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Adherence to standardized 8-week mindfulness-based interventions among women with breast or gynecological cancer: a scoping review

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Abstract

Participant adherence to standardized 8-week mindfulness-based interventions (MBIs) may be challenging, and adaptations from intervention protocols have been reported in mindfulness research. We conducted a scoping review to determine how women with breast or gynecological cancer adhered to standardized 8-week MBIs delivered in intervention studies. Searches were conducted for articles published till February 2020 in PubMed, Embase, CINAHL EBSCO, PsycINFO Ovid SP, and Cochrane Library Wiley. The following outcomes were investigated: class and silent retreat attendance, intervention completion rate (ICR), adherence to home practice, and reasons for dropping out from an MBI study. Among the 25 included MBI studies, mindfulness-based stress reduction was the most often delivered intervention and mostly women with stage I–III breast cancer were represented. The duration of classes varied from 1.5 to 3.5 hours. Planned home practice varied from 20 to 60 min/day, and silent retreat varied from 4.5 to 8 hours. Due to heterogeneity in the reporting of class attendance, the data could not be pooled. Six studies reported an average class attendance ranging from 5 to 8.2 classes. Overall, intervention completion rate (the proportion who completed all classes) varied from 26.3% to 100%; however, discontinuations were not systematically reported. Home practice time was reported in 20% of the studies and ranged from 17 to 24 min/day. The main reasons for dropping out from an MBI study were health-related problems, organizational challenges, travel distance, and lack of motivation/commitment. About 70% of the studies reported some data on participant adherence, revealing a relatively high overall frequency of class attendance. However, the monitoring and reporting of participant adherence should be improved in future studies to increase our knowledge on the required amount of participant engagement to improve health outcomes and facilitate the implementation of effective interventions on a larger scale.

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... Adherence to web-based programs in previous reports has varied between 39.5% and 92% [9] compared with adherence to face-to-face settings, where the rates ranged between 26% and 100% [13] (based on definitions of 100% program completion). Mindfulness programs are often 8 weeks long in duration [9], with higher adherence having an impact on improved participant outcomes [14]. ...
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The purpose of this study was to examine the effects of a MBSR program on physiological and psychological outcomes among early-stage breast cancer survivors. A quasi-experimental, pre-and posttest control group design was selected. The intervention group received the MBSR intervention. The control group received no MBSR intervention. ANOVA and ANCOVA were used to analyze data. The intervention group demonstrated statistically significant improvement in physiological and psychological outcomes including reduced blood pressure, heart rate, and respiratory rate and increased mindfulness state at the level of p = .05 to p = .001. The effects of MBSR on reducing stress in this sample were statistically significant on the physiological outcome (morning cortisol) at the measurement after the intervention completion, but this effect was not sustained at 1-month follow-up. MBSR showed a trend toward improving psychological outcomes by reducing mood disturbance in this sample.
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Article
A growing number of psychosocial interventions are being offered to cancer patients during and after their medical treatment. Here, we examined whether Mindfulness-Based Stress Reduction (MBSR), a stress management course, helps women to cope better with stress and illness once their breast cancer treatment is completed. Our aim was to understand how MBSR may benefit those who participate in the course. Our cohort study enrolled 59 women in an 8-week MBSR program. They completed "before and after" questionnaires pertaining to outcomes (stress, depression, medical symptoms) and process variables (mindfulness, coping with illness, sense of coherence). Paired t-tests examined changes from before to after the MBSR course. Changes in mindfulness were correlated with changes in post-MBSR variables, and a regression analysis examined which variables contributed to a reduction in stress after program participation. Adherence to the program was 91%. Participants reported significant reductions in stress (p < 0.0001), depression (p < 0.0001), and medical symptoms (p < 0.0001), and significant improvements in mindfulness (p < 0.0001), coping with illness (p < 0.0001), and sense of coherence (p < 0.0001). Changes in mindfulness were significantly related to changes in depression, stress, emotional coping, and sense of coherence. Increases in mindfulness and sense of coherence predicted reductions in stress. It appears that learning how to be mindful is beneficial for women after their treatment for breast cancer.
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Article
To provide a descriptive overview of the clinical trials assessing meditation practices for health care. Systematic review of the literature. Comprehensive searches were conducted in 17 electronic bibliographic databases through September 2005. Other sources of potentially relevant studies included hand searches, reference tracking, contacting experts, and gray literature searches. Included studies were clinical trials with 10 or more adult participants using any meditation practice, providing quantitative data on health-related outcomes, and published in English. Two independent reviewers assessed study relevance, extracted the data, and assessed the methodological quality of the studies. Four hundred clinical trials on meditation (72% described as randomized) were included in the review (publication years 1956-2005). Five broad categories of meditation practices were identified: mantra meditation, mindfulness meditation, yoga, t'ai chi, and qigong. The three most studied clinical conditions were hypertension, miscellaneous cardiovascular diseases, and substance abuse. Psychosocial measures were the most frequently reported outcomes. Outcome measures of psychiatric and psychological symptoms dominate the outcomes of interest. Overall, the methodological quality of clinical trials is poor, but has significantly improved over time by 0.014 points every year (95% CI, 0.005, 0.023). Most clinical trials on meditation practices are generally characterized by poor methodological quality with significant threats to validity in every major quality domain assessed. Despite a statistically significant improvement in the methodological quality over time, it is imperative that future trials on meditation be rigorous in design, execution, analysis, and the reporting of results.
Article
Aim: To evaluate the efficacy of mindfulness-based stress reduction on objective and subjective sleep parameters and hypnotic medication use of patients with insomnia secondary to cervical cancer. Methods: This was a randomized controlled trial enrolled insomnia patient who were caused or worsened by cervical cancer. Seventy patients with insomnia caused or aggravated by cervical cancer were at random divided into either a usual care group or an 8-week mindfulness-based stress reduction group. Subjective sleep parameters, objective sleep parameters and hypnotic medication consumption were assessed at baseline, after the program, 6- and 12-month after finishing the interventions. Results: The results showed that mindfulness-based stress reduction had a positive effect on subjective sleep parameters (Total wake time: ∆ = 45.32, P < 0.05; Sleep efficacy: ∆ = 6.87, P < 0.05; Total sleep time: ∆ = 22.22, P < 0.01). Compared with control group, polysomnography data in mindfulness-based stress reduction group were not improved significantly. There were no associations between subjective sleep parameters and objective sleep parameters. Conclusion: Mindfulness-based stress reduction had a definite impact on patients with insomnia that was secondary to cervical cancer just after the intervention, but no long-term influences. Trial registration: ChiCTR1800018571; 9/25/2018; retrospectively registered.
Article
Background: Women newly diagnosed with breast cancer experience psychological distress, accompanied by reduced Natural Killer Cell Activity (NKCA) and altered levels of cytokines, which may compromise cancer control. Few studies have evaluated psycho-immune outcomes of mindfulness-based stress reduction (MBSR) for women newly diagnosed with breast cancer in comparison to an active control condition. Objective: The purpose of this study was to determine whether MBSR benefits psychological, behavioral, and immunological function in women recently diagnosed with breast cancer. Design: After confirmation of breast cancer staging, women diagnosed with early-stage breast cancer (n = 192) were randomized to an 8-week MBSR program or an 8-week active control condition (ACC). The ACC consisted of a series of cancer recovery and health education classes. Both MBSR and the ACC were administered in group format. Methods: Women completed psychometric instruments and provided blood for NKCA and cytokine levels at pre-, mid-, and completion of program, as well as at 1- and 6-months post-program. One hundred and twenty four women completed all five-assessments (MBSR, n = 63; ACC, n = 61). Hierarchical linear modeling was used to analyze trajectories of outcomes over time and between groups. Results: Compared to the ACC group, women randomized to MBSR exhibited decreasing trajectories of perceived stress, fatigue, sleep disturbance, and depressive symptoms. Further, compared to women randomized to ACC, MBSR women exhibited trajectories demonstrating significantly more rapid restoration of NKCA, accompanied by lower circulating TNF-alpha levels, lower IL-6 production, and greater IFN-gamma production. Conclusions: These results demonstrate early provision of MBSR for women newly diagnosed with breast cancer provides not only psychological benefit, but also optimizes immune function supportive of cancer control.
Article
Background: Breast cancer is the most common cancer in women. Diagnosis and treatment may drastically affect quality of life, causing symptoms such as sleep disorders, depression and anxiety. Mindfulness-based stress reduction (MBSR) is a programme that aims to reduce stress by developing mindfulness, meaning a non-judgmental, accepting moment-by-moment awareness. MBSR seems to benefit patients with mood disorders and chronic pain, and it may also benefit women with breast cancer. Objectives: To assess the effects of mindfulness-based stress reduction (MBSR) in women diagnosed with breast cancer. Search methods: In April 2018, we conducted a comprehensive electronic search for studies of MBSR in women with breast cancer, in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trial registries (World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov). We also handsearched relevant conference proceedings. Selection criteria: Randomised clinical trials (RCTs) comparing MBSR versus no intervention in women with breast cancer. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Using a standardised data form, the review authors extracted data in duplicate on methodological quality, participants, interventions and outcomes of interest (quality of life, fatigue, depression, anxiety, quality of sleep, overall survival and adverse events). For outcomes assessed with the same instrument, we used the mean difference (MD) as a summary statistic for meta-analysis; for those assessed with different instruments, we used the standardised mean difference (SMD). The effect of MBSR was assessed in the short term (end of intervention), medium term (up to 6 months after intervention) and long term (up to 24 months after intervention). Main results: Fourteen RCTs fulfilled our inclusion criteria, with most studies reporting that they included women with early breast cancer. Ten RCTs involving 1571 participants were eligible for meta-analysis, while four studies involving 185 participants did not report usable results. Queries to the authors of these four studies were unsuccessful. All studies were at high risk of performance and detection bias since participants could not be blinded, and only 3 of 14 studies were at low risk of selection bias. Eight of 10 studies included in the meta-analysis recruited participants with early breast cancer (the remaining 2 trials did not restrict inclusion to a certain cancer type). Most trials considered only women who had completed cancer treatment.MBSR may improve quality of life slightly at the end of the intervention (based on low-certainty evidence from three studies with a total of 339 participants) but may result in little to no difference up to 6 months (based on low-certainty evidence from three studies involving 428 participants). Long-term data on quality of life (up to two years after completing MBSR) were available for one study in 97 participants (MD 0.00 on questionnaire FACT-B, 95% CI -5.82 to 5.82; low-certainty evidence).In the short term, MBSR probably reduces fatigue (SMD -0.50, 95% CI -0.86 to -0.14; moderate-certainty evidence; 5 studies; 693 participants). It also probably slightly reduces anxiety (SMD -0.29, 95% CI -0.50 to -0.08; moderate-certainty evidence; 6 studies; 749 participants), and it reduces depression (SMD -0.54, 95% CI -0.86 to -0.22; high-certainty evidence; 6 studies; 745 participants). It probably slightly improves quality of sleep (SMD -0.38, 95% CI -0.79 to 0.04; moderate-certainty evidence; 4 studies; 475 participants). However, these confidence intervals (except for short-term depression) are compatible with both an improvement and little to no difference.In the medium term, MBSR probably results in little to no difference in medium-term fatigue (SMD -0.31, 95% CI -0.84 to 0.23; moderate-certainty evidence; 4 studies; 607 participants). The intervention probably slightly reduces anxiety (SMD -0.28, 95% CI -0.49 to -0.07; moderate-certainty evidence; 7 studies; 1094 participants), depression (SMD -0.32, 95% CI -0.58 to -0.06; moderate-certainty evidence; 7 studies; 1097 participants) and slightly improves quality of sleep (SMD -0.27, 95% CI -0.63 to 0.08; moderate-certainty evidence; 4 studies; 654 participants). However, these confidence intervals are compatible with both an improvement and little to no difference.In the long term, moderate-certainty evidence shows that MBSR probably results in little to no difference in anxiety (SMD -0.09, 95% CI -0.35 to 0.16; 2 studies; 360 participants) or depression (SMD -0.17, 95% CI -0.40 to 0.05; 2 studies; 352 participants). No long-term data were available for fatigue or quality of sleep.No study reported data on survival or adverse events. Authors' conclusions: MBSR may improve quality of life slightly at the end of the intervention but may result in little to no difference later on. MBSR probably slightly reduces anxiety, depression and slightly improves quality of sleep at both the end of the intervention and up to six months later. A beneficial effect on fatigue was apparent at the end of the intervention but not up to six months later. Up to two years after the intervention, MBSR probably results in little to no difference in anxiety and depression; there were no data available for fatigue or quality of sleep.
Article
Objectives: Mindfulness-based intervention has been receiving growing attention in cancer care. This study aimed to examine feasibility and to preliminary explore effectiveness of mindfulness-based cognitive therapy (MBCT) in Japanese breast cancer patients, and to explore possible modification of the program so that it fits better with this population. Methods: Twelve participants with diagnosis of Stage I-III breast cancer received an eight session, weekly MBCT intervention in a group therapy format. The participants were followed up until 3 months after the completion of the program. Results: All the participants completed the program with high attendance rate (mean number of attended sessions = 7.7). Significant improvement in anxiety (Hospital Anxiety and Depression Scale (HADS) - anxiety subscale; effect size Cohen's d = 0.88, P < 0.05), trauma-related psychological symptoms (Impact of Event Scale-revised; d = 0.64, P < 0.01) and quality of life (Functional Assessment of Cancer Therapy-Breast Cancer: FACT-B; d = 0.72, P < 0.01), and trend-level improvement in depression (HADS - depression subscale; d = 0.53, P = 0.054) were observed. Qualitative analyses suggested the program may be beneficial for alleviating fear of cancer recurrence and for increasing spiritual well-being. Some recommended modification of the program was indicated from the post-intervention interviews. Conclusions: Mindfulness-based cognitive therapy was well accepted by Japanese breast cancer patients and yielded favorable effect on their psychological status and quality of life. Further effectiveness study in a randomized-control design is warranted.
Article
Objective: The object of this study was to explore the use of complementary health approaches among U.S. adults with a cancer diagnosis in the past 5 years and distinguish use for general wellness from use specifically for treatment. Methods: Using data from the 2002, 2007, and 2012 National Health Interview Survey, the study included 1359 persons with a cancer diagnosis of selected cancers in the past 5 years. Participants were asked about their use of complementary health approaches for general reasons and cancer treatment in the past 12 months. Responses were aggregated into the use of any complementary approach as well as examined by mode of practice. Results: Overall, 35.3% of persons with a cancer diagnosis used complementary health approaches in the past 12 months. These persons were more likely to have used a biologically based approach (22.8%) compared with other approaches. Persons with breast cancer were significantly more likely to use any complementary health approach (43.6%) compared with those with other recently diagnosed cancers. Few persons with a cancer history (2.3%) used complementary approaches specifically for cancer treatment. However, prevalence of use for treatment varied by cancer type (0.4%-6.8%). Conclusions: This study highlights differences in the use of various types of complementary health approaches for different reasons among persons with recent diagnoses of some of the most commonly diagnosed cancers in the United States.
Article
This nonequivalent control group pre-/posttest study investigated the effectiveness of a mindfulness-based stress reduction program at improving both the physical status and psychological status of 18 patients with metastatic breast cancer. The mindfulness-based stress reduction program had a mild effect of improving average pain and alleviating distress.
Article
Incomplete and inadequate reporting is an avoidable waste that reduces the usefulness of research. The CONSORT (Consolidated Standards of Reporting Trials) Statement is an evidence-based reporting guideline that aims to improve research transparency and reduce waste. In 2008, the CONSORT Group developed an extension to the original statement that addressed methodological issues specific to trials of nonpharmacologic treatments (NPTs), such as surgery, rehabilitation, or psychotherapy. This article describes an update of that extension and presents an extension for reporting abstracts of NPT trials. To develop these materials, the authors reviewed pertinent literature published up to July 2016; surveyed authors of NPT trials; and conducted a consensus meeting with editors, trialists, and methodologists. Changes to the CONSORT Statement extension for NPT trials include wording modifications to improve readers' understanding and the addition of 3 new items. These items address whether and how adherence of participants to interventions is assessed or enhanced, description of attempts to limit bias if blinding is not possible, and specification of the delay between randomization and initiation of the intervention. The CONSORT extension for abstracts of NPT trials includes 2 new items that were not specified in the original CONSORT Statement for abstracts. The first addresses reporting of eligibility criteria for centers where the intervention is performed and for care providers. The second addresses reporting of important changes to the intervention versus what was planned. Both the updated CONSORT extension for NPT trials and the CONSORT extension for NPT trial abstracts should help authors, editors, and peer reviewers improve the transparency of NPT trial reports.
Article
Introduction Breast cancer affects the thoughts and emotions related to patientś body image and it has a negative impact in their quality of life. The purpose of this study was to conduct a randomized controlled trial in patients with breast cancer comparing mindfulness training to improve body image with a program based on personal image advice. Method A total of 29 women with breast cancer were randomly allocated into one of 2 groups: an experimental (mindfulness program) and control (personal image advice) group. The assessment tools were semi-structured interviews and the BIS and SBC questionnaires. Data was analyzed using quantitative techniques. Results The mindfulness program was effective in decreasing negative thoughts and emotions related to body image and dissociation (p < 0.01), and in increasing positive thoughts and body awareness (p < 0.01). Moreover, there were significant differences in body image between control and experimental group (F(1,28) = 12.616; p < 0.01; ηp2 = 0.335). Conclusion The mindfulness program was useful in improving psychological and emotional changes related to body image in breast cancer patients. Changes in body image are a key component in the treatment of breast cancer patients with the ability to improve the patientś quality of life.
Article
Purpose: To assess the efficacy of mindfulness-based cognitive therapy (MBCT) for late post-treatment pain in women treated for primary breast cancer. Methods: A randomized wait list-controlled trial was conducted with 129 women treated for breast cancer reporting post-treatment pain (score ≥ 3 on pain intensity or pain burden assessed with 10-point numeric rating scales). Participants were randomly assigned to a manualized 8-week MBCT program or a wait-list control group. Pain was the primary outcome and was assessed with the Short Form McGill Pain Questionnaire 2 (SF-MPQ-2), the Present Pain Intensity subscale (the McGill Pain Questionnaire), and perceived pain intensity and pain burden (numeric rating scales). Secondary outcomes were quality of life (World Health Organization-5 Well-Being Index), psychological distress (the Hospital Depression and Anxiety Scale), and self-reported use of pain medication. All outcome measures were assessed at baseline, postintervention, and 3-month and 6-month follow-up. Treatment effects were evaluated with mixed linear models. Results: Statistically significant time × group interactions were found for pain intensity (d = 0.61; P = .002), the Present Pain Intensity subscale (d = 0.26; P = .026), the SF-MPQ-2 neuropathic pain subscale (d = 0.24; P = .036), and SF-MPQ-2 total scores (d = 0.23; P = .036). Only pain intensity remained statistically significant after correction for multiple comparisons. Statistically significant effects were also observed for quality of life (d = 0.42; P = .028) and nonprescription pain medication use (d = 0.40; P = .038). None of the remaining outcomes reached statistical significance. Conclusion: MBCT showed a statistically significant, robust, and durable effect on pain intensity, indicating that MBCT may be an efficacious pain rehabilitation strategy for women treated for breast cancer. In addition, the effect on neuropathic pain, a pain type reported by women treated for breast cancer, further suggests the potential of MBCT but should be considered preliminary.
Article
Breast cancer (BC) patients in China suffered from a variety of psychology stress such as perceived stress and anxiety, posttraumatic growth (PTG) as a positive factor could promote their psychology health and quality of life. This study aimed to investigate the efficacy of mindfulness-based stress reduction (MBSR) on promoting PTG, decreasing perceived stress and anxiety of Chinese BC patients. A randomized controlled trial of 60 BC patients (Stages I-III) was conducted. They were randomly divided to the 8-week MBSR group or usual care (UC) group. PTG inventory, Perceived Stress Scale of Chinese version (CPSS) and State Trait Anxiety Inventory (STAI) evaluated the PTG level, perceived stress and anxiety at three times(before intervention-T1, after intervention-T2 and follow up at 3 months-T3). A repeated-measures analysis of variance model was used to compare each outcome measure of two groups at the three times. There was one patient discontinued the intervention and one lose to follow up in MBSR group, finally 58 BC patients completed the research. There was no difference between two groups before the intervention. The results showed significant improvements in MBSR group comparing with the UC group that PTG level was much higher after the 8-week intervention and the follow up (F = 34.73, p < .00). At the same time, CPSS (F = 14.41, p < .00) and STAI (F = 15.24, p < .00) scores were significant decreased at T2 and T3. The results showed that MBSR promoted the level of PTG and decreased perceived stress and anxiety state of Chinese BC patients, and the results persisted at three months after intervention. The research preliminary proved that MBSR was suitable to Chinese BC patients. MBSR should be recommending to BC survivors in China.
Article
A growing number of psychosocial interventions are being offered to cancer patients during and after their medical treatment. Here, we examined whether Mindfulness-Based Stress Reduction (MBSR), a stress management course, helps women to cope better with stress and illness once their breast cancer treatment is completed. Our aim was to understand how MBSR may benefit those who participate in the course. Methods Our cohort study enrolled 59 women in an 8-week MBSR program. They completed "before and after" questionnaires pertaining to outcomes (stress, depression, medical symptoms) and process variables (mindfulness, coping with illness, sense of coherence). Paired t-tests examined changes from before to after the MBSR course. Changes in mindfulness were correlated with changes in post-MBSR variables, and a regression analysis examined which variables contributed to a reduction in stress after program participation. Results Adherence to the program was 91%. Participants reported significant reductions in stress (p < 0.0001), depression (p < 0.0001), and medical symptoms (p < 0.0001), and significant improvements in mindfulness (p < 0.0001), coping with illness (p < 0.0001), and sense of coherence (p < 0.0001). Changes in mindfulness were significantly related to changes in depression, stress, emotional coping, and sense of coherence. Increases in mindfulness and sense of coherence predicted reductions in stress. Conclusions It appears that learning how to be mindful is beneficial for women after their treatment for breast cancer.
Book
This edited volume provides chapters on the leading evidence-based mindfulness interventions as of 2006: mindfulness-based stress reduction, mindfulness-based cognitive therapy, dialectical behavior therapy, and acceptance and commitment therapy. Applications for clinical, medical, and nonclinical but stressed populations, as well as children, adolescents, and older adults, are described. Each chapter includes a detailed case study illustrating how the intervention is implemented, conceptual background, empirical support, and a discussion of practical issues that clinicians wishing to use these treatments must consider. A second edition (2014) focusing on MBSR, MBCT, and related treatment programs is also available.
Article
The effects of an eight-week mindfulness-based program (MBSR) were investigated on psychological and physical symptoms in women with cancer. Specifically, state anxiety and depression, pain and distress symptoms were investigated in forty women with breast cancer. A focus of this study was to expand the use of instruments in this area by administering the following measures: the Centre for Epidemiologie Studies Depression Scale (CES-D), the short form of the McGill Pain Questionnaire (SF-MPQ), and the Symptom Distress Scale for cancer (SDS). Results showed positive and significant changes in pre-to-post scores on the above factors including state anxiety. Future studies that expand on factors and instruments are needed to fully determine the effectiveness of MBSR programs in alleviating distress and suffering in individuals with cancer.
Article
A treatment-as-usual randomized wait-list controlled trial was conducted to investigate the feasibility and impact of an online synchronous Mindfulness-Based Cancer Recovery (MBCR) group program for underserved distressed cancer survivors. Sixty-two men and women exhibiting moderate to high distress within 3 years of completing primary cancer treatment without access to in-person MBCR were randomized to either immediate online MBCR (n = 30) or to wait for the next available program (n = 32). Participants completed questionnaires preintervention and postintervention or wait period online. Program evaluations were completed after MBCR. Feasibility was tracked through monitoring eligibility and participation through the protocol. Intent-to-treat mixed-model analyses for repeated measures were conducted. Feasibility targets for recruitment and retention were achieved, and participants were satisfied and would recommend online MBCR. There were significant improvements and moderate Cohen d effect sizes in the online MBCR group relative to controls after MBCR for total scores of mood disturbance (d = 0.44, p = .049), stress symptoms (d = 0.49, p = .021), spirituality (d = 0.37, p = .040), and mindfully acting with awareness (d = 0.50, p = .026). Main effects of time were observed for posttraumatic growth and remaining mindfulness facets. Results provide evidence for the feasibility and efficacy of an online adaptation of MBCR for the reduction of mood disturbance and stress symptoms, as well as an increase in spirituality and mindfully acting with awareness compared with a treatment-as-usual wait-list. Future study using larger active control RCT designs is warranted.Trial Registration: Clinical Trials.gov: NCT01476891.
Book
Fifteen to twenty years is how long it takes for the billions of dollars of university-based research to translate into evidence-based policies and programs suitable for public use. Over the past decade, an exciting science has emerged that seeks to narrow the gap between the discovery of new knowledge and its application in public health, mental health, and health care settings. Dissemination and implementation (D&I) research seeks to understand how to best apply scientific advances in the real world, by focusing on pushing the evidence-based knowledge base out into routine use. To help propel this crucial field forward, this book aims to address a number of key issues, including: how to evaluate the evidence base on effective interventions; which strategies will produce the greatest impact; how to design an appropriate study; and how to track a set of essential outcomes. D&I studies must also take into account the barriers to uptake of evidence-based interventions in the communities where people live their lives and the social service agencies, hospitals, and clinics where they receive care. The challenges of moving research to practice and policy are universal, and future progress calls for collaborative partnerships and cross-country research. The fundamental tenet of D&I research-taking what we know about improving health and putting it into practice-must be the highest priority.
Article
PURPOSETo compare the efficacy of the following two empirically supported group interventions to help distressed survivors of breast cancer cope: mindfulness-based cancer recovery (MBCR) and supportive-expressive group therapy (SET). PATIENTS AND METHODS This multisite, randomized controlled trial assigned 271 distressed survivors of stage I to III breast cancer to MBCR, SET, or a 1-day stress management control condition. MBCR focused on training in mindfulness meditation and gentle yoga, whereas SET focused on emotional expression and group support. Both intervention groups included 18 hours of professional contact. Measures were collected at baseline and after intervention by assessors blind to study condition. Primary outcome measures were mood and diurnal salivary cortisol slopes. Secondary outcomes were stress symptoms, quality of life, and social support.ResultsUsing linear mixed-effects models, in intent-to-treat analyses, cortisol slopes were maintained over time in both SET (P = .002) and MBCR (P = .011) groups relative to the control group, whose cortisol slopes became flatter. Women in MBCR improved more over time on stress symptoms compared with women in both the SET (P = .009) and control (P = .024) groups. Per-protocol analyses showed greater improvements in the MBCR group in quality of life compared with the control group (P = .005) and in social support compared with the SET group (P = .012). CONCLUSION In the largest trial to date, MBCR was superior for improving a range of psychological outcomes for distressed survivors of breast cancer. Both SET and MBCR also resulted in more normative diurnal cortisol profiles than the control condition. The clinical implications of this finding require further investigation.
Article
Purpose: Group-based mindfulness training is frequently described in psycho-oncology literature, but little is known of the effectiveness of mindfulness-based cognitive therapy (MBCT). We investigated the effectiveness and acceptability of MBCT for women with breast and gynecologic cancer. Methods: Fifty women were recruited to participate in eight weekly 2-h mindfulness sessions. Outcomes of distress, quality of life (QOL), post-traumatic growth, and mindfulness were assessed pre-intervention, post-intervention, and again 3 months later using validated measures. Data were analyzed with repeated measures ANOVAs with a Bonferroni correction. Participant satisfaction and evaluation were also assessed. Results: Forty-two women completed the program, and complete data were available for 36 women. Significant improvements with large effect sizes (ηρ(2)) were observed for distress (P < 0.001; ηρ(2) = 0.238), QOL (P = 0.001; ηρ(2) = 0.204), mindfulness (P < 0.001; ηρ(2) = 0.363) and post-traumatic growth (P < 0.001; ηρ(2) = 0.243). Gains were maintained 3 months post-intervention. Improvements in outcomes did not differ based on diagnostic group, psychological status, or physical well-being at entry. Change indices further support these findings. Scores on measures of distress, QOL, and post-traumatic growth decreased as a function of increased mindfulness at each time point (all P < 0.05). Participants reported experiencing the program as beneficial, particularly its group-based nature, and provided positive feedback of the therapy as a whole as well as its individual components. Conclusions: Within the limits of a non-randomized trial, these findings provide preliminary support for the potential psychosocial benefits of MBCT in a heterogeneous group of women with cancer. Future, more comprehensive trials are needed to provide systematic evidence of this therapy in oncology settings.
Article
Introduction: As the incidence of and survival from breast cancer continue to raise, interventions to reduce anxiety and depression before, during and after treatment are needed. Previous studies have reported positive effects of a structured 8-week group mindfulness-based stress reduction program (MBSR) among patients with cancer and other conditions. Purpose: To test the effect of such a programme on anxiety and depression among women with breast cancer in a population-based randomised controlled study. Methods: A total of 336 women who had been operated on for breast cancer (stage I-III) were randomised to usual care or MBSR+usual care. Questionnaires including the Symptom Checklist-90r anxiety and depression subscales and the Center for Epidemiological Studies-Depression scale were administered before randomisation and immediately, 6 and 12 months after the intervention. Results: Intention-to-treat analyses showed differences between groups in levels of anxiety (p=0.0002) and depression (SCL-90r, p<0.0001; CES-D, p=0.0367) after 12 months. Graphical comparisons of participants with higher levels of anxiety and depression at baseline showed a significantly greater decrease in the intervention group throughout follow-up and no differences among least affected participants. Medium-to-large effects were found for all outcomes in the intervention group in analyses of change scores after 12 months' follow-up. Conclusion: The 8-week group based MBSR intervention had clinically meaningful, statistically significant effects on depression and anxiety after 12 months' follow-up, and medium-to-large effect sizes. Our findings support the dissemination of MBSR among women with breast cancer. (Clintrials.gov No.: NCT00990977).
Article
The number of cancer patients seeking complementary mind-body therapies has increased within recent years. The purpose of this study was to investigate the effectiveness of a mindfulness-based stress reduction and relaxation program (MBSR) on stress, state anxiety, mental adjustment to cancer, and health locus of control in 27 women with diagnosed breast cancer. Findings indicated significant decreases in pre-to-post stress and state anxiety levels; also, results showed significant and beneficial changes for mental adjustment to cancer and health locus of control scores following completion of the MBSR intervention. These results provide initial support for the application of mindfulness-based interventions to individuals struggling with the stress and threat of cancer. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The aim of this study was determine the effectiveness of a mindfulness-based stress-reduction (MBSR) program on quality of life (QOL) and psychosocial outcomes in women with early-stage breast cancer, using a three-arm randomized controlled clinical trial (RCT). This RCT consisting of 172 women, aged 20-65 with stage I or II breast cancer consisted of the 8-week MBSR, which was compared to a nutrition education program (NEP) and usual supportive care (UC). Follow-up was performed at three post-intervention points: 4 months, 1, and 2 years. Standardized, validated self-administered questionnaires were adopted to assess psychosocial variables. Statistical analysis included descriptive and regression analyses incorporating both intention-to-treat and post hoc multivariable approaches of the 163 women with complete data at baseline, those who were randomized to MBSR experienced a significant improvement in the primary measures of QOL and coping outcomes compared to the NEP, UC, or both, including the spirituality subscale of the FACT-B as well as dealing with illness scale increases in active behavioral coping and active cognitive coping. Secondary outcome improvements resulting in significant between-group contrasts favoring the MBSR group at 4 months included meaningfulness, depression, paranoid ideation, hostility, anxiety, unhappiness, and emotional control. Results tended to decline at 12 months and even more at 24 months, though at all times, they were as robust in women with lower expectation of effect as in those with higher expectation. The MBSR intervention appears to benefit psychosocial adjustment in cancer patients, over and above the effects of usual care or a credible control condition. The universality of effects across levels of expectation indicates a potential to utilize this stress reduction approach as complementary therapy in oncologic practice.
Article
This investigation used a non-randomized controlled design to evaluate the effect and feasibility of a mindfulness based stress reduction (MBSR) program on immune function, quality of life (QOL), and coping in women recently diagnosed with breast cancer. Early stage breast cancer patients, who did not receive chemotherapy, self-selected into an 8-week MBSR program or into an assessment only, control group. Outcomes were evaluated over time. The first assessment was at least 10 days after surgery and prior to adjuvant therapy, as well as before the MBSR start-up. Further assessments were mid-MBSR, at completion of MBSR, and at 4-week post-MBSR completion. Women with breast cancer enrolled in the control group (Non-MBSR) were assessed at similar times. At the first assessment (i.e., before MBSR start), reductions in peripheral blood mononuclear cell NK cell activity (NKCA) and IFN-gamma production with increases in IL-4, IL-6, and IL-10 production and plasma cortisol levels were observed for both the MBSR and Non-MBSR groups of breast cancer patients. Over time women in the MBSR group re-established their NKCA and cytokine production levels. In contrast, breast cancer patients in the Non-MBSR group exhibited continued reductions in NKCA and IFN-gamma production with increased IL-4, IL-6, and IL-10 production. Moreover, women enrolled in the MBSR program had reduced cortisol levels, improved QOL, and increased coping effectiveness compared to the Non-MBSR group. In summary, MBSR is a program that is feasible for women recently diagnosed with early stage breast cancer and the results provide preliminary evidence for beneficial effects of MBSR; on immune function, QOL, and coping.
Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide ©. Center for Mindfulness in Medicine
  • J Kabat-Zinn
  • S F Saki
  • M-M Florence
  • L Koerbel
Kabat-Zinn J, Saki SF, Florence M-M, Koerbel L. Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide ©. Center for Mindfulness in Medicine, Health Care, and Society (CFM). Worcester: University of Massachussetts Medical School; 2017.