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<p>Little attention has been paid to the psychological determinants by which benefits are accrued via yoga practice in cancer-related clinical settings. Using a longitudinal multilevel modeling approach, associations between affect, mindfulness, and patient-reported mental health outcomes, including mood disturbance, stress symptoms, and health-related quality of life (HRQL), were examined in an existing seven-week yoga program for cancer survivors. Participants (N = 66) were assessed before and after the yoga program and at three- and six-month follow-ups. Decreases in mood disturbance and stress symptoms and improvements in HRQL were observed upon program completion. Improvements in mood disturbance and stress symptoms were maintained at the three- and six-month follow-ups. HRQL exhibited further improvement at the three-month follow-up, which was maintained at the six-month follow-up. Improvements in measures of well-being were predicted by initial positive yoga beliefs and concurrently assessed affective and mindfulness predictor variables. Previous yoga experience, affect, mindfulness, and HRQL were related to yoga practice maintenance over the course of the study.</p>
During the past 30 years, there has been an increase in the incidence of cancer in adolescents. While recent studies have illustrated remarkable resilience in youth living with cancer, they can also face daunting acute and chronic adjustment struggles, cognitive and school problems, family and peer relational difficulties, depression, post-traumatic stress symptoms, and other anxiety disorders. Mindfulness-based interventions (MBIs), increasingly shown to be effective in a variety of medical and mental health settings, may be particularly beneficial for adolescents with cancer. This paper reviews evidence from clinical trials of MBIs showing a variety of benefits for adult cancer patients, adolescents with anxiety disorders and chronic pain, and clinically healthy teenagers, which collectively point to likely benefits of MBIs for teen cancer patients. The authors also explore ways that the particular psychological problems often faced by teen cancer patients, including anxiety about the future, may be especially well suited to mindfulness approaches such as learning to observe physical sensations, thoughts, and emotions, as well as cultivating compassion towards themselves and others. The paper concludes with an exploration of unanswered and potential research questions regarding the future use of MBIs with adolescents with cancer, and potentially with teenagers with other chronic diseases.
Objective: To provide a descriptive overview of the clinical trials assessing meditation practices for health care.Design: Systematic review of the literature. Comprehensive searches were conducted in 17 electronic bibliographic databases through September 2005. Other sources of potentially relevant studies included hand searches, reference tracking, contacting experts, and gray literature searches. Included studies were clinical trials with 10 or more adult participants using any meditation practice, providing quantitative data on health-related outcomes, and published in English. Two independent reviewers assessed study relevance, extracted the data, and assessed the methodological quality of the studies.Results: Four hundred clinical trials on meditation (72% described as randomized) were included in the review (publication years 1956–2005). Five broad categories of meditation practices were identified: mantra meditation, mindfulness meditation, yoga, t'ai chi, and qigong. The three most studied clinical conditions were hypertension, miscellaneous cardiovascular diseases, and substance abuse. Psychosocial measures were the most frequently reported outcomes. Outcome measures of psychiatric and psychological symptoms dominate the outcomes of interest. Overall, the methodological quality of clinical trials is poor, but has significantly improved over time by 0.014 points every year (95% CI, 0.005, 0.023).Conclusions: Most clinical trials on meditation practices are generally characterized by poor methodological quality with significant threats to validity in every major quality domain assessed. Despite a statistically significant improvement in the methodological quality over time, it is imperative that future trials on meditation be rigorous in design, execution, analysis, and the reporting of results.
Mindfulness‐based stress reduction (MBSR) programmes have demonstrated beneficial outcomes in a variety of populations. Self‐compassion and empathy have theoretical connections to mindfulness, the key element of the MBSR programme; however, previous studies examining the programme's impact on self‐compassion or empathy have demonstrated mixed results. This study examined the impact of MBSR on self‐compassion and empathy, as well as on mindfulness, symptoms of stress, mood disturbance and spirituality in a community sample. Significant reductions in symptoms of stress and mood disturbance, as well as increases in mindfulness, spirituality and self‐compassion were observed after programme participation. With regards to empathy, a significant increase was seen in perspective taking and a significant decrease in personal distress; no significant change was observed for empathic concern. Changes in self‐compassion were predicted by changes in mindfulness. Self‐compassion and aspects of empathy revealed strong associations with psychological functioning. Implications of MBSR as an intervention for enhancing self‐compassion and empathy are discussed.
The present study is a waitlist-controlled investigation of the impact of a Mindfulness-Based Stress Reduction (MBSR) program on mindful attentiveness, rumination and blood pressure (BP) in women with cancer. Female post-treatment cancer patients were recruited from the MBSR program waitlist. Participants completed self-report measures of mindfulness and rumination and measured casual BP at home before and after the 8-week MBSR program or waiting period. MBSR group participants demonstrated higher levels of mindful attentiveness and decreased ruminative thinking following the intervention but no difference in BP, when compared to controls. In the MBSR group, decreases in rumination correlated with decreases in SBP and increases in mindful attention. When participants were assigned to “Higher BP” and “Lower BP” conditions based on mean BP values at week 1, “Higher BP” participants in the MBSR group (n = 19) had lower SBP at week 8 relative to the control group (n = 16). A MBSR program may be efficacious in increasing mindful attention and decreasing rumination in women with cancer. Randomized controlled trials are needed to evaluate an impact on clinically elevated BP.
Sleep disturbance is a very common problem for cancer patients that has largely not been addressed in the clinical intervention literature. Mindfulness meditation has demonstrated clinical benefits for a variety of patient populations in other areas of functioning. This study examined the effects of an 8-week Mindfulness-Based Stress Reduction (MBSR) program on the sleep quality of a heterogeneous sample of 63 cancer patients. Overall sleep disturbance was significantly reduced (p < .001) and participants reported that their sleep quality had improved (p < .001). There was also a significant reduction in stress (p < .001), mood disturbance (p = .001), and fatigue (p < .001). The associations among these changes and implications for improving quality of life of cancer patients are discussed.
BackgroundClinically significant psychological distress in pregnancy is common, with epidemiological research suggesting that between 15 and 25 % of pregnant women experience elevated symptoms of stress, anxiety, and depression. Untreated psychological distress in pregnancy is associated with poor obstetrical outcomes, changes in maternal physiology, elevated incidence of child physical and psychological disorders, and is predictive of maternal postpartum mood disorders. Despite the wide-ranging impact of antenatal psychological distress on mothers and their children, there is a gap in our knowledge about the most effective treatments that are available for psychological distress experienced in pregnancy. Additionally, no trials have focused on potential physiological changes that may occur as a result of receiving mindfulness training in pregnancy. The proposed trial will determine the effectiveness of an 8-week modified Mindfulness-based Cognitive Therapy (MBCT) intervention delivered during pregnancy.
Methods
A randomized controlled trial (RCT) design with repeated measures will be used to evaluate the effectiveness of MBCT to treat psychological distress in pregnancy. A sample of 60 consenting pregnant women aged 18 years and above will be enrolled and randomized to the experimental (MBCT) or control (treatment as usual) condition. Primary (e.g., symptoms of stress, depression, and anxiety), secondary (cortisol, blood pressure (BP), heart rate variability (HRV), and sleep) and other outcome data (e.g., psychological diagnoses) will be collected via a combination of laboratory visits and at-home assessments from both groups at baseline (T1), immediately following the intervention (T2), and at 3 months postpartum (T3). Descriptive statistics will be used to describe sample characteristics. Data will be analyzed using an intention-to-treat approach. Hierarchical linear models will be used to test intervention effects on primary and secondary outcomes.
Discussion
The trial is expected to improve knowledge about evidence-based treatments for psychological distress experienced in pregnancy and to evaluate the potential impact of mindfulness-based interventions on maternal physiology.
The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions. Shapiro, Shauna L.; Carlson, Linda E.; Publisher: American Psychological Association; 2009, pp. 63-73. [Chapter] Abstract: In this chapter, we focus on research studies that have investigated the effects of mindfulness-based (MB) interventions on people with psychological problems such as depression and anxiety. We also cover psychological outcomes measured in groups of healthy individuals.
Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “dose” in determining outcomes.
BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder of the lower gastrointestinal (GI) tract affected by stress, which may benefit from a biopsychosocial treatment approach such as mindfulness-based stress reduction (MBSR).PURPOSE: A treatment as usual (TAU) wait-list controlled trial was conducted in Calgary, Canada to investigate the impact of MBSR on IBS symptoms. It was hypothesized that MBSR patients would experience greater reduction in overall IBS symptom severity and self-reported symptoms of stress relative to control patients.
METHOD: Ninety patients diagnosed with IBS using the Rome III criteria were randomized to either an immediate MBSR program (n = 43) or to wait for the next available program (n = 47). Patients completed IBS symptom severity, stress, mood, quality of life (QOL), and spirituality scales pre- and post-intervention or waiting period and at 6-month follow-up. Intent-to-treat linear mixed model analyses for repeated measures were conducted, followed by completers analyses.
RESULTS: While both groups exhibited a decrease in IBS symptom severity scores over time, the improvement in the MBSR group was greater than the controls and was clinically meaningful, with symptom severity decreasing from constantly to occasionally present. Pre- to post-intervention dropout rates of 44 and 23 % for the MBSR and control groups, respectively, were observed. At 6-month follow-up, the MBSR group maintained a clinically meaningful improvement in overall IBS symptoms compared to the wait-list group, who also improved marginally, resulting in no statistically significant differences between groups at follow-up. Improvements in overall mood, QOL, and spirituality were observed for both groups over time.
CONCLUSIONS: The results of this trial provide preliminary evidence for the feasibility and efficacy of a mindfulness intervention for the reduction of IBS symptom severity and symptoms of stress and the maintenance of these improvements at 6 months post-intervention. Attention and self-monitoring and/or anticipation of MBSR participation may account for smaller improvements observed in TAU patients.
BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder of the lower gastrointestinal (GI) tract affected by stress, which may benefit from a biopsychosocial treatment approach such as mindfulness-based stress reduction (MBSR).PURPOSE: A treatment as usual (TAU) wait-list controlled trial was conducted in Calgary, Canada to investigate the impact of MBSR on IBS symptoms. It was hypothesized that MBSR patients would experience greater reduction in overall IBS symptom severity and self-reported symptoms of stress relative to control patients.
METHOD: Ninety patients diagnosed with IBS using the Rome III criteria were randomized to either an immediate MBSR program (n = 43) or to wait for the next available program (n = 47). Patients completed IBS symptom severity, stress, mood, quality of life (QOL), and spirituality scales pre- and post-intervention or waiting period and at 6-month follow-up. Intent-to-treat linear mixed model analyses for repeated measures were conducted, followed by completers analyses.
RESULTS: While both groups exhibited a decrease in IBS symptom severity scores over time, the improvement in the MBSR group was greater than the controls and was clinically meaningful, with symptom severity decreasing from constantly to occasionally present. Pre- to post-intervention dropout rates of 44 and 23 % for the MBSR and control groups, respectively, were observed. At 6-month follow-up, the MBSR group maintained a clinically meaningful improvement in overall IBS symptoms compared to the wait-list group, who also improved marginally, resulting in no statistically significant differences between groups at follow-up. Improvements in overall mood, QOL, and spirituality were observed for both groups over time.
CONCLUSIONS: The results of this trial provide preliminary evidence for the feasibility and efficacy of a mindfulness intervention for the reduction of IBS symptom severity and symptoms of stress and the maintenance of these improvements at 6 months post-intervention. Attention and self-monitoring and/or anticipation of MBSR participation may account for smaller improvements observed in TAU patients.
The use of mindfulness-based stress reduction (MBSR) programmes has become increasingly common in many healthcare settings over the last decade. However, the use and indications for MBSR in an oncology setting has not been well explicated. This paper provides an overview of the psychosocial challenges of cancer diagnosis, treatment and recovery, followed by a description of how MBSR programmes have and may be used with cancer populations, using our programme in Calgary, Canada, as an exemplar.Research investigating the use of MBSR shows significant improvements in mood, decreased stress symptoms, and normalisation of hormonal and immune function. MBSR has also been shown to be effective for decreasing the high levels of sleep disturbance often found in cancer patients. An instrument to measure levels of mindfulness, the Mindful Attention Awareness Scale (MAAS), has been developed and validated for use with cancer patients. Issues germane to working with this population such as considerations during patient screening for the MBSR programme and facilitatory training are discussed. Finally, the use of research designs such as dismantling studies and qualitative methods are considered.
Objectives:This study investigated the relationships between a mindfulness-based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, lymphocyte counts, and cytokine production.
Methods:
Forty-nine patients with breast cancer and 10 with prostate cancer participated in an 8-week MBSR program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life (EORTC QLQ C-30), mood (POMS), stress (SOSI), and counts of NK, NKT, B, T total, T helper, and T cytotoxic cells, as well as NK and T cell production of TNF, IFN-γ, IL-4, and IL-10 were assessed pre- and postintervention.
Results:
Fifty-nine and 42 patients were assessed pre- and postintervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality. Although there were no significant changes in the overall number of lymphocytes or cell subsets, T cell production of IL-4 increased and IFN-γ decreased, whereas NK cell production of IL-10 decreased. These results are consistent with a shift in immune profile from one associated with depressive symptoms to a more normal profile.
Conclusions:
MBSR participation was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients. This study is also the first to show changes in cancer-related cytokine production associated with program participation.
Objectives: This study investigated the relationships between a mindfulness-based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, and levels of cortisol, dehydroepiandrosterone-sulfate (DHEAS) and melatonin.Methods: Fifty-nine patients with breast cancer and 10 with prostate cancer enrolled in an eight-week Mindfulness-Based Stress Reduction (MBSR) program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life, mood, stress, and the hormone measures of salivary cortisol (assessed three times/day), plasma DHEAS, and salivary melatonin were assessed pre- and post-intervention.
Results: Fifty-eight and 42 patients were assessed pre- and post-intervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality, but these improvements were not significantly correlated with the degree of program attendance or minutes of home practice. No significant improvements were seen in mood disturbance. Improvements in quality of life were associated with decreases in afternoon cortisol levels, but not with morning or evening levels. Changes in stress symptoms or mood were not related to changes in hormone levels. Approximately 40% of the sample demonstrated abnormal cortisol secretion patterns both pre- and post-intervention, but within that group patterns shifted from “inverted-V-shaped” patterns towards more “V-shaped” patterns of secretion. No overall changes in DHEAS or melatonin were found, but nonsignificant shifts in DHEAS patterns were consistent with healthier profiles for both men and women.
Conclusions: MBSR program enrollment was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients, and resulted in possibly beneficial changes in hypothalamic-pituitary-adrenal (HPA) axis functioning. These pilot data represent a preliminary investigation of the relationships between MBSR program participation and hormone levels, highlighting the need for better-controlled studies in this area.
ObjectivesThis study investigated the ongoing effects of participation in a mindfulness-based stress reduction (MBSR) program on quality of life (QL), symptoms of stress, mood and endocrine, immune and autonomic parameters in early stage breast and prostate cancer patients.
Methods
Forty-nine patients with breast cancer and 10 with prostate cancer enrolled in an eight-week MBSR program that incorporated relaxation, meditation, gentle yoga and daily home practice. Demographic and health behaviors, QL, mood, stress symptoms, salivary cortisol levels, immune cell counts, intracellular cytokine production, blood pressure (BP) and heart rate (HR) were assessed pre- and post-intervention, and at 6- and 12-month follow-up.
Results
Fifty-nine, 51, 47 and 41 patients were assessed pre- and post-intervention and at 6- and 12-month follow-up, respectively, although not all participants provided data on all outcomes at each time point. Linear mixed modeling showed significant improvements in overall symptoms of stress which were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up. Immune patterns over the year supported a continued reduction in Th1 (pro-inflammatory) cytokines. Systolic blood pressure (SBP) decreased from pre- to post-intervention and HR was positively associated with self-reported symptoms of stress.
Conclusions
MBSR program participation was associated with enhanced quality of life and decreased stress symptoms, altered cortisol and immune patterns consistent with less stress and mood disturbance, and decreased blood pressure. These pilot data represent a preliminary investigation of the longer-term relationships between MBSR program participation and a range of potentially important biomarkers.
PURPOSE: A growing number of cancer survivors suffer high levels of distress, depression and stress, as well as sleep disturbance, pain and fatigue. Two different mind-body interventions helpful for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been evaluated in the same study or directly compared. This study will be the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors. It will also allow for secondary analyses of which program best targets specific symptoms in particular groups of survivors, based on preferences and baseline characteristics.METHODS AND SIGNIFICANCE: The design is a preference-based multi-site randomized comparative effectiveness trial. Participants (N=600) with a preference for either MBCR or TCQ will receive their preferred intervention; while those without a preference will be randomized into either intervention. Further, within the preference and non-preference groups, participants will be randomized into immediate intervention or wait-list control. Total mood disturbance on the Profile of mood states (POMS) post-intervention is the primary outcome. Other measures taken pre- and post-intervention and at 6-month follow-up include quality of life, psychological functioning, cancer-related symptoms and physical functioning. Exploratory analyses investigate biomarkers (cortisol, cytokines, blood pressure/Heart Rate Variability, telomere length, gene expression), which may uncover potentially important effects on key biological regulatory and antineoplastic functions. Health economic measures will determine potential savings to the health system.
Objective: Cancer patients experience many negative psychological symptoms including stress, anxiety, and depression. This distress is not limited to the patient, as their partners also experience many psychological challenges. Mindfulness‐based stress reduction (MBSR) programs have demonstrated clinical benefit for a variety of chronic illnesses, including cancer. This is the first study to report MBSR participation with partners of cancer patients.Methods: This study examined the impact of an 8‐week MBSR program for 21 couples who attended the program together on outcomes of mood disturbance, symptoms of stress, and mindfulness.
Results: Significant reductions for both patients and partners in mood disturbance (p<0.05) and the Calgary Symptoms of Stress Inventory (C‐SOSI) subscales of muscle tension (p<0.01), neurological/GI (p<0.05), and upper respiratory (p<0.01) symptoms were observed after program participation. Significant increases in mindfulness (p<0.05) were also reported in both groups. No significant correlations were observed between patient and partner scores on any measures at baseline or on change scores pre‐ to post‐intervention; however, after MBSR participation couple's scores on the Profile of Mood States and C‐SOSI were more highly correlated with one‐another. Post‐intervention, partners' mood disturbance scores were significantly positively correlated with patients' symptoms of stress and negatively correlated with patients' levels of mindfulness.
Conclusions: Overall, the MBSR program was helpful for improving psychological functioning and mindfulness for both members of the couple. Several avenues of future research are suggested to further explore potential benefits of joint couple attendance in the MBSR program.
Quantitative research has shown Mindfulness‐based Stress Reduction (MBSR) programmes can reduce mood disturbance, improve quality of life, and decrease stress symptoms of cancer patients. However, the range of subjective effects experienced by programme participants has not been clearly described. Nine cancer patients who had participated in an 8‐week MBSR programme through the Tom Baker Cancer Centre's Department of Psychosocial Resources, and who continued to attend weekly drop‐in MBSR sessions were interviewed for this study. Qualitative research was conducted using grounded theory analysis. Data from semi‐structured interviews and a focus group were analysed using QSR N6 software to identify themes concerning the effects patients experienced by adding meditation to their lives. Five major themes emerged from the data: (1) opening to change; (2) self‐control; (3) shared experience; (4) personal growth; (5) spirituality. This information was used to develop specific theory concerning mechanisms whereby MBSR effects change for cancer patients. These understandings may be used to refine and further develop MBSR programmes to better assist patients during cancer diagnosis, treatment and recovery.
Objective: The objective of this study was to assess the effects of participation in a mindfulness meditation–based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients. Methods: A randomized, wait-list controlled design was used. A convenience sample of eligible cancer patients enrolled after givinginformed consent and were randomly assigned to either an immediate treatment condition or a wait-list control condition. Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention. The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice. Results: Ninety patients (mean age, 51 years) completed the study. The group was heterogeneous in type and stage of cancer. Patients’ mean preintervention scores on dependent measures were equivalent
between groups. After the intervention, patients in the treatment group had significantly lower scores on Total
Mood Disturbance and subscales of Depression, Anxiety, Anger, and Confusion and more Vigor than control
subjects. The treatment group also had fewer overall Symptoms of Stress; fewer Cardiopulmonary and Gastrointestinal symptoms; less Emotional Irritability, Depression, and Cognitive Disorganization; and fewer Habitual Patterns of stress. Overall reduction in Total Mood Disturbance was 65%, with a 31% reduction in Symptoms of Stress. Conclusions: This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and ages. Key words: meditation, cancer, stress, mood, intervention, mindfulness.
ObjectivesThis 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.