Publication Date

Winter 2025

Item Type

Text

Executive Summary

Mindfulness in Homeless Women Experiencing Anxiety

Half of Washington's homeless population resides in Seattle, King County (Axios, 2024). In response, seven Seattle Pacific University nursing students conducted an assessment on homeless women in Seattle. Partnering with a women’s day center, we assessed their health needs and barriers as part of a nursing leadership project. Through activities like bingo, we aimed to build trust and surveyed the women and staff on health concerns. Our findings revealed chronic anxiety as a key issue, leading to underutilization of health resources. Such resources include a mobile emergent dental van that previous nursing students earned funding for to address oral health issues, like extractions, abscesses, and pain. To address the underutilization, we introduced mindfulness activities—chair yoga, deep breathing, and coping cards—to help manage anxiety and promote engagement in health services, including the mobile emergent dental van. We were able to use the nursing process to study the effects of these mindfulness interventions in hopes to have long term positive results in maintaining anxiety within this population.

Background

Homelessness in women is primarily caused by substance use disorder, domestic violence, and mental health issues (Zhao, 2022). About 33% of women who experience domestic violence become homeless after leaving their abuser. Many face poor credit, employment records, and the burden of being the sole caregiver for their children, as 80% of shelter families are led by mothers (Rector, 2020). Women's shelters offer safe spaces and services like counseling, healthcare, housing support, and job assistance. Rising living costs exacerbate these challenges, with over half of Americans spending 50% of their wages on housing, making it hard to maintain stability (Padgett, 2020). This creates a cycle of homelessness, with trauma, stigma, and heightened anxiety further complicating access to care. Many women avoid dental treatment due to financial constraints, fear of pain, or past stigma, often resorting to unsafe self-care methods (Mago et al., 2018; Purkey & MacKenzie, 2022). At the women’s shelter, we identified chronic anxiety as a prevalent issue, along with a lack of accessible coping tools. To address this, we aimed to provide simple, portable strategies that the women could use in their daily lives. As a result, we chose to demonstrate and educate them on various mindfulness activities designed to help manage anxiety.

Activities

Mindfulness activities have been shown to increase the ability to regulate attention, to accept difficult thoughts and emotions, to increase self-awareness and self-control, to improve mood and interpersonal relationships, and to decrease negative emotions and emotional reactivity (Maddock et al., 2017). We implemented deep breathing, yoga and coping cards as mindfulness activities to ease anxiety.

We used deep breathing as one of our mindfulness activities to help homeless women cope with anxiety and other stressful situations. These women face a lot of hardships and housing instability that affects their well-being, making it difficult to focus on themselves or to overcome their anxiety in situations like this (Padgett, 2020). Emotion-focused coping, such as deep breathing, was commonly used in response to a stressor or a stressful emotion (Garfin et al., 2023). Many of the participants who engaged in breathing techniques were successful in downregulating heightened emotional states such as anger, anxiety, and stress (Garfin et al., 2023). By practicing deep breathing and focusing on these strategies, the residents saw a difference in being able to manage their emotions based on their reports.

Another mindfulness activity we implemented is Yoga. Yoga postures are simple, yet another important intervention to reduce anxiety. A systematic review of controlled trials indicates that yoga has a significant short-term effect of reducing anxiety compared to control groups that did no yoga (Cramer et al., 2018). Evaluation of the safety of yoga shows that there is no association between yoga and increased risk of physical injury. Yoga reduces anxiety by increasing GABA (gamma-aminobutyric acid) levels in the brain. GABA is a natural neurotransmitter that stimulates the parasympathetic system, thereby inducing relaxing and calming effects on the body (Streeter et al., 2018).

Based on suicide prevention research by Wang et al. (2015), coping cards significantly reduced suicide risk and depression. These tools could serve as an effective intervention for the homeless population. The cards could provide structured relaxation techniques, affirmations, and information about community resources, helping individuals manage both dental anxiety and broader emotional distress. By implementing this low-cost, evidence-based tool in shelters, organizations could improve both mental health outcomes and healthcare access for this vulnerable population, while addressing the immediate need for better communication and more compassionate care identified by (Mago et al., 2018).

Outcomes

Our overarching goal was to introduce mindfulness strategies and help residents manage anxiety, especially those using the dental van services and experiencing dental-related anxiety. We introduced chair yoga, deep breathing exercises, and coping cards to support them in reducing stress and improving their use of health services. To evaluate the effectiveness of our interventions, we surveyed residents before and after their appointments, noted their specific concerns, and gathered feedback on the mindfulness activities.

Out of nine dental van appointments, five residents attended. One couldn't participate due to a heart condition and suggested earlier screening. Pre-service anxiety averaged three out of five, with three participants expressing specific concerns about incomplete treatment, distrust of staff, or fear of injury. Post-service evaluation of two participants showed mixed results: one reported reduced anxiety as one out of five while the other came out very agitated, not wanting to talk to us, and said, “They attacked me.”

Thirteen women participated in our interventions, with an average helpfulness rating of four out of five. Eight received coping cards and mindfulness education, while one tried chair yoga and found it extremely helpful, rating it ten out of five. Another woman showed interest in yoga and took a visual guide with different poses. Of the 20 printed pamphlets, 15 were distributed. Many residents were uninterested in yoga, likely due to the lack of incentives. Our limited rapport with them made engagement challenging, and better advertising could have increased participation. Our goal of reducing anxiety around the dental van services was only partially met since not all participants used our interventions. Coordinating appointments with activities was more difficult than expected, but we successfully provided therapeutic communication to one woman, which seemed to ease her nervousness.

Conclusion

In partnership with the agency, we addressed healthcare issues within the shelter related to the dental van. We encouraged utilization of the dental van for urgent oral health problems and provided an educational session on mindfulness and anxiety coping strategies, such as yoga and coping cards. The intervention was partially effective in reducing dental-related anxiety, with some residents benefiting from mindfulness activities.

References

Cramer, H., Lauche, R., Anheyer, D., Pilkington, K., de Manincor, M., Dobos, G., & Ward, L. (2018). Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials. Depression and anxiety, 35(9), 830–843. https://doi.org/10.1002/da.22762

Garfin, D. R., Amador, A., Osorio, J., Ruivivar, K. S., Torres, A., & Nyamathi, A. M. (2023). A multi-method exploration of mindfulness as a coping tool: Perspectives from trauma-exposed, unhoused women residing at a drug treatment facility. Stress and Health, 39(2), 347–360. https://doi.org/10.1002/smi.3188

Maddock, A., Hevey, D. & Eidenmueller, K. (2017). Mindfulness training as a clinical intervention with homeless adults: A pilot study. International Journal Mental Health Addiction, 15, 529–544. https://doi.org/10.1007/s11469-016-9718-7

Mago, A., MacEntee, M. I., Brondani, M., & Frankish, J. (2018). Anxiety and anger of homeless people coping with dental care. Community Dentistry and Oral Epidemiology, 46(3), 225–230. https://doi.org/10.1111/cdoe.12363

Padgett D. K. (2020). Homelessness, housing instability and mental health: Making the connections. BJPsych bulletin, 44(5), 197–201. https://doi.org/10.1192/bjb.2020.49

Purkey, E., & MacKenzie, M. (2019). Experience of healthcare among the homeless and vulnerably housed a qualitative study: Opportunities for equity-oriented health care. International Journal for Equity in Health, 18(1). https://doi.org/10.1186/s12939-019-1004-4

Santos, M., Feng, A., & Fitzpatrick, A. (2024). Washington had sixth-highest U.S. homelessness rate in 2023. Axios Seattle. https://www.axios.com/local/seattle/2024/01/11/highest-homelessness-rate-federal-report

Streeter, C. C., Gerbarg, P. L., Nielsen, G. H., Brown, R. P., Jensen, J., & Silveri, M. M. (2018). Effects of yoga on thalamic gamma-aminobutyric acid, mood and depression: Analysis of two randomized controlled trials. Neuropsychiatry, 8 (6), 1923-1939. https://www.jneuropsychiatry.org/peer-review/effects-of-yoga-on-thalamic-gammaaminobutyric-acid-mood-and-depression-analysis-of-two-randomized-controlled-trials-12856.html

Wang, Y. C., Hsieh, L. Y., Wang, M. Y., Chou, C. H., Huang, M. W., & Ko, H. C. (2016). Coping card usage can further reduce suicide reattempt in suicide attempter case management within 3-month intervention. Suicide & Life-Threatening Behavior, 46(1), 106–120. https://doi.org/10.1111/sltb.12177

Zhao, E. (2022). The key factors contributing to the persistence of homelessness. International Journal of Sustainable Development & World Ecology, 30(1), 1–5. https://doi.org/10.1080/13504509.2022.2120109

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