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A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer


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The purpose of this study was to gather data on the efficacy of a newly developed psychosocial group intervention for cancer patients, called mindfulness-based art therapy (MBAT). One hundred and eleven women with a variety of cancer diagnoses were paired by age and randomized to either an eight-week MBAT intervention group or a wait-list control group. Ninety-three participants (84%) completed both the pre- and post-study measurements. As compared to the control group, the MBAT group demonstrated a significant decrease in symptoms of distress (as measured by the Symptoms Checklist-90-Revised) and significant improvements in key aspects of health-related quality of life (as measured by the Medical Outcomes Study Short-Form Health Survey). This investigation of MBAT provides initial encouraging data that support a possible future role for the intervention as a psychosocial treatment option for cancer patients.
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Psycho-Oncology (in press)
Published online in Wiley InterScience ( DOI: 10.1002/pon.988
Thomas Jefferson University, Philadelphia, PA, USA
The purpose of this study was to gather data on the efficacy of a newly developed psychosocial group intervention
for cancer patients, called mindfulness-based art therapy (MBAT). One hundred and eleven women with a variety of
cancer diagnoses were paired by age and randomized to either an eight-week MBAT intervention group or a wait-list
control group. Ninety-three participants (84%) completed both the pre- and post-study measurements. As compared
to the control group, the MBAT group demonstrated a significant decrease in symptoms of distress (as measured by
the Symptoms Checklist-90-Revised) and significant improvements in key aspects of health-related quality of life
(as measured by the Medical Outcomes Study Short-Form Health Survey). This investigation of MBAT provides
initial encouraging data that support a possible future role for the intervention as a psychosocial treatment option
for cancer patients. Copyright #2005 John Wiley & Sons, Ltd.
KEY WORDS: cancer; stress; mindfulness; art; oncology
The overall prevalence rate of cancer in the United
States continues to increase, especially for some
cancers that commonly affect women (e.g. breast
cancer) (American Cancer Society, 2003). For
many women, the diagnosis of cancer means
coping with a chronic illness that will have a
variable course for an undetermined amount of
time. Receiving a cancer diagnosis can be a highly
distressing event and the illness experience for
cancer patients often presents numerous stressful
challenges. Cancer patients frequently report a
high level of unmet psychosocial needs, which
contributes to the stress inherent in the illness
experience (Sanson-Fisher et al., 2000). Stress
(Cohen et al., 1998; Heim, 1991), negative percep-
tions of the illness in relation to self and the
outside world (Mishel et al., 1991; Nelson, 1996),
poor coping strategies (Sanson-Fisher et al., 2000;
Jacobsen and Holland, 1991) and inadequate
social supports (Wortman and Lehman, 1985; Ell
et al., 1992) can all negatively impact health status.
Targeting these variables is a primary goal in
current cancer care (Hewitt and Rowland, 2002;
Sanson-Fisher et al., 2000).
Supportive group therapy is the most studied
psychosocial intervention for cancer patients;
researchers using group interventions have had
documented success at addressing psychosocial
needs and decreasing distress (Spiegel et al., 1981;
Fawzy et al., 1995; Helgeson et al., 2000). Such
interventions tend to be diagnosis specific (e.g.
breast cancer or prostate cancer), and they almost
exclusively rely on verbal exchanges (e.g. sharing
of experiences, educational lectures, etc.). An
estimated 20–40% of cancer patients have high
stress levels (McGarvey, 1998; Goodwin and
Leszcz, 2001); yet, only a fraction of them
participate in group interventions. There are
several possible explanations for this, including
limited access, negative perceptions about group
process, and stigma (Krizek et al., 1999). There-
fore, there is an apparent need to develop
innovative group formats for cancer patients that
Received 28 December 2004
Copyright #2005 John Wiley & Sons, Ltd. Accepted 15 August 2005
*Correspondence to: Jefferson Medical College, 1020 Sansom
Street - 1652 Thompson Bldg., Philadelphia, PA 19107, USA.
could potentially accommodate a broad range of
patients and provide alternative modes of infor-
mation processing.
The present study was designed to assess the
effectiveness of a recently developed psychosocial
group intervention for cancer patients, called
mindfulness-based art therapy (MBAT). MBAT
integrates mindfulness meditation skills and as-
pects of art therapy into an eight-week, gender-
segregated, supportive group therapy format. The
multi-modal design is intended to provide oppor-
tunities for both verbal and non-verbal expression,
enhanced support, and expanded coping strategies.
The overall goal is to decrease distress and improve
quality of life. The structure of MBAT also allows
for a different composition of participants than the
typically available psychosocial cancer group
programs. Since MBAT is designed with a focus
on health-promoting skills and behaviors applic-
able to a wide variety of cancer patients, the groups
are intended to accommodate a patient population
that is heterogeneous in regard to cancer type.
Theoretical framework: The MBAT intervention
is conceptually rooted in the principles of self-
regulation theory (Leventhal et al., 1984, 1992),
which provides a foundation for understanding
reactions to perceptions of physical and emotional
well-being. Self-regulation theory explains how
people cope with and adapt to, stressful situations
such as health problems or threats. The model
reflects two modes of information processing: (1)
objective representation of a (health) problem in
cognitive terms, such as the laboratory result or
tumor stage, and (2) subjective representation of
the problem in emotional terms, such as fear or
anger. An essential component to this theory is the
schema that is formed from the combined objec-
tive and subjective representations of the health
threat. Within the context of this model, there are
two main self-regulatory issues involved in coping
with health problems: the content of the represen-
tations and the process by which the representa-
tions are appraised and changed over time. The
ability to negotiate subjective and objective
representations directly affects stress levels (Folk-
man, 1984; Heim, 1991).
MBAT is designed to provide specific skills for
cultivating self-regulation in a format that is not
confined to verbal processing alone. For example,
one aspect of the MBAT intervention, mind-
fulness-based stress reduction (MBSR) (Kabat-
Zinn et al., 1987), provides standardized tools to
help participants observe, assess, and negotiate
their objective and subjective representations of
the illness experience. MBSR programs have had
documented success in reducing stress in cancer
populations (Speca et al., 2000; Carlson et al.,
2004). Mindfulness practices may foster self-
regulation through cultivation of focused attention
and acceptance of self in the present moment; this
may allow for conscious observation of both the
actual experience (objective representation) and
emotional responses to it (subjective representa-
tion), which may allow for more choices in regard
to stimulus reminders (Kabat-Zinn, 1990).
Another aspect of MBAT, art therapy, provides
concrete tasks for expressing representations in a
tangible and personally meaningful manner.
Research with cancer patients and with other
populations supports the use of tasks that allow
for focused expression of unpleasant emotions,
which can lead to a reduction in medical symp-
toms, such as pain, and an increased sense of
well-being (Shakin et al., 1989; Smyth, 1998;
Pennebaker et al., 1997; Stanton et al., 2001).
Although there are numerous published case and
qualitative studies from the field of art therapy,
including the widely reported and beneficial use of
art therapy with cancer populations in both
individual and group formats (Gabriel et al.,
2001; Deane et al., 2000; Luzzatto, 1998; Mal-
chiodi, 1999), few controlled studies exist. How-
ever, a recent clinical trial of an art therapy
intervention with hospitalized children with post-
traumatic stress disorder supports the way in
which MBAT utilizes specific art tasks. In that
study it was shown that art therapy tasks could be
designed in a way that may integrate brain
pathways related to distressing experiences, pro-
viding a mechanism for stress reduction (Chapman
et al., 2001).
Chapman’s neurodevelopmental approach to
art therapy posits that recollection of a blocked
pattern of memory (perceived experience stored as
images) due to stress trauma can be: (1) restored
from partial data, (2) tolerated affectively, and (3)
integrated into consciousness when art tasks are
designed to follow a neurodevelopmental course.
Specifically, the right hemisphere of the brain is
thought to be the predominate storage site for
traumatic memories (Schiffer et al., 1995). The
stimulation of art media used in art tasks may
activate the right hemisphere via kinesthetic and
sensory activity (Lusebrink, 2004), which leads to
greater awareness of different aspects of threaten-
ing events, including emotional responses. The
Copyright #2005 John Wiley & Sons, Ltd. Psycho-Oncology (in press)
final stage is verbal articulation of the image and
what it represents (left hemisphere activity).
Representational integration, including the bilateral
integration of information processing between right
and left hemispheres, in particular, has been
proposed to be a core component of the resolution
of unresolved trauma (Siegel, 1999). It is interesting
that MBSR training also results in left-sided
activation (Davidson et al., 2003). Chapman’s
model supports the use of art therapy in distressed
cancer patients, especially given the very high
incidence of reported distressing cancer-related
experiences and recollections in this population.
In the MBAT intervention, art therapy tasks
also are designed to meaningfully complement the
MBSR curriculum, which may enhance the non-
verbal process of identifying and organizing
internal and external representations. The process
orientation in mindfulness practice and art making
in MBAT thus supports the potential transforma-
tion of threat schemas, thereby advancing more
adaptive coping. MBAT is conducted in a
supportive group milieu, which provides a verbal
mode of processing subjective representations that
emerge from group tasks, and allows for expres-
sion of related personal meanings and schemas
(a brief review of the eight-week intervention is
provided in Table 1). Hence, the MBAT format is
intended to integrate verbal and non-verbal modes
of information processing for the purpose of
facilitating healthful self-regulation.
Here we report our findings of a randomized,
controlled, clinical trial of women with hetero-
geneous cancer diagnoses, comparing the eight-
week MBAT intervention to a wait-list control
condition. There were two primary aims of the
study. The first aim was to test the hypothesis that
participants who receive an eight-week group of
MBAT along with usual medical care, will
demonstrate significantly greater reductions in
symptoms of distress, as measured by the Symp-
tom Checklist -90-Revised (SCL-90-R) anxiety
and depression subscales, than patients who
receive usual medical care alone. The second
aim was to test the hypothesis that partici-
pants, who receive the MBAT intervention
along with usual medical care, will demonstrate
significantly greater improvement in health-
related quality of life, as measured by the
Medical Outcomes Study Short-Form Health
Survey (SF-36) physical health composite
score, than patients who receive usual medical
care alone.
The protocol, research design and recruitment
plan for the MBAT study were reviewed and
approved by the Institutional Review Board of
Thomas Jefferson University. Female subjects were
recruited from a diversity of referral sources
throughout the Jefferson Cancer Network that
includes 16 hospitals within the Philadelphia region,
although the majority of subjects were directly
referred by Jefferson’s Kimmel Cancer Center. The
study population consisted of 111 adult women
who had a cancer diagnosis. Each subject was
beyond four months and within two years of an
original diagnosis of cancer (or cancer recurrence),
at the time of randomization. Patients were
excluded if they were terminal, or had a current
psychiatric diagnosis of a major mood disorder,
psychotic disorder, or significant cognitive deficits
as determined by their physicians. Patients receiving
permission from their treating health professional
in order to enter the study.
Psychological distress and stress-related somatic
complaints were assessed immediately pre- and
post-intervention (at weeks 0, 8 and 16), using
the Symptoms Checklist Revised (SCL-90-R)
(Derogatis, 1993). The SCL-90-R is a 90-item
inventory, which assesses nine symptom dimen-
sions and a summary score, the Global Severity
Index (GSI). The GSI is the best single indicator
of the current level of distress. The nine symptom
constructs are; somatization, obsessive-com-
pulsive, interpersonal sensitivity, depression,
anxiety, hostility, phobic anxiety, paranoid idea-
tion, and psychoticism. Respondents are asked
to respond to 90 items by how much they were
bothered by an item anchored to a specific time
frame on a five-point scale (0=not at all; 4=
extremely). The reliability of the SCL-90-R has
been demonstrated by internal consistency
(r¼0:77–0.90) and the test–retest reliability
(r¼0:78–0.90) for all scales (Derogatis, 1994).
The SCL-90-R is considered sufficiently sensitive
to discern changes in stress-related symptoms and
has been used specifically with cancer patients
Copyright #2005 John Wiley & Sons, Ltd. Psycho-Oncology (in press)
(Derogatis et al., 1983). As an initial measure of
treatment retention and supportive information
regarding any treatment effects, the SCL-90-R was
administered at week 16 (i.e. eight-weeks post-
intervention for the experimental group and
immediately post-intervention for the controls
who were ‘crossed over’ to receive the intervention
at week 9).
Health-related quality of life also was assessed
immediately pre- and post-intervention (at weeks
0, 8 and 16), using the Medical Outcomes Study
Short-Form Health Survey (SF-36) (Ware, 1999).
This is a 36-item measure used to assess eight
health concepts: (1) limitations in physical activ-
ities; (2) limitations in social activities; (3) limita-
tions in role activities because of health problems;
(4) limitations in role activities because of emo-
tional problems; (5) bodily pain; (6) general health
perceptions; (7) vitality (energy and fatigue); and
(8) mental health (psychological distress and well-
being). Mental health items tap general well-being,
anxiety, and depression on a six-point scale.
Table 1. MBAT eight-week program curriculum
Week Mindfulness skills development:
MBSR curriculum content
Mindful art activity
Home and in-group practice discussion, didactic,
experiential components included in each session
Group discussion of direct experience of
process and pictures in each session
1 Introduction to Program and Intervention Introduction to art-making.
Embodied well-being: responding vs ‘Draw a complete picture of yourself’
Reacting to the stress of life Self-picture assessment (SPA) task
Body scan meditation
2 Body scan meditation
Attitudinal foundations of mindfulness
Anchoring attention with the breath (AOB)
Mindful exploration of art materials (colored
pencil, marker, pastel, watercolor crayon, paint).
Awareness of sensory stimulus and response
3 Gentle yoga and sitting meditation
Intending well-being/loving kindness meditation
Exploring the mind body relationship: pre–post
assessment of mind/body relationship before and
after gentle yoga
4 Cultivating receptive attention Creative problem solving/imaging self-care.
Gentle yoga and sitting meditation
Loving kindness meditation
Transforming mental, emotional and physical pain;
introducing self-care imagery into the picture
5 Expanding awareness
Sitting (meditation) with thoughts and feelings
Loving kindness meditation
Exploring meditation practice experience: art productions,
using collage element, serve as basis for increasing skills with
mindfulness practice in the realm of thoughts and feelings
6 The physiology of stress
Walking meditation
Loving kindness meditation
Stressful and pleasant event pictures as introduction to
the physiology of stress including stressful communication/
non-reactive communication skills
7 An evening (or) afternoon silent retreat:
guided meditation practices and open studio
Open studio: free art-making
8 Guided imagery to a place of healing Drawing from the healing place
Program review and discussion of program
close as new beginning. Closing ceremony
‘Draw a complete picture of yourself’
Self-picture assessment (SPA) task
Derived from Kabat-Zinn and Santorelli (1999).
Derived from Fleming and Cox (1989).
Copyright #2005 John Wiley & Sons, Ltd. Psycho-Oncology (in press)
General health consists of five items measuring an
individual’s perception of wellness or illness.
Alpha coefficients ranged from 0.81 to 0.88 for
the patient sample (N¼11 186) and were similar
to those for the general population (N¼2008)
studied. Both convergent and discriminant validity
were demonstrated in these two groups. The
validity and reliability for the instrument has been
demonstrated in several chronic illness popula-
tions (McHorney et al., 1993).
Over 16 months, in three study recruitment
periods, 7 groups of women with cancer who
met the inclusion criteria were enrolled in the
clinical trial. After informed consent was signed,
and after adequate subjects were accrued to form
two treatment groups, subjects were sorted by
age, and one subject of each successive pair
was randomized to either the intervention
group (MBAT) or to the control group
(wait-list) yielding 7 intervention groups and
7 control groups. After the eight-week study
period, wait-list controls were offered the inter-
The intervention groups received MBAT, a
supportive-expressive group therapy that includes
skills training in mindfulness meditation and
group art therapy tasks. The intervention con-
sisted of eight consecutive, weekly meetings of two
and a half-hours each in length. Each of the eight
weekly sessions had a standardized format and
agenda. Participants received training in the
practice of mindfulness meditation (including
body scan meditation, sitting meditation, gentle
Hatha yoga, and walking meditation), within a
MBSR program curriculum similar to the format
described by Kabat-Zinn and Santorelli (1999).
Home assignments included the practice of mind-
fulness meditation 6 days a week for 30 min. An
audiotape with guided body scan and sitting
meditation was provided to each participant for
this purpose. Recommendations for reading to
support the MBSR program curriculum were also
offered. The group art therapy component of the
intervention focused on non-verbal activities (i.e.
the making of directed and spontaneous art
productions) that were interwoven with the verbal
processes within the group. Specific art tasks were
directed to explore present moment experience and
learning related to the experiential and cognitive
elements of the mindfulness-based curriculum.
Study investigator C. Peterson, who is both a
registered art therapist and an advanced level
MBSR instructor, led the groups. The groups
followed the format of our standardized MBAT
treatment manual (unpublished).
This trial was sized to have 80% power for a 0.62
standardized effect size, the smallest effect seen in
our pilot work among our three primary end-
points. We determined sample size based on a
1.67% test, adjusting for the three primary end-
points by the Bonferroni correction. After allow-
ing for an intra-class correlation of 0.05, with a
consequent sample size inflation of 35% with an
average class size of 8, and for 10% loss-to-follow-
up, we planned to accrue 96 subjects, or 48 per
group. Early in the study, we found that the
dropout rate was higher than we had planned for
and increased the planned sample size to 110.
The data were analyzed on an intent-to-treat
basis in that all subjects with week 0 (baseline) or
week 8 (post-experimental period) values were
included in the analyses in their treatment group as
randomized, regardless of extent of participation.
Missing data were not imputed. For the MBAT
arm, the mean number of groups attended was
approximately five (S:D:¼2:63), and median
number attended was six.
Subscales for the SCL-90-R and SF-36 were
each analyzed separately. The SCL-90-R scales
were transformed by taking square-roots of weeks
0 and 8 values; the SF-36 scales from weeks 0 and
8 values were not transformed. Transformation
was done so the distribution of residuals would be
better approximated by a normal distribution.
Weeks 0 and 8 scores were analyzed as a mixed
effects, repeated measures, analysis of variance.
Week, treatment (MBAT or control) and the week
treatment interaction were fixed effects and age
at start of treatment (included because of the
matching) was a continuous covariate. Recruit-
ment period (1, 2, 3) was a random effect. For the
repeated measures within subject, we used the
heterogeneous compound symmetry covariance
structure (allowing the variances at weeks 0 and
8 to differ) that was allowed to vary with treatment
group. Satterthwaite degrees-of-freedom were used
for all tests and contrasts.
Copyright #2005 John Wiley & Sons, Ltd. Psycho-Oncology (in press)
A statistically significant week–treatment inter-
action constitutes an indication of a treatment
effect (indicating that the change in scores over
time was different for the two treatments). A
treatment effect was estimated by computing the
contrast of the treatment difference (week 8 mean
week 0 mean) for the MBAT (intervention)
group, minus the treatment difference (week 8
mean week 0 mean) for the observation group
(based on least-square adjusted means). This
analysis thus corrects for any difference between
groups at baseline (week 0).
No adjustments were made for multiple com-
Subject characteristics
The mean age at baseline of the women was 53.6
years (S:D:¼11:5, range ¼26282) (Table 2).
Fifty-five of the women were in the control
group arm (mean age ¼54:1, S:D:¼10:7, range ¼
35282), and 56 were in the MBAT intervention
group arm (mean ¼53:1, S:D:¼12:4, range ¼
26276). Racial and ethnic distribution was as
follows: 75% of the women were Caucasian; 21%
African-American; 2% Asian; 2% Hispanic; and 1%
other. Cancer diagnoses were varied: breast (51),
gynecologic (19, including 12 ovarian), hematologic
participants in the study continued their usual
medical care, regardless of group assignment. Of
the 111 enrolled subjects, 74 were in active treatment
during their participation in the study, receiving
either chemotherapy, radiation, treatment for side
effects or other outpatient cancer-related procedures.
Of the 111 women randomized, 93 provided eight-
week data (45 in the MBAT intervention group and
48 in the control group), yielding a retention rate of
84%. The majority of dropouts were due to
progression of illness and/or cancer treatment
complications. The intervention group and the
control group were at comparable stages of disease
(28/55 control and 29/56 MBAT intervention sub-
jects were of stage 0, 1 or 2, and 27/55 control and
27/56 intervention subjects were of stage 3 or 4).
Scores at baseline for the two groups though
somewhat different (Table 2), reflect higher levels
of reported distress and reduced health-related
quality of life for persons with cancer, as compared
to baseline scores for heterogeneous patients parti-
cipating in Jefferson’s stress reduction program
based on mindfulness meditation (Reibel et al.,
Psychological distress
Results for the SCL-90-R are presented in Table
3. Results are for data that have been transformed
by taking the square-root of week 0 and week 8
SCL-90-R scores for all subscales, as well as for
the overall GSI. Presented in the table are age
adjusted least-squares means, on the square-root
scale, for weeks 0 and 8, and differences of these
Table 2. Subject characteristics
Age at baseline (yrs) All subjects Control MBAT
Mean 53.6 54.1 53.1
Standard deviation 11.5 10.7 12.4
Range 26–82 35–82 26–76
All subjects Control MBAT
Caucasian 83 (75%) 38 (69%) 45 (80%)
African-American 23 (21%) 13 (24%) 10 (18%)
Asian 2 (2%) 1 (2%) 1 (2%)
Hispanic 2 (2%) 2 (4%) 0
Other 1 (1%) 1 (2%) 0
Cancer type
Breast 51 (46%) 19 (35%) 32 (57%)
Gynecologic 19 (17%) 8 (15%) 11 (20%)
Hematologic 13 (12%) 8 (15%) 5 (9%)
Neurologic 5 (5%) 5 (9%) 0
Rectal 6 (5%) 4 (7%) 2 (4%)
Other 17 (15%) 11 (20%) 6 (11%)
Mean (S.D.)
All subjects Control MBAT
Baseline SCL-90-R ðN¼111ÞðN¼55ÞðN¼56Þ
Overall 0.89 (0.29) 0.82 (0.54) 0.93 (0.53)
Anxiety 0.85 (0.42) 0.85 (0.77) 0.97 (0.78)
Depression 1.08 (0.36) 1.22 (0.82) 1.37 (0.74)
Mean (S.D.)
All subjects Control MBAT
Baseline SF-36 ðN¼111ÞðN¼55ÞðN¼56Þ
Physical composite score 38.9 (10.4) 39.8 (11.3) 38.0 (9.56)
Mental composite score 41.2 (12.2) 43.0 (12.4) 39.5 (11.7)
Copyright #2005 John Wiley & Sons, Ltd. Psycho-Oncology (in press)
means. For example, for the depression subscale,
the mean for the control group for week 0 was 1.03
and for week 8 was 0.95; the score changed 0.08,
a slight improvement. For the MBAT intervention
group, the mean for week 0 was 1.13 and for week
8 was 0.85; the score decreased 0.27, also an
improvement. The difference of differences
(0:19 ¼0:08 ð0:27Þ) is the effect due to
treatment, and is statistically significant
(p¼0:001). Statistical significance was demon-
strated on both targeted endpoints (depression
subscale, p¼0:001; anxiety subscale, p¼0:022.
p-values reported are not adjusted for multiple
comparisons. However, using the Hommel (1988)
modification of the Bonferroni adjustment, the
reported p-values of p=0.001 for the depression
subscale and p=0.022 for the anxiety subscale
become, 0.004 and 0.044, respectively. That is, they
retain statistical significance. Significance also was
demonstrated on all of the other subscales pertinent
to the subject population (see Table 3). The overall
score (GSI) also was highly significant (p50:001).
Finally, we separated the sleep questions from the
‘additional items’ subscale, demonstrating high
significance on the sleep items.
In addition, we were able to obtain week 16
follow-up data on the SCL-90-R. For the MBAT
subjects from week 8 to week 16, the means altered
little, suggesting possible maintenance of treat-
ment of effect; the GSI was 0.73 and 0.74, anxiety
was 0.63 and 0.60, and depression was 0.85 and
0.85 (at weeks 8 and 16, respectively). (Full
analysis of week 16 data for both groups will be
presented in a future paper.)
Health-related quality of life
Results for the SF-36 are presented in Table 4.
Groups were similar at baseline. The data pre-
sented in Table 4 are age adjusted least-squares
means (not transformed), for weeks 0 and 8, and
differences of these means for the SF-36 subscales.
A statistically significant treatment effect was not
demonstrated on the physical composite score
(p¼0:19); however, there was significance on the
mental composite (p¼0:025) and on the general
health (p¼0:008), mental health (p50:001), social
functioning (p¼0:048) and vitality (p¼0:010)
subscales. Additionally, on the SF-36, after
accounting for change in the control group, we
report improvements of five points or more for
subscales related to physical functioning, bodily
pain, general health, vitality, social functioning
and mental health (Table 4). These improvements
are indicative of clinically or socially relevant
change (Ware, 1999). As in the SCL-90-R, there
was little change in means on the SF-36 from week
8 to week 16 for the MBAT subjects, suggesting
maintenance of improvements in general health,
mental health, vitality and social functioning.
Consistent with the first primary aim of the study,
subjects who received the eight-week MBAT
intervention demonstrated statistically signifi-
cantly greater decreases in symptoms of distress
as compared to subjects in the wait-list control, as
Table 3. SCL-90-R MBAT results summary table ðN¼111Þ
Adjusted mean score
Change in means Effect
SCL-90-R Control MBAT (week 8week 0) (control - MBAT)
factor Week 0 Week 8 Week 0 Week 8 Control MBAT (95% CI) p
Overall (GSI) 0.85 0.81 0.93 0.73 0.04 0.20 0.16 (0.08, 0.24) 50.001
Anxiety 0.82 0.72 0.89 0.63 0.10 0.26 0.16 (0.02, 0.29) 0.022
Depression 1.03 0.95 1.13 0.85 0.08 0.27 0.19 (0.07, 0.30) 0.001
Hostility 0.51 0.48 0.69 0.51 0.03 0.18 0.16 (0.04, 0.27) 0.007
Interpersonal sensitivity 0.69 0.67 0.77 0.60 0.02 0.17 0.15 (0.03, 0.26) 0.012
Obsessive-compulsive 1.01 0.96 1.08 0.90 0.05 0.18 0.13 (0.03, 0.24) 0.012
Somatization 0.91 0.92 0.93 0.75 0.01 0.19 0.20 (0.09, 0.31) 0.001
Additional items 0.96 0.96 1.09 0.84 0.00 0.26 0.26 (0.14, 0.38) 50.001
1.03 1.07 1.20 0.91 0.04 0.29 0.33 (0.15, 0.51) 0.001
Square-root scale.
Sleep questions from additional items subscale.
Copyright #2005 John Wiley & Sons, Ltd. Psycho-Oncology (in press)
measured by the SCL-90-R anxiety and depression
subscales. In addition, subscales related to hosti-
lity, interpersonal sensitivity, obsessive-compulsive
and somatization were significantly improved in
the intervention group. There was also a highly
statistically significant change in the Global
Severity Index (GSI) score. Additionally, for the
MBAT subjects, means at week 16 were similar to
those at week 8.
The second aim of the study was to assess the
effects of MBAT on health-related quality of life,
as measured by the SF-36. As compared to wait-
list controls, subjects in the MBAT intervention
group demonstrated statistically significant im-
provement on some, but not all, of the SF-36
scores and subscales. Significance was not demon-
strated for the physical composite summary scale,
although it was for the mental composite summary
scale. High statistical significance was demon-
strated on the mental health, general health, and
vitality subscales. Social functioning also was
significantly improved.
Overall, the results of the study provide
preliminary support for the hypotheses that the
MBAT intervention can help cancer patients
decrease distress levels and improve quality of life.
Results of this study are consistent with those of
other mindfulness studies of heterogeneous patient
groups and cancer patients (Reibel, 2001; Speca,
2000), although, we note that this is the first
randomized, controlled mindfulness-based study
reporting significant outcomes for cancer patients
predominantly in active treatment. In addition, the
results indicate a possible advantage over standard
support, when comparing SF-36 results of a recent
study by Helgeson et al. (2001). Clearly, further
testing is required to assess whether the synergy of
the proven techniques incorporated in the MBAT
protocol provides an advantage for cancer patients
in active treatment over any one of these
techniques alone.
It is noteworthy that two of the three endpoints
we chose for the study did not demonstrate the
greatest therapeutic effect as compared to other
measured endpoints. For example, changes in the
anxiety subscale of the SCL-90-R were significant,
but not as large as the changes in the depression
subscale. Certainly, the most sensitive indicator of
change on the SCL-90-R for this study group was
the GSI, which is considered to be the best single
indicator of current level of emotional distress
(Derogatis et al., 1983).
Likewise, we predicted that quality of life
improvements would best be reflected in the
physical composite summary scale of the SF-36.
The results revealed statistically significant im-
provements on four of eight SF-36 subscales, and
to a lesser degree on the mental composite
summary scale. Statistical significance was not
demonstrated on the physical composite summary
score as hypothesized. However, there were
improvements, greater than or equal to 5 points,
on 3 of the 4 subscales of the PCS, which is
indicative of clinically or socially relevant change
(Ware, 1999). One possible explanation is that
symptoms that comprise the physical composite
score, such as bodily pain and physical function-
ing, were not significantly moderated by the
Table 4. SF-36 results MBAT summary table ðN¼111Þ
Adjusted mean score
Change in means Effect
SF-36 Control MBAT (week 8week 0) (control - MBAT)
factor Week 0 Week 8 Week 0 Week 8 Control MBAT (95% CI) p
Physical composite score 39.64 39.71 37.78 40.06 0.06 2.29 2.23 (5.60, 1.15) 0.19
Physical functioning 64.37 64.42 58.23 65.01 0.05 6.78 6.73 (13.8, 0.37) 0.06
0.0 25.0 0.0 50.0 0.0 0.0 0.0 0.64
Bodily pain 58.14 58.74 54.23 60.14 0.60 5.91 5.31 (14.1, 3.50) 0.23
General health 55.78 55.19 47.13 55.09 0.59 7.97 8.56 (14.8,2.29) 0.008
Mental composite score 42.82 44.86 39.64 46.13 2.04 6.49 4.45 (8.32,0.58) 0.025
Vitality 42.63 42.91 40.26 50.06 0.28 9.79 9.52 (16.7,2.37) 0.010
Social functioning 60.04 64.91 51.22 66.60 4.87 15.38 10.5 (20.9,0.10) 0.048
33.33 66.67 33.33 66.67 0.0 0.0 0.0 0.84
Mental health 64.91 67.07 56.90 69.95 2.16 13.05 10.9 (16.8,4.96) 50.001
For role-physical and role-emotional because of non-normality of the data, observed medians (and median differences) are
presented, and p-value is for the Wilcoxon rank sum test.
Copyright #2005 John Wiley & Sons, Ltd. Psycho-Oncology (in press)
intervention. This would be surprising for the pain
aspect, given that relaxation is part of the
intervention. Other possible explanations are that
the study time period was not sufficient for newly
acquired skills to affect those variables or that the
receipt of active treatment (radiation, chemother-
apy, etc.) for their cancer diagnosis by the majority
of subjects inhibited a response. It was not
surprising that the mental health subscale was
highly significant, since, like the SCL-90-R, it is an
indicator of psychological distress.
The high statistical significance on the general
health subscale of the SF-36, an indicator of
perception of wellness or illness, may reflect the
intervention’s success at helping patients focus on
a life perspective that is broader than that of
having cancer. In the MBAT intervention, parti-
cipants receive support to develop tools for
observing and assessing their experiences. MBAT
is intended to facilitate a sense of control in
participants through awareness that they have the
choice to hold their illness experience as is, or alter
their relationship to particular aspects and events.
In the MBAT model, this goal is accomplished by
learning self-awareness through directed observa-
tion (mindfulness practices) and creative expres-
sion of internal thoughts and emotions (art
therapy), and by enhancing self-acceptance
through verbal and non-verbal bonding and social
support (group therapy).
The high statistical significance on the vitality
subscale of the SF-36 was of interest given that
there was also significant improvement on the
sleep items embedded in the ‘additional items’
dimension of the SCL-90-R. Together, these data
strongly suggest that women in the experimental
intervention felt more rested, and perhaps less
fatigued. This is noteworthy because fatigue is a
well-documented problem among cancer patients
(Hann et al., 1998), and it negatively affects quality
of life by limiting participation in activities of daily
living (Jacobsen and Stein, 1999). Other para-
meters of fatigue might be explored in future
There were several limitations to the study.
First, this was a pilot study that had an inactive
control group (wait-list). Since MBAT is a multi-
modal intervention, the control group for the next
level of investigation should be an active compo-
nent of the MBAT intervention, such as a support
group without the other components. This also
would control for contact time with study person-
nel. Second, for logistical reasons, week 0 assess-
ments were done post-randomization, and thus
may reflect some psychological response to group
assignment, though we do not see this in the
between-group comparisons of week 0 data. Third,
we report only on short-term effects of the
intervention. The eight-week post-intervention
SCL-90-R data are encouraging, but not sufficient
to predict long-term effects of the intervention.
The results of the study cannot be generalized to
all female cancer patients. The study participants
tended to be middle-aged, about half of them had
breast cancer, and three quarters of them were
white; this demographic distribution is consistent
with national trends of those seeking and partici-
pating in cancer support groups (Barg and
Gullatte, 2001).
In summary, this randomized, controlled inves-
tigation of MBAT provides encouraging initial
data regarding the intervention’s potential for
reducing symptoms of distress and improving
key aspects of quality of life in women with
cancer. Currently, there are few randomized,
controlled, clinical trials on standardized alter-
natives to the usual supportive-expressive cancer
group model. Although there are some study
limitations, the results provide support for further
investigation of this novel intervention.
This research was supported by grant R21-AT-683 from
the National Institutes of Health.
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... Following screening of the full MCCLOY ET AL. The comparator used was mainly (n = 11, 52%) [43][44][45][46]49,52,55,56,58,[60][61][62][63] waitlist control or UC with only (n = 8, 38%) 47,48,50,51,53,54,57,59,64 using an AC. Only one study 49 assessed fatigue at baseline and stated fatigue severity score as an inclusion criteria. ...
... Many of the included studies had the primary aim of psychological well-being. [43][44][45][46]48,[52][53][54][55]58,59,63,69 be because some studies failed to report these data, but may also be a result of differences in the length of follow-ups being, weeks or several months after the intervention. ...
... 75 Most of the included studies in this review had exclusion criteria associated with mental health contraindications for participating in mindfulness. [43][44][45][46][48][49][50][51][52][53][54][55][56][57][58][59][60][61] However, this may suggest that recruitment into mindfulness studies to ameliorate CRF may not be representative of the general cancer population and this has implications for clinical practice as discussed below. ...
Full-text available
Background: Cancer diagnosis and treatment can cause fatigue, stress and anxiety which can have a detrimental effect on patients, families and the wider community. Mindfulness-based interventions appear to have positive effects on managing these cancer-related symptoms. Objective: To investigate the efficacy of mindfulness on cancer related fatigue (CRF) and psychological well-being in female cancer patients. Methods: Five databases (CINHAL, Ovid Medline, Ovid Psych Info, Scopus, and Cochrane), and two trial registers (WHO and were searched for randomised control trials from inception to April 2021 and updated in August 2022. Meta-analysis was performed using Review Manager 5.4. The standardised mean difference (SMD) and 95% confidence intervals (CI) were used to determine the intervention effect. Subgroup analysis was performed for adaptation to types of mindfulness, length of intervention and types of comparator used. Results: Twenty-one studies with a total of 2326 participants were identified. Mindfulness significantly improved CRF (SMD -0.81, 95% CI -1.17 to -0.44), depression (SMD-0.74, 95% CI -1.08 to -0.39) and anxiety (SMD -0.92, 95% CI -1.50 to -0.33). No effect was observed for quality of life (SMD 0.32, 95% CI -0.13-0.87) and sleep (SMD -0.65, 95% CI -1.34-0.04). Subgroup analysis revealed that there was little difference in SMD for adapted type of mindfulness (p = 0.42), wait list control compared to active comparator (p = 0.05) or length of intervention (p = 0.29). Conclusion: Mindfulness appears to be effective in reducing CRF and other cancer related symptoms in women. Adaptations to mindfulness delivery did not have negative impact on results which may aid delivery in the clinical settings.
... A main therapeutic change factor is compassion toward the self and others, which is embodied by the therapist-facilitator (Neff, 2016;Williams, 2018). Mindfulness-based art therapy (MBAT; Hinchey, 2018;Monti et al., 2006;Peterson, 2015) has demonstrated effectiveness for the medical arts (Beerse et al., 2020;Jalambadani & Borji, 2019;Meghani et al., 2018). MBAT's change factors include here-and-now mindfulness and non-judgmental awareness of cognition, bodily sensations, feelings, and attitudes (Goldin & Gross, 2010). ...
... Compassionate and Art Therapy Approaches Both MBAT and CBA approaches aim to promote therapeutic equanimity through the acceptance of impermanence, compassion, and happiness; however, they pursue these aims differently. MBAT curriculums first introduce structured, attention-based, mindfulness practices and media, to safely scaffold vulnerable, affective, loving kindness experiences later (Monti et al., 2006). The theoretical underpinning is that acquisition of cognitive skills and structured media support the capacity for tender, yet safe, engagement. ...
The Compassionate Arts Psychotherapy (CAP) program integrates self-compassion and arts psychotherapy practices, which are informed by a compassionate arts media (CAM) continuum. A mixed methods pilot program evaluation with a pretest-posttest single group design, followed by an open-ended survey, was conducted. Participants included 18 graduate students who engaged in ten 2.5-hour meetings, over the course of two weekends. Results showed statistically significant increases in self-compassion, and cognitive and affective mindfulness over time and at two-week follow-up. Qualitatively, participants reported positive gains, specifically: openness to new experiences, here-and-now mindful awareness, and self-compassion. These results suggest the clinical utility of CAP and provide novel perspectives on the directionality of the traditional art therapy media continuum.
... Art-making, similar to gardening, is thought to be an innate behavior of humans [17,18], and both art-making and art therapy (AT) have been shown to provide therapeutic benefits across a range of clinical settings [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Art therapy is centered on the idea that art-making is often a nonverbal form of communication of one's thoughts and feelings involving a creative process that fosters healing, personal growth, self-understanding, quality of life improvements, and transient respite from life's ongoing challenges [35]. ...
... In the present study, SF-36 Physical Health and Mental Health component scores improved by 1% and 4%, respectively, following the art intervention and 2% and 7%, respectively, following gardening. No studies were found that implemented a gardening or art intervention and measured health outcomes with the SF-36; however, results from Monti and colleagues [19] indicated no changes for the SF-36 Physical Health Component, but statistically significant improvements in SF-36 Mental Health Component after an 8-week art and yoga intervention. ...
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Background: There is mounting anecdotal and empirical evidence that gardening and art-making afford therapeutic benefits. Objectives: This randomly controlled pilot study tested the hypothesis that participation in group-based indoor gardening or art-making activities for one hour twice a week for four weeks would provide quantifiably different therapeutic benefits to a population of healthy women ages 26-49. Methods: A population of 42 volunteers was randomly assigned to parallel gardening or art-making treatment groups. A total of 36 participants initiated the treatment protocol and 32 (Gardening n = 15 and Art n = 17) received the interventions and completed all assessments. Treatments included eight one-hour group-based gardening or art intervention sessions. Self-report psychometric assessments were conducted for anxiety, depression symptomatology, mood disturbance, stress, satisfaction with discretionary social activities, and quality of life measures. Cardiac physiological data were also collected. Outcomes were measured at baseline, during, and post-intervention. Results: Engaging in both gardening and art-making activities resulted in apparent therapeutic improvements for self-reported total mood disturbance, depression symptomatology, and perceived stress with different effect sizes following eight one-hour treatment sessions. Gardening also resulted in improvements for indications of trait anxiety. Based on time-course evidence, dosage responses were observed for total mood disturbance, perceived stress, and depression symptomatology for both gardening and art-making. However, gardening or art-making did not have an apparent influence on heart rate or blood pressure or result in marked improvement for satisfaction with discretionary leisure activities. Conclusion: The data did not support the hypothesis of differential therapeutic benefits of gardening and art-making for healthy women. When taken together, group-based gardening or art-making can provide quantitatively measurable improvements in healthy women's psychosocial health status that imply potentially important public health benefits. Trial registration: NCT03266120.
... Mindfulness-based interventions have shown positive results on otherwise healthy patients who were suffering from increased stress (Monti et al., 2005). Like the chronic pain study conducted by Kabat-Zinnn et al. (1985), MBSR-based program interventions have produced positive outcomes by producing changes in biological health markers, e.g., when , conducted RCTs' on patients suffering from psoriasis (stress-sensitive inflammatory skin condition), the participants showed a significant amount of clearing of skin when the treatment ended. ...
This chapter is an attempt to analyse the key factors of adoption of alternative business models by the handicraft artisans during COVID-19 pandemic. This paper is a part of doctoral study and is based on the part of primary research conducted by the scholar. The study primarily analyses the strength of the relationship of the factors. A structured questionnaire was employed to collect data for conducting the study. Descriptive statistics, correlation and multiple linear regressions have been used as statistical tools for analysis. The findings of the study demonstrate the linkage and effect of critical aspects on the performance of alternative business models, resulting in conclusions that leave room for future research. The novelty of this study is that it has made an initial attempt to identify the key factors of adoption of the alternative business model for the artisans. The study is limited to a specific field of the craft sector. The policy-makers will have substantial theoretical consequences for the development of the artisans regarding their alternative business model. It is important to improve artisan’s entrepreneurial skills and capabilities to strengthen them in the global market today.KeywordsAlternative businessHandicraft sectorArtisanCOVID-19Social media
... Perry et al., (2008) report that creative arts can be complementary to conventional therapies when treating PMADs, especially in cases that are not severe. Utilizing art-based interventions to support core DBT principals is an example of this (Clark, 2016;Heckwolf et al., 2014;Franklin, 2010;Kalmanowitz & Ho, 2017;Monti, et al., 2006). Case studies combining DBT and art therapy document the successful outcomes that can occur when combining the two approaches (Huckvale & Learmonth, 2009;Heckwolf et al., 2014). ...
Perinatal Mood and Anxiety Disorders (PMADs) is a serious condition impacting up to 21 percent of woman after the birth of a child (Byrnes, 2018). Jane, a 32-year-old female presented for treatment for anxiety, depression and mood disturbance (5th ed.; DSM-5; American Psychiatric Association, 2013) and in need of feeling more connected to her baby and her life. The use of creative techniques including mindfulness, distress tolerance activity, emotion regulation, and interpersonal skills (Linehan, 2015, 2016) were implemented. The use of these skills can be added to the repertoire of practice of a mental health counselor working with clients with PMADs.
... This was explained by Ledesma and Kumano (2009), as one of the elements that could have caused a small mean effect size may be due to determining the physical measurements after a very short period of time from the post intervention. Some mindfulness studies included physical health measurements in their research (Monti et al., 2006). Ledesma and Kumano (2009) stated that, there would be only a very small enhancement in the physical component, this might be due to the patients who are actively undergoing chemotherapy, radiotherapy, or different types of cancer treatment. ...
Full-text available
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.
The COVID pandemic has generated unprecedented discomfort and uncertainty among people all over the world (WHO, Coronavirus disease (COVID-19) pandemic, 2020). It has affected work, family, and social life, devasted the physical and psychological well-being to an alarming degree. In this situation, our potent weapon is undoubtedly our mental capacity and strength. Strengthening the mind will endow us with the ability and conviction to deal with the current situation (Wu et al., CMAJ 192:E459–E460, 2020). At present, there are various techniques and tools available for this purpose like pranayama, physical exercise, music and, yoga and meditation (Torre et al., Journal of Clinical Medicine 9:1–13, 2020) depending upon one’s individual preferences. Today, meditation is considered as a useful tool to quieten the chattering mind, which is preferred by many individuals (Nalawade and Pradhan, 2016), and therefore, it is gathering momentum as a useful intervention in health care. Of the different types of meditation practices in use today, mindfulness meditation practice has originated from the Buddhist tradition and has been taught by the Buddha 2500 years ago to make the mind calm, focused, and strong. Being mindful means, being fully present in the present moment. Research has shown that being mindful reduces the tendency to be reactive and to become more equanimous and enables one to come out of suffering. Especially in the healthcare domain mindfulness interventions have proven to be effective in enhancing psychological and physical health. This literature review is focused on benefits of mindfulness practice as an intervention, which is cost-effective and non-intrusive in nature. For this purpose, a systematic review was conducted to understand and highlight advantages and applications of mindfulness. The literature review has reiterated the ability of mindfulness practice to help one handle trying situations with equanimity by modulating one’s behavior effectively (Antonova et al., 2020). This study highlights a few clinical case studies and discusses the scope for future studies and limitations faced by researchers in this area. Also, some of the cases where it has been implemented effectively in COVID-19 situations are enumerated with the hope that it will highlight the usefulness of this intervention in the trying and stressful situation at present as well as in future. The limitation of this study is the lack of the availability of long-term research data at present describing the benefits of mindfulness practice in the current pandemic situation.
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Mindfulness-based art therapy has shown to improve psychological well-being. Zentangle is an easy-to-learn, mindfulness-based art therapy suitable for everyone. We reported the transition from face-to-face to online Zentangle workshops in family social services during COVID-19. We explored feedback from face-to-face workshops and the acceptability of an online approach utilizing information communication technology (ICT) to achieve greater service reach, satisfaction, and knowledge and related outcomes. Under the Hong Kong Jockey Club SMART Family-Link Project and in collaboration with Caritas Integrated Family Service Centre—Aberdeen, this study was conducted in two phases: a four-session, face-to-face workshop (phase one) and eleven online single-session workshops (phase two) from September 2019 to September 2020. A total of 305 participants joined the workshops. Phase one participants (n = 11) reported high satisfaction (4.7 out of 5), increases in knowledge (4.2/5) and confidence (3.9/5) towards managing stress, increases in knowledge (4.1/5) and confidence (3.9/5) in showing support and care towards family members, and an increase in knowledge towards strengthening family relationships (4.0/5). Phase two participants (n = 294) also reported high satisfaction (4.7/5) and strongly agreed that ICT helped with learning Zentangle more conveniently, that they had increased knowledge and interest in Zentangle (all 4.7/5), and would definitely join the workshop again (4.8/5). The qualitative data supported the quantitative findings. We are the first to report on the utilization of ICT in an exploratory trial of brief, online Zentangle art workshops targeting the general public, with high satisfaction and positive participant experiences with ICT integration, learning Zentangle, and enhanced psychological and family well-being. This study provided preliminary evidence on the use of ICT to successfully transition face-to-face to online workshops and reach a wider audience.
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Art therapy is the intentional therapeutic use of the fine arts. Like music, dance, poetry and theater therapy, it is assigned to artistic therapy. This article provides an overview of general and recent developments as well as the state of the art in teaching in the discipline art therapy. Furthermore, two art therapeutic forms of intervention, the body outline image method (KUM) and Photo-Art-Therapy, are introduced. The aim is to further standardize the education and further training landscapes of art therapy, not least in order to further increase patient safety. This includes, for example, conveying systematically checked interventional measures and manuals that the students learn both theoretically and in the form of self-awareness. For about 10 years now, more and more high-impact quality research studies have been carried out Further evaluation studies in this field are desirable.
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Książka zawiera przegląd badań na temat znaczenia twórczości dla kształtowania, utrzymywania oraz powracania do zdrowia oraz dobrostanu. Ukazuje również model wyjaśniający mechanizm „prozdrowotnego” oddziaływania twórczości, na podstawie dotychczasowych ustaleń teoretycznych oraz najnowszych wyników badań empirycznych. Dla uzyskania pełnego obrazu tego zjawiska uwzględnione zostały zarówno procesy pozytywnie oddziałujące na zdrowie, jak i czynniki ryzyka towarzyszące twórczości, które mogą być dla niego pewnym zagrożeniem. Ukazane zostały także najważniejsze kierunki rozwoju i wyzwania w zakresie badań naukowych i praktyki w obszarze związków między twórczością a funkcjonowaniem zdrowotnym.
Background Fatigue is one of the most common and distressing symptoms experienced by breast cancer survivors. Despite its prevalence, relatively little is known about the characteristics, etiology, or treatment of fatigue in breast cancer survivors. Methods This report reviews studies that assessed fatigue in breast cancer patients previously treated with adjuvant radiotherapy, adjuvant chemotherapy, or autologous bone marrow transplantation. Results A review of the literature suggests that breast cancer patients who undergo adjuvant chemotherapy or autologous bone marrow transplantation experience clinically significant levels of fatigue for months or even years following the completion of active treatment. In contrast, there is little evidence that patients who receive only regional therapy (ie, surgery plus adjuvant radiotherapy) experience clinically significant fatigue as a long-term treatment side effect. Conclusions A growing body of evidence indicates that persistent fatigue can be a long-term side effect of certain forms of breast cancer treatment. The challenges for the future will be to determine the etiology of fatigue among breast cancer survivors and to develop interventions that are effective in preventing or reducing fatigue following breast cancer treatment.
Breast cancer is one of the most common, and most feared, neoplasms in women. In the developed countries it has been by far, the most extensively studied cancer for its psychological aspects. Most published reports about women’s reactions to breast cancer have, therefore, been heavily influenced by cultural factors, particularly, the stigma attached to cancer and the emphasis placed on women’s sexual and maternal roles. These roles are viewed quite differently in many developing countries. Coupled with the lack of information about the importance of seeing a doctor for a nonpainful lump in the breast, in some countries women present for treatment with far less curable stages of breast cancer, thereby influencing survival. Social factors also influence how a woman reacts in relation to the universal emotions of threat to life, femininity, attractiveness, and self-esteem. In addition, treatment of primary breast cancer varies from country to country, altering the experience to which the woman must adapt. These factors are influenced by the existence of a broader issue; that neither societal views nor medical practices are static. Both are changing all the time. Treatment of breast cancer is a prime example of such changes. The past 10 years have seen a dramatic shift in the nature of primary treatment, resulting from our increased understanding of the biology of breast cancer. In addition, in the developed countries cancer diagnosis is more often revealed and there is greater candor in doctor-patient-family communications.
BACKGROUND The aim of this study was to determine the prevalence and predictors of the perceived unmet needs of cancer patients undergoing treatment for their disease at public treatment centers.METHODSA total of 1492 consecutive patients attending the surgical, radiation, or medical oncology departments of 9 major public cancer treatment centers in New South Wales, Australia, were asked to participate. Of the 1370 eligible patients, 1354 (99%) consented to participate and 888 (65%) returned completed surveys. Eligible consenting patients were given a Supportive Care Needs Survey to complete at home and return by mail within 7 days.RESULTSPatients' perceived needs were assessed across the following five areas: psychologic, health system and information, physical and daily living, patient care and support, and sexuality. Patients' perceived needs were highest in the psychologic, health system and information, and physical and daily living domains. Logistic regression modeling revealed subgroups of patients with different types of needs. The significant predictors of reporting some unmet need for help varied according to the domain examined.CONCLUSIONS This statewide study shows that cancer patients experience high levels of unmet needs across the range of domains examined. The study provides information that may be valuable in identifying areas where interventions could be tested and evaluated in an attempt to address the unmet needs of people living with cancer. [See related article on pages 217–25, this issue.] Cancer 2000;88:225–36. © 2000 American Cancer Society.