Mindfulness,spiritual well-being,and visual impairment: An exploratory study

Abstract

Mindfulness is a form of meditative practice that involves paying attention to present-moment experiences in a non-judgemental way in order to cultivate a stable and nonreactive awareness. Although mindfulness has been studied in relation to various health conditions, no known published study exists which considers mindfulness in the context of visual impairment. Semi-structured interviews were therefore conducted with blind and partially sighted individuals who participated in regular mindfulness practice. Their narratives were then analysed thematically. The results suggest that mindfulness enhanced spiritual well-being by increasing their sense of intrapersonal, interpersonal, and transpersonal ‘connectedness’, which was seen to be related to a self-perceived increase in emotional, social, and physical health. The findings of this exploratory study call for further research into the utility of mindfulness as a well-being resource for individuals with a visual impairment.

Keywords

Holistic mindfulness spiritual well-being thematic analysis visual impairment

Background

Although there are various interpretations of spirituality and its relationship to well-being in health-care settings, ‘meaning’ and ‘purpose in life’ have been suggested as primary components of a definition of spirituality (Daaleman, Frey, Wallace, & Studenski, 2001). Furthermore, links may be drawn between such concepts of spirituality and that of the dimension of eudemonic well-being (Ryff & Singer, 1998). Nevertheless, a gap remains in the literature on the role of spirituality (as an inclusive, all-encompassing concept) and the well-being of blind and partially sighted individuals. Very few studies have explicitly considered the role spirituality plays in adapting to and living with visual impairment. Furthermore, despite a growing academic interest in mindfulness as a form of therapy or support (Keng, Smoski, & Robins, 2011), no known published study has specifically considered the utility of mindfulness as a form of spiritual support for blind and partially sighted individuals. This qualitative study therefore sought to develop the ideas of Brennan (2002, 2004), Brennan and Cardinali (2000), and Wang, Chan, Ng, and Ho (2008), who underlined the importance of further research into spirituality and visual impairment. Brennan and Cardinali (2000) specifically underlined the need for further research into the role of the more existential elements of spirituality (e.g., meaning and purpose in life), as opposed to religious faith-based elements of spirituality. Since mindfulness has been associated with increased feelings of these particular elements of spirituality and thus linked to spiritual well-being (Harris, 2007), it was deemed to be an appropriate form of well-being support to investigate.

With its roots in Buddhist philosophy, mindfulness has been deemed a form of practice and support that involves intentionally paying attention to present-moment experiences (physical sensations, perceptions, affective states, thoughts, and imagery) in a non-judgemental way, which is said to cultivate a stable and nonreactive awareness (Miller, Fletcher, & Kabat-Zinn, 1995). By learning to be ‘mindful’ in everyday situations, which may provoke a stressful response, individuals can learn to re-evaluate their reactions to such situations. It can thus be argued that although mindfulness is a practice which is based on experiencing the present, it may simultaneously be a tool for helping to shape the way individuals manage events and situations in the future. In this way, mindfulness may be perceived as encouraging personal development (Shapiro, Carlson, Austin, & Freedman, 2006), which may lead to a fundamental shift in perspective regarding an individual’s personal values and purpose in life. Mindfulness may therefore encourage long-term changes in an individual’s sense of eudemonic well-being by encouraging the conditions within which individuals are able to find meaning and act in a reflexive way.

Mindfulness shares both similarities and differences with Western concepts of support. Being non-judgemental, being aware of the body and sensations, and consciously disengaging from habitual cognitive and behavioural patterns are elements also found, for example, in Gestalt therapy (Brownell, 2010) and person-centred approaches such as Rogerian counselling (Bien, 2006). However, in contrast to such approaches to therapy, mindfulness differs in its specific emphasis on ‘non-doing’, which is viewed as being transformative in itself. Mindfulness therefore embraces whatever is arising in the present moment and has no intrinsic rules, expectations, or limitations. In this sense, it can be seen as a ‘journey without a goal’ (Kabat-Zinn, 2003). Furthermore, Western psychological therapies, such as cognitive-behavioural therapy (CBT), tend to place emphasis on challenging ‘negative’ thoughts and substituting these with ‘positive’ thoughts and eliciting feedback (Hofmann & Asmundson, 2008). The goals of mindfulness, conversely, are to foster acceptance of unwanted thoughts and feelings (Hayes, 2005) and discourage ‘experiential avoidance’, which is the unwillingness to experience negatively evaluated feelings, physical sensations, and thoughts (Hayes, 2004). As such, the foundations of mindfulness are more in line with the philosophy of eudemonia: Rather than trying to avoid or change all negative thoughts in a constant striving for happiness, mindfulness highlights the need for a conceptual change which permits a greater acceptance of difficult emotions (Kabat-Zinn, 2003).

Mindfulness research in the West has predominantly occurred in the fields of psychology and neuroscience. This has given rise to different types of mindfulness-based ‘interventions’, which contain varying degrees of meditation practice and which are evaluated on outcomes based on cause and effect (Rothwell, 2006). Such interventions have found significant appeal within the dominant medical-model discourses and practices of health care, particularly in the United States, where evidence-based methodologies dominate professional practice. It has been argued, however, that such ‘secular’ approaches to mindfulness run the risk of losing any links to their spiritual origins and have been criticised in the literature for being ‘psychologised’ and thus only emphasising the intrapersonal effects of mindfulness as a form of support for well-being (Chambers, Gullone, & Allen, 2009). Conversely, there are the more holistic approaches to mindfulness, which emphasise not only the intrapersonal but importantly the inter- and transpersonal significance of the practice. These holistic approaches appreciate the spiritual roots and meditative element of mindfulness, which is often combined with other practices such as yoga. In this approach, mindfulness interventions incorporate meditation to cultivate spiritual well-being, rather than specific outcomes which can be ‘measured’ within the parameters of scientific thinking (Rothwell, 2006). The focus of research from this standpoint is less on specific, ‘measureable’ outcomes and more on understanding and developing our knowledge about how mindfulness meditation may engender a sense of spiritual well-being in individuals, and importantly, how this sense of spiritual well-being is holistically linked to our physical and emotional health. Practitioners from this perspective therefore seek to understand mindfulness from the relativist paradigm, which naturally aligns itself not with cause and effect, but with more qualitative forms of enquiry. It is within this second approach to conceptualising mindfulness that this field study is situated.

Aims of the study

In order to attempt to develop the theories discussed by the above studies, this study sought to consider the role mindfulness may play in the well-being of individuals with a visual impairment, and thus building upon the wider literature on spiritual well-being and adaptation to long-term health conditions (Bussing & Koenig, 2010; Lindstrom & Eriksson, 2010; Whitford & Olver, 2011).

Methodology

Participants

As the participants in the study were all deemed to be non-vulnerable adults, the Ethics Committee at the University of Sunderland confirmed that ethics approval would not be necessary. Participants were blind or partially sighted adults and had experience of mindfulness meditation. Sampling was purposive (Patton, 1990): Participants were recruited via a holistic health centre in the North-East of England by referral from practitioners and the centre manager. Interested participants were then sent a study information sheet, or this was read aloud to them over the telephone. A preliminary telephone call was then arranged to allow for any questions about the study. A consent form was sent to interested participants following the initial telephone call, and consent was subsequently given prior to participation in the study either verbally or in written form. Consent included allowing participant narratives from the interviews to be used in future research publications. A date and time was then agreed for the interview to take place in the coffee shop of the holistic health centre.

Procedure

Data were collected using semi-structured interviews containing key questions that helped define the themes to be explored. This allowed the interviewer and participant to expand upon particular thoughts in more detail. This approach provides participants with some guidance about the content of the interviews, which participants may find helpful and allow the researcher to ‘break the ice’ (Creswell, 2007). The interviews were conducted in accordance with Schein’s (1983) ‘interactive interview technique’. The interview schedule was devised to talk first about the participants’ visual impairment and then move on to their mindfulness practice and the impact it was perceived to have on their well-being. Questions were used to guide the interview around this schedule, but additional questions could be asked depending on the flow of the participants’ narrative (Corbetta, 2003, p. 270).

The questions were open to allow participants to respond as closely as possible to their own experience, and did not ‘lead’ participants into giving particular responses (Kvale, 1996). The role of the researcher was to be non-judgemental, encouraging responses and not indicating personal opinion on the subject matter being discussed (Trochim, 2002).

Eight face-to-face interviews were conducted between September and November 2011 in the North-East of England. The age range for the participants was between 32 and 73 years. Five participants were partially sighted, two had become blind, and one was congenitally blind. All of the participants were of White British ethnic origin and seven of the eight stated ‘none’ when demographic information was sought about a religious faith. One of the participants stated he belonged to a Christian (but non-practising) faith. The type of meditation practised was primarily mindfulness, but meditative yoga and martial arts were also commented upon within the context of the principles of mindfulness.

Data analysis

Each interview was audio-recorded with the participant’s permission and then transcribed. The interview transcripts were analysed using a deductive/theoretical style of thematic analysis (Braun & Clarke, 2006; King & Horrocks, 2010). Thematic analysis was chosen as the method of data analysis for the flexibility it allows the researcher by not having to be tied to one particular theoretical framework. Instead, it may be influenced or informed by a variety of epistemological standpoints or researcher assumptions. These assumptions are summarised in Table 1.

Table 1.

Assumptions made prior to thematic analysis.

Decisions as a reflexive researcher	Assumptions made about the data in this study
What counts as a ‘theme’?	A theme constitutes something that captures an important part of the data in relation to the aims of the study, and it is not about the frequency that it occurs
Is the analysis a rich description of the entire data set (all the interviews) or a detailed account of one particular aspect?	A rich description of the entire data set is given so as to ensure that the analysis and discussion would not ignore or ‘skim over’ potentially important themes from the data.
Is the analysis inductive/data driven (bottom-up) or deductive/theoretical (bottom-down)?	A loosely deductive/theoretical approach was taken, driven by and potentially expanding upon existing themes and theories in the literature on well-being and the impact of visual impairment and spirituality. As King and Horrocks (2010) point out, however, although this approach may be taken to develop existing ideas, new concepts which demand a more inductive approach may emerge from the interview analysis.
Are themes at a semantic (explicit) or latent (interpretative) level?	A semantic approach was taken when analysing the data: The process began with a description, and then, it was interpreted by attempting to theorise the significance of the themes and their broader meanings and interpretations in relation to the wider literature (Patton, 1990).
Epistemology: essentialist/realist; contextualist or constructionist thematic analysis	The analysis took a contextualist approach. This approach acknowledges the way individuals make meaning of their experiences, and how social and discursive contexts may impinge on those meanings. While assuming that the language used reflects the participants’ experiences, it is also assumed that such an experience is dependent upon time and place.

Results

The interview process yielded nine subordinate themes: intrapersonal connectedness, inter- and transpersonal connectedness, resilience and empowerment, immediate satisfaction, improved community/social network, encouraging altruistic behaviours, benefits of ritual, increased physical functioning, and improved mobility. These were further condensed into four superordinate themes of well-being: spiritual, emotional, social, and physical. The superordinate and subordinate themes are addressed below using quotes from the participants’ narratives.

Spiritual well-being

The first theme identified was the spiritual impact of mindfulness. This was found in two subthemes which concerned the experience of mindfulness meditation in relation to a sense of spiritual well-being: (1) intrapersonal connectedness and (2) inter- and transpersonal connectedness.

Intrapersonal connectedness

Intrapersonal connectedness was identified in relation to the sense of internal strength that participants’ experienced during and following meditation:

No matter what is going on I know that when I meditate, even if it’s just for five minutes, those five minutes seem to be like I’m recharging my batteries for the whole day. (Male, 40 years, congenitally blind)

Participants also spoke about how mindfulness provided a sense of development and growth through helping participants to re-evaluate their lives and seek meaning and a sense of moving forward:

In one way you learn . . . to put all the things that come into your head away in boxes and you’re just there, just in the moment . . . and then afterwards, you kind of re-evaluate your priorities and it just . . . it’s a funny thing, I know . . . (Female, 42 years, partially sighted)

Another participant spoke of thinking in the ‘present’ and in the process changing the way he thought about his future:

It stops you going over and over stuff and thinking about what could have been . . . and instead you just concentrate on the now and how you feel . . . and how that might change the way you think about things tomorrow . . . (Male, 32 years, partially sighted)

Inter- and transpersonal connectedness

Participants also spoke of how they felt like when they were receiving energy from their external environment. This subtheme was defined in the analysis as ‘inter- and transpersonal connectedness’ and related to a sense of being connected to an external source of energy. This energy was conceived as being interpersonal through connecting with known others, including other species and the natural physical environment. It was also defined by some participants as being transpersonal through a sense of relatedness to the unknown or a power greater than the self, or a combination of the two:

Meditation makes you feel like you’re part of something bigger and, and you feel like it’s linking you to other things . . . and I guess that makes me feel like I’m sort of tapping into something. (Female, 58 years, partially sighted)

Another participant spoke of how the attentiveness her meditation cultivates encourages her to be aware of being connected with her physical, natural environment and other species:

It’s energy. It’s nature . . . it’s possible to feel it when you hear a bird sing . . . or the rain . . . it’s connecting to things that go beyond us humans . . . (Female, 34 years, partially sighted)

Emotional well-being

The second theme concerned the relationship between mindfulness and the participants’ sense of emotional well-being. This was divided into the subthemes of (1) resilience and empowerment and (2) immediate satisfaction.

Resilience and empowerment

The participants also spoke of a perceived improvement in their self-esteem and self-control, as noted, for example, by one individual in relation to his experience of mindfulness as part of his martial art practice:

You develop your sense of self, instead of other people telling you how you should do it . . . it’s everything inside you and it makes you feel that you can control things yourself. (Male, 45 years, blind)

This sense of empowerment through mindfulness practices was also described in relation to an increased sense of hope and optimism. By feeling more optimistic and hopeful, some participants spoke of how they felt able to ‘cope’ or ‘manage’ difficult situations. For example, one participant spoke of how mindfulness had given her a sense of hope:

It’s given me a sense of hope . . . I’m so grateful for that. Being mindful is part of me now, and I’m living without being able to see properly, but at the same time, it’s like the lights have been turned on. (Female, 34 years, partially sighted)

Similarly, another participant spoke of how mindfulness had helped him to change the way he thought about aspects of his life, encouraging a more optimistic perspective:

It’s not a magic bullet, but for me it helps maintain a positive outlook on life, and when you have this . . . it’s like you can achieve so much more. (Male, 40 years, congenitally blind)

Immediate satisfaction

Apart from provoking a sense of empowerment and resilience, which may be related to long-term eudemonic well-being, mindfulness was also identified with a more hedonic sense of satisfaction. This was described in terms of happiness or good mood:

I just feel happier afterwards. It’s simple as that really. (Female, 58 years, partially sighted)

Social well-being

The experience of mindfulness practices was also linked to an increased sense of social well-being through a sense of interpersonal connectedness. This was divided into two subthemes: (1) improved community/social network and (2) encouraging altruistic behaviours.

Improved community/social network

This subtheme relates to social participation and a perceived improved connectedness with other people:

I think it’s made me feel less resentful, and more connected to society again . . . (Male, 40 years, blind)

Encouraging altruistic behaviours

Participants also spoke of feelings of wanting to help others and share what they had learned. One participant, a martial arts teacher with 20 years of experience of mindfulness, spoke of his desire to help others:

I want to help others, and that’s why I teach what I know. I want to help other people, not just visually impaired people . . . to understand how mindfulness can help. (Male, 45 years, blind)

Physical well-being

The fourth theme concerned the relationship between mindfulness and the participants’ perceived physical well-being, which was divided into two subthemes: (1) increased physical functioning and (2) improved mobility.

Increased physical functioning

The participants spoke of how mindful practices seemed to help to reduce the physical symptoms of the stress and anxiety caused by their visual impairment. One participant spoke of being more aware of her reactions to difficult situations, which she felt in turn lessened the physical effects of their anxiety:

I think more than anything . . . it teaches you to be more aware of how you . . . how you process things. So I’ve tried to use as a way of managing my condition . . . like thinking of my reactions differently . . . In situations where I’d have got all sweaty and my heart would’ve been going ten to the dozen, I’m calmer now . . . (Female, 34 years, partially sighted)

Another participant spoke of how his disturbed sleep had improved:

I sometimes found sleeping terrible . . . I often would wake up through the night . . . and that would have a knock-on effect on a whole load of other things . . . but it’s so much better now . . . I definitely feel calmer . . . I get less worked up . . . and not sleeping and being aware of the lights . . . it just isn’t so much of an issue. (Male, 40 years, congenitally blind)

Improved mobility

Mindfulness was also identified by the participants as leading to improved mobility. This was found to be through (1) improvement of balance and posture and (2) an awareness of bodily movement. For example, when commenting on her experience of meditative yoga, one participant noted an increased sense of stability and alignment, which in turn helped her later when mobile in the external environment:

It helps me from bumping into things or falling over . . . I think focusing on my body and the postures really makes me more aware of myself. (Female, 42 years, partially sighted)

Another participant spoke of a heightened state of awareness regarding how his mind and his body worked together:

It makes me feel calm . . . and balanced . . . both psychologically and in the way my body actually works . . . how it all works together. (Male, 40 years, blind)

Discussion

The analysis found that mindfulness influenced four key thematic areas relating to the spiritual, emotional, social, and physical well-being of the visually impaired participants. These findings will now be considered in relation to the literature on mindfulness and well-being.

Mindfulness was identified as contributing primarily to a sense of spiritual well-being. The participants spoke of a feeling of internal (intrapersonal) and external (interpersonal and transpersonal) connectedness during mindfulness practice. They also spoke of their experiences in terms of giving them a sense of meaning and purpose. This supports the theory that spiritual well-being may lead to more positive health outcomes since it can provide a sense of purpose and meaning of life, especially when trying to understand life experiences (Lindstrom & Eriksson, 2010; Whitford & Olver, 2011). The literature also underlines the importance of these elements of spiritual well-being for eudemonia and flourishing, as noted by Haybron (2000) and Nussbaum (2005). Similarly, Bussing and Koenig (2010) and Andre, Foglio, and Brody (2001) suggest that by providing meaning in life, spiritual well-being can lead to personal growth and a habit of reflection.

The narratives suggest that the practice of mindfulness offered participants a framework for interpreting a positive meaning and purpose to experiencing visual impairment. It is suggested that this sense of meaning may positively affect their adjustment to visual impairment through helping to diminish the ‘existential vacuum’ where life events are felt to have no meaning, ‘buffering’ potentially negative psychological outcomes (Andre et al., 2001; Bussing & Koenig, 2010; Coyle, 2002). It is therefore suggested that by developing a sense of spiritual well-being, the participants felt that their lives had meaning and purpose, which in turn may foster acceptance of their visual impairment. It may not necessarily bring about immediate gratification and instant happiness; however, it offers the prospect of long-term adaptation to and acceptance of their visual impairment. This suggestion is congruent with clinical and empirical studies that conclude that long-term adaptation to visual impairment often hinges on the emotional acceptance of the condition (Conrod & Overbury, 1998; Fenwick et al., 2012; Fitzgerald, Ebert, & Chambers, 1987; Nyman, Dibb, Victor, & Gosney, 2011; Wang & Chan, 2009; Weber & Wong, 2010).

A sense of spiritual well-being was also identified by participants as the process of receiving strength, and concerned ‘connecting’ or ‘tapping into’ a source of energy that they felt was all around them. This relationship can be seen as interpersonal or transpersonal, as it involves not only the individual and the way they relate to themselves through their spiritual practices, but their relationship to the exterior world as well. Some participants spoke of a feeling of ‘connectedness’, and of receiving strength from an external source when they meditated. In this sense, mindfulness may contribute to a sense of spiritual well-being in terms of receiving energy, which in turn impacts upon a sense of social well-being (e.g., Bussing & Koenig, 2010), thus emphasising the holistic impact of the practice.

The feeling of connectedness and ‘receiving’ energy or strength from both within and external to the self may in turn increase the participants’ sense of emotional well-being in terms of their levels of confidence, self-esteem, and self-control. This lends support to existing theory on how spiritual well-being may enhance cognitive and emotional perceptions. Wong (2010), Keyes and Lopez (2002), and Coyle (2002) all have noted how the sense of meaning that spiritual well-being provides enables effective coping styles; the reduction of stress, anxiety, and depressive symptoms; and the building of resilience. This may in turn ameliorate the suffering and distress caused by chronic illness or functional impairment (Ferraro & Koch, 1994). By feeling empowered and more in control of their lives, it is suggested that the participants in this study were able to cope with and manage their visual impairment more easily. As noted elsewhere in the literature, a sense of spiritual well-being is therefore related to positive emotions, which may facilitate acceptance and reformulation of life priorities, resulting in a better adaptation to living with particular health conditions (Bartlett, Piedmont, Bilderback, Matsumoto, & Bathon, 2003; Bussing & Koenig, 2010). Spiritual well-being achieved through mindfulness may therefore increase an individual’s sense of emotional well-being, and thus be conceived of as a coping mechanism which in turn can reduce depression and anxiety (Fallot, 1998). Indeed, previous studies have also found that there is a significant relationship between spirituality and emotional adjustment to health conditions such as diabetes mellitus (e.g., Landis, 1996), sickle cell disease (e.g., Harrison et al., 2005), rheumatoid arthritis (Bartlett et al., 2003), cancer (e.g., Laubmeier, Zakowski, & Bair, 2004), and HIV disease (e.g., McCormick, Holder, Wetsel, & Cawthon, 2001). This study therefore adds qualitative data to this existing theory, suggesting that spirituality may promote positive emotional outcomes in terms of resilience and empowerment in blind and partially sighted people.

Participants also commented how their experience of mindfulness involved positive feelings and emotions. The thematic analysis found that through mindfulness meditation, the participants achieved a sense of spiritual well-being, which in turn fostered feelings of optimism and hope, which also have been linked to happiness (Bussing & Koenig, 2010; McSherry, 2006). Hope can be construed as ‘an energizing mental activity focused on future outcomes important for the individual’ (Fowler, 1997, p. 111), and a spur to action (Fowler, 1997; Frank, 1968). Similarly, Piedmont (2001) suggested that spiritual well-being in rehabilitation settings takes on the role of a ‘motivational trait’ that is defined as an individual’s attempts to discover personal meaning through spiritual belief and is stable over time. Elsewhere in the literature, Coyle (2002) underlined how hope enhances the adaptive capabilities of people with chronic conditions, and Seligman (2011) noted how a sense of meaning in life can enhance adaptive capabilities, and in turn contribute to both hope and optimism. Therefore, spiritual well-being may foster the emotional strengths of hope and optimism, and may motivate blind and partially sighted people to achieve rehabilitation goals. This lends support to existing theory developed by Brennan and MacMillan (2008), who considered spirituality and the achievement of vision rehabilitation goals. They concluded that a sense of hope engendered through spirituality acts as an important personal resource in rehabilitation settings. In their findings, they note that since rehabilitation training involves learning new ways of everyday performing tasks, hope may act to overcome the frustrations of having to relearn particular physical functions, while the practice of being mindful may encourage individuals to focus on activities that one could previously do with little thought. It is therefore suggested that in this study, mindfulness helped participants to envisage positive expectations for the future and counteracted feelings of depression, which may otherwise have served as a barrier to progress (Horowitz, Reinhardt, Brennan, MacMillan, & Cantor, 2003; Russinova, 1999).

These findings therefore suggest that mindfulness may positively influence both the eudemonic and hedonic dimensions of well-being by providing meaning and direction and thus increasing self-esteem and self-control, as well as provoking feelings of hope and life satisfaction.

The participants also spoke of feelings of social well-being during and following mindfulness practices, primarily through sharing experiences with others and actively participating in friendships and community networks. This finding is similar to Ryff’s (1989) well-being dimension of ‘positive relationships with others’. More recently in the literature, Bussing and Koenig (2010) highlighted the act of ‘actively giving’ as being the result of the feeling of ‘connectedness’ that spiritual well-being is associated with. ‘Actively giving’ is seen as the intention to leave the role model of ‘passive sufferer’ to become an active, self-actualising, giving individual.

Oh and Sarkisian (2012) considered the impact of spirituality on both interpersonal and intrapersonal outcomes, and akin to the participants in this study, they found that practices such as mindfulness not only foster a sense of self but also promote a sense of social connectedness. They found that activities such as meditative yoga were positively associated with altruistic behaviours and participation in voluntary associations, and therefore, spiritual well-being was associated with positive social and community relationships. Similarly, Coyle (2002) noted that as spiritual well-being increases, so does a sense of social well-being through a sense of being connected to others. In turn, individuals are more able to help others, which, in a cyclical fashion, enhances their own spiritual well-being. Similarly, Montgomery (1991) noted that caring for others can provide a sense of empowerment and increased self-esteem (emotional well-being) and as such altruism may be seen a beneficial consequence of social well-being.

Mindfulness was also noted by some participants as heightening their awareness of the natural, physical environment and other species. This supports previous studies by Fisher (2011), Bussing and Koenig (2010), and Underwood and Teresi, (2002), who underline the importance of ‘connectedness’ with the natural, external environment, and non-human animals. Similarly, Kirsten, Van der Walt and Viljoen (2009, p. 4) point to the importance of being connected with all elements of the ‘social’ environment: In their critique of the World Health Organization’s (WHO) neglect of the spiritual dimension of the human being, they argue that connecting with the external environment consists of both living and non-living elements or domains. In their anthropological eco-systemic approach to understanding holistic well-being, they point to connecting not only with the social, ‘human-made’ environment, as suggested by the WHO, or only a social, economic, and technical environment, as suggested by Capra (1982), but also with a physical environment, including other living creatures and a symbolic dimension representing language, art, literature, and other cultural ‘symbols’. Similar evidence for a sense of ‘socio-ecological’ well-being can be found in Fisher’s (2011) creation of the ‘environmental domain’ of well-being or the importance of handling the environment in Ryff’s (1989) core eudemonic dimension of ‘environmental mastery’. Mindfulness was therefore seen to enhance the participants’ social well-being in a way which supports work by Shapiro (2008), who concluded that mindfulness

. . . allows people to connect with something larger than themselves . . . As we practice mindfulness, we realise that . . . we are all part of the same body in this world, connected to other human beings and our environment. So the appropriate response is to take care of ourselves, to take care of each other, and to take care of the environment – we are all interconnected so this is the only thing that makes sense. (p. 3)

The participants also spoke of the impact mindfulness has on their sense of physical well-being. This was particularly noted when mindfulness was incorporated into meditative aspects of yoga and martial arts and was identified in terms of increased physical functioning and mobility. However, the findings of this study provoked the question of whether or not a sense of spiritual well-being achieved through mindfulness directly influences the positive physical outcomes described by the participants. This led to an unexpected finding: In the wider literature on spiritual well-being and health outcomes, various authors have concluded that a sense of spiritual well-being may indirectly lead to increased physical outcomes. Building upon the findings in the wider literature on mindfulness, spiritual well-being, and various other health conditions (Brennan & MacMillan, 2008), the interviews sought to discover if such findings were also applicable to this group of blind and partially sighted individuals and thus build upon and develop existing theory. Indeed, the findings of this study do support these previous findings: During the interviews, the participants described how their visual impairment had previously affected their everyday functionality and mobility, making them more dependent upon others and provoking various negative emotional responses. One of the participants, who had been born with a visual impairment, noted that although his visual impairment was something he felt he could manage, he felt that his ‘vulnerability’ was increased when he experienced another (temporary) health condition. Visual impairment was therefore perceived as being linked to negative outcomes in terms of physical well-being by the physiological result of reduced sight and decreased mobility and functionality, or when combined with other health conditions. Furthermore, the participants spoke of the negative impact their visual impairment had on their sense of social and emotional well-being, which could in turn lead to further reduced physical functioning and mobility (this ongoing negative ‘reciprocal relationship’ has been discussed widely in the visual impairment literature, e.g., Brennan & MacMillan, 2008; Nosek & Hughes, 2001). However, did mindfulness meditation lead to a direct perceived improvement in the participants’ physical well-being? Analysis of the study narratives suggested first that the experience of mindfulness did indeed lead to a sense of spiritual well-being (meaning and purpose in life and growth), which was found to contribute to a state of emotional well-being (empowerment and resilience) and also social well-being (a sense of connectedness to others and the natural physical environment), which in turn was found to lead to positive physical outcomes. Thus, it is suggested that mindfulness increased the participants’ sense of spiritual well-being, which indirectly lead to a sense of improved physical functioning and mobility through an improved emotional and social state. This echoes the findings in the literature on the use of mindfulness practices for improving emotional well-being by reducing symptoms of stress (Chong, Tsunaka, Tsang, Chan, & Cheung, 2011), depression (Pilkington, Kirkwood, Rampes, & Richardson, 2005), and anxiety (Kirkwood et al., 2005). Improved emotional well-being may then lead to improvements in the physical symptoms of stress, depression, or anxiety, such as the sleep disturbances acknowledged in this study. This supports similar findings in the wider literature concerning the benefits of mindfulness-based practices on older adults (Manjunath & Telles, 2005), cancer patients (Cohen, Warneke, Fouladi, Rodriguez, & Chaoul-Reich, 2004), and cardiorespiratory factors (Harinath et al., 2004). Spiritual well-being, achieved through mindfulness meditation, could therefore help to ‘buffer’ the negative impact of visual impairment by improving emotional and social outcomes (increased self-esteem, self-control, connectedness to others), which may in turn lead to the individual feeling more spiritually, emotionally, and socially ‘fit’ to engage in activities or rehabilitation which would require them to be more physically mobile (Yampolsky, Wittich, Webb, & Overbury, 2008).Therefore, it would be possible to conclude at this point that the impact of mindfulness meditation on physical well-being is positive, but arguably indirect.

However, the findings of this study suggest that it would be premature to conclude at this point. Although it is pertinent to highlight that this was an exploratory, concept-building piece of research, and thus did not seek generalisations, the qualitative data gleaned suggest that the sense of spiritual well-being achieved through mindfulness may have directly influenced the participants’ physical well-being. The narratives also highlighted how mindfulness, especially when practised in conjunction with yoga or martial arts, appeared to have a direct positive effect on an individual’s mobility through an increased sense of balance and bodily awareness. Vision is an important tool which enables an individual to navigate his or her environment. As such, a lack of, or loss of, vision may be accompanied by a reduced awareness of one’s body within the environment. This has been shown to lead to a decrease in balance, postural stability, and mobility, which may in turn increase the likelihood of injury from falls (Ray, Horvat, Croce, Mason, & Wolf, 2008; Wood et al., 2011). As vision declines, adopting training strategies that enhance the use of other sensory information may act as a way of developing awareness of the body as it moves through space. The findings of this study may therefore suggest that mindfulness is one such training strategy.

Mindfulness has been shown to increase awareness and attentiveness to one’s bodily functions elsewhere in the literature (Carmody, Crawford, & Churchill, 2006; Carmody, Reed, Kristeller, & Merriam, 2008). Focusing on breathing, for example, draws attention inward towards the individual, and at the same time has been found to promote awareness of muscular movements and alignment (Shelov, Suchday, & Friedberg, 2009). By cultivating a sense of bodily awareness through mindfulness, the participants appeared to directly improve their physical functioning and mobility through improved balance and space orientation. This in turn may help to reduce their risk of falls, which has been identified as a risk factor for blind and partially sighted individuals in the literature (West et al., 2002). Further research may therefore wish to consider both the indirect and direct effects of mindfulness practices on the physical well-being of blind and partially sighted individuals.

Limitations

There are several limitations associated with this study. First, in contrast to the nomothetic statements which can be inferred from representative samples typically found in quantitative research, the findings in this study are idiographic and analytic in presentation and cannot be generalised to all individuals with a visual impairment. To do so, a mixed-methods approach would be required. Longitudinal research may help to understand the longer-term impact of mindfulness and how this may differ according to particular factors such as the degree and aetiology of visual impairment or the type of support received.

Conclusion

Contribution to practice: recommendations for the visual impairment sector

The aim of this study was to gather qualitative, narrative data on the experiences of mindfulness meditation for blind and partially sighted individuals, building upon the wider literature on spiritual well-being and adaptation to long-term health conditions. The findings indeed enable a deeper understanding of this, providing highly personal narratives on the perceived impact of mindfulness practice on the well-being of individuals with a visual impairment. This study’s contribution to practice is therefore a space to enable a deeper understanding and reflection of the concepts discussed in the analysis, which may in turn instigate further research into the application of mindfulness as a form of well-being support for blind and partially sighted people.

Future research may wish to use a larger sample size and a mixed-methods approach to seek quantitative evidence of the link between mindfulness and well-being in this population, particularly in terms of physical functioning and mobility. It is also important to note that such larger studies in future research may wish to distinguish between those with congenital and acquired visual impairment as well as between those individuals who are blind and those who are partially sighted. Furthermore, larger studies may wish to consider such variables in order to help determine whether there are ‘baseline’ differences in responses to a period of mindfulness ‘training’ for individuals with a visual impairment.

Footnotes

Acknowledgements

This research was conducted as a part of a completed Professional Doctorate project at Sunderland University.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

References

Andre

Foglio

Brody

(2001). Moral growth, spirituality, and activism: The humanities in medical education. In Wear

Bickel

(Eds.), Educating for professionalism: Creating a culture of humanism in medical education (pp. 81–94). Iowa City: University of Iowa Press.

Bartlett

S. J.

Piedmont

Bilderback

Matsumoto

A. K.

Bathon

J. M.

(2003). Spirituality, well-being, and quality of life in people with rheumatoid arthritis. Arthritis & Rheumatism, 49, 778–783.

Bien

(2006). Mindful therapy. Somerville, MA: Wisdom Publications.

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.

Brennan

(2002). Spirituality and psychosocial development in middle-age and older adults with visual impairment. Journal of Adult Development, 9, 31–46.

Brennan

(2004). Spirituality and religiousness predict adaptation to visual impairment in middle-aged and older adults. The International Journal for the Psychology of Religion, 14, 193–214.

Brennan

Cardinali

(2000). Religiousness and spirituality in adaptation to vision impairment among middle-age and older adults. In Stuen

Arditi

Horowitz

Lang

M. A.

Rosenthal

Seidman

(Eds.), Vision rehabilitation: Assessment, intervention and outcomes (pp. 645–649). Amsterdam, The Netherlands: Swets & Zeitlinger.

Brennan

MacMillan

(2008). Spirituality, religiousness, and the achievement of vision rehabilitation goals among middle-age and older adults. Journal of Religion Spirituality & Aging, 20, 267–287.

Brownell

(2010). Gestalt therapy: A guide to contemporary practice. New York, NY: Springer.

10.

Bussing

Koenig

C. G.

(2010). Spiritual needs of patients with chronic diseases. Religions, 1(1), 18–27.

11.

Capra

(1982). The turning point. London, England: Fontana/Flamingo.

12.

Carmody

Crawford

Churchill

(2006). A pilot study of mindfulness-based stress reduction for hot flushes. Menopause, 13, 760–769.

13.

Carmody

Reed

Kristeller

Merriam

(2008). Mindfulness, spirituality, and health-related symptoms. Journal of Psychosomatic Research, 64, 393–403.

14.

Chambers

Gullone

Allen

N. B.

(2009). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29, 560–572.

15.

Chong

C. S. M.

Tsunaka

Tsang

H. W. H.

Chan

E. P.

Cheung

W. M.

(2011). Effects of yoga on stress management in healthy adults: A systematic review. Alternative Therapies in Health and Medicine, 17(1), 32–38.

16.

Cohen

Warneke

Fouladi

R. T.

Rodriguez

M. A.

Chaoul-Reich

(2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer, 100, 2253–2260.

17.

Conrod

B. E.

Overbury

(1998). The effectiveness of perceptual training and psychosocial counseling in adjustment to the loss of vision. Journal of Visual Impairment & Blindness, 92, 464–482.

18.

Corbetta

(2003). Social research theory, methods and techniques. London, England: SAGE.

19.

Coyle

(2002). Spirituality and health: Towards a framework for exploring the relationship between spirituality and health. Journal of Advanced Nursing, 37, 589–597.

20.

Creswell

J. W.

(2007). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: SAGE.

21.

Daaleman

T. P.

Frey

B. B.

Wallace

Studenski

(2001). The Spirituality Index of Well-Being Scale: Development and testing of a new measure. Journal of Family Practice, 51, 952.

22.

Fallot

R. D.

(Ed.). (1998). Spirituality and religion in recovery from mental illness. San Francisco, CA: Jossey-Bass.

23.

Fenwick

Rees

Pesudovs

Dirani

Kawasaki

Wong

T. Y.

Lamoureux

(2012). Social and emotional impact of diabetic retinopathy: A review. Clinical & Experimental Ophthalmology, 40, 27–38.

24.

Ferraro

K. F.

Koch

J. R.

(1994). Religion and health among black and white adults: Examining social support and consolation. Journal for the Scientific Study of Religion, 33, 362–380.

25.

Fisher

(2011). The four domains model: Connecting spirituality, health and well-being. Religions, 2, 17–28.

26.

Fitzgerald

R. G.

Ebert

J. N.

Chambers

(1987). Reactions to blindness: A four-year follow-up study. Perceptual and Motor Skills, 64, 363–378.

27.

Fowler

S. B.

(1997). Hope and a health-promoting lifestyle in persons with Parkinson’s Disease. Journal of Neuroscience Nursing, 29, 111–116.

28.

Frank

(1968). The role of hope in psychotherapy. International Journal of Psychiatry, 5, 383–385.

29.

Harinath

Malhotra

A. S.

Pal

Prasad

Kumar

Kain

T. C.

Rail

Sawhney

R. C.

(2004). Effects of Hatha yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. The Journal of Alternative and Complementary Medicine, 10, 261–268.

30.

Harris

(2007). The happiness trap: How to stop struggling, start living. Wollombi, New South Wales, Australia: Exisle Publishing Ltd.

31.

Harrison

M. O.

Edwards

C. L.

Koenig

H. G.

Bosworth

H. B.

Decastro

Wood

(2005). Religiosity/spirituality and pain in patients with sickle cell disease. The Journal of Nervous and Mental Disease, 193, 250–257.

32.

Haybron

(2000). Two philosophical problems in the study of happiness. Journal of Happiness Studies, 1, 207–225.

33.

Hayes

S. C.

(2004). Acceptance and commitment therapy and the new behavior therapies: Mindfulness, acceptance and relationship. In Hayes

S. C.

Follette

V. M.

Linehan

M. M.

(Eds.), Mindfulness and acceptance: Explaining the cognitive–behavioral tradition (pp. 66–97). New York, NY: Guilford Press.

34.

Hayes

S. C.

(2005). Get out of your life and into your life: The new acceptance and commitment therapy. Oakland, CA: New Harbinger Publications.

35.

Hofmann

S. G.

Asmundson

G. J.

(2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28, 1–16.

36.

Horowitz

Reinhardt

J. P.

Brennan

MacMillan

Cantor

(2003, November). Is depression a barrier to rehabilitation service use? Poster presented at the annual scientific meeting of The Gerontological Society of America, San Diego, CA.

37.

Kabat-Zinn

(2003). Mindfulness-based interventions in context: Past, present and future. Clinical Psychology: Science and Practice, 10, 144–156.

38.

Keng

Smoski

M. J.

Robins

C. J.

(2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31, 1041–1056.

39.

Keyes

C. L. M.

Lopez

S. J.

(2002). Toward a science of mental health: Positive directions in diagnosis and interventions. In Snyder

C. R.

Lopez

S. J.

(Eds.), Handbook of positive psychology (pp. 45–62). New York, NY: Oxford University Press.

40.

King

Horrocks

(2010). Interviews in qualitative research. London, England: SAGE.

41.

Kirkwood

Rampes

Tuffrey

Richardson

Pilkington

Ramaratnam

(2005). Yoga for anxiety: A systematic review of the research evidence. British Journal of Sports Medicine, 39, 884–891.

42.

Kirsten

T. G. J. C.

Van der Walt

H. J. L.

Viljoen

C. T.

(2009). Health, wellbeing and wellness: An anthropological eco-systemic approach. Health SA Gesondheid, 14(1), 1–7.

43.

Kvale

(1996). Interviews: An introduction to qualitative research interviewing. London, England: SAGE.

44.

Landis

B. J.

(1996). Uncertainty, spiritual well-being and psychosocial adjustment to chronic illness. Issues in Mental Health Nursing, 17, 217–231.

45.

Laubmeier

K. K.

Zakowski

S. G.

Bair

J. P.

(2004). The role of spirituality in the psychological adjustment to cancer: A test of the transactional model of stress and coping. International Journal of Behavioral Medicine, 11, 48–55.

46.

Lindstrom

Eriksson

(2010). The Hitchehikers Guide to Salutogenesis: Salutogenic pathways to health promotion. Helsinki, Finland: Folkhälsan.

47.

Manjunath

N. K.

Telles

(2005). Influence of Yoga and Ayurveda on self-rated sleep in a geriatric population. The Indian Journal of Medical Research, 121, 683–690.

48.

McCormick

D. P.

Holder

Wetsel

M. A.

Cawthon

T. W.

(2001). Spirituality and HIV disease: An integrated perspective. Journal of the Association of Nurses in AIDS Care, 12, 58–65.

49.

McSherry

(2006). Making sense of spirituality in nursing and health care practice: An interactive approach. London, England: Jessica Kingsley Publishing.

50.

Miller

Fletcher

Kabat-Zinn

(1995). Three year follow up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17, 192–200.

51.

Montgomery

(1991). The care-giving relationship: Paradoxical and transcendent aspects. The Journal of Transpersonal Psychology, 23, 91–104.

52.

Nosek

M. A.

Hughes

R. B.

(2001). Psychospiritual aspects of sense of self in women with physical disabilities. The Journal of Rehabilitation, 67(1), 20–25.

53.

Nussbaum

M. C.

(2005). Capabilities as fundamental entitlements: Sen and social justice. In Agarwal

Humphries

Robeyns

(Eds.), Amartya Sen’s work and ideas: A gender perspective (pp. 35–62). New York, NY: Routledge.

54.

Nyman

S. R.

Dibb

Victor

C. R.

Gosney

M. A.

(2011). Emotional well-being and adjustment to visual impairment in later life: A meta-synthesis of qualitative studies. Disability and Rehabilitation, 34, 1–11.

55.

Sarkisian

(2012). Spiritual individualism or engaged spirituality? Social implications of holistic spirituality among mind–body–spirit practitioners. Sociology of Religion, 73, 299–322.

56.

Patton

M. Q.

(1990). Qualitative evaluation and research methods. London, England: SAGE.

57.

Piedmont

R. L.

(2001). Spiritual transcendence and the scientific study of spirituality. Journal of Rehabilitation, 67, 4–14

58.

Pilkington

Kirkwood

Rampes

Richardson

(2005). Yoga for depression: The research evidence. Journal of Affective Disorders, 89, 13–24.

59.

Ray

C. T.

Horvat

Croce

Mason

R. C.

Wolf

S. L.

(2008). The impact of visual impairment on postural stability and balance strategies in individuals with profound visual impairment. Gait Posture, 28, 58–61.

60.

Rothwell

(2006). The different facets of mindfulness. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 24, 79–86.

61.

Russinova

(1999). Providers’ hope-inspiring competence as a factor optimizing psychiatric rehabilitation outcomes. Journal of Rehabilitation, 65(4), 50–57.

62.

Ryff

C. D.

(1989). Happiness is everything, or is it? Explorations on the meaning of psychological wellbeing. Journal of Personality and Social Psychology, 57, 1069–1081.

63.

Ryff

C. D.

Singer

B. H.

(1998). The role of purpose in life and personal growth in positive human health. In Wong

P. T. P.

Fry

P. S.

(Eds.), The human quest for meaning: A handbook of psychological research and clinical applications (pp. 213–235). Mahwah, NJ: Lawrence Erlbaum Associates.

64.

Schein

E. H.

(1983). Organisational culture and leadership. Oxford, UK: Jossey-Bass Publishers.

65.

Seligman

M. E.

(2011). Flourish. New York, NY: Free Press.

66.

Shapiro

S. L.

(2008). Exploring the effects of mindfulness meditation on health, well-being, and spirituality. Spirituality in Higher Education Newsletter, 4(2), 1–6.

67.

Shapiro

S. L.

Carlson

L. E.

Austin

J. A.

Freedman

(2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373–386.

68.

Shelov

D. V.

Suchday

Friedberg

J. P.

(2009). A pilot study measuring the impact of yoga on the trait of mindfulness. Behavioural and Cognitive Psychotherapy, 37, 595–598.

69.

Trochim

W. M. K.

(2002). Types of surveys, research methods knowledge base. London, England: Routledge.

70.

Underwood

L. G.

Teresi

J. A.

(2002). The Daily Spiritual Experience Scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data. Annals of Behavioral Medicine, 24, 22–33.

71.

Wang

C. W.

Chan

C. L.

(2009). Psychosocial adaptation status and health-related quality of life among older Chinese adults with visual disorders. Quality of Life Research, 18, 841–851.

72.

Wang

C. W.

Chan

C. L.

S. M.

A. H.

(2008).The impact of spirituality on health-related quality of life among Chinese older adults with vision impairment. Aging & Mental Health, 12, 267–275.

73.

Weber

J. A.

Wong

K. B.

(2010). Older adults coping with visual impairment. Home Health Care Services Quarterly, 29, 105–119.

74.

West

C. G.

Gildengorin

Haegerstrom-Portnoy

Lott

L. A.

Schneck

M. E.

Brabyn

J. A.

(2002). Is vision function related to physical functional ability in older adults? Journal of the American Geriatrics Society, 50, 136–145.

75.

Whitford

H. S.

Olver

I. N.

(2011). The multidimensionality of spiritual wellbeing: Peace, meaning, and faith and their association with quality of life and coping in oncology. Psycho-oncology, 17, 1121–1128.

76.

Wong

P. T. P.

(2010). The positive psychology of meaning in life and well-being. Retrieved from http://www.drpaulwong.com/index.php?view=articleandcatid=52:positive-psychologyandid=149:the-positive-psychology-of-meaning-in-life-and-well-beingandtmpl=componentandprint=1andpage=

77.

Wood

J. M.

Lacherez

Black

A. A.

Cole

M. H.

Boon

Kerr

G. K.

(2011). Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration. Investigative Ophthalmology & Visual Science, 52, 5088–5092.

78.

Yampolsky

Wittich

Webb

Overbury

(2008). The role of spirituality in coping with visual impairment. Journal of Visual Impairment & Blindness, 102, 28–39.