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Effect of MBSR on immune function, quality of life, and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior and Immunology, 22, 969-981
Abstract
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.
... Of the qualities of positive psychology, improved quality of life [23,42], coping capacity [42], and posttraumatic growth [8] have been reported in earlier studies among women with breast cancer. To these, our study adds improved resilience; and self-compassion and mindfulness skills, which however remained unchanged. ...
... Of the qualities of positive psychology, improved quality of life [23,42], coping capacity [42], and posttraumatic growth [8] have been reported in earlier studies among women with breast cancer. To these, our study adds improved resilience; and self-compassion and mindfulness skills, which however remained unchanged. ...
... Growing evidence suggests that mindfulness has favorable influence on immune system function among breast cancer patients [8,42,49,50]. Beneficial changes in NK cell activity [8,42], cytokine levels [42,48], and number of NK-and B-cells [8] have been reported among participants during the MBSR program. There are also few reports of the association of attending the mindfulness intervention and cortisol levels: among recently diagnosed breast cancer patients, evening plasma cortisol levels were significantly lower in those attending the MBSR at the end of the program compared to control individuals [42]. ...
Abstract Background The aim of this clinical single group pilot study was to assess mental well-being, psychological symptoms, and a set of stress biomarkers among breast cancer survivors with high depressive symptoms undergoing the Mindfulness-Based Stress Reduction (MBSR) program. Methods Participants included 23 curatively treated breast cancer survivors from the Helsinki University Central Hospital with clinically significant symptoms of depression (Beck Depression Inventory > 13, and assessed by a psychiatrist), at 1-year post-operative follow-up. Mental wellbeing and psychological symptoms were assessed with self-reported questionnaires (Resilience Scale, Self-Compassion Scale, Five Facet Mindfulness Questionnaire, World Health Organization Quality of Life-questionnaire, Perceived Stress Scale, Beck Depression Inventory, Beck Anxiety Inventory, Insomnia Severity Index); in addition, stress response was assessed with biomarkers (cortisol, adrenocorticotropine, and high-sensitivity-CRP from blood; 24 h-cortisol from urine). All measures were addressed at baseline, mid-program (4 weeks after baseline) and at the completion of the 8-week MBSR program. Engagement to the independent mindfulness home practice was collected with a diary. Results From baseline to the completion of the 8-week MBSR program, we observed significant increases in resilience (d = 0.60, p = 0.005), and quality of life (d = 0.92, p = 0.002), and significant reductions in symptoms of depression (d = − 1.17, p
... Evidence in the literature indicates that mindfulness (especially in the form of MBSR) is an effective strategy for the management of physical and psychological conditions. In terms of physical conditions, MBSR has been shown to improve outcomes for individuals with irritable bowel syndrome (Zernicke et al., 2013), chronic pain and fibromyalgia (Bakhshani et al., 2016;Cramer et al., 2012;Weissbecker et al., 2002), and cancers (particularly, breast cancers; Matousek & Dobkin, 2010;Vella & Budd, 2011;Witek-Janusek et al., 2008;Zainal et al., 2013) whilst also leading to greater post-traumatic growth after cancer treatment (Garland et al., 2007;Labelle et al., 2015). ...
... In addition to cognitive and emotional improvements, mindfulness has also been shown to improve immune functioning (Witek-Janusek et al., 2008), sleep quality (Frank et al., 2015), and overall quality of life (Witek-Janusek et al., 2008). Furthermore, an eight-week MBSR has been found to induce brain changes (e.g., earlier amygdala deactivation, less grey matter, and better connectivity) similar to traditional long-term (i.e., years long) meditation practice (Gotink et al., 2016). ...
... In addition to cognitive and emotional improvements, mindfulness has also been shown to improve immune functioning (Witek-Janusek et al., 2008), sleep quality (Frank et al., 2015), and overall quality of life (Witek-Janusek et al., 2008). Furthermore, an eight-week MBSR has been found to induce brain changes (e.g., earlier amygdala deactivation, less grey matter, and better connectivity) similar to traditional long-term (i.e., years long) meditation practice (Gotink et al., 2016). ...
Given the vast range of salutogenic effects of mindfulness, the current study sought to quantitively and qualitatively evaluate the effectiveness of a trauma informed and Te Ao Māori enriched adaptation of MBSR, the ‘Aotearoa Mindfulness and Awareness’, delivered virtually in Hindi (i.e., the ‘H–AMA’) to a South Asian cohort (N = 28) in Auckland, New Zealand. Quantitative data were analysed using paired-samples t-tests and Chi-Squared test, whilst qualitative data were analysed using basic thematic analysis. Quantitative analyses revealed H–AMA as being effective in reducing physical distress and anxiety-related symptoms, whilst qualitative analyses revealed there to be five major themes in relation to participants’ experiences of the H–AMA: knowledge, self-awareness, relationships, psychological wellbeing, and physical wellbeing. Implications and limitations of these results are discussed in the study, along with suggestions for future research.
... By training an attitude of equanimity with present-moment experience, including the distress associated with feeling alone, mindfulness interventions are thought to diminish loneliness and social threat ; in turn, mindfulness interventions show potential to interrupt hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) stress response cascades (Lindsay et al., 2018) in ways that may improve immunocompetence (Creswell and Lindsay, 2014). To date, few studies have focused on whether mindfulness interventions can alter innate immunocompetence (Elsenbruch et al., 2005;Witek-Janusek et al., 2008;Zautra et al., 2008), and none to our knowledge have examined this question in the context of healthy aging. In a large sample of lonely older adults, the current study tests the impact of 8-week Mindfulness-Based Stress Reduction (MBSR) vs. control Health Enhancement Program (HEP) interventions on stimulated interleukin-6 (IL-6) production, an in vitro measure of innate immune responsivity to bacterial challenge. ...
... This study adds to a sparse literature testing the effects of mindfulness and other mind-body interventions on stimulated cytokine production. To our knowledge, this study is the first to show that mindfulness training increases stimulated IL-6 production, and it is the only study to examine this question in the context of healthy aging (Elsenbruch et al., 2005;Witek-Janusek et al., 2008;Zautra et al., 2008). In doing so, this study contributes to a longstanding question in psychoneuroimmunology about whether stress management interventions enhance or suppress stimulated cytokine production (Carlson et al., 2003). ...
... In doing so, this study contributes to a longstanding question in psychoneuroimmunology about whether stress management interventions enhance or suppress stimulated cytokine production (Carlson et al., 2003). To date, mindfulness and mind-body interventions have shown no effects or reductions in stimulated cytokine production in midlife adults with inflammatory disease or breast cancer (Elsenbruch et al., 2005;Witek-Janusek et al., 2008;Zautra et al., 2008;Irwin et al., 2014;Kiecolt-Glaser et al., 2014). Together with this previous work, the current study suggests that intervention effects on stimulated cytokine response depend heavily on disease status and lifespan factors. ...
Loneliness is a potent psychosocial stressor that predicts poor health and mortality among older adults, possibly in part by accelerating age-related declines in immunocompetence. Mindfulness interventions have shown promise for reducing loneliness and improving markers of physical health. In a sample of lonely older adults, this two-arm parallel trial tested whether mindfulness training enhances stimulated interleukin-6 (IL-6) production, a measure of innate immune responsivity. Lonely older adults (65-85 years; N=190) were randomized to an 8-week Mindfulness-Based Stress Reduction (MBSR) or control Health Enhancement Program (HEP) intervention. Lipopolysaccharide (LPS)-stimulated production of IL-6 was measured in vitro by blinded outcome assessors at pre-intervention, post-intervention, and 3-month follow-up. Mixed-effects linear models tested time (pre, post, follow-up) by condition (MBSR vs. HEP) effects. As predicted, a significant time × condition effect on stimulated IL-6 production was observed across pre, post, and follow-up timepoints. Significant MBSR vs. HEP differences emerged from pre- to post-intervention (p=.009, d=.38) and from pre-intervention to 3-month follow-up (p=.017, d=.35), with larger increases in IL-6 production following MBSR compared to HEP. No study-related adverse events were reported. Results show that mindfulness training may be effective for boosting innate immunocompetence among lonely older adults. Given that immunocompetence tends to decline with age, mindfulness training may help to counteract the effects of aging and psychosocial stress on infection risk and recovery from injury.
... The trials comparing yoga to other interventions or no intervention showed a clear effect on cortisol levels; however, a study by Witek-Janusek et al. [52] investigated the cortisol level changes in breast cancer patients assigned to yoga intervention compared to cancer-free women. The breast cancer patients included in the study had been treated surgically while some also subsequently received radiotherapy. ...
... The study found that cancer women who did not receive the stress reduction program had significantly higher serum cortisol levels, compared to the study group. Interestingly, cancer-free women turned out to have significantly lower cortisol concentrations than women in the cancer groups, both those who received the program and those who only participated in assessment [52]. ...
Breast cancer is one of the most prevalent cancers in women worldwide, often accompanied by significant psychological distress and hormonal imbalances, including elevated cortisol levels. Cortisol, as a crucial hormone secreted in response to physical and psychological stress, plays an important role in regulation of numerous human body systems. A vast number of studies showed that chronic stress and prolonged hypersecretion of cortisol promote carcinogenesis and tumor growth. Because of the known relaxing effects of yoga and its ability to lower cortisol levels, complementary therapies including integrated yoga programs have gained attention due to their potential to mitigate the adverse effects of cancer and its treatment. To this day, multiple studies to evaluate the positive impact of yoga on lowering cortisol levels in breast cancer patients have been carried out. This review aims to shed light on how cortisol level impacts cancer development and progression as well as summarize the beneficial effect of yoga on cortisol levels in breast cancer patients and its potential as an adjunctive therapy.
... We further classified these articles into three larger groups according to the immune or neuroendocrine biomarkers as an outcome: cortisol, lymphocytes, and pro-inflammatory cytokines in order not to lose the cortisol values if cortisol was not the primary or sole outcome of the study. Since the current paper is based on cortisol (both salivary and plasma), 16 reports were pre-selected into this category (Davis, 1986;Gruber et al., 1993;Schedlowski, 1994;van der Pompe et al., 1997;Cruess et al., 2000;Chan et al., 2006;Nunes et al., 2007;Witek-Janusek et al., 2008;Antoni et al., 2009;Matchim et al., 2011; . /fpsyg. . ...
... When published articles did not present sufficient data to calculate the effect size, we contacted authors for the required information. However, for the remaining seven articles, the authors either did not respond or were unable to provide essential data (Davis, 1986;Gruber et al., 1993;van der Pompe et al., 1997;Nunes et al., 2007;Witek-Janusek et al., 2008;Antoni et al., 2009;Webster et al., 2016;Lengacher et al., 2019), except one study of Baker et al. (2012), where we obtained additional information. Therefore, only eight studies exhibited sufficient data to calculate effect size and additional data that included pre-and all postintervention means, SDs, and sample sizes for each treatment arm. ...
Introduction
Cancer initiation, progression and recurrence are intricate mechanisms that depend on various components: genetic, psychophysiological, or environmental. Exposure to chronic stress includes fear of recurrence that can affect biological processes that regulate immune and endocrine systems, increase cancer risk, and influence the survival rate. Previous studies show that psychological interventions might influence the level of cortisol that has been extensively used as a biomarker for measuring hypothalamic-pituitary-adrenal axis functioning and body's immunity response. This meta-analysis aimed to provide a quantitative scrutiny of the effect of certain types of psychosocial interventions on cortisol as a neuroendocrine biomarker in saliva or blood and might predict breast cancer (BC) progression.
Methods
A literature search was performed in the following databases: PubMed, The Cohrane Library, Scopus, WOS, PsychInfo, Google Scholar, Ovid Science Direct. After methodical selection of originally generated 2.021 studies, the search yielded eight articles that met inclusion criteria. All these studies explored effects of psychosocial interventions that measured cortisol in total of 366 participants with BC, stages 0-IV, in randomized control trial or quasi experimental study design setting. We applied random effects model to conduct meta-analyses on the parameters of salivary and plasma cortisol and used PRISMA Guidelines as validated methodology of investigation to report the results.
Results
Eight studies selected for meta-analysis have shown the reduction of cortisol level due to applied psychosocial intervention. The random effects model showed that interventions produced large effect sizes in reductions of cortisol in blood (Cohen's d = −1.82, 95% Confidence Interval (CI): −3.03, −0.60) and slightly less in saliva (d = −1.73, 95%CI: −2.68, −0.78) with an overall effect of d = −1.76 (95%CI: −2.46, −1.07).
Conclusion
Our study concluded that certain types of psychosocial interventions reduce cortisol (indicator of chronic stress) in patients with BC. Application of specific psychosocial support as adjuvant non-invasive therapy for affected females with BC at all phases of treatment could contribute to more cost-effective health care.
... Meditative practices have been related to anti-inflammatory cytokine activity in a variety of studies, [66][67][68][69][70][71] and has been reported in systematic reviews. 72,73 For example, after 6 weeks of daily meditation, each lasting only 20 minutes, Bower et al 66 found a downregulation of pro-inflammatory genes in cancer survivors. ...
... 79,80 It had also been found that meditation has led to increasing vagal tone, 81,82 as well as inflammatory-based diseases. 68,71,83,84 The benefits of meditation practice have also occurred with 90 minutes of yogic practice over a 2week period, which found increased expression of important antimicrobial peptides, 85 which is of interest for work with COVID patients as they are expressed in respiratory epithelial cells. 8 A mind-body intervention down-regulated cytokine receptors and C-reactive protein. ...
Some individuals infected with SARS CoV-2 have developed Post-Acute Sequelae of SARS CoV-2 infection (PASC) or what has been referred to as Long COVID. Efforts are underway to find effective treatment strategies for those with Long COVID. One possible approach involves alternative medical interventions, which have been widely used to treat and manage symptoms of a variety of medical problems including post-viral infections. Meditation has been found to reduce fatigue and unrefreshing sleep, and for those with post-viral infections, it has enhanced immunity, and reduced inflammatory-driven pathogenesis. Our article summarizes the literature on what is known about mindfulness meditation interventions, and reviews evidence on how it may apply to those with Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Evidence is reviewed suggesting effective and sustainable outcomes may be achieved for symptomatology and underlying pathology of post-viral fatigue (PASC and ME/CFS).
... 228 One RCT in Stage 0 to II post-surgical breast cancer patients who did not receive chemotherapy found that 8 weeks of MBSR was associated with greater increases in NK cell cytotoxicity and IFNγ production versus a no-treatment control. 255 In another RCT among 82 Stage 0 to III breast cancer patients recently completing lumpectomy and adjuvant radiation with or without chemotherapy, women receiving 6 weeks of MBSR showed greater LPR to phytohemagglutinin (PHA) and an increased ratio of Th1:Th2 cell numbers versus TAU controls up to 2 weeks after the intervention. 255,256 In another RCT, younger breast cancer survivors (<50 years) who had completed cancer treatment 3 months to 10 years prior were randomized to 6-week group-based mindfulness awareness practices (MAP) intervention (N = 39) or wait-list control (N = 32). ...
... 255 In another RCT among 82 Stage 0 to III breast cancer patients recently completing lumpectomy and adjuvant radiation with or without chemotherapy, women receiving 6 weeks of MBSR showed greater LPR to phytohemagglutinin (PHA) and an increased ratio of Th1:Th2 cell numbers versus TAU controls up to 2 weeks after the intervention. 255,256 In another RCT, younger breast cancer survivors (<50 years) who had completed cancer treatment 3 months to 10 years prior were randomized to 6-week group-based mindfulness awareness practices (MAP) intervention (N = 39) or wait-list control (N = 32). Those assigned to the MAP intervention showed decreases in pre-post intervention perceived stress, and reduced leukocyte NF-κB and increased GR and IFN Type-I gene expression versus controls, suggestive of decreased inflammation and increased inflammatory control. ...
The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.
... The results demonstrated that mindfulness training significantly increased self-compassion in women with breast cancer, such that the mean self-compassion in the experimental group significantly increased compared to the control group. Thus, this study's findings align with the prior research (Birnie, 2010;Boellinghaus, 2014;Brown, 2003;Carlson, 2007;Carlson, 2004;Evans, 2018;Gonzalez-Hernandez, 2018;Lengacher, 2019;Sanada, 2017;Small, 2017;Witek-Janusek, 2008;Würtzen & Flyger, 2015). To explain this finding, it can be argued that self-compassion is defined as how one deals with suffering, harm, and a sense of helping oneself to solve one's own problems (Wren, 2012). ...
Objective: This study aimed to examine the impact of mindfulness training on experiential avoidance, self-compassion, and certain physiological indices in women diagnosed with breast cancer. Method: This applied research was conducted as a quasi-experimental study with a pre-test, post-test, and control group design. The population included all women with stage 1 and 2 breast cancer who were under medical care after completing chemotherapy or radiotherapy at Shahid Tajrish Hospital in 2020-2021. A convenience sampling method was used to select 40 female breast cancer patients, who were equally divided into an experimental group (20 participants) and a control group (20 participants). Data were collected using the Neff's Self-Compassion Scale (Neff, 2003), the Bond et al.'s Experiential Avoidance Questionnaire (2011), and physiological indices. Mindfulness training, based on the protocol by Lengacher et al. (2019), consisted of 8 sessions of 90 minutes each for the experimental group, while the control group received no intervention. Data were analyzed using covariance analysis. Findings: The results indicated that mindfulness training significantly increased self-compassion (F = 6.35, p < .05) and decreased experiential avoidance (F = 4.75, p < .05) in women with breast cancer. Additionally, the training significantly reduced cortisol levels (F = 7.38, p < .05), but did not have a significant effect on the concentrations of IL-6 (F = 0.83, p > .05) and CRP (F = 0.04, p > .05). Conclusion: Considering the current findings, it can be said that mindfulness training is effective in improving the psychological condition and reducing stress in women with breast cancer.
... 3 Skrining yang dilakukan pada TORCH umumnya menggunakan immunoserologi dengan melakukan deteksi terhadap keberadaan antibodi yang muncul yang bertujuan untuk melihat infeksi kronis yang menandakan pasien telah terinfeksi lebih dari 3-6 bulan. 4 Kondisi medis yang diketahui dengan menggunakan alat labor umumnya akan mempengaruhi level kecemasan pasien. Semakin berat gangguan dengan diagnosis yang buruk, maka semakin tinggi pula level kecemasan. ...
Pendahuluan: Toxoplasma gondii, Rubella, Cytomegalovirus dan Herpes simplex virus yang bisa disingkat TORCH merupakan kelompok penyakit infeksi yang disebabkan oleh virus dan parasite. Sebagian besar penderita TORCH mengalami peningkatan Imunoglobulin G didalam darah. Pasien juga mengalami berbagai gejala seperti demam, nyeri tenggorokan, gangguan kehamilan dari yang ringan hingga berat. Tujuan: Untuk mengetahui hubungan antara gejala klinis dan level jumlah IgG terhadap tingkat kecemasan masa depan pasien yang melakukan terapi komplementer infeksi TORCH di Aquatreat Therapy Indonesia. Metode: Metode penelitian bersifat korelasi kuantitatif menggunakan pendekatan cross-sectional. Variabel independen dalam penelitian ini yaitu gejala TORCH dan Level IgG sedangkan variabel Dependen kecemasan masa depan. Populasi sebanyak 220 orang dan sampel 69 orang. Instrumen penelitian masa depan menggunakan Future Anxiety Scale-1 (FAS-1) sebanyak 39 item pertanyaan dan dilakuakn uji validitas dan reliabilitas sehingga ditemukan 32 item pertanyaan yang valid. Analisis data digunakan uji spearman rank. Hasil: Gejala yang dirasakan pasien sebagian besar berada pada kategori ringan yaitu sebanyak 59.4%. Level jumlah IgG sebagian besar berada pada kategori ringan 36 responden (52,2%) Tingkat kecemasan masa depan pasien dengan gejala ringan sebanyak 52,2%. Hubungan antara karakteristik responden dengan kecemasan masa depan dengan nilai p-value > 0,05 dan hubungan antara level IgG TORCH dengan kecemasan masa depan responden dengan nilai p-value 0,000 (<0,05). Kesimpulan: Tidak terdapat hubungan antara karakteristik responden dengan kecemasan masa depan di Aquatreath Therapy Indonesia dan Terdapat hubungan antara level IgG TORCH dengan kecemasan masa depan responden dengan nilai di Aquatreat Therapy Indonesia. Lama terapi memberikan banyak perubahan terhadap nilai IgG, Level keluhan dan perbaikan gejala klinis, terapi komplementer terbukti bisa menjadi terapi terbaik untuk pengobatan.
... Meditative practices represent another kind of useful, moderate, and low-cost intervention that may contribute to the mitigation of long COVID symptoms. In a variety of studies, the outcome of meditation has been associated with anti-inflammatory cytokine activity [164][165][166][167][168], as has been reported in numerous systematic reviews [169,170]. Meditation has been shown to cause neural reorganization, "re-modulation, and re-regulation" of the neuroimmune responses [171,172]. ...
Advanced age is one of the significant risk determinants for coronavirus disease 2019 (COVID-19)-related mortality and for long COVID complications. The contributing factors may include the age-related dynamical remodeling of the immune system, known as immunosenescence and chronic low-grade systemic inflammation. Both of these factors may induce an inflammatory milieu in the aged brain and drive the changes in the microenvironment of neurons and microglia, which are characterized by a general condition of chronic inflammation, so-called neuroinflammation. Emerging evidence reveals that the immune privilege in the aging brain may be compromised. Resident brain cells, such as astrocytes, neurons, oligodendrocytes and microglia, but also infiltrating immune cells, such as monocytes, T cells and macrophages participate in the complex intercellular networks and multiple reciprocal interactions. Especially changes in microglia playing a regulatory role in inflammation, contribute to disturbing of the brain homeostasis and to impairments of the neuroimmune responses. Neuroinflammation may trigger structural damage, diminish regeneration, induce neuronal cell death, modulate synaptic remodeling and in this manner negatively interfere with the brain functions.
In this review article, we give insights into neuroimmune interactions in the aged brain and highlight the impact of COVID-19 on the functional systems already modulated by immunosenescence and neuroinflammation. We discuss the potential ways of these interactions with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and review proposed neuroimmune mechanisms and biological factors that may contribute to the development of persisting long COVID conditions. We summarize the potential mechanisms responsible for long COVID, including inflammation, autoimmunity, direct virus-mediated cytotoxicity, hypercoagulation, mitochondrial failure, dysbiosis, and the reactivation of other persisting viruses, such as the Cytomegalovirus (CMV). Finally, we discuss the effects of various interventional options that can decrease the propagation of biological, physiological, and psychosocial stressors that are responsible for neuroimmune activation and which may inhibit the triggering of unbalanced inflammatory responses. We highlight the modulatory effects of bioactive nutritional compounds along with the multimodal benefits of behavioral interventions and moderate exercise, which can be applied as postinfectious interventions in order to improve brain health.
... In another study on clinical patients, Witek-Janusek et al. (2008) reported that patients with cancer had undergone an MBSR program and improved quality of life and increased life satisfaction levels. On the other hand, Kabat-Zinn expresses MBSR as a popular mind-body medicine intervention that can help the patients to cope with chronic pain, stress and diseases, to relieve their pain, to improve their quality of life, to improve life satisfaction positively and to feel themselves as a whole. ...
Stress is part of survival as a driving force, but excessive stress can cause mental and physical harm. According on the circumstances and time of time, stress manifests itself in various ways and causes a variety of symptoms. In this context, numerous sorts of studies on stress and coping mechanisms have been conducted since people's methods of dealing with stress vary from one individual to the next and from one culture to another. This study, which uses empirical research, looks at the outcomes of a stress-reduction program developed using mindfulness principles that have been culturally adjusted. This program has been tested on the level of life satisfaction, mindfulness, and stress levels of individuals. The program was called as the "Culture-Adapted Mindfulness Stress Reduction Program" (CAMSR). In this study, 2x3 experimental model was used with the pre-test, post-test, follow-up test, and control-experimental groups. As a result of the analyzes, it can be said that culture-adapted stress reduction program has shown significant differences between the groups (control and experimental groups) in terms of three variables. The results show that CAMSR has a positive and lasting impact on each of the three factors.
... Accordingly, Witek-Janusek et al. JOURNAL of MEDICINE and LIFE JOURNAL of MEDICINE and LIFE reduce automatic and habitual responses to stressful experiences, and developing insight and greater acceptance of life-changing events over time can reduce the activation of the stress response system [30]. The present research indicated that considering the group-time interaction, the levels of anxiety reported in the three phases were significantly different for the participants in the intervention group. ...
Old age is rapidly increasing and is linked to with chronic diseases, especially diabetes. Diabetes is associated with increased anxiety, stress, and depression and, in turn, can increase cortisol secretion. To this end, the present research studied the impact of mindfulness-based stress reduction (MBSR) training on serum cortisol levels, depression, anxiety, and stress in type 2 diabetic (T2DM) older adults during the COVID-19 epidemic. The participants in this interventional work were 56 older adult patients with type 2 diabetes chosen through systematic random sampling and then randomly divided into control and intervention groups containing equal members. In the intervention group, the participants attended eight mindfulness-based stress reduction (MBSR) training sessions. The subjects in the control group received no intervention. Since four patients left the study, only data for 52 patients were collected using the Depression Anxiety Stress Scale (DASS-21) and a demographic and disease information questionnaire. Data were examined with SPSS18 software using the Kolmogorov-Smirnov test, chi-square test, Fisher test, independent samples t-test, and two-way ANOVA; the significance was p<0.05. Statistically significant differences were observed between the mean scores of anxiety, stress, depression, and cortisol levels in the intervention group (p<0.00001) before, directly after, and three months after the intervention. However, no statistically significant difference was observed in the mentioned variables in the control group. The mindfulness-based stress reduction (MBSR) intervention can improve anxiety, depression, stress, and cortisol levels in older adults suffering from T2DM.
... Since the study did not include any other measures that would inform clinical status, it is difficult to interpret these findings. Other studies provide support that mindfulness interventions significantly modulate cytokine marker levels in breast and prostate cancers [44][45][46][47]. Other studies provide preliminary support for anti-inflammatory effects of mindfulness in healthy populations, such as the down-regulation of pro-inflammatory NF-κB transcription in isolated older adults. ...
Chronic inflammatory diseases are the most significant cause of death in the world and entail severe impairment to quality of life. The World Health Organization (WHO) ranks chronic inflammatory diseases as the greatest threat to human health and wellbeing. Inflammation is epicentral to many clinical conditions and symptoms, and it is anticipated that the health, economic, and mortality burdens associated with chronic inflammation will steadily increase in the United States over the next 30 years. An inflammatory model of disease premises that peripheral injury/trauma/toxins release signaling mediators that activate glial components of peripheral and central cellular circuitry which if prolonged causes toxification of the central nervous system, or neuroinflammation. This inflammatory process is associated with an array of systemic symptomatology affecting somatic, neurocognitive, and affective domains, that can often be misdiagnosed and/or ineffectively treated in the clinic. Centralized neuroinflammation determines a range of conditions and their clinical trajectories, from autoimmune diseases, cancers, cardiovascular diseases, chronic pain, to neurological and psychiatric disorders. It is coming to light that mind-body medicine, defined here as mindfulness- and yoga-based interventions, appear to modulate peripheral cell signaling involved with inflammatory response. Translational mechanism nor intervention specificity of this early data is currently clearly delineated, posing an exciting and highly beneficial frontier for further empirical exploration in the field of integrative mind-body medicine. Here we initiate an allostasis model of working mechanism that aims to inform methodological design and ensuing empirical perspectives.
... Interferon-gamma (IFN-γ) is encoded by the IFNG gene located at 12q15. IFN-γ plays a role in stress-induced immune dysregulation [159]. Women with higher subjective stress after breast cancer surgery but before adjuvant therapy were found to have lower basal and IFN-γ-augmented NK cells and reduced T cell proliferative response to mitogens [160,161]. ...
Depression is one of the leading mental illnesses worldwide and lowers the quality of life of many. According to WHO, about 5% of the worldwide population suffers from depression. Newer studies report a staggering global prevalence of 27.6%, and it is rising. Professionally, depression belonging to affective disorders is a psychiatric illness, and the category of major depressive disorder (MDD) comprises various diagnoses related to persistent and disruptive mood disorders. Due to this fact, it is imperative to find a way to assess depression quantitatively using a specific biomarker or a panel of biomarkers that would be able to reflect the patients’ state and the effects of therapy. Cytokines, hormones, oxidative stress markers, and neuropeptides are studied in association with depression. The latest research into inflammatory cytokines shows that their relationship with the etiology of depression is causative. There are stronger cytokine reactions to pathogens and stressors in depression. If combined with other predisposing factors, responses lead to prolonged inflammatory processes, prolonged dysregulation of various axes, stress, pain, mood changes, anxiety, and depression. This review focuses on the most recent data on cytokines as markers of depression concerning their roles in its pathogenesis, their possible use in diagnosis and management, their different levels in bodily fluids, and their similarities in animal studies. However, cytokines are not isolated from the pathophysiologic mechanisms of depression or other psychiatric disorders. Their effects are only a part of the whole pathway.
... Supporting this hypothesis, Galvan notes "previous work has shown that, under identical stress conditions, teens show greater cortisol release than adults" [48]. Cahn et al. [49] note additional research further indicates that increases in cortisol following a yoga intervention may be a normal finding for adults, especially when combining yoga and mindfulness practices [50][51][52][53][54]. Moreover, a comprehensive literature review of yoga and heart rate variability research also suggests that yoga interventions do increase heart rate variability among participants [55]. ...
Given the prevalence of mental health issues for both educators and adolescents in rural Montana, this project is designed to help mitigate the impact of stressors by providing coping strategies linked to improvements in overall mental health outcomes for teachers, which may ultimately lead to improved co-regulation of students and classroom climate. The immediate goal of this pilot study was to measure physical and mental health outcomes of educators resulting from a remotely-delivered trauma-informed yoga intervention. Findings suggest improvements in participants’ depression and anxiety levels, trauma symptoms, sleep quality, and non-significant changes in heart rate variability and cortisol levels.
... PNE has been found to be effective for reducing pain disability, catastrophizing, avoidance behaviors and physical inactivity in patients with FM (Malfliet et al., 2017). Concurrently, there is high agreement among clinical guidelines that CBT and therapeutic physical exercise should constitute the main therapeutic elements when treating FM (Jones et al., 2006;Bernardy et al., 2010;Sosa-Reina et al., 2017;Bernardy et al., 2018); furthermore, combining both interventions has been shown to be particularly effective (Witek-Janusek et al., 2008;Black et al., 2013). There is also mounting evidence that mindfulness training can be an efficacious and cost-effective approach for improving quality of life, functional impairment, anxiety, depression, and other symptoms in patients with FM (Haugmark et al., 2019;Pérez-Aranda et al., 2019). ...
Introduction: The On&Out study is aimed at assessing the effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent intervention conducted in two different settings: online (FIBRO-On) or outdoors (FIBRO-Out). Both interventions have proved to be efficacious in the short-term but there is no study assessing their comparative effectiveness nor their long-term effects. For the first time, this study will also evaluate the cost-utility (6-month time-horizon) and the effects on immune-inflammatory biomarkers and Brain-Derived Neurotrophic Factor (BDNF) levels of both interventions. The objectives of this 6-month, randomized, controlled trial (RCT) are 1) to examine the effectiveness and cost-utility of adding FIBRO-On or FIBRO-Out to Treatment-As-Usual (TAU) for individuals with fibromyalgia (FM); 2) to identify pre–post differences in blood biomarker levels in the three study arms and 3) to analyze the role of process variables as mediators of 6-month follow-up clinical outcomes.
Methods and analysis: Participants will be 225 individuals with FM recruited at Vall d’Hebron University Hospital (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs. TAU + FIBRO-On vs. TAU + FIBRO-Out. A comprehensive assessment to collect functional impairment, pain, fatigue, depressive and anxiety symptoms, perceived stress, central sensitization, physical function, sleep quality, perceived cognitive dysfunction, kinesiophobia, pain catastrophizing, psychological inflexibility in pain and pain knowledge will be conducted pre-intervention, at 6 weeks, post-intervention (12 weeks), and at 6-month follow-up. Changes in immune-inflammatory biomarkers [i.e., IL-6, CXCL8, IL-17A, IL-4, IL-10, and high-sensitivity C-reactive protein (hs-CRP)] and Brain-Derived Neurotrophic Factor will be evaluated in 40 participants in each treatment arm (total n = 120) at pre- and post-treatment. Quality of life and direct and indirect costs will be evaluated at baseline and at 6-month follow-up. Linear mixed-effects regression models using restricted maximum likelihood, mediational models and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed.
Ethics and dissemination: This study has been approved by the Ethics Committee of the Vall d’Hebron Institute of Research. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities. Trial registration number NCT05377567 ( clinicaltrials.gov ).
... The models portray negative thoughts or actions that occur when one is at the dying stage of life, with the exception of models: 'journey', 'closing the book', 'performance' and 'story', as these can be interpreted to have either a positive or negative connotation for an individual, depending upon their perception or satisfaction of life experiences. Research conducted upon mentality, outlook, mindfulness, creating meaning from activities and improved quality of life has demonstrated the positive adjustments that dying people can experience (Cadrin, 2006;Carlson, Speca, Patel & Goodey, 2003;Foley, Baillie, Huxter, Price & Sinclair, 2010;Tacón, 2011;Witek-Janusek et al., 2008). This indicates that 13 of the 17 partial models are not inclusive enough or representative of the vast amount of positive or balanced perspectives that dying people can construct and live with for improved quality of life (Leung et al., 2010). ...
Cancer communication
Oesophageal cancer experience
Health promotion
Health journalism
... Yoga helps in mental wellbeing which also improves cellular immunity. Yoga practices promote antiinflammatory and typically reduce pro-inflammatory 15 cytokine activity. Another study had suggested 6 weeks of 20-min daily mindfulness meditation a significant decrease in activity of the pro-inflammatory transcription factor nuclear factor kappa B (NF-κB) and an increase of antiinflammatory glucocorticoid receptor activity and reductions in circulating levels of C-reactive protein (CRP) 16 and IL-6. ...
... Dysregulated diurnal salivary cortisol is associated with an increased risk for mental and physical disorders, including metabolic disease. 49 Previous studies have found mixed results related to salivary cortisol changes associated with MBSR with some studies reporting decreases in salivary cortisol following 4 weeks 19 and 50 Others reported no change in cortisol levels related to MBSR. 51 We found no significant changes in IL-6 or IFN-γ production over time or differences between the MBSR and ACC groups. ...
Background
Women veterans experience higher levels of stress-related symptoms than their civilian counterparts. Psychological stress is associated with greater inflammation and may increase risk for cardiovascular disease (CVD). Mindfulness-based stress reduction (MBSR) has been found to improve psychological well-being in other populations but no randomized controlled trials (RCT) have been conducted examining the impact of MBSR on well-being and inflammation in women veterans at risk for CVD.
Objective
Determine the effectiveness of MBSR in improving psychological well-being, cortisol, and inflammation associated with CVD in women veterans.
Design
The design is a RCT comparing MBSR to an active control condition (ACC) consisting of a health education program.
Participants
Women veterans ( N =164) with risk factors for CVD from the Chicagoland area participated in the study.
Intervention
An 8-week MBSR program with weekly 2.5-h classes was compared to an ACC consisting of an 8-week health promotion education program with weekly 2.5-h classes.
Main Measures
The outcomes were psychological well-being [perceived stress, depressive symptoms, loneliness, and post-traumatic stress disorder (PTSD)] symptoms and stress-related markers, including diurnal salivary cortisol and cytokines interleukin-6 (IL-6) and interferon gamma (IFN-γ). Data were collected at baseline, 4 weeks (mid-point of intervention), 8 weeks (completion of intervention), and 6 months after completion of MBSR or ACC.
Key Results
Compared to the ACC, women who participated in MBSR reported less perceived stress, loneliness, and symptoms of PTSD. Although there were no significant differences between groups or changes over time in IL-6 or IFN-γ, participants in the MBSR program demonstrated a more rapid decline in diurnal salivary cortisol as compared to those in the ACC.
Conclusions
MBSR was found to improve psychological well-being and decrease diurnal salivary cortisol in women veterans at risk for CVD. Health care providers may consider MBSR for women veterans as a means by which to improve their psychological well-being.
... To our knowledge, breast cancer patients are prone to negative emotions, such as anxiety, depression, and stress (Suppli et al., 2017), which might contribute to this group's higher baseline assessment scores and greater improvement after interventions. Additionally, previous studies have demonstrated MBIs' effectiveness on QoL for breast cancer patients (Hoffman et al., 2012;Lengacher et al., 2016;Witek-Janusek et al., 2008). Accordingly, Zhang et al. (2019) suggested that MBSR should be recommended to patients with breast cancer as a complementary therapy. ...
In this study, we sought to evaluate the efficacy of mindfulness-based interventions (MBIs) for anxiety, depression, and quality of life (QoL) among cancer patients in China. Two independent researchers systematically searched major databases for randomized controlled trials (RCTs) examining MBIs’ effectiveness regarding anxiety, depression, and QoL among cancer patients in China. The reviewed databases included CNKI, the WanFang database, VIP Database, PubMed, Embase, Cochrane Library, PsycInfo, and Web of Science. We used the Cochrane risk-of-bias tool to assess the risk of bias, and we used Stata 15.1 for our meta-analysis. In total, 1,796 patients were included in the 18 RCTs we selected and reviewed. Our meta-analysis showed that compared to usual care, MBI can effectively improve anxiety (SMD = − 1.32, 95% CI [− 1.69, − 0.94], p < 0.001), depression (SMD = − 1.21, 95% CI [− 1.52, − 0.89], p < 0.001), and QoL (SMD = 1.09, 95% CI [0.73, 1.44], p < 0.001). Current evidence indicates that MBIs can effectively manage anxiety, depression, and QoL among cancer patients in China. Hence, MBIs should be included as part of the multidisciplinary treatment approach to treat cancer patients in China in order to protect their psychological well-being and QoL.
... The authors concluded that psychological interventions directly reduced inflammation and pain/depressive symptoms [9]. Currently, the effects that psychological interventions have on the neuroendocrine and inflammatory responses to surgical stress are consistently described in several observational or interventional studies [32][33][34]. In all studies selected in this systematic review and reported in Table 1, these biochemical effects are associated with improved surgical outcomes, such as pain and/or anxiety. ...
Background
An amplified and/or prolonged surgical stress response might overcome the organs’ functional reserve, thus leading to postoperative complications. The aim of this systematic literature review is to underline how specific psychological interventions may contribute to improve surgical outcomes through the positive modulation of the surgical stress response in surgical patients.
Methods
We conducted a comprehensive literature search in the Cochrane Register of Controlled Trials, PubMed, EMBASE, Scopus, PsycINFO, and CINAHL databases. Only studies published in English from Jan 2000 to Apr 2022 and reporting pain and/or anxiety among outcome measures were included in the review. The following psychological interventions were considered: (1) relaxation techniques, (2) cognitive-behavioral therapies, (3) mindfulness, (4) narrative medicine, (5) hypnosis, and (6) coping strategies.
Results
Among 3167 records identified in the literature, 5 papers were considered eligible for inclusion in this review because reporting the effects that psychological features have on neurochemical signaling during perioperative metabolic adaptation and those metabolic and clinical effects that the psychological interventions had on the observed population.
Conclusion
Our findings confirm that psychological interventions may contribute to improve surgical outcomes via the positive influence on patients’ metabolic surgical stress response. A multidisciplinary approach integrating physical and non-physical therapies can be considered a good strategy to successfully improve surgical outcomes in the perioperative period.
... The "immediate" means there were no follow-up analysis has been done, days or weeks after the intervention, only immediately after it. The participants who received MBST reported significantly reduced perceived stress, anxiety and depression scores, and increased hopefulness and perceived self-efficacy, which has similar outcomes with the earlier randomised (Kenne-Sarenmalm et al., 2017;Compen et al., 2019;Lorca et al., 2019;Shao et al., 2020) and non-randomised (Witek-Janusek et al., 2008;Monti et al., 2012) mindfulness studies, except MBST has a greater reduced length in intervention time. Lemanne and Maizes (2018) claim that there are mixed findings regarding the usefulness of guided imagery for alleviating stress, anxiety, and depression in cancer patients (Redd et al., 2001). ...
Objective
Combining 3rd-wave-therapies with Cognitive-Behavioural-Therapy (CBT) has increased in recent years. Usually these therapies require longer sessions which therefore increases the psychotherapy drop-out rate for cancer patients for multiple medical reasons. This inspired intervention of a shorter 20 min-long mindfulness-therapy (MBST) to be developed for Breast-Cancer-patients (BC).
Method
This pilot randomised controlled trial was to assess the immediate-outcome of the MBST-intervention for its efficacy for BC-patients by using the Pearson Chi-square test, Fisher–Freeman–Halton exact test, and McNemar test for categorical variables; Mann–Whitney U and Wilcoxon test for the continuous variables. The Emotion Thermometer, State Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Self-Efficacy for Managing Chronic Disease, and Beck’s Hopelessness Scale were used for measuring the intervention outcomes. One hundred seventy-three BC patients were randomly assigned in two-groups (equal-mean-age, p = 0.417). Control-Group (CG, n = 82) received cognitive-disputation-technique a form-of-CBT, and Intervention-Group (IG, n = 74) received MBST. The directives are given to IG: psychoeducation about Mindfulness, and to imagine themselves swinging-in a peaceful environment. When the patients imagine their swing going up, they physically take a deep-breath, and when going down they physically release their breath, and this process is repeated.
Result
Outcomes post-treatment showed significant higher-improvement in IG in all the assessed-measurements, with large-effect-size: anxiety (p < 0,05, r = 0,67) and depression-levels (p < 0,05, r = 0,71); anxiety-trait (p < 0,05; r = 0,79) reduced, it increases self-efficacy for managing-disease (p < 0,05, r = 0,82) as-well-as hopefulness (p < 0,05, r = 0,61) and saturation-level measured by pulse-meter/oximeter (p < 0,05, r = 0,51).
Conclusion
MBST is an efficacious intervention to reduce psychotherapy session time for immediate relief from clinical anxiety and hopelessness as well as increase self-efficacy and improve tranquillity for BC-women. It may have a particular clinical significance for supporting patient’s adherence to treatment. Although in this pilot sample MBST was found to be effective for short-term-outcome, its efficacy for longer-term-outcome should be examined in future trials. Additionally, breathing laps can be increased possibly for a greater result on rise of saturation levels of patients.
... reported improvements related to both the physical (pain, inflammation, fatigue, and sleep symptoms) and psychological (anxiety, depression, emotional regulation, and spiritual) components of Quality of Life [39,43,44]. The hypothesis that this improvement in Quality of Life is due to individual and group psychoncological interventions can be supported by the literature, which shows that Mindfulness-based programs that also include meditation, relaxation, and daily practice, may lead to a significant improvement in psychological wellbeing [45]. We hope this hypothesis will be supported by future research on experimental and control groups for the purpose of generating evidence-based scientific data. ...
In the last decade, Mindfulness-based interventions have been increasingly used in health care settings, particularly in the context of cancer. Research documents the efficacy of these interventions for decreasing the burdens of stress, anxiety, depression, fatigue, sleep disorders, and other symptoms. This article describes the case report of a patient with breast cancer, highlighting her personality, defense mechanisms, and traumatization connected with the disease. General information about the patient’s personal and medical history is presented in addition to the trajectory of psychoncological support, focusing on objectives, intervention strategies based on Mindfulness, and outcomes. The intervention is a combination of individual and group therapies, with particular reference to the use of Mindfulness in a group setting. The goal is to provide the patient with both a peer sharing experience as well as the tools to manage psychoemotional reactions through the development of awareness and a better relationship with herself. The main hypothesized consequences are an increase in self-esteem and coping strategies, which are necessary for a successful adaptation to cancer. The objective of the Mindfulness intervention is to promote the maintenance of an adequate Quality of Life (QoL) and psychological well-being, during and after treatment, transferring these skills into daily life.
... [71] For example, in patients with breast cancer, cognitive-behavioral stress management (CBSM) and mindfulness-based stress reduction (MBSR) can reverse the anxiety-related upregulation of circulating leukocyte proinflammatory gene expression. [53,72,73] Similar to most medical interventions for cancer, the effectiveness of psychosocial interventions may vary with the type and stage of cancer, patient characteristics, and the type and extent of health behavior interventions. More importantly, epidemiological evidence related to psychological and social factors provides evidence for studying the biological signaling pathways and mechanisms underlying these observations. ...
Chronic stress refers to continuous emotional changes and psychological pressure that individuals experience when they are unable to adjust and stabilize the internal environment over an extended period. It can increase the pressure on endocrine mediators and cytokines in the circulation, as well as tissues throughout the hypothalamic-pituitary-adrenaline (HPA) axis and sympathetic nervous system (SNS); thus, evolving the internal environment of the tumor. This review assesses several key issues, involving psychosocial factors, and integrates clinical, cellular, and molecular studies—as well as the latest research progress—to provide a mechanistic understanding regarding breast oncopsychology. We propose that chronic stress contributes to large individual differences in the prognosis of breast cancer survivors because they change the basic physiological processes of the endocrine and immune systems, which in turn regulate tumor growth. The study of psychological and physiological reactions of breast cancer patients suggests a new idea for psychological intervention and clinical treatment for breast cancer patients.
... Another controlled clinical trial on 75 patients with early-stage breast cancer, looked at the effects of a yoga mindfulness-based stress reduction (MBSR) intervention versus a control group that received the study assessments only on immune function and quality of life. MBSR was delivered for 2.5 hours per week, for 8 weeks, and it included yogic techniques such as breath awareness exercises, meditation, and mindful yoga [84]. Women enrolled in the intervention had lower cortisol levels, higher quality of life scores and increased coping effectiveness following the sessions. ...
Yoga is an ancient system for integrating the mind, body, and spirit. In the hatha yoga ashtanga tradition (the eight limb Patanjali Yoga), three of the limbs are meditation, breathwork (pranayama) and physical postures (asana), which are widely practised in yoga classes. The benefits of yoga for mental and physical health are rooted in the practice's origins: in yoga, stress is said to be the root of all diseases.
The established fields of psychoneuroimmunology and immunopsychiatry study the interplay between the immune system and mood or mental states. This mini-review has shifted the emphasis from research that focuses on yoga's benefits for stress, the most commonly studied outcome of yoga research, to a summary of the research on the effects of yoga practices on the immune system. The current literature bears strong evidence for the benefits of yoga on the levels of circulating cortisol and classical inflammatory markers, such as C-reactive protein (CRP) and cytokines such as interleukin-1 beta (IL-1β), interleukin 6 (IL-6), tumour necrosis factor-alpha (TNF-α) and interferon-gamma (INF-γ). The evidence for other less studied markers, telomerase activity, β-endorphins, Immunoglobulin A (IgA) and brain-derived neurotrophic factor (BDNF) is also growing. This mini-review centres around the interplay between yoga and these markers in stress management and depression, vascular and immune function in the older population, cardiovascular and metabolic diseases, auto-immune diseases, breast cancer and pregnancy.
Overall, the literature examined reveals the novelty of this field of research and sheds light on methodological challenges; however, it uncovers the potential for yoga to be used as adjuvant therapy in conditions with an inflammatory component.
... Prolonged stress can lead to chronic activation of the HPA-axis, which is commonly evaluated via circulating inflammatory cytokines such as interleukin (IL)-6 and indicators of systemic inflammation such as C-reactive protein (CRP) [26,27]. Studies in various samples of individuals affected by cancer have found that MBSR is associated with decreased concentrations of proinflammatory cytokines [25,[28][29][30], though findings related to CRP are mixed [24,31]. Moreover, research shows that MBSR is associated with reduced blood pressure in samples of individuals affected by cancer [25,32], which could be protective for cardiovascular risk. ...
Background:
This was a secondary analysis of a pilot randomized controlled trial (RCT) of mindfulness-based stress reduction (MBSR) among young adult (YA) survivors of cancer, which showed preliminary evidence for improving psychosocial outcomes. Secondary outcomes assessed were the feasibility of collecting biological data from YAs and preliminary effects of MBSR on markers of inflammation and cardiovascular function.
Method:
Participants were randomized to 8-week MBSR or a waitlist control condition. Participants provided whole blood spot samples for analysis of C-reactive protein (CRP) and interleukin (IL)-6 as well as blood pressure data in-person at baseline and 16-week follow-up. Feasibility was assessed with rates of providing biological data. Linear mixed effects modeling was used to evaluate preliminary effects of MBSR on inflammatory markers and blood pressure over time.
Results:
Of 126 total participants enrolled, 77% provided biological data at baseline (n = 48/67 MBSR, n = 49/59 control). At 16 weeks, 97% of the 76 retained participants provided follow-up biological data (n = 34/35 MBSR, n = 40/41 control). Relative to the control group, MBSR was associated with decreased systolic blood pressure (p = 0.042, effect sizes (ES) = 0.45) and decreased diastolic blood pressure (p = 0.017, ES = 0.64). There were no changes in CRP or IL-6.
Conclusion:
This was the first study to explore the feasibility of collecting biological data from YA survivors of cancer and assess preliminary effects of MBSR on inflammatory and cardiovascular markers in an RCT. Minimally invasive biological data collection methods were feasible. Results provide preliminary evidence for the role of MBSR in improving cardiovascular outcomes in this population, and results should be replicated.
... The process was relatively heterogeneous but primarily focused on adult populations across the world. Journal of Inflammation Research 2021:14 https://doi.org/10.2147/JIR.S323356 DovePress 4863 Gonzalez-Garcia et al, 2014; 66 Javanmard et al, 2016; 67 Lengacher et al, 2013; 68 Qin et al, 2020a, 69 2020b; 69 Rausch-Fan et al, 2002; 70 Raygan et al, 2019; 71 Rosenkranz et al, 2016; 72 Shete et al, 2017; 73 Smolen et al, 2008;74 Wang et al, 2020;75 Witek-Janusek et al, 2008;76 Zhang et al, 2020. 39 ...
Introduction:
COVID-19 poses a chronic threat to inflammatory systems, reinforcing the need for efficient anti-inflammatory strategies. The purpose of this review and analysis was to determine the efficacy of various interventions upon the inflammatory markers most affected by COVID-19. The focus was on the markers associated with COVID-19, not the etiology of the virus itself.
Methods:
Based on 27 reviewed papers, information was extracted on the effects of COVID-19 upon inflammatory markers, then the effects of standard treatments (Remdesivir, Tocilizumab) and adjunctive interventions (vitamin D3, melatonin, and meditation) were extracted for those markers. These data were used to approximate effect sizes for the disease or interventions via standardized mean differences (SMD).
Results:
The data that were available indicated that adjunctive interventions affected 68.4% of the inflammatory markers impacted by COVID-19, while standard pharmaceutical medication affected 26.3%.
Discussion:
Nonstandard adjunctive care appeared to have comparable or superior effects in comparison to Remdesivir and Tocilizumab on the inflammatory markers most impacted by COVID-19. Alongside standards of care, melatonin, vitamin D3, and meditation should be considered for treatment of SARS-COV-2 infection and COVID-19 disease.
... Importantly, Antoni and Dhabhar 8 suggested that stress-management interventions can have physiological protective effects against tumour progression through improving protective immunity (for example, immunosurveillance), reducing chronic inflammatory processes and inhibiting immunosuppressive mechanisms (for example, regulatory T cell activity). Indeed, in breast cancer survivors, yoga and tai chi reduced pro-inflammatory processes 312,313 , and mindfulness-based stress reduction increased the T helper 1 cell (T H 1)/T helper 2 cell (T H 2) ratio 314 , decreased nuclear factor-κB (NF-κB) activity and increased anti-inflammatory signalling and gene expression of type 1 interferon 315 . Similar effects were noted by Antoni, studying the effects of a cognitive behavioural therapy (CBT)-based stress-management intervention in patients with breast cancer following surgery 316 . ...
The notion that stress and cancer are interlinked has dominated lay discourse for decades. More recent animal studies indicate that stress can substantially facilitate cancer progression through modulating most hallmarks of cancer, and molecular and systemic mechanisms mediating these effects have been elucidated. However, available clinical evidence for such deleterious effects is inconsistent, as epidemiological and stress-reducing clinical interventions have yielded mixed effects on cancer mortality. In this Review, we describe and discuss specific mediating mechanisms identified by preclinical research, and parallel clinical findings. We explain the discrepancy between preclinical and clinical outcomes, through pointing to experimental strengths leveraged by animal studies and through discussing methodological and conceptual obstacles that prevent clinical studies from reflecting the impacts of stress. We suggest approaches to circumvent such obstacles, based on targeting critical phases of cancer progression that are more likely to be stress-sensitive; pharmacologically limiting adrenergic–inflammatory responses triggered by medical procedures; and focusing on more vulnerable populations, employing personalized pharmacological and psychosocial approaches. Recent clinical trials support our hypothesis that psychological and/or pharmacological inhibition of excess adrenergic and/or inflammatory stress signalling, especially alongside cancer treatments, could save lives.
The incidence rate of cancer is increasing year by year due to the aging of the population, unhealthy living, and eating habits. At present, surgery and medication are still the main treatments for cancer, without paying attention to the impact of individual differences in health management on cancer. However, increasing evidence suggests that individual psychological status, dietary habits, and exercise frequency are closely related to the risk and prognosis of cancer. The reminder to humanity is that the medical concept of the unified treatment plan is insufficient in cancer treatment, and a personalized treatment plan may become a breakthrough point. On this basis, the concept of “Humanistic Health Management” (HHM) is proposed. This concept is a healthcare plan that focuses on self‐health management, providing an accurate and comprehensive evaluation of individual lifestyle habits, psychology, and health status, and developing personalized and targeted comprehensive cancer prevention and treatment plans. This review will provide a detailed explanation of the relationship between psychological status, dietary, and exercise habits, and the regulatory mechanisms of cancer. Intended to emphasize the importance of HHM concept in cancer prevention and better prognostic efficacy, providing new ideas for the new generation of cancer treatment.
Various reviews and meta‐analyses have shown the positive effects of mindfulness‐based interventions (MBIs) on the mental health of cancer patients and survivors. Some studies have also investigated the impact of MBIs on physiological markers of health in oncology, but a systematic review has not been conducted in this field. The current paper aims to fill this gap in the literature. Following preferred reporting items for systematic reviews and meta‐analyses 2020 guidelines, data were obtained from the databases of Pubmed, Scopus, Web of Science in May 2022. Twenty‐five studies were included. Globally, 35 biomarkers were employed in these studies and were categorized 8 groups (cortisol; blood pressure (BP), heart rate, and respiratory rate; C‐reactive protein; telomere length and telomerase activity (TA); genetic signature; cytokines and hormones; leucocyte activation; leucocyte count and cell subpopulation analysis). In seven of these categories of biomarkers, positive effects of MBIs were observed. The most promising results were obtained for cortisol, BP, TA and pro‐inflammatory gene expression. However, the generally low number of studies per single biomarker limits the possibility to draw reliable conclusions. The present review presents a comprehensive state‐of‐the‐art for MBIs in oncology on biomarkers, confirming MBIs' potential for improving physiological health in cancer patients and survivors besides those already shown in literature on psychological well‐being.
Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors’ quality of life.
Integrasi Kedokteran Keluarga dan Islam dalam Praktik Kedokteran Layanan Primer
Karakteristik dari ilmu kedokteran keluarga adalah memberikan perhatian berimbang aspek biomedik penyakit juga konteks pasien yang mengalami penderitaan sakit dan keluarganya. Islam di satu sisi merupakan agama komprehensif dan holistik yang memberikan pencerahan dan pengaturan pada berbagai aspek kehidupan manusia baik di ruang publik maupun di ruang internal psiko-sosio-spritiual seseorang. Praktik kedokteran layanan primer merupakan ujung tombak dari sistem kesehatan nasional. Praktik kedokteran layanan primer mempunyai beban ganda yang berat yakni penyakit menular dan kekurangan gizi yang belum kunjung tuntas, di sisi lain penyakit tidak menular katastrotik menjadi beban lebih tambahan, mengingat biaya tinggi dalam pengelolannya di layanan sekunder. Integrasi ilmu kedoteran keluarga dan Islam dalam praktik kedokteran layanan diharapkan dapat menjadi inspirasi agar pasien dan keluarga dapat engage dengan upaya kesehatan yang dicanangkan dokter.
Dopamine, norepinephrine, and epinephrine are endogenous catecholamines, known to play many different roles in the body, such as increasing heart rate, blood pressure, and blood glucose, controlling movement, and acting on mood and behavior. Catecholamines were first described as neurotransmitters of the sympathetic nervous system, but they also act as hormones released by the adrenal medulla, and increasing evidence indicates their crucial role in the immune system. In this chapter, we will describe how catecholamines modulate immune cells in physiologic as well as pathologic conditions and provide evidence indicating that catecholamines are also to be considered cytokines, that is compounds synthesized by immune cells, which act as local intercellular signaling mediators. We will then describe how this knowledge will be helpful for new therapeutic strategies.
The direct relationship between good health and positive emotions has been demonstrated at length by current literature. Instead, only a few studies have focused on the psycho-physiological constructs that relate to positive emotions. This chapter explores specific psycho-neuro-metabolic and immunologic processes that explain the underpinnings of positive psychology. Specifically, the primary objective of this chapter is to explore the epigenetic connection between the psychological/experiential and physiological biomarker levels by assessing the key roles of the: (a) the dopaminergic system, (b) cholinergic anti-inflammatory pathway, and (c) interoceptive information.
To date, there is no established treatment for facial numbness or dysesthesia of unspecified causes. Herein, we report a case of unexplained facial numbness and confirmed hypesthesia that achieved clinical response to stellate ganglion blockade (SGB). SGB might be an effective treatment of psychological stress‐related facial numbness of unknown origin. To date, there is no established treatment for facial numbness or dysesthesia of unknown origin. A 50‐year‐old man with no history of psychosomatic consultation and a tendency toward anxiety on the Hospital Anxiety and Depression Scale presented with facial numbness. He was successfully treated using a stellate ganglion block (SGB).
Psychosocial and stress-related factors (PSFs), defined as internal or external stimuli that induce biological changes, are potentially modifiable factors and accessible targets for interventions that are associated with adverse pregnancy outcomes (APOs). Although individual APOs have been shown to be connected to PSFs, they are biologically interconnected, relatively infrequent, and therefore challenging to model. In this context, multi-task machine learning (MML) is an ideal tool for exploring the interconnectedness of APOs on the one hand and building on joint combinatorial outcomes to increase predictive power on the other hand. Additionally, by integrating single cell immunological profiling of underlying biological processes, the effects of stress-based therapeutics may be measurable, facilitating the development of precision medicine approaches.
Objectives
The primary objectives were to jointly model multiple APOs and their connection to stress early in pregnancy, and to explore the underlying biology to guide development of accessible and measurable interventions.
Materials and Methods
In a prospective cohort study, PSFs were assessed during the first trimester with an extensive self-filled questionnaire for 200 women. We used MML to simultaneously model, and predict APOs (severe preeclampsia, superimposed preeclampsia, gestational diabetes and early gestational age) as well as several risk factors (BMI, diabetes, hypertension) for these patients based on PSFs. Strongly interrelated stressors were categorized to identify potential therapeutic targets. Furthermore, for a subset of 14 women, we modeled the connection of PSFs to the maternal immune system to APOs by building corresponding ML models based on an extensive single cell immune dataset generated by mass cytometry time of flight (CyTOF).
Results
Jointly modeling APOs in a MML setting significantly increased modeling capabilities and yielded a highly predictive integrated model of APOs underscoring their interconnectedness. Most APOs were associated with mental health, life stress, and perceived health risks. Biologically, stressors were associated with specific immune characteristics revolving around CD4/CD8 T cells. Immune characteristics predicted based on stress were in turn found to be associated with APOs.
Conclusions
Elucidating connections among stress, multiple APOs simultaneously, and immune characteristics has the potential to facilitate the implementation of ML-based, individualized, integrative models of pregnancy in clinical decision making. The modifiable nature of stressors may enable the development of accessible interventions, with success tracked through immune characteristics.
Patients with cancer and their caregivers are exposed to various disease- and treatment-related challenges along the illness and recovery continuum that elicit anxiety, emotional distress, and a depressed mood. Mindfulness-based practices facilitate the individual’s adjustment to stress by downregulating biological and behavioral stress response systems and by attenuating emotional reactivity to stressors. Regular practice may also gently shift the mind toward living fully in the present rather than in a fearful future or a mourned past. Mindful practices are particularly well suited to individuals with chronic illnesses such as cancer. The relaxation response technique is an expedient and effective mindfulness strategy that may be carried out with the patient or caregiver at the bedside or in clinic one on one or in a group workshop. The clinical benefits of other mindful practices such as the manualized 6–8-weekly mindfulness-based cancer recovery program offered in workshops are particularly suited for cancer survivors. MM is part of a comprehensive multimodal, multi-targeted approach that facilitates healing and resilience.KeywordsCancer careThe relaxation response techniqueMindful meditation practicesHealing and resilient technique
Bu araştırmanın amacı, üniversite öğrencilerinde bilinçli farkındalık ile otomatik düşünceler arasında ki ilişkide öz anlayışın aracılık rolünün olup olmadığını belirlemektir. Bununla birlikte, araştırmanın bir diğer amacı bilinçli farkındalık, öz anlayış ve otomatik düşüncelerin cinsiyete göre farklılaşıp farklılaşmadığının saptanmasıdır. Araştırmanın örneklemini 268’i (%69.6) kadın 117’si (%30.4) erkek olmak üzere toplam 385 üniversite öğrencisi oluşturmaktadır. Araştırmada veri toplamak amacıyla “Kişisel Bilgi Formu”, “Bilinçli Farkındalık Ölçeği”, “Öz Anlayış Ölçeği” ve “Otomatik Düşünceler Ölçeği” kullanılmıştır. Verilerin analizinde t testi, Pearson korelasyon analizi ve regresyon temelli bootstrapping yöntemi kullanılmıştır. Analiz sonuçlarına göre, erkek öğrencilerin öz anlayış düzeylerinin kız öğrencilere göre anlamlı düzeyde daha yüksek olduğu belirlenmiştir. Bununla birlikte, bilinçli farkındalık ile öz anlayış arasında pozitif yönlü anlamlı bir ilişki saptanmıştır. Bilinçli farkındalık ve öz anlayış ile otomatik düşünceler arasında ise negatif yönlü anlamlı ilişkiler bulunmuştur. Aracılık analizi sonuçlarına göre; bilinçli farkındalık ile otomatik düşünceler arasındaki ilişkiye öz anlayışın aracılık ettiği belirlenmiştir. Elde edilen sonuçlar ilgili alanyazın ışığında tartışılmaya çalışılmış ve öneriler sunulmuştur.
Introduction: Active duty (AD) women suffer with chronic pelvic pain (CPP) while providers tackle diagnoses and treatments to keep them functional without contributing to the opioid epidemic. The purpose of this randomized trial was to determine the effectiveness of noninvasive, self-explanatory mindfulness-based stress reduction (MBSR) or self-paced healthy lifestyle (HL) interventions on CPP in AD women. Methods: A 6-week, interventional prospective study with AD women aged 21-55 years at Mountain Home (MTHM), Idaho, was conducted. Women were randomly assigned to MBSR (N = 21) or HL (N = 20) interventions. The primary outcome was pain perception. The secondary outcomes were depression and circulating cytokine levels. Results: Women in the MBSR group exhibited reduced pain interference (p < 0.01) and depression (p < 0.05) alongside decreased interleukin (IL)-4 (p < 0.05), IL-6 (p < 0.05), eotaxin (p < 0.05), monocyte chemoattractant protein-1 (p = 0.06), and interleukin-1 receptor antagonist (IL-1ra) (p < 0.01) and increased vascular endothelial growth factor (p < 0.05). Women in the HL group did not have changes in pain; however, they did exhibit reduced depression (p < 0.05) alongside decreased granulocyte-macrophage colony-stimulating factor (p < 0.05) and increased tumor necrosis factor alpha (p < 0.05), stromal cell-derived factor-1 (p < 0.01), and IL-1ra (p < 0.01). Conclusions: AD women receiving MBSR or HL had reduced depression scores and altered circulating cytokine levels; however, only those receiving MBSR had reduced pain perception. Findings support MBSR as an effective and viable behavioral treatment for AD women suffering from CPP and provide premise for larger randomized controlled studies. Clinical Trial Registration: MOCHI-An RCT of mindfulness as a treatment for CPP in AD Women NCT04104542 (September 26, 2019).
SECCION IX. Síndrome Post COVID-19: complicaciones tardías y rehabilitación
To date, there is no established treatment of facial numbness or dysaesthesia of unspecified causes. Herein, we report a case of unexplained facial numbness and confirmed hypaesthesia that achieved clinical response to stellate ganglion blockade (SGB). SGB might be an effective treatment of psychological-stress-related facial numbness of unknown origin.
The stress in human life has become undeniable, so that studies on stress have
been being carried out for a long time. As the stress arises into different processes and
symptoms that vary according to the time and conditions experienced, and as the ways
of coping change from individual to another one and from culture to the other cultures,
these lead to the execution of different types of studies on stress.
This study is an empirical study that examines the effects of a stress reduction
program based on culturally responsive and mindfulness fundamentals, on the level of
life satisfaction, mindfulness and stress levels of individuals. In the study, pre-test posttest control group pattern which is frequently used in experimental studies was used. In
the 2x3 split-plot design, the first factor represents treatment groups (an experiment and
a control group); the second factor represents the measures of the dependent variables
(pre-test, post-test, follow-up test). There are an independent; and three dependent
variables in the research model. The independent variable of the study is the "Culturally
Responsive Stress Program" (CRSP); and the dependent variables are life satisfaction,
mindfulness and stress levels.
Because the study was conducted with an experimental pattern, the "study
group" was used in the research rather than the universe and the sampling process. The
study group of this research consists of the students getting education in Van Yüzüncü
Yıl University, ErciĢ Vocational School, during the academic year of 2017/2018. The
"Mindfulness Awareness Scale", "Life Satisfaction Scale" and "Perceived Stress Scale"
used in the study were applied to 331 students getting education at ErciĢ Vocational
School. According to the results obtained from the scales, having validity and reliability
studies, 40 students with low mindfulness and life satisfaction levels and high stress
levels were selected. These students were assigned to the experimental and control
groups, randomly. For the experiment group, the techniques in the context of the CRSP
were applied for eight sessions. For the control group, any intervention was not applied.
viii
Obtained findings showed that the prepared program was effective on the three
variables considered in the study. At the mindfulness levels, the pre-test mean of the
experimental group was x =39,85 while the post-test mean was increased to x =76,10. In
the follow-up test, the mean of the experimental group's points was found as x =72,60.
When looking at the means, it can be seen that the levels of mindfulness points of the
participants were increased and according to the follow-up test results persistence was
going on. These findings show that the program has an effect on mindfulness levels. As
a result of literature surveys, these findings were supported. According to life
satisfaction points, the mean of the participants' points in the experimental group was
x =9,95 in pre-test, while the post-test mean was increased to x =19,20. For the follow-up
test, the mean of the experimental group's points was x =18,85. Taking these findings
into account, it is possible to say that prepared program increases the life satisfaction
points and it supports the permanence of the attitude changes. Finally, when we look at
the stress variable, the mean of the experimental group's points in pre-test measures was
x =23,70; the mean of the post-test was x =8,30. In the follow-up test, the mean of the
experimental group's points was x =8,80. These findings show that the prepared program
is effective on the perceived stress scores and reduces the participant’s stress levels. It is
possible to say that the obtained point reductions were continued according to the
follow-up test results.
As a result of the analyzes, it was found that mean differences showed
significant differences between the groups in terms of three variables. As a result of the
findings, it can be revealed that CRSP is effective and permanent on all three variables.
Background: At 2005, stomach, gullet, breast and prostate cancer were diagnosed as the leading causes of cancer among Iranian population. The purpose of this pilot study with follow-up and control groups was to investigate the effectiveness of stress management and relaxation training for Women with Breast Cancer (B-SMART) in reducing the negative affect and improving quality of Life of women with breast cancer. Methods: The population of the study were all the women with breast cancer who referred to Mostafa Khomeyni Hospital and 18 patients based on inclusion and exclusion criteria were randomly allocated to experimental group (9 patients) and control group (9 patients). The stress management and relaxation training program for women with breast cancer was performed on the experimental group during 10 weekly sessions. PANAS questionnaire for Negative Affect and QLQ -C30, QLQ-Br23 questionnaires for quality of life, were completed by both groups before, after and 2 months after program. Results: The data analyzed using Variance for repeated measures (tests of within Subjects effects and between Subjects effects) revealed that B-SMART led to a significant decrease in negative affect and improvement in some subscales of quality of life in experimental group after training and 2 months later in comparison with the control group. Conclusion: Stress management and relaxation programs for women with breast cancer will increase their quality of life and psychological status.
The historic roots of contemplative practice can be traced back to traditions in Buddhism, Confucianism, Aristotelian thought, and Christianity, with the most common contemplative practices including breathing meditation, quiet sitting, prayer, tai-chi, qigong, and yoga. Contemplative practices in contemporary times include more activities than traditionally conceptualized, including meditative artistic pursuits (such as painting, sewing, or knitting), physical pursuits (such as running, weightlifting, or dancing), or quiet independent pursuits (such as listening to music). This chapter reviews the research supporting the ways that engaging in contemplative practices is effective in regulating one's emotional states. Additionally, this chapter proposes that engaging in contemplative practice can help a person become more reflexive in their interactions with others in order to socially regulate an emotional conversation.
Over three decades of research on the role of meditation in hypertension have shown beneficial effects. The authors glue together the effects of different forms of meditation on hypertension from the earliest to the latest.KeywordsMeditationCardiovascular diseaseRisk factorsPsychological stressStress reductionMBSRTMYoga
This chapter advances the description and exploration of real mindfulness and the personal understanding and practices of it that were provided in the previous chapter to the understanding and practice of mindfulness in practice, including clinical mindfulness. The essence of clinical mindfulness is that it is mindfulness that is applied—to therapeutic, counselling, workplace and other professional settings—where it can help a wide range of people with a wide range of life problems.
In this paper, we examine how pension eligibility affects the psychological distress levels of older women in Australia by exploiting the exogenous changes in the eligibility ages of the old Age Pension (AP). The unique features of the Australian AP allow us to study the impact of the reform on the non‐working, as well as on the working population. The empirical results show that pension eligibility has a modest but consistently beneficial effect on psychological stress levels. Reaching pension eligibility significantly reduces the stress levels of women who were out of the labor force, indicating the positive role of the AP for disadvantaged groups. At the same time, women with strenuous jobs experience a significant improvement in their stress levels when they transit into retirement. We show that an improvement in stress levels accompanies an increase in financial security and improvements in social participation and health behaviors. Our results highlight the potentially overlooked consequences of pension reforms for the well‐being of vulnerable populations and for health inequalities across socio‐economic groups.
There is a psychosocial component to many physical health conditions, such that chronic and acute psychological distress can trigger the physiological stress response and lead to unhealthy lifestyle behaviors which may alone and in combination contribute to risk for, or exacerbate symptoms of, many medical conditions including cancer, pain, cardiovascular conditions, HIV/AIDS, and irritable bowel syndrome. Mindfulness-based interventions help to target many elements of the disease process which contribute to the experience of subjective stress including lack of control, unpredictability, symptom burden, fear of death, grief, and loss. We briefly review the empirical research across a range of conditions which supports the use of MBIs for symptom and distress management, as well as their effects on stress and disease biomarkers that may play a role in the disease process. Recommendations for methodological improvements and future directions are also included.KeywordsMindfulnessMindfulness-based stress reduction (MBSR)CancerImmune systemInflammationNatural killer (NK) cellsCytokine levels CortisolTelomere lengthTelomere activityPainCardiovascular diseaseCardiovascular systemHypertensionHuman immunodeficiency virus (HIV)Irritable bowel syndrome (IBS)Irritable bowel disease (IBD)
Mindfulness-Based Cognitive Therapy (MBCT) has a strong evidence base for the prevention of depressive relapse and for resolving residual symptoms in patients with recurrent depression. Meta-analytic studies demonstrate that MBCT outperforms non-active controls, and performs on par with maintenance antidepressant medication. Initial studies suggest that these treatment effects result from the development of skills in metacognitive awareness that inform affect regulation and are easily incorporated into daily routines. MBCT has been effectively extended to a variety of patient populations and most recently has been digitized to enable web-based delivery and increase dissemination. To maximize public health impact, future research will need to examine how MBCT can be integrated into depression care pathways offered to patients at front line points of care.
In this study, we examined the secretory immune system, the body's first line of defense against invading organisms, and its relation to daily fluctuations of mood. Specifically, secretory immunoglobulin A (sIgA) was studied. Unlike other psychoimmunity studies that examined all sIgA protein regardless of specificity to invading organisms, ours examined an antigen-specific sIgA response to the oral administration of a harmless protein (rabbit albumin) and monitored the antibody produced in response to the protein. Dental students recorded their daily mood thrice weekly for 8⅓ weeks, and parotid saliva was obtained from subjects during these contacts. Using a within-subjects analyses strategy, we found that antibody response was lower on days with high negative mood relative to days with lower negative mood, and conversely, sIgA antibody response was higher on days with high positive mood relative to days with lower positive mood. Results from total sIgA protein were in the opposite direction, although not significantly so. These results extend our knowledge of immunological changes and mood, and they suggest that minor life events' role in health may be mediated by the secretory immune system.
This study is presented as a model for studying the psychosocial sequelae of successful cancer treatment. It compares the psychological adjustment of 60 male Hodgkin’s disease survivors, aged 20–47, with an aged-matched sample of 20 physically healthy men. Assessment included objective self-report, projective testing, observer rating, and interview. All participants had received no treatment and had shown no evidence of disease for the previous 6–140 months (median 2 years). On most measures, no differences were found between cancer survivors and healthy controls. However, the hypothesis of greater psychosocial dysfunction in the cancer sample overall was partially confirmed by significantly lowered intimacy motivation, increased avoidant thinking about illness, prolonged difficulty in returning to premorbid work status, and illness-related concerns. Conversely, cancer patients were significantly more appreciative of life than nonpatients. Within the patient group, late stage (aggressively treated) patients were found to be at highest risk for psychological distress and psychosocial disruption during the first 2 years off treatment.
Objective.
—This article defines stress and related concepts and reviews their historical development. The notion of a stress system as the effector of the stress syndrome is suggested, and its physiologic and pathophysiologic manifestations are described. A new perspective on human disease states associated with dysregulation of the stress system is provided.
Natural killer (NK) cells are thought to provide the first line of defence against tumors, particularly major histocompatibility complex (MHC) class I− variants. We have confirmed in C57BL/6 (B6) mice lacking perforin that peritoneal growth of MHC class I− RMA-S tumor cells in unprimed mice is controlled by perforin-dependent cytotoxicity mediated by CD3− NK1.1+ cells. Furthermore, we demonstrate that B6 mice lacking tumor necrosis factor (TNF) are also significantly defective in their rejection of RMA-S, despite the fact that RMA-S is insensitive to TNF in vitro and that spleen NK cells from B6 and TNF-deficient mice are equally lytic towards RMA-S. NK cell recruitment into the peritoneum was abrogated in TNF-deficient mice challenged with RMA-S or RM-1, a B6 MHC class I− prostate carcinoma, compared with B6 or perforin-deficient mice. The reduced NK cell migration to the peritoneum of TNF-deficient mice correlated with the defective NK cell response to tumor in these mice. By contrast, a lack of TNF did not affect peptide-specific cytotoxic T lymphocyte–mediated rejection of tumor from the peritoneum of preimmunized mice. Overall, these data show that NK cells delivering perforin are the major effectors of class I− tumor rejection in the peritoneum, and that TNF is specifically critical for their recruitment to the peritoneum.
The diagnosis of breast cancer creates emotional distress for patients as well as family members. This article reviews studies on the psychological adjustment of women and their family members during the diagnosis, hospitalization, and early convalescence from breast surgery. Studies indicate that the diagnostic phase is an extremely stressful time for women, marked by high anxiety, uncertainty, and difficulty making decisions. The hospital phase is especially difficult for spouses, who must juggle work responsibilities with added home responsibilities and also spend time at the hospital supporting their wives. In the convalescent phase, patients and family members need to adjust to changes in family roles, cope with fears about recurrence, and learn to balance the needs of all family members. In order to provide high quality health care to breast cancer patients and their family members, physicians and nurses need to address the emotional as well as the physical aspects of recovery.
This article defines stress and related concepts and reviews their historical development. The notion of a stress system as the effector of the stress syndrome is suggested, and its physiologic and pathophysiologic manifestations are described. A new perspective on human disease states associated with dysregulation of the stress system is provided.
Published original articles from human and animal studies and selected reviews. Literature was surveyed utilizing MEDLINE and the Index Medicus.
Original articles from the basic science and human literature consisted entirely of controlled studies based on verified methodologies and, with the exception of the most recent studies, replicated by more than one laboratory. Many of the basic science and clinical studies had been conducted in our own laboratories and clinical research units. Reviews cited were written by acknowledged leaders in the fields of neurobiology, endocrinology, and behavior.
Independent extraction and cross-referencing by the authors.
Stress and related concepts can be traced as far back as written science and medicine. The stress system coordinates the generalized stress response, which takes place when a stressor of any kind exceeds a threshold. The main components of the stress system are the corticotropin-releasing hormone and locus ceruleus-norepinephrine/autonomic systems and their peripheral effectors, the pituitary-adrenal axis, and the limbs of the autonomic system. Activation of the stress system leads to behavioral and peripheral changes that improve the ability of the organism to adjust homeostasis and increase its chances for survival. There has been an exponential increase in knowledge regarding the interactions among the components of the stress system and between the stress system and other brain elements involved in the regulation of emotion, cognitive function, and behavior, as well as with the axes responsible for reproduction, growth, and immunity. This new knowledge has allowed association of stress system dysfunction, characterized by sustained hyperactivity and/or hypoactivity, to various pathophysiologic states that cut across the traditional boundaries of medical disciplines. These include a range of psychiatric, endocrine, and inflammatory disorders and/or susceptibility to such disorders.
We hope that knowledge from apparently disparate fields of science and medicine integrated into a working theoretical framework will allow generation and testing of new hypotheses on the pathophysiology and diagnosis of, and therapy for, a variety of human illnesses reflecting systematic alterations in the principal effectors of the generalized stress response. We predict that pharmacologic agents capable of altering the central apparatus that governs the stress response will be useful in the treatment of many of these illnesses.
We investigated the capacity of murine T lymphocytes, isolated from various lymphoid organs of normal or antigen-primed donors, to produce IL-2 or IL-4 after activation with anti-CD3 or specific antigen. Our results established that T cells resident within lymphoid organs being drained by nonmucosal tissue sites (e.g., axillary, inguinal, brachial lymph nodes, or spleen) produced IL-2 as the predominant T cell growth factor (TCGF) after activation. Conversely, activated T cells from lymphoid organs being drained by mucosal tissues (Peyer's patches, and cervical, periaortic, and parathymic lymph nodes) produced IL-4 as the major species of TCGF. Analysis of the lymphoid tissues obtained from adoptive recipients of antigen-primed lymphocytes provided by syngeneic donors provided evidence that direct influences were being exerted on T cells during their residence within defined lymphoid compartments. These lymphoid tissue influences appeared to be responsible for altering the potential of resident T cells to produce distinct species of TCGF. Steroid hormones, known transcriptional enhancers and repressors of specific cellular genes, were implicated in the controlling mechanisms over TCGF production. Glucocorticoids (GCs) were found to exert a systemic effect on all recirculating T cells, evidenced by a marked dominance in IL-4 production by T cells obtained from all lymphoid organs of GC-treated mice, or after a direct exposure of normal lymphoid cells to GCs in vitro before cellular activation with T cell mitogens. Further, the androgen steroid DHEA appeared to be responsible for providing an epigenetic influence to T cells trafficking through peripheral lymphoid organs. This steroid influence resulted in an enhanced potential for IL-2 secretion after activation. Anatomic compartmentalization of the DHEA-facilitated influence appears to be mediated by differential levels of DHEA-sulfatase in lymphoid tissues. DHEA-sulfatase is an enzyme capable of converting DHEA-sulfate (inactive) to the active hormone DHEA. We find very high activities of this enzyme isolated in murine macrophages. The implications of our findings to immunobiology are very great, and indicate that T cells, while clonally restricted for antigen peptide recognition, also appear to exhibit an extreme flexibility with regards to the species of lymphokines they produce after activation. Regulation of this highly conservative mechanism appears to be partially, if not exclusively, controlled by cellular influences being exerted by distinct species of steroid hormones, supplied in an endocrine or a paracrine manner where they mediate either systemic or tissue-localized influences, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)
Immune surveillance against tumors usually depends on T cell recognition of tumor antigens presented by major histocompatibility complex (MHC) molecules, whereas MHC class I- tumors may be controlled by natural killer (NK) cells. Perforin-dependent cytotoxicity is a major effector function of CD8+ MHC class I-restricted T cells and of NK cells. Here, we used perforin-deficient C57BL/6 (PKO) mice to study involvement of perforin and Fas ligand in tumor surveillance in vivo. We induced tumors in PKO and normal C57BL/6 mice by (a) injection of different syngeneic tumor cell lines of different tissue origin in naive and primed mice; (b) administration of the chemical carcinogens methylcholanthrene (MCA) or 12-O-tetradecanoylphorbol-13-acetate (TPA) plus 7,12-dimethylbenzanthracene (DMBA), or (c) by injection of acutely oncogenic Moloney sarcoma virus. The first set of models analyzes the defense against a tumor load given at once, whereas the last two sets give information on immune defense against tumors at the very moment of their generation. Most of the tumor cell lines tested were eliminated 10-100-fold better by C57BL/6 mice in an unprimed situation; after priming, the differences were more pronounced. Lymphoma cells transfected with Fas were controlled 10-fold better by PKO and C57BL/6 mice when compared to untransfected control cells, indicating some role for FasL in tumor control. MCA-induced tumors arose more rapidly and with a higher incidence in PKO mice compared to C57BL/6 or CD8-deficient mice. DMBA+TPA-induced skin papillomas arose with similar high incidence and comparable kinetics in both mouse strains. C57BL/6 and PKO mice have a similar incidence of Moloney murine sarcoma and leukemia virus-induced sarcomas, but tumors are larger and regression is retarded in PKO mice. Thus, perforin-dependent cytotoxicity is not only a crucial mechanism of both cytotoxic T lymphocyte- and NK-dependent resistance to injected tumor cell lines, but also operates during viral and chemical carcinogenesis in vivo. Experiments addressing the role of Fas-dependent cytotoxicity by studying resistance to tumor cell lines that were stably transfected with Fas neither provided evidence for a major role of Fas nor excluded a minor contribution of Fas in tumor surveillance.
We provide the first demonstration, using experimental and spontaneous models of metastasis in C57BL/6 (B6) (RM-1 prostate carcinoma) and BALB/c (DA3 mammary carcinoma) mice, that tumor metastasis is primarily controlled by perforin-dependent cytotoxicity mediated by NK1.1+ cells. MHC class Ilow RM-1 and DA3 tumor cells were sensitive in vitro to Fas-mediated lysis or spleen NK cells in a perforin-dependent fashion. Perforin-deficient NK cells did not lyse these tumors, and perforin-deficient mice were 10-100-fold less proficient than wild-type mice in rejecting the metastasis of tumor cells to the lung. Fas ligand mutant gld mice displayed uncompromised protection against tumor metastasis. Depletion of NK subsets resulted in greater numbers of metastases than observed in perforin-deficient mice, suggesting that perforin-independent effector functions of NK cells may also contribute to protection from tumor metastasis.
Natural cytotoxicity mediated by natural killer (NK) cells is believed to play an important role in host anticancer defense mechanisms. The aim of this study was to examine the prognostic significance of NK cell activity after hepatectomy in patients with hepatocellular carcinoma.
We investigated the capacity of murine T lymphocytes, isolated from various lymphoid organs of normal or antigen-primed donors, to produce IL-2 or IL-4 after activation with anti-CD3 or specific antigen. Our results established that T cells resident within lymphoid organs being drained by nonmucosal tissue sites (e.g., axillary, inguinal, brachial lymph nodes, or spleen) produced IL-2 as the predominant T cell growth factor (TCGF) after activation. Conversely, activated T cells from lymphoid organs being drained by mucosal tissues (Peyer's patches, and cervical, periaortic, and parathymic lymph nodes) produced IL-4 as the major species of TCGF. Analysis of the lymphoid tissues obtained from adoptive recipients of antigen-primed lymphocytes provided by syngeneic donors provided evidence that direct influences were being exerted on T cells during their residence within defined lymphoid compartments. These lymphoid tissue influences appeared to be responsible for altering the potential of resident T cells to produce distinct species of TCGF. Steroid hormones, known transcriptional enhancers and repressors of specific cellular genes, were implicated in the controlling mechanisms over TCGF production. Glucocorticoids (GCs) were found to exert a systemic effect on all recirculating T cells, evidenced by a marked dominance in IL-4 production by T cells obtained from all lymphoid organs of GC-treated mice, or after a direct exposure of normal lymphoid cells to GCs in vitro before cellular activation with T cell mitogens. Further, the androgen steroid DHEA appeared to be responsible for providing an epigenetic influence to T cells trafficking through peripheral lymphoid organs. This steroid influence resulted in an enhanced potential for IL-2 secretion after activation. Anatomic compartmentalization of the DHEA-facilitated influence appears to be mediated by differential levels of DHEA-sulfatase in lymphoid tissues. DHEA-sulfatase is an enzyme capable of converting DHEA-sulfate (inactive) to the active hormone DHEA. We find very high activities of this enzyme isolated in murine macrophages. The implications of our findings to immunobiology are very great, and indicate that T cells, while clonally restricted for antigen peptide recognition, also appear to exhibit an extreme flexibility with regards to the species of lymphokines they produce after activation. Regulation of this highly conservative mechanism appears to be partially, if not exclusively, controlled by cellular influences being exerted by distinct species of steroid hormones, supplied in an endocrine or a paracrine manner where they mediate either systemic or tissue-localized influences, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)
Objectives: This study examined the construct and criterion validity of the Mindful Attention Awareness Scale (MAAS) in cancer outpatients, using matched community members as controls. Methods: Cancer outpatients (n = 122) applying for enrollment in a mindfulness-based stress reduction (MBSR) program completed the MAAS and measures of mood disturbance and stress. Local community members (n = 122) matched to the patients on gender, age, and education level completed the same measures. Results: The single-factor structure of the MAAS was invariant across the groups. Higher MAAS scores were associated with lower mood disturbance and stress symptoms in cancer patients, and the structure of these relations was invariant across groups. Conclusions: The MAAS appears to have appropriate application in research examining the role of mindfulness in the psychological well-being of cancer patients, with or without comparisons to nonclinical controls. (c) 2005 Elsevier Inc. All rights reserved.
The purpose of the study on which this article is based was to assess the validity and reliability of an instrument designed to measure quality of life. Sixty-four items applicable to both healthy subjects and dialysis patients were tested with graduate students (n = 88); six items relative to dialysis were added, and the instrument was administered to dialysis patients (n = 37). Items were based on literature review, which supported content validity. Correlations between the instrument and an overall satisfaction with life question of 0.75 (graduate students) and 0.65 (dialysis patients) supported criterion-related validity. Support for reliability was provided by test-retest correlations of 0.87 (graduate students) and 0.81 (dialysis patients) and Cronbach's alphas of 0.93 (graduate students) and 0.90 (dialysis patients).
We have investigated the expression of AP-1 and NFkB in peripheral blood lymphocytes of women scheduled for breast biopsy. Samples were collected when women were informed of the need for biopsy (prebiopsy, T1, 5–7 days prior to the actual biopsy) and 7–10 days after they learned the result of their biopsy (postbiopsy, T2). At the time of blood collection, psychological stress was evaluated using Speilberger's State Trait Anxiety Inventory (STAI) and the Profile of Mood States (POMS). Women scheduled to undergo breast biopsy reported significant increases in anxiety (STAI) and mood disturbance (POMS). Gel shift mobility assays showed that mitogen stimulated peripheral blood lymphocytes of these women were less capable of the nuclear expression of AP-1 or NFkB at T1. Similar assessments, 7–10 days after the women learned of the results of their breast biopsy, showed these same women to have a marked reduction in anxiety and mood disturbance and an increased nuclear translocation of AP-1 and NFkB. These results show a significant decrease in nuclear AP-1 and NFkB expression during the period of emotional distress prior to biopsy with a return of nuclear transcription activity to normal levels when distress was relieved. Several studies have correlated increased psychological stress with decreased immune function. The results of this study suggest that psychological stress may mediate immunosuppression by altering the expression of the transcription factors, AP-1 and NFkB.
Negative mood (e.g., emotional distress) is known to affect immune function, but little research has addressed effects of positive mood. In the present study, positive and negative mood (over a day) were examined for their relations to natural killer cell activity (NKCA) in 48 healthy women. Results indicated that women reporting some negative mood (N = 26) had lower levels of NKCA than women who had no negative mood, while those with higher levels of positive mood had higher NKCA. However, as indicated by the significant interaction between positive and negative mood, the relation between positive mood and NKCA depended upon the women's experience of negative mood. Higher levels of positive mood were related to higher levels of NKCA only among the women who reported having some negative mood over the day. These results raise the possibility that positive mood may moderate, or buffer, the effects of negative mood on immune function.
BACKGROUND
Natural cytotoxicity mediated by natural killer (NK) cells is believed to play an important role in host anticancer defense mechanisms. The aim of this study was to examine the prognostic significance of NK cell activity after hepatectomy in patients with hepatocellular carcinoma.METHODS
The NK cell activity in 210 patients with hepatocellular carcinoma was measured and evaluated in relation to clinicopathologic variables using univariate and multivariate analyses.RESULTSThe NK cell activity was decreased significantly in hepatocellular carcinoma patients compared with the control groups (P < 0.001). No correlation was observed between NK cell activity and the clinicopathologic variables. Multivariate analyses indicated that NK cell activity as well as intrahepatic metastases, platelet count, and serum albumin level were independent prognostic factors.CONCLUSIONS
This study suggests that the preoperative NK cell activity will help predict recurrence and prognosis after hepatectomy in patients with hepatocellular carcinoma. Cancer 1998;83:58-63. © 1998 American Cancer Society.
There is much interest in the factors that control the cytokine profile of T-helper (Th) lymphocytes, and attention has focused on feedback from the cytokines themselves. In general, Th1 cytokines promote Th1 activity and inhibit Th2 activity, and vice versa. Both Th1 and Th2 responses should therefore be stable. However, in vivo, many responses start predominantly as Th1 and then shift to Th2. Why do they do this? As discussed here, an important influence on this shift that has been largely ignored in in vitro work is the endocrine system.
The mechanisms of stress-related immune alterations have not been fully elucidated. Cell-mediated immune responses as well as antibody and certain cytokines are reported as being suppressed during times of high stress. However, the role of suppression vs dysregulation has not been established in human stress models. The effect of exam stress on regulatory cytokines in 16 healthy medical students was assessed by measuring type-1 (IFN-γ) and type-2 (IL-10) cytokines from 72-h PHA/PMA-stimulated PBMC 4 weeks before and 48 h after exams. Results demonstrated decreased IFN-γ accompanied by increased IL-10 during exam stress that resulted in a decreased IFN-γ:IL-10 ratio. There was a significant correlation between the cytokine response to PHA/PMA and number and subjective adjustment to daily hassles. Additionally, students who reported greater levels of loneliness also reported greater numbers of and poorer subjective adjustment to hassles. The differences were consistent in both males and females but did not correlate with AM cortisol levels. Additionally, when individuals were grouped into high vs low preexam hassle levels, the type-1/type-2 shift in the IFN-γ:IL-10 ratio occurred in the low hassles group only. These data suggest that psychologically stressful situations shift type-1/type-2 cytokine balance toward type-2 and result in an immune dysregulation rather than overall immunosuppression. This may partially explain the increased incidence of type-2-mediated conditions such as increased viral infections, latent viral expression, allergic/asthmatic reactions, and autoimmunity reported during periods of high stress.
This study developed an instrument to measure the quality of life (QOL) of patients with cancer that would account for individual values, as well as satisfaction. The sample consisted of patients with breast cancer (n = 111) listed in the tumor registry of a major hospital. Ferrans and Power's Quality of Life Index (QLI) was modified based on an extensive review of the oncology literature, which supported content validity. The findings supported the internal consistency reliability of the entire QLI (alpha = 0.95) and of the four subscales: health and functioning, socioeconomic, psychological/spiritual, and family (alphas = 0.90, 0.84, 0.93, and 0.66, respectively). Support for concurrent validity was provided by a strong correlation (r = 0.80) between the QLI and a measure of satisfaction with life. Support for construct validity was provided by significantly higher mean QOL scores for subjects who had less pain, less depression, and were coping better with stress, using the known group technique. The positive results obtained from this assessment and the fact that many patients can complete the QLI independently are important variables to consider when health professionals are selecting instruments for research and practice.
In this study, we examined the secretory immune system, the body's first line of defense against invading organisms, and its relation to daily fluctuations of mood. Specifically, secretory immunoglobulin A (sIgA) was studied. Unlike other psychoimmunity studies that examined all sIgA protein regardless of specificity to invading organisms, ours examined an antigen-specific sIgA response to the oral administration of a harmless protein (rabbit albumin) and monitored the antibody produced in response to the protein. Dental students recorded their daily mood thrice weekly for 8 1/3 weeks, and parotid saliva was obtained from subjects during these contacts. Using a within-subjects analyses strategy, we found that antibody response was lower on days with high negative mood relative to days with lower negative mood, and conversely, sIgA antibody response was higher on days with high positive mood relative to days with lower positive mood. Results from total sIgA protein were in the opposite direction, although not significantly so. These results extend our knowledge of immunological changes and mood, and they suggest that minor life events' role in health may be mediated by the secretory immune system.
This study is presented as a model for studying the psychosocial sequelae of successful cancer treatment. It compares the psychological adjustment of 60 male Hodgkin's disease survivors, aged 20-47, with an aged-matched sample of 20 physically healthy men. Assessment included objective self-report, projective testing, observer rating, and interview. All participants had received no treatment and had shown no evidence of disease for the previous 6-140 months (median 2 years). On most measures, no differences were found between cancer survivors and healthy controls. However, the hypothesis of greater psychosocial dysfunction in the cancer sample overall was partially confirmed by significantly lowered intimacy motivation, increased avoidant thinking about illness, prolonged difficulty in returning to premorbid work status, and illness-related concerns. Conversely, cancer patients were significantly more appreciative of life than nonpatients. Within the patient group, late stage (aggressively treated) patients were found to be at highest risk for psychological distress and psychosocial disruption during the first 2 years off treatment.
Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months post-meditation training for all measures except present-moment pain. The majority of subjects reported continued high compliance with the meditation practice as part of their daily lives. The relationship of mindfulness meditation to other psychological methods for chronic pain control is discussed.
Quality of life index : development and psychometric properties
The purpose of the study on which this article is based was to assess the validity and reliability of an instrument designed to measure quality of life. Sixty-four items applicable to both healthy subjects and dialysis patients were tested with graduate students (n = 88) ; six items relative to dialysis were added, and the instrument was administered to dialysis patients (n = 37). Items were based on literature review, which supported content validity. Correlations between the instrument and an overall satisfaction with life question of 0.75 (graduate students) and 0.65 (dialysis patients) supported criterion-related validity. Support for reliability was provided by testretest correlations of 0.87 (graduate students) and 0.81 (dialysis patients and Cronbach’s alphas of 0.93 (graduate students) and 0.90 (dialysis patients.
The Jalowiec Coping Scale consists of 40 coping behaviors culled from a comprehensive literature review, which are rated on a 1- to 5-point scale to indicate degree of use. Twenty judges classified the items to permit analysis of the coping behaviors according to a problem-oriented/affective-oriented dichotomy; 15 problem and 25 affective items resulted. Overall agreement by the judges was 85%, with greater consensus on problem items. Evaluation of stability using a two-week retest interval (N = 28) yielded significant rhos of .79 for total coping scores, .85 for problem, and .86 for affective. With a one-month interval (N = 30) coefficients were .78, .84, and .83, respectively. Alpha reliability coefficients of .86 (N = 141) and .85 (N = 150) supported instrument homogeneity. Content validity is substantiated by the systematic manner of tool development, by the large number of items used, and by the inclusion of diverse coping behaviors. Factor analysis (N = 141) was used to investigate construct validity. A two-factor solution to evaluate the validity of the dichotomous classification showed that 80% of the problem items loaded on Factor I, but only 56% of the affective items loaded on Factor II. To examine this multidimensional aspect, several other factor solutions were explored. Ultimately, the four-factor solution provided the most intelligible conceptual pattern with the least loss of information. Conceptual composition of these factors is discussed, and several tentative labels for each factor are suggested.
Natural killer activity of peripheral blood mononuclear cells against the human cell line K 562 was evaluated in 11 patients with mycosis fungoides and simultaneously in 10 age- and sex-matched controls. In the patient group, nine had no previous treatment and in two topical therapy had been discontinued more than 3 months before. None had any associated disease or concurrent therapy that could interfere with the immune system. Patients with early disease showed a mean specific lysis and a range of individual data similar to the controls whereas patients with advanced disease had a significant defect of natural killer activity at effector: target ratios of 100 : 1, 50 : 1, and 25 : 1, as shown by the Mann-Whitney test. Preincubation of effector cells with alpha-interferon for 1 h in a single patient with low natural killing capacity led to a clear increase of the specific lysis, suggesting reduced functional activity rather than depletion of effector cells.
Using a neutralizing monoclonal antibody specific for murine IFN gamma we show that endogenously produced IFN gamma plays an obligate role in mediating LPS-induced rejection of the Meth A fibrosarcoma tumor in syngeneic BALB/c mice. To examine the cellular targets of IFN gamma action, we generated IFN gamma-insensitive tumor cells by stably overexpressing in Meth A a truncated dominant negative form of the murine IFN gamma receptor alpha chain. When implanted in BALB/c mice, IFN gamma-insensitive Meth A cells displayed enhanced tumorigenicity compared with control Meth A cells and were not rejected when tumor-bearing mice were treated with concentrations of LPS that eliminated control tumors. In Meth A immune mice, IFN gamma-insensitive Meth A did not establish tumors while IFN gamma-insensitive tumors grew in a progressive manner. In addition, the IFN gamma-insensitive tumor cells were unable to elicit strong protective immunity to subsequent wild-type tumor challenge. These results show that IFN gamma has direct effects on tumor cell immunogenicity and thus plays an important role in promoting tumor cell recognition and elimination.
Perforin-deficient mice have been generated by homologous recombination to determine whether the effects of CD8+ cytolytic T cells and natural killer cells are mediated by pore formation involving perforin. These mice are viable and fertile and have normal numbers of CD8+ T cells and natural killer cells which do not lyse virus-infected or allogeneic fibroblasts or natural killer target cells in vitro. The mice fail to clear lymphocytic choriomeningitis virus and they eliminate fibrosarcoma tumour cells with reduced efficiency. Perforin is therefore a key effector molecule for T-cell- and natural killer-cell-mediated cytolysis.
This exploratory study examined breast cancer patients' psychosocial and functional status at the time of diagnosis and during the initial phase of treatment. The purpose was to better understand the impact of diagnosis and treatment on patients' physical state and psychosocial well-being. A convenience sample was drawn from a population of newly diagnosed stage 1 and 2 breast cancer patients undergoing either modified radical mastectomy or lumpectomy with radiation. Subjects completed instruments designed to measure uncertainty, quality of life, functional status, and reaction to diagnosis on two separate occasions: at the time of diagnosis, but before treatment selection and then approximately 8 weeks after surgery. Data obtained from 52 subjects indicated that patients' perceptual uncertainty and various aspects of their functional status declined over the initial course of treatment, but that quality of life was unaffected. The results also showed no relationship between type of breast cancer treatment and patients' uncertainty, quality of life, and functional status. Mastectomy and lumpectomy patients also responded in similar ways to the cancer diagnosis. Both groups experienced the same amount of distress and used conformational coping strategies to similar degrees. Clinical implications are discussed and recommendations are made for future research.
To distinguish between fatigue and weakness and review symptom management for both and to suggest directions for research and practice.
Articles and book chapters pertaining to fatigue and weakness.
Fatigue and weakness are important but long-neglected symptoms, and comparatively little effort has been invested in developing techniques to mitigate these symptoms. Research is needed to differentiate between these concepts, to determine the relation between fatigue and weakness, to delineate their causes, and to develop interventions aimed at the prevention and treatment of these symptoms.
Early assessment of risk factors, mobility and sensory problems, and usual level of activity will help identify those patients who may benefit from nursing interventions or referrals for occupational or physical therapy. It is important to repeatedly evaluate these symptoms in relation to treatment, situational changes, interventions used to manage other symptoms, and tumor progression. Developing clinical guidelines and intervention strategies will contribute greatly to the functional independence and the quality of life of patients.
Social stress, psychological distress, and psychosocial support effect the adjustment of breast cancer patients, influence their experience of and adherence to medical treatment, and may effect the course of the disease. The literature indicates that levels of distress, depression, and anxiety are substantially elevated among patients with breast cancer. These problems persist in a sizable minority of patients even years after diagnosis. Coping styles are related to adjustment and, in some studies, survival time. The nature of the relationship with physicians affects adjustment to the illness, satisfaction with treatment outcome, and adherence to medical treatment protocols, which can influence relapse and survival. In many but not all studies, serious life stress adversely affects medical outcome. Social support in general and structured psychotherapy in particular have been shown to positively affect both adjustment and survival time. Clear and open communication, expression of appropriate emotion, and collaborative planning and problem-solving enhance adjustment and improve outcome. Conversely, influences that isolate breast cancer patients from others or undermine support can have adverse medical and psychological consequences.
The authors investigated whether host immunity contributes to the development of asynchronous distant metastases in colorectal carcinomas. The host immunity was examined 8 times, pre- and postoperatively during a one year period in 77 curatively operated cases. A prospective study was performed using obtained personal data. During the mean follow-up period of 920 days, 13 patients developed distant metastases. Among the immunological parameters, the preoperative natural killer (NK) cell activity differed significantly between the metastases positive and negative groups. On univariate analysis, dichotomous NK activity, presence of nodal metastases, and venous invasion correlated with metastases. The hazard ratios on multivariate analysis were 4.53, 3.82, and 4.81, respectively. No correlation was noted between NK activity and the progression stages of colorectal carcinomas. These data suggested that attenuated preoperative NK activity is an important background factor for the development of asynchronous distant metastases following curative resection of colorectal carcinomas.
Adults who undergo chronic stress, such as the diagnosis and surgical treatment of breast cancer, often experience adjustment difficulties and important biologic effects. This stress can affect the immune system, possibly reducing the ability of individuals with cancer to resist disease progression and metastatic spread. We examined whether stress influences cellular immune responses in patients following breast cancer diagnosis and surgery.
We studied 116 patients recently treated surgically for invasive breast cancer. Before beginning their adjuvant therapy, all subjects completed a validated questionnaire assessing the stress of being cancer patients. A 60-mL blood sample taken from each patient was subjected to a panel of natural killer (NK) cell and T-lymphocyte assays. We then developed multiple regression models to test the contribution of psychologic stress in predicting immune function. All regression equations controlled for variables that might exert short- or long-term effects on these responses, and we also ruled out other potentially confounding variables.
We found, reproducibly between and within assays, the following: 1) Stress level significantly predicted lower NK cell lysis, 2) stress level significantly predicted diminished response of NK cells to recombinant interferon gamma, and 3) stress level significantly predicted decreased proliferative response of peripheral blood lymphocytes to plant lectins and to a monoclonal antibody directed against the T-cell receptor.
The data show that the physiologic effects of stress inhibit cellular immune responses that are relevant to cancer prognosis, including NK cell toxicity and T-cell responses. Additional, longitudinal studies are needed to determine the duration of these effects, their health consequences, and their biologic and/or behavioral mechanisms.
To describe the patterns of fatigue and activity and rest and their relationship during adjuvant breast cancer chemotherapy.
Prospective, descriptive, repeated measures.
Midwestern oncology clinics and subjects' homes.
72 women, ages 30-69, who were receiving chemotherapy after surgery for stage I or II breast cancer.
The Piper Fatigue Scale was used to measure fatigue 48 hours after each treatment and at treatment cycle midpoints for three cycles. Wrist actigraphs were used to measure activity and rest cycles for 96 hours at each treatment and for 72 hours at each cycle midpoint.
Fatigue, activity and rest cycles, chemotherapy protocols (doxorubicin- or non-doxorubicin-based protocols).
Total and subscale fatigue scores were significantly different over time, with scores higher at treatments and lower at cycle midpoints. Activity levels were significantly different over time in a mirror-image pattern of fatigue. Fatigue was negatively correlated with activity levels at all times except the cycle 2 midpoint and positively correlated with awakenings at night only at the cycle 2 midpoint. Activity levels were significantly lower in women receiving doxorubicin-based protocols.
Roller-coaster patterns of fatigue and activity have not been previously reported in this patient population. Examination of the inverse relationship between fatigue and activity will assist nurses in the development and testing of interventions to modify fatigue.
Women should be instructed to monitor the intensity of fatigue and encouraged to maintain activity levels balanced with efficient rest periods. Nurses can inform women that these patterns may be expected to be similar during the first three chemotherapy cycles.
This study demonstrates that endogenously produced interferon gamma (IFN-gamma) forms the basis of a tumor surveillance system that controls development of both chemically induced and spontaneously arising tumors in mice. Compared with wild-type mice, mice lacking sensitivity to either IFN-gamma (i.e., IFN-gamma receptor-deficient mice) or all IFN family members (i.e., Stat1-deficient mice) developed tumors more rapidly and with greater frequency when challenged with different doses of the chemical carcinogen methylcholanthrene. In addition, IFN-gamma-insensitive mice developed tumors more rapidly than wild-type mice when bred onto a background deficient in the p53 tumor-suppressor gene. IFN-gamma-insensitive p53(-/-) mice also developed a broader spectrum of tumors compared with mice lacking p53 alone. Using tumor cells derived from methylcholanthrene-treated IFN-gamma-insensitive mice, we found IFN-gamma's actions to be mediated at least partly through its direct effects on the tumor cell leading to enhanced tumor cell immunogenicity. The importance and generality of this system is evidenced by the finding that certain types of human tumors become selectively unresponsive to IFN-gamma. Thus, IFN-gamma forms the basis of an extrinsic tumor-suppressor mechanism in immunocompetent hosts.
Natural cytotoxicity mediated by natural killer (NK) cells is believed to play an important role in host anticancer defense mechanisms. The aim of this study was to examine the prognostic significance of NK cell activity after hepatectomy in patients with hepatocellular carcinoma.
The NK cell activity in 210 patients with hepatocellular carcinoma was measured and evaluated in relation to clinicopathologic variables using univariate and multivariate analyses.
The NK cell activity was decreased significantly in hepatocellular carcinoma patients compared with the control groups (P < 0.001). No correlation was observed between NK cell activity and the clinicopathologic variables. Multivariate analyses indicated that NK cell activity as well as intrahepatic metastases, platelet count, and serum albumin level were independent prognostic factors.
This study suggests that the preoperative NK cell activity will help predict recurrence and prognosis after hepatectomy in patients with hepatocellular carcinoma.
For laryngeal carcinoma, the present TNM clinical staging system does not seem completely satisfactory as a guide for providing a prognosis for survival. We believe that natural killer cell activity would probably have a role in a more reliable system. Therefore, we analyzed the disease outcome with previously untreated epidermoid carcinoma of the larynx, evaluating classic clinical and pathologic factors, as well as natural killer cell activity in peripheral blood samples of the patients.
To determine the level of natural killer cell activity in patients with laryngeal carcinoma and to analyze the prognostic value of this finding when associated with other clinical and pathologic variables.
Prospective cohort study of surveillance of laryngeal cancer. Mean follow-up of 42.8 months.
Tertiary care referral center and ambulatory and hospitalized care.
We compared 81 men (mean age, 62.4 years; range, 35-89 years) with laryngeal carcinoma with 44 healthy men serving as control subjects (mean age, 57.6 years; range, 37-82 years).
Natural killer cell activity was significantly reduced in patients who had died of cancer-related causes in comparison with tumor-free survivors. Overall actuarial survival differed significantly in histologically assessed nodal involvement and low natural killer cell activity. Use of the Cox proportional hazards regression model showed that the factors that seem to have a prognostic effect on survival are histologically determined nodal involvement and low natural killer cell activity.
These results support the prognostic significance of the determination of pretreatment natural killer cell activity in peripheral blood samples from patients with laryngeal carcinoma and suggest that assessment of adding such a determination to the current tumor staging system is advisable.
The Telephone Counseling Trial for Breast Cancer Survivors is a randomized, controlled study designed to test the impact of a telephone-based counseling intervention on quality of life of early-stage breast cancer patients who have completed adjuvant treatment. A psychoeducational counseling model is utilized to promote adaptive coping to re-entry stressors and survivorship issues. Adaptation is fostered through the exploration of thematic materials, application of active coping strategies, encouragement of a personal expression of the breast cancer experience and the provision of psychological support. Patients are being recruited in collaboration with two NCI-designated clinical cooperative oncology groups: the Eastern Cooperative Oncology Group (ECOG) and the Southwest Cooperative Oncology Group (SWOG). The recruitment goal is 400 breast cancer survivors with Stage 1, Stage 2 and Stage 3 disease (with no greater than 10 positive lymph nodes involved). Patients are being enrolled by data managers on-site during their last treatment visit. The intervention is being delivered by the Cancer Information and Counseling Line (CICL) of the AMC Cancer Research Center. It includes 16 telephone outcalls which are delivered over a 12-month period. Primary outcome measures are quality of life, mood, social support, self-efficacy, and sexual functioning, assessed at baseline, 3, 6, 12 and 18 months follow-up. This article provides a description of the intervention protocol and study design. It is argued that this study could provide a model for developing and testing other psychosocial interventions within clinical cooperative groups nationwide.
The purpose of this study was to examine the effect of dexamethasone (DEX) on the production of granulocyte and granulocyte-macrophage colony stimulating factors (G-CSF and GM-CSF) by neonatal mononuclear cells. Mononuclear cells were isolated from umbilical cord blood and cultured with either phorbol myristate acetate/phytohemagglutinin (PMA/PHA) or Candida albicans with or without DEX (10(-8)-10(-6) M) for 48 h. Cell supernatants were assayed for G-CSF and GM-CSF by ELISA. Mononuclear cells from term and preterm infants responded to PMA/PHA stimulation with a significant increase in G-CSF production over baseline levels. The PMA/PHA-induced increase in G-CSF production was markedly augmented by the addition of DEX to cell cultures. DEX augmented production of G-CSF was significantly less in mononuclear cells from preterm infants. Similarly, production of G-CSF was significantly less by mononuclear cells from infants with acute physiology scores of > or = 10, as judged by the Score for Acute Neonatal Physiology. In contrast, DEX significantly inhibited PMA/PHA-induced GM-CSF production. Although C. albicans induced mononuclear cells to produce G-CSF, DEX did not significantly augment this production. No significant effect of DEX on C. albicans induced GM-CSF production was observed. The data show DEX induced differential regulation of infant peripheral blood mononuclear cell production of G-CSF and GM-CSF. These results suggest that glucocorticoids may enhance certain aspects of host immune function in addition to their well-documented immunosuppressive effects. Further, the neutrophilia observed in DEX-treated infants may be due to enhanced G-CSF production.
Recently, it has been reported that serum interleukin-1 beta (IL-1 beta), but not soluble IL-2 receptor (sIL-2R), concentrations were significantly higher in patients with posttraumatic stress disorder (PTSD) than in normal volunteers, and that psychological stress in humans is associated with increased secretion of proinflammatory cytokines, such as IL-6.
The aim of the present study was to examine the inflammatory response system in patients with PTSD through measurements of serum IL-6, sIL-6R, sgp130 (the IL-6 signal transducing protein), sIL-1R antagonist (sIL-1RA; an endogenous IL-1 receptor antagonist), CC16 (an endogenous anticytokine), and sCD8 (the T suppressor-cytotoxic antigen).
Serum IL-6 and sIL-6R, but not sgp130, sIL-RA, CC16, or sCD8, concentrations were significantly higher in PTSD patients than in normal volunteers. Serum sIL-6R concentrations were significantly higher in PTSD patients with concurrent major depression than in PTSD patients without major depression and normal volunteers. There were no significant relationships between serum IL-6 or sIL-6R and severity measures of PTSD.
The results suggest that PTSD is associated with increased IL-6 signaling. It is hypothesized that stress-induced secretion of proinflammatory cytokines is involved in the catecholaminergic modulation of anxiety reactions.
To describe the side-effects burden experienced over time by 53 women who were receiving treatment for breast cancer and to describe the association of side-effects burden with psychological adjustment and life quality.
Data were drawn from the Self-Help Intervention Project (SHIP), an intervention study designed to test the effectiveness of nursing interventions for women receiving treatment for breast cancer.
Subjects were interviewed in their homes or treatment locations three times over a period of four to five months.
53 women randomly assigned to the control group of the SHIP.
The researchers collected data after treatment was initiated, six to eight weeks later, and three months after that.
Side-effects burden, psychological adjustment, and life quality.
Fatigue was the most problematic side effect over time. Other problematic side effects included sore arm(s), difficulty sleeping, hair loss, and skin irritation. Significant associations were evident for psychological adjustment with symptom extension and number of side effects at Time 2 and Time 3. Depression burden and anxiety burden were associated significantly with psychological adjustment at all three times. Overall life quality and present life quality was associated negatively with symptom extension and number of side effects at all three times. Fatigue burden was associated negatively with life quality at Time 2 and Time 3 with depression burden and anxiety burden negatively associated with life quality at all three times.
Over time, evidence showed that negative feelings, in particular depression burden and anxiety burden, persist. Depression burden and anxiety burden each were negatively associated with overall and present life quality at all three times.
A need exists for clinically individualized nursing interventions that will reduce the side effects burden of women receiving treatment for breast cancer. Interventions can do much to reduce the perception of illness severity so that psychological adjustment and life quality can be maintained.