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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1248-1253
The effect of mindfulness-based stress reduction on social anxiety of the deaf


1 Department of Medical-Surgical Nursing, Sabzevar University of Medical Science, Sabzevar, Iran
2 Department of Clinical Psychology, Sabzevar University of Medical Science, Sabzevar, Iran
3 Department of Clinical Psychology, Head Consultant of Department of Education, Sabzevar, Iran

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Date of Web Publication6-Nov-2017
 

   Abstract 


Background and Aim: Individuals with social phobia do not have flexible approach to deal with stress, and they are weak to practice social skills. The aim of this study was to investigate the effect of mindfulness-based stress reduction (MBSR) on social anxiety of the deaf. Research Methodology: In a quasi-experimental pre- and post-test study with a control group, in 2015, 24 deaf individuals in Sabzevar city were selected for sampling and were randomly divided into control and experimental groups. Subjects completed Social Anxiety Inventory (SPIN) in pre-test and post-test. Then, ANCOVA was used to analyze the data. Results: Data analysis showed that MBSR leads to a reduction in the total score of social anxiety and physiological responses component related to the experimental group compared with the control group treated. Conclusion: It was concluded that teaching MBSR resulted in decreased social anxiety of the deaf.

Keywords: Mindfulness, social anxiety, stress, the deaf

How to cite this article:
Dehnabi A, Radsepehr H, Foushtanghi K. The effect of mindfulness-based stress reduction on social anxiety of the deaf. Ann Trop Med Public Health 2017;10:1248-53

How to cite this URL:
Dehnabi A, Radsepehr H, Foushtanghi K. The effect of mindfulness-based stress reduction on social anxiety of the deaf. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Dec 15];10:1248-53. Available from: http://www.atmph.org/text.asp?2017/10/5/1248/217513



   Introduction Top


Deprivation of vital cognitive-psychological action of “hearing” through life span will inevitably entail significant cognitive and psychosocial features. A deaf person is someone who during the process of developing their character deprived of listening to voice messages and audio stimuli. Deprivation of voice weakens psychosocial ties considerably and causes a sense of environmental dissociation and feelings of isolation, depression, and social anxiety. Examining the psychosocial status of the deaf highlights the fact that “low self-confidence, social insecurity, isolation, generalized anxiety, poor motivation, and selective situational aggression and depression” are among the salient behavioral and personality features of the deaf.[1] social anxiety disorder (SAD) is characterized by an intense fear of social actions or situations, in which an individual may be judged, attended, and scrutinized by others or feel very confused and ashamed.[2] SAD diagnosis requires that the situations which create fear always initiate an anxiety response in an individual.[2] Anxiety sensitivity of somatic symptoms with anxiety arousal (increased heart rate, shortness of breath, and dizziness) is among the psychological components of social anxiety.[3] Cognitive theories of anxiety suggest that selective attention to threats intensifies anxiety and impairs judgment about social events.[4],[5] Deaf people with SAD predict lack of internal control on their emotional responses when faced with situations of social anxiety.[6] Among the factors that improve the situation for this group of the society is to help them improve their general health (physical and mental).[5] Reduced accountability [7] and absence from work [8] are the consequences of this disorder. In addition, showing bias in information, processing is a common thread in all cognitive patterns of social anxiety.[9],[10]

Mindfulness is a skill that lets people at present, get events less uncomfortable than they really are.[11] The goal of mindfulness is not a changed state of consciousness, but it is a self-observation state without evaluating and considering the current reality.[12] The most common way of mindfulness training is the mindfulness-based stress reduction (MBSR) in the form of stress reduction and relaxation training known as the most effective regulators of anxiety.[13] Stress reduction based on mindfulness is behavioral intervention based on self-consideration and self-focus, and its practices are done with concentration on thoughts, feelings, and perceptions.[14] MBSR is a combination of relaxation and mindfulness.[13] In addition, it is a constructive and creative cognitive process with “attention releasing” as one of its basic concepts [15] but mindfulness training method based on stress plays an important role in reducing anxiety, depression, somatic symptoms with increased attention to the thoughts, emotions, and desires and help a person balance their experienced negative emotions.[16] Results of a study showed that the MBSR techniques are effective in reducing anxiety disorders.[17],[18],[19] The previous studies have shown that MBSR training is effective in improving psychological, physical, and emotional well-being,[20] reducing symptoms of anxiety and depression in patients with generalized anxiety disorder [21] in the regulation of negative behavioral patterns, automatic thoughts, and positive behaviors related to health.[22] Tanay et al.[23] reported on the consequences MBSR training that statistically and clinically showed that the approach was very effective in reducing the symptoms of vulnerable mood and anxiety. The results of Anderson and Hope [24] showed that the youth with SAD suffers more psychological anxiety and arousal when compared with their normal counterparts.

In MBSR training, the ability to see thoughts is practiced independently and impartially, but overall knowledge is obtained through regular mindfulness training which can be defined as paying attention at the present time without judgment.[13] MBSR training includes maintaining awareness voluntarily. It is based on attention to particular concern and the physical sensations in the body and “relaxation” from one moment to another.[25] In this approach, mind is diverted to thoughts, feelings, voices, and the content of awareness is remembered. Then the awareness returns to its goals precisely and decisively. One important aspect of the therapy based on MBSR is that people learn how to overcome negative emotions and thoughts and mental events through relaxation training and thinking about positive side of experience.[26] MBSR due to its underlying mechanisms such as increasing awareness, desensitization, being at the present, nonjudgmental observation, confrontation and acceptance, can reduce the symptoms and consequences of anxiety, increase the effectiveness of treatment and eventually coordinates adaptive behaviors, positive psychological states, improve the individuals' ability and tendency of people toward social activities.[27] Due to the growing use of this approach in the treatment of various disorders, this study aimed to investigate the effect of the MBSR on social anxiety of the deaf in Sabzevar city.


   Research Methodology Top


In a quasi-experimental pre- and post-test with a control group using purposive sampling, 24 deaf individuals (12 in experimental group and 12 in control group) were selected from Sabzevar city and were evaluated based on deaf Social Phobia Inventory (SPIN).[28] This questionnaire was developed to assess social fear or anxiety. The questionnaire with 17 items is a self-report scale which has three minor scales clinical symptoms of fear with 17 items (6 items) with an internal consistency coefficient of (alpha, 89.0), avoidance symptoms (7 items) with the Alpha coefficient 91.0, and the scale of physiological symptoms (4 items) with the alpha coefficient 80.0 which was used as a valid tool for assessing the severity of social anxiety symptoms. In SPIN questionnaire, every item is scored based on the Likert five-point scale of five points (0 - not at all, 1 - a little, 2 - somewhat 3 - much 4 - very much). Based on the results for the interpretation of scores, cutoff point 40 with the discrimination accuracy of 80% and cutoff point of 50 with discrimination accuracy of 89% distinguishes people with SAD from others. This questionnaire has high validity. The reliability of this scale in retest for groups with SAD diagnosis was equal to 78.0–89.0 internal consistency coefficient alpha for the total scale in a group of normal subjects was reported 94.[28] Zanjani [29] conducted the survey on university students using retest method and reported its reliability equal as 82.0 and the internal consistency with Cronbach's alpha coefficient as 86.0. In addition, construct validity compared to the results of the test in two groups with SAD diagnosis showed a significant difference. SPIN having stable characteristics can be used as a valid tool for assessing the severity of social anxiety symptoms and testing response to treatment.[30] Analysis of covariance was used to analyze the data.

Procedure

In this research, the intervention was conducted on the experimental group based on MBSR proposed by Kabat-Zinn.[13] This technique is a combination of behavioral techniques including relaxation training, meditation and breath control training, attention, observation, and feeling physical sensations. In addition, description of feelings and thoughts, accepting them without judgment and being present at the moment, especially in the everyday activities are included in the techniques. 8 sessions a week were held with the following content for the experimental group, with the cooperation of a deaf teacher assistant to provide better conditions for the deaf to teach them therapeutic concepts and techniques.

  • First session: Communication, definition and conceptualization, and the necessity of using mindfulness training (describing the nature of the session for the deaf, the impact of social anxiety on consciousness, gaining trust, business confidence, and explaining the objectives of treatment)
  • Second session: Relaxation training through the creation of tension and release in the muscles that are associated with excitement (learning about the relaxation for 14 groups of muscles including forearm, upper arm, calf muscles, thighs, abdomen, chest, shoulders, neck, lips, eyes, jaws, and forehead)
  • Third session: Relaxation training through refreshing muscle groups previously called muscle tension release (relaxation training for 6 groups of muscles including hands and arms, legs, thighs, abdomen, chest, neck and shoulders, jaws, forehead and lips, and homework relaxation)
  • Fourth session: Generalized relaxation training in everyday situations and activities as well as training of mindfulness breathing (a short review of the previous session, familiarity with mindfulness breathing, training inhalation and exhalation techniques with comfort and without thinking about something else, training the breathing watching techniques as well as mindfulness breathing homework before going to bed for 20 min)
  • Fifth session: Breath control practice, breathing meditation, and training body scanning techniques. Complete awareness through observation of bodily sensations, attending to body movement during breathing techniques, focusing on the body organs and their movements and searching for physical sensations (hearing, taste, etc.), mindfulness eating homework (eating with comfort and attention to taste and sight of food)
  • Sixth session: Extended learning breath control and breathing meditation in daily activities and thoughts' mindfulness training. Attending to the mind, negative and positive thoughts, pleasant and unpleasant thoughts, allowing the entry of negative and positive thoughts to the mind and letting them easily out of mind without judging them and deep attention to them. In addition, the homework of writing positive and negative experiences daily without judging them
  • Seventh session: Comprehensive Mindfulness including a brief review of the previous session and continuing practices done in sessions 4, 5, and 6, each for 20–30 min
  • Eighth session: Wrap the items listed in the previous meetings and conducting the posttest.



   Results Top


Most participants in the experimental group (5 persons or 41.7) and control group (7 persons or 58.3) had Bachelor's degree. In terms of gender, most of the participants in the experimental group (9 persons or 75%) were male and control group (5 persons or 41.1) were female. On the other hand, most of deaf people in the age groups between 31 and 40 years (59.1) and control age groups between 20 and 30 years (66.7).

In [Table 1], the mean scores of social anxiety and its components, as well as the results of Kolmogorov–Smirnov test for analyzing the normality of data distribution are given.
Table 1: Kolmogorov–Smirnov test results for variables

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Results of [Table 1] show that the distribution of data across all variables in the pre- and post-test is normal. [Table 2] shows the results of tests to evaluate the homogeneity of variances of social anxiety scores and its subscales (avoidance, fear, physiological) for both female and male subjects.
Table 2: Levine test for homogeneity of variances

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According to the results in [Table 3], the distribution of scores on the pre- and post-test of social anxiety variance was homogeneous between groups. [Table 3] shows the assumption of homogeneity of social anxiety regression slopes and its subscales (avoidance, fear, physiological) for the deaf participants. According to the results, the homogeneity assumption of the regression slope of social anxiety variable is confirmed.
Table 3: Assumption of homogeneity of regression slopes

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In [Table 4], covariance analysis results are given to compare the two groups. According to the result, it can be concluded that MBSR has influences over social anxiety and its physiological component.
Table 4: The results of covariance analysis of the effects of mindfulness training on anxiety

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   Discussion and Conclusion Top


This study aimed at assessing the effectiveness of MBSR on social anxiety of the deaf. Analysis of the results showed that the overall social anxiety and social anxiety-induced physiological distress of the subjects under this treatment compared with the control group decreased significantly; however, MBSR had not significant effect on the components of avoidance and fear of the deaf although a slight improvement can be seen on the two components.

This result is consistent with the results of Howell et al.,[31] Sohrabi et al.,[32] and Beyrami and Abdi,[33] Eng et al.,[34] and Kabat-Zinn and saddle.[35] It is also consistent with the findings of Sedaghat et al.[36] that relaxation training is effective in reducing anxiety and Baer,[11] who holds that unhealthy attention is the core of anxiety symptoms and neuroscience researchers who use [37] psychological factors to analyze the effects of treatment. It is also consistent with the study of Broderick [38] which shows that meditation and mindfulness are focused on self-acceptance and awareness of breathing process and consistent with Semple et al.,[39] who demonstrated that mindfulness training techniques basically increased attention techniques which are useful in the treatment of patients with anxiety and depression. In fact, from the results, it can be said that one way to improve people's awareness and knowledge is introducing strategies that enhance the effectiveness and attention of functions mindfulness.

Many practices that are used for mindfulness are sustained attention practices.[40] Some researchers identify mindfulness as the maximum internal and external control of body experiences, which can be considered the same as the scope of individual attention.[41] The key point in the meditation treatment is the use of mindfulness techniques. Although the traditional treatment of meditation can be differentiated from mindfulness techniques, the cognitive status that a person experiences after meditation treatment will be considered as mindfulness.[42] Among the major issue in strengthening, mindfulness is to differentiate and adjust various aspects of emotional states.[43] Barlow et al.[44] states that poor emotional control is one of the important aspects of anxiety disorders. It seems that for active participation in social situations and not avoiding them, it is necessary to have sufficient social skills to deal effectively with these situations and the correct the understanding of the situation and the lack of distorted beliefs.

Schütz et al.[45] suggests that willingness to engage in processes with regard to automatic processing along with attention without flexibility and lack of awareness of the present moment make people to think and ruminate about anxiety more and more anxious and thus estimate its severity high. Anxious and depressed people cannot consider difficult situations as controllable. This inflexible cognitive style strengthens anxiety states and depressive moods through the creation of an automatic bias in admission of dysfunctional thoughts.[46],[47] In a study conducted by Wells,[48] it was concluded that a person's sense of control over anxiety responses in the face of difficult situations is an important factor in the treatment of SAD. It helps a patient to learn that feelings and concerns about the physiological distresses can be easily tolerated and that they make a person perform social functions poorly.[49] In many cases, judgment and prejudice cause tension, stress, and discomfort in people, and this is the origin of social anxiety. In addition, increased anxiety strengthens negative emotions and stress. It was noted before that this destructive cycle can lead to increased social anxiety and reduced quality of life. To reduce social anxiety, it is necessary for people to avoid judgment and to perceive feelings, emotions, and events as they really are. One of the working methods for reducing anxiety is to implement MBSR that provide relaxing and nonjudgmental techniques to help reduce the use of nonadaptive coping strategies. Kabat-Zinn [35] noted that observing without judgment used in mindfulness reduces the emotional responses of anxiety or pain. Hence, the practice of mindfulness skill improves the ability for users to tolerate negative emotional states and enable them to deal with them effectively. In addition, it will reduce the use of nonadaptive coping strategies. Another result of this study was that MBSR had no positive and significant effect on two scales (avoidance and fear) of social anxiety compared to the control group. These results are not consistent with research results of Sohrabi et al.,[32] Beyrami and Abdi,[33] Howell et al.,[31] and Eng et al.[34] These differences in these studies may be due to differences in volume samples, sample population, and the different tools as well as social and cultural differences.

Since the relaxation training is based on attention to the present moment and bodily sensations of the deaf, we found that situational fears are not predictable due to their physical conditions. However, generally, it can be said that mindfulness training was effective regarding their overall anxiety and that they had more control over their physiological symptoms in social situations.

Finally, it can be concluded that MBSR training for deaf people with social anxiety due to its conscious and unbiased techniques makes them accept the physical symptoms of their fears. This reduces the attention and hypersensitivity to report physical symptoms and anxiety; or we can say that MBSR training causes people with social anxiety to practice body checking, positive thoughts restoration as well as increasing their knowledge about fears to help them reduce their social anxiety. However, it should be noted that the persistence of this effect requires continuous training and development of mindfulness techniques across the life is as the way to become a style of life.

Among the major limitations of this study is the lack of follow-up evaluation of the research results and the limited number of deaf people participants in Sabzevar city, which make it difficult to generalize the results with other deaf people in other geographic areas. It is recommended that follow-up studies be conducted to determine the stability of the therapeutic effects. In addition, conducting a research with homogeneous samples with different age groups and in more extensive geographic areas can prepare the grounds for better comparison and increased generalizability of the results. Due to the flexibility of this approach, the combination of MBSR training with holistic cognitive-behavioral group therapy and for people with poor basic skills is likely to be effective in improving behavior and can reduce anxiety, fears, avoidance, and physiological symptoms of anxiety. Studies conducted in this area could help to prove this.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Hamid Radsepehr
Department of Clinical Psychology, Sabzevar University of Medical Science, Sabzevar
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_280_17

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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