MATER Staff Turns to their Mindfulness Therapy Research to Navigate COVID-19 Stressors

Having already shown how mindfulness plays a role in improving the quality of parenting among mothers receiving treatment for opioid addiction, researchers at Jefferson’s Maternal Addiction Treatment Education & Research (MATER) program now believe that mindfulness therapy can be applied to virtually any population in crisis – whether those with addiction issues, leaders managing through a pandemic crisis, or professionals working from home while trying to home school their children.

A mindfulness study published by Jefferson researchers in 2017 in the Journal of Addiction Medicine, was the first to scientifically test a mindfulness-based parenting intervention among mothers who participated in a trauma-informed, mindfulness-based parenting intervention, while also in medication-assisted treatment for opioid use disorder.

“The more you take part in mindfulness dialogue the more you feel relief from pressure and stress,” says Diane Abatemarco, PhD, MSW, director of MATER. “When you’re stressed, you feel like you can’t do one more thing. But by practicing mindfulness dialogue, it’s as if your cup feels bigger and it’s not overflowing and guess what? You can actually do more.”

Research studies show that eight in 10 Americans experience stress in their daily lives and have a hard time relaxing their bodies and calming their minds, which puts them at high risk of heart disease, stroke and other illnesses. Of the myriad offerings aimed at fighting stress, from exercise to yoga to meditation, mindfulness meditation has become the hottest commodity in the wellness universe.

Modeled after the Mindfulness-Based Stress Reduction program created in 1979 by Jon Kabat-Zinn to help counter stress, chronic pain, and other ailments, mindfulness courses these days can be found in venues ranging from schools to prisons to sports teams. Even the U.S. Army recently adopted it to “improve military resilience.”

Mindfulness’ popularity has been bolstered by a growing body of research showing that it reduces stress and anxiety, improves attention and memory, and promotes self-regulation and empathy. Following on their 2017 findings about the effectiveness of using mindfulness to treat opioid use disorder, Dr. Abatemarco and her colleagues at MATER are using Mindfulness Dialogue for Life (MDfL) to help clinicians navigate the stress they encounter when  treating young mothers with opioid abuse disorder; this has been particularly difficult during COVID-19.

“It’s a very stressful position being a therapist, a navigator or a nurse in our program because of the high mortality rates of children and women who have this disorder,” Dr. Abatemarco says.

As the pandemic unfolded, including a surge of local cases and deaths, MATER therapy, case management, patient navigation, and physician visits moved to telehealth platforms. That in itself created an elevated level of stress within the MATER staff.

“We knew that when we transitioned to being virtual, that the therapist not being there on site as the women got their medication would be breaking a physical link that kept women in their therapeutic treatment,” she says. “All of us felt like we were caught in a very stressful situation. We treat a high-risk population who we knew were more likely to be exposed to COVID because of their living conditions. And we had the stress of not wanting to feel detached from this physical structure of being there when they come in and need us.”

The team decided that the MATER staff would apply some of their research findings to help them manage their own stress. Staff and leadership met weekly using virtual MDfL sessions to enhance communication during virtual work and counseling, and to provide a supportive meeting space during this unprecedented time.

MDfL sessions provided a space for both sharing the fears associated with the new virtual therapeutic platform and to think creatively to mediate risks. Says Dr. Abatemarco, “With the majority of MATER’s nearly 70 employees suddenly working remotely, we had to improve communication and help staff manage the stress that the abrupt changes to their work—and home—lives caused.”

“Necessity breeds innovation, and we were dealing with COVID,” says Dennis Hand, PhD, associate director of MATER. “Mindfulness has been very helpful for re-imagining what’s possible. In my mindfulness practice, I find that it really opens me up to alternatives and helps me make space for other things.”

Dr. Hand is also the principal investigator for a new study funded by the Pennsylvania Department of Drug & Alcohol Programs known as SUPER – Supporting Engagement and Recovery in Families Affected by Stimulant Use. SUPER provides and evaluates the effectiveness of comprehensive support services for pregnant and parenting women who use cocaine, amphetamine and/or methamphetamine.

Study participants in SUPER will receive care management for physical and behavioral health care, including prenatal and well-child care; mindfulness-based relapse prevention; mindfulness-based family support; mindfulness-based parenting; contingency management; employment coaching and support; and connection with community support systems.

Dr. Hand is hopeful that this project will have similar success in helping mothers who use stimulants as MATER has had with programs for mothers using opioids. “We’re going to learn a lot,” Dr. Hand says. “We're going learn how to treat stimulant use disorders and identify some of the similarities and differences. So I think we're going to continue to develop our success with this carefully, thoughtfully and studiously.”

The MATER staff’s mindfulness sessions, which were evaluated over a course of 30 weeks, began last April. Every Monday, staff received an email describing the weekly theme, and the email included a recorded mindfulness-dialogue reflection and meditation. Staff then received a reminder mid-week, and attended a live, one-hour session on Fridays via a video conference. The agenda for each session included a review of the prior week’s themes, an opening meditation, a brief MDfL didactic presentation introducing a theme and a poem or music, discussions of each stage, and a closing meditation for discovery of surfacing insights and reflections.

As part of their own research, two MATER research staff attended each session and took detailed notes on attendance, content, quotes, body language and facial expressions. Key overarching themes identified from the sessions included the desire for connection, control and discovery and the acknowledgement that there is fear. Researchers substantiated these overarching themes from subthemes, creating a theoretical framework describing the experience of staff during the pandemic. Staff acknowledged a perceived loss of control and shift in their perspective on how they care for themselves, realizing through the pandemic that there is a fundamental need to take time to energize and restore themselves to continue providing great care to their clients.

Overall, Dr. Abatemarco says, staff expressed increased connection to their peers through this shared experience and felt safe talking about their anxieties and discomforts with transitions from pre- to post-COVID-19 life. Insights from their own research equipped MATER staff to develop better coping skills and mindfulness practices.

“What we’re striving for is deeper and more courageous conversations with each other,” she notes. “What we learned in mindfulness is that if you really care for the staff, you're really improving the quality of care to the patient.”