011) · Brain Impairment · doi:10.1375/brim.12.3.210 · Cited by 15
An Exploration of Mindfulness in Speech-Language Pathology
Medina, A. M., & Mead, J. S. (2020) · Communication Disorders Quarterly · doi:10.1177/1525740120942141 · Cited by 14
“Bedard et al. (2003) conducted a pretest and posttest study on participants with mild to moderate TBI who were 1 year post injury.”
BackgroundPolich, G. R., Gray, S., Tran, D., Morales-Quezada, L., & Glenn, M. B. (2020) · Brain Injury · doi:10.1080/02699052.2020.1802781 · Cited by 15
Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)
Mansour, A., & Lajiness-O'Neill, R. R. (2015) · Psychology · doi:10.4236/psych.2015.64033 · Cited by 17
“Investigators using such designs have demonstrated that: peer-group training of pragmatic language skills may benefit individuals with communication problems following TBI (Snow, Douglas, & Ponsford, 1998), that mindfulness-based stress reduction program may be effective in treating depressed mood (Bedard et al., 2003…”
BackgroundCallahan, C. E., Beisecker, L., Zeller, S., & Donnelly, K. Z. (2023) · Brain Injury · doi:10.1080/02699052.2023.2168062 · Cited by 13
“, meditation, breathing exercises, visualization) for TBI rehabilitation has also reported improvements in physical and behavioral symptoms (21), attention (22), and QOL (21,22).”
BackgroundHaller, C. S. (2015) · Brain Injury · doi:10.3109/02699052.2014.989906 · Cited by 8
The Relation of Meditation to Power and Well-Being
Kim, T. S., Park, J. S., & Kim, M. A. (2007) · Nursing Science Quarterly · doi:10.1177/0894318407310777 · Cited by 13
“These findings concur with findings found in studies using other forms of meditation where meditation facilitated an improvement in depression (Bedard et al., 2003; Gross et al., 2004; Koar, 1995), anxiety (Gross et al., 2004; Koar, 1995; Tacon et al., 2003), quality of life (Bedard et al., 2003;…”
BackgroundMethodResultInfluentialDiagnosis and Treatment of Depression Following Traumatic Brain Injury
Tsaousides, T., Ashman, T. A., & Gordon, W. A. (2013) · Brain Impairment · doi:10.1017/brimp.2013.8 · Cited by 12
“Bedard et al. (2003) conducted a pilot study to evaluate a mindfulness-based stress reduction intervention to improve quality of life.”
BackgroundSmart, C. M., Ali, J. I., Viczko, J., & Silveira, K. (2021) · Mindfulness · doi:10.1007/s12671-021-01779-2 · Cited by 17
“, 2014), as well as mental healthrelated quality of life and internal health locus of control (Bédard et al., 2003).”
BackgroundKünzi, P., Ackert, M., Holtforth, M. G., Hund‐Georgiadis, M., & Hediger, K. (2022) · Scientific Reports · doi:10.1038/s41598-022-14584-1 · Cited by 14
Vanhove, A. J., & Herian, M. N. (2015) · Cited by 12
Ho, H. C. Y., Mui, M. W.-K., Wan, A., Yew, C. W.-S., & Lam, T. H. (2019) · Journal of Happiness Studies · doi:10.1007/s10902-018-00071-w · Cited by 13
Ozen, L. J., Dubois, S. J., Gibbons, C., Short, M. M., Maxwell, H., & Bédard, M. (2016) · Mindfulness · doi:10.1007/s12671-016-0577-x · Cited by 13
“It is important to mention that the MBIs were not identical across all the three studies (Bédard et al., 2003; Bédard et al., 2012; Bédard et al., 2014).”
MethodResultInfluentialSelf-citation
Metadata
- Authors
- BÉdard, M., Felteau, M., Mazmanian, D., Fedyk, K., Klein, R., Richardson, J., Parkinson, W., & Minthorn-Biggs, M.-B.
- Affiliations
- Lakehead Psychiatric Hospital (CA)
- Lakehead University (CA)
- Venue
- Disability and Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2003-01
- Volume
- 25
- Issue
- 13
- Pages
- 722-731
- ISSN
- 0963-8288 (ISSN-L)
- 1464-5165
- OpenAlex
- W1969004293
- Cited by
- 204
- References
- 71
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 8 · 2021: 5 · 2020: 11 · 2019: 33 · 2018: 9 · 2017: 7 · 2016: 16 · 2015: 14 · 2014: 12 · 2013: 11 · 2012: 14
- FWCI
- 2.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Disability and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Neurotrauma Foundation
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- mindfulness-based stress reduction, traumatic brain injury, quality of life, depression, psychological distress, acceptance, group intervention, insight meditation, guided imagery, breathing exercises, SF-36, Beck Depression Inventory-II, SCL-90-R
- MeSH terms
- Adaptation, Psychological, Adult, Analysis of Variance, Brain Injuries, Female, Holistic Health, Humans, Male, Pilot Projects, Quality of Life, Surveys and Questionnaires, Relaxation Therapy, Stress, Psychological, Program Evaluation, Trauma Severity Indices
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