The Effectiveness of Mindfulness and Biofeedback-Relaxation Training on Anxiety, Depression and Dynamic and Static Balance in the Elderly Women with Mild Anxiety and Depression

Anxiety and depression are psychological problems and lack of balance and stability are common physical problems regarding elderly’s health, which can affect other aspects of their health. The current study aimed to determine the effect of mindfulness training and bio-relaxation feedback on anxiety, depression and dynamic and static balance in the older women with mild depression and anxiety. The present study a quasi-experimental with a pretest-posttest design with control group. The statistical population included all elderly women of nursing homes located in distinct 1, Tehran, Iran in 2018, among whom 30 (65-75 years) were selected using purposive sampling method and eligibility criteria, and divided into three equal 10-membered groups of mindfulness, biofeedback-relaxation and control according to their depression score in pre-test phase. Used befor and after the interventions were Beck’s anxiety questionnaire, Beck’s depression questionnaires for Iranian elderly and balance tests. Mindfulness training and biofeedback-relaxation groups performed 12 30-minute sessions (3 sessions a week) of their tasks. Data were analyzed using One-Way ANCOVA in SPSS-22. The results indicated that anxiety, depression and dynamic balance in mindfulness and biofeedback-relaxation groups and static and dynamic balance variable in the biofeedback-relaxation group had a significant improvement. Likewise, there was a significant difference between mindfulness and control groups, as well as between biofeedback-relaxation and control groups in terms of anxiety and depression mindfulness and biofeedback-relaxation training are suggested to be applied as a supplementary program to improve balance and psychological factors in the elderly. References Afshari, A., Rezai, R., & Dadras, F. (2019). The Effectiveness of structured reminiscence on anxiety and depression in the elderly. Aging Psychology, 5(3), 201-215. https://doi.org/ 10.22126/jap.2019.4704.1368 [Persian] Ahmadi, E., Farsi, A., & Vaez Mousavi, M. (2015). Effect of biofeedback and relaxation training on state-competitive anxiety among football players. Journal of Health Promotion Management, 4(3), 9-21. [Persian] Afshari, A., Rezai, R.,& Dadras, F. (2019).The Effectiveness of structured reminiscence on anxiety and depression in the elderly. Aging Psychology, 5(3), 201-215. https://doi.org/10.22126/jap.2019.4704.1368 [Persian] Alizadeh, M., Hoseini, M., Shojaeizadeh, D., Rahimi, A., Arshinchi, M., & Rohani, H. (2012). Assessing anxiety, depression and psychological wellbeing status of urban elderly under represent of Tehran Metropolitan City. Salmand: Iranian Journal of Ageing, 7 (3), 66-73. [Persian] Askari, M., Mohammadi, H., Radmehr, H., Jahangir,AH. (2018). The effect of spiritual–religious psychotherapy on enhancing quality of life and reducing symptoms of anxiety and depression among the elderly. Journal of Religion and Health, 4(2), 29- 41. [Persian] Aslankhani, M., Farsi, A., Fathirezaie, Z., Zamani Sani, H., & Aghdasi, M. T. (2015). Validity and reliability of the timed up and go and the anterior functional reach tests in evaluating fall risk in the elderly. Iranian Journal of Ageing, 10(1), 16-25. [Persian] Bastami, F. , Salahshoori, A. , Shirani, F., Mohtashami, A., & Sharafkhani, N. (2016). Risk factors of depression on the elderly: A review study. Journal of Gerontology, 1(2), 54-65. [Persian] Britton, W. B., Shahar, B., Szepsenwol, O., & Jacobs, W. J. (2012). Mindfulness-based cognitive therapy improves emotional reactivity to social stress: results from a randomized controlled trial. Behavior therapy, 43(2), 365-380. Daniel, F. N. R., Vale, R. G. S., Nodari Júnior, R. J., Giani, T. S., Bacellar, S., Batista, L. A., & Estelio, H. M. D. (2015). Static balance of elderly women submitted to a physical activity program. Revista Brasileira de Geriatria e Gerontologia, 18(4), 735-742. Deandrea, S., Lucenteforte, E., Bravi, F., Foschi, R., La Vecchia, C., & Negri, E. (2010).Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology, 21(5), 658- 68. De Bruin, E. I., Van Der Zwan, J. E., & Bögels, S. M. (2016). A RCT comparing daily mindfulness meditations, biofeedback exercises, and daily physical exercise on attention control, executive functioning, mindful awareness, self-compassion, and worrying in stressed young adults. Mindfulness, 7(5), 1182-1192. Javanmardi, F., Naeimi, E., Moatamedi, A.(2020). The Effectiveness of mindfulness model on improving intimate attitudes and elderly depression. Aging Psychology, 6(1), 39-52. [Persian] Gadalla, M.(2009). Determinants, correlates and mediators of psychological distress: A longitudinal study. Social Science & Medicine, 68(3), 2199-205. Ghasempour, L., Hoseini, F. S., Soleymani, M., & Ahmadi, M. (2017). Effects of physical fitness exercise, mental exercise and mindfulness exercise on static and dynamic balance in elderly women. Iranian Journal of Ageing, 12(2), 180-191. [Persian] Goldin, P. R., & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, 10(1), 83-91. Gould, D., & Maynard, I. (2009). Psychological preparation for the Olympic Games. Journal of Sports Sciences, 27(13), 1393-1408. https://doi.org/10.1080/02640 Habibi, M., & Hanasabzadeh, M. (2014). The Effectiveness of mindfulness based art therapy on depression, anxiety, stress and quality of life among postmenopausal women. Salmand: Iranian Journal of Ageing, 9(1), 22-31. [Persian] Hallman, D. M., Olsson, E. M., Von Schéele, B., Melin, L., & Lyskov, E. (2011). Effects of heart rate variability biofeedback in subjects with stress-related chronic neck pain: a pilot study. Applied Psychophysiology and Biofeedback, 36(2), 71-80. Hamidi, R., Fekrizadeh, Z., Azadbakht, M., Garmaroudi, G., Taheri Tanjani, P., Fathizadeh, S., & Ghisvandi, E. (2015). Validity and reliability Beck Depression Inventory-II among the Iranian elderly Population. Journal of Sabzevar University of Medical Sciences, 22(1), 189-198. [Persian] Heidari, A., & Saedi, S. (2011). The Effect of relaxation and gradual stress removal accompanied by biofeedback on the anxiety of the students. Knowledge & Research in Applied Psychology, 12(45), 3-11. [Persian] Hojjati, H., Koochaki, G., & Sanagoo, A. (2012). The Relationship between Loneliness and Life Satisfaction of the Elderly in Gorgan and Gonbad Cities. Journal of Research Development in Nursing and Midwifery, 9(1), 61-68. [Persian] Hull, S. L., Kneebone, I. I., & Farquharson, L. (2013). Anxiety, depression, and fall-related psychological concerns in community-dwelling older people. The American Journal of Geriatric Psychiatry, 21(12), 1287-1291. Iaboni, A., & Flint, A. J. (2013). The complex interplay of depression and falls in older adults: A clinical review. The American Journal of Geriatric Psychiatry, 21(5), 484-492. Lerche, S., Gutfreund, A., Brockmann, K., Hobert, M. A., Wurster, I., Sünkel, U., & Berg, D. (2018). Effect of physical activity on cognitive flexibility, depression and RBD in healthy elderly. Clinical Neurology and Neurosurgery, 165, 88-93. Liu, D., Xi, J., Hall, B. J., Fue, M., Zhang, B., Guo, J., & Feng, X. (2020). Attitudes toward Aging, Social Support and Depression among Older Adults: Difference by Urban and Rural Area in China. Journal of Affective Disorders, 274, 85-92. Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice, 10(2), 144-156. Kaviani, H., & Mousavi, A. (2008). Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University Medical Journal TUMS Publications, 66(2), 136-140. [Persian] Kee, Y. H., Chatzisarantis, N. N., Kong, P. W., Chow, J. Y., & Chen, L. H. (2012). Mindfulness, movement control, and attentional focus strategies: effects of mindfulness on a postural balance task. Journal of Sport and Exercise Psychology, 34(5), 561-579. Khazan, I. Z. (2013). The clinical handbook of biofeedback: A step-by-step guide for training and practice with mindfulness: John Wiley & Sons. Kok, R. M., & Reynolds, C. F. (2017). Management of depression in older adults: a review. Journal of the American Medical Association, 317(20), 2114-2122. Khezri Moghadam N, Vahidi S, Ashormahani M. (2018). Efficiency of Cognitive-Existential Group Therapy on Life Expectancy and Depression of Elderly Residing in Nursing Home. Salmand: Iranian Journal of Ageing. 13 (1) :62-73, URL: http://salmandj.uswr.ac.ir/article-1-1269-fa.html.(Persian). Mirkena, Y., Reta, M. M., Haile, K., Nassir, Z., & Sisay, M. M. (2018). Prevalence of depression & associated factors among older adults at ambo town, Oromia region, Ethiopia. BMC psychiatry, 18(1), 338-338. Mohammad, L., Gholami Heidarabadi, Z. (2019). The Effectiveness of Training the Problem Solving-based Cognitive Strategies on depression in elderly women. Aging Psychology, 4(4), 337-349. https://doi.org/10.22126/jap.2019.1126. [Persian] Moshref-Razavi S, Sohrabi M, Sotoodeh M S.(2017) Effect of Neurofeedback Interactions and Mental Imagery on the Elderly’s Balance. Salmand: Iranian Journal of Ageing, 12(3), 288-299. [Persian] Muir, S. W., Berg, K., Chesworth, B., Klar, N., & Speechley, M. (2010). Quantifying the magnitude of risk for balance impairment on falls in communitydwelling older adults: a systematic review and meta-analysis. Journal Clinical Epidemiol, 63(4), 389-406. Najafian, J., & Akhavan Tabib, A. (2011). Comparison OF The Efect Of Relaxation And Biofeedback-assisted Relaxation On Stress And Anxiety Score In Patients With Mild Hypertention. Pars Journal of Medical Sciences, 9(2), 12-20. [Persian] Rainforth, M. V., Schneider, R. H., Nidich, S. I., Gaylord-King, C., Salerno, J. W., & Anderson, J. W. (2007). Stress reduction programs in patients with elevated blood pressure: A systematic review and meta-analysis. Current hypertension reports, 9(6), 520-528. Rossiter-Fornoff, J. E., Wolf, S. L., Wolfson, L. I., Buchner, D. M., & Group, F. (1995). A cross-sectional validation study of the FICSIT common data base static balance measures. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 50(6), M291-M297. Ruwer SL, Rossi AG, Simon LF. (2005). Balance in the elderly. Brazilian Journal of Otorhinolaryngology, 71(3), 298-303. Santorelli, S., & Kabat-Zinn, J. (2002). Mindfulness-based stress reduction professional training resource manual. Worcester (master thesis). The Center for Mindfulness in Medicine, Healthcare and Society. Seyedian, M., Falah, M., Nouruzian, M., Nejat, S., Delavar, A., & Ghasezadeh, H. A. (2008). Validity of the Farsi version of mini-mental state examination. Journal of Medical Council of Iran, 25(4), 13-27. [Persian] Smith J.(2003). Stress and aging: theoretical and empirical challenges for interdisciplinary research. Neurobiology of Aging 3, 24, 77-80. Taheri M, Irandoust K, Seghatoleslami A, Rezaei M. (2018). The Effect of yoga practice based on biorhythms theory on balance and selective attention of the elderly women. Salmand: Iranian Journal of Ageing, 13 (3), 312-323. http://salmandj.uswr.ac.ir/article-1-1463-fa.html [Persian] Thurman, D. J., Stevens, J. A., Rao, J. K. (2008). Quality standards subcommittee of the American academy of neurology. Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): Report of the quality standards subcommittee of the American Academy of Neurology. Neurology, 70(6), 473-9. Van Der Zwan, J. E., De Vente, W., Huizink, A. C., Bögels, S. M., & De Bruin, E. I. (2015). Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction: a randomized controlled trial. Applied psychophysiology and biofeedback, 40(4), 257-268. Wang, G., Hu, M., Xiao, S. Y., & Zhou, L. (2017). Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: a cross-sectional study. BMJ open, 7(10), Article e016091. Wilson, V. E., Peper, E., & Moss, D. (2006). "The Mind Room" in Italian soccer training: The use of biofeedback and neurofeedback for optimum performance. Biofeedback, 34(3), 79-81. Yucha, C., & Montgomery, D. (2008). Evidence-based practice in biofeedback and neurofeedback: AAPB Wheat Ridge, CO. Yousefi Afrashteh, M., & Sharifi, K. (2015). The Relationship between Depression, Perceived Stress and Social Support with Quality of Life in Elderly with Alzheimer''s disease. Aging Psychology, 1(2), 1-10. [Persian] Zijlstra, A., Mancini, M., Chiari, L., & Zijlstra, W. (2010). Biofeedback for training balance and mobility tasks in older populations: a systematic review. Journal of neuroengineering and rehabilitation, 7(1), Article 58