Improve Mood and Stress Symptoms in Breast Cancer Survivors with Mindfulness
By John M. de Castro, Ph.D.
“One of the main reasons people with cancer use meditation is to help them to feel better. Meditation can reduce anxiety and stress. It might also help control problems such as pain, difficulty sleeping, tiredness, feeling sick, high blood pressure” – Cancer Research UK
About 12.5% of women in the U.S. develop invasive breast cancer over their lifetimes and every year about 40,000 women die. Indeed, more women in the U.S. die from breast cancer than from any other cancer, besides lung cancer. Breast cancer diagnosis, however, is not a death sentence. Death rates have been decreasing for decades from improved detection and treatment of breast cancer. Five-year survival rates are now at around 95%. The improved survival rates mean that more women are now living with cancer.
Surviving cancer, however, carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” (National Cancer Survivors Day). Also, breast cancer survivors can have to deal with a heightened fear of reoccurrence, and an alteration of their body image. Additionally, cancer survivors frequently suffer from anxiety, depression, mood disturbance, Post-Traumatic Stress Disorder (PTSD), sleep disturbance, fatigue, sexual dysfunction, loss of personal control, impaired quality of life, and psychiatric symptoms which have been found to persist even ten years after remission.
Mindfulness training has been shown to help with general cancer recovery and breast cancer recovery. Mindfulness helps to alleviate many of the residual physical and psychological symptoms, including stress, sleep disturbance, and anxiety and depression. Most forms of mindfulness training contain a number of non-mindfulness components such as the social support and social interactions that occur in the course of treatment. In today’s Research News article “Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406481/, Schellekens and colleagues examine the contribution of social support to the effectiveness of mindfulness training in alleviating distress in breast cancer survivors.
They recruited women with breast cancer and randomly assigned them to receive either 8-weeks of Mindfulness Based Cancer Recovery (MBCR) or 12-weeks of Supportive Expressive Group Therapy (SET). MBCR was based upon Mindfulness Based Stress Reduction (MBSR) program which includes body scan meditation, yoga, and meditation practice but was modified for cancer patients. MBCR was administered in 8 weekly 90 minute sessions with home practice strongly encouraged. SET is a group based program designed to develop mutual and family support and openness and emotional expressiveness. SET was administered in 12 weekly 90 minute group sessions. Before and after treatment the participants were measured for mood disturbance, stress symptoms, quality of life, mindfulness, and social support. Mood disturbance was calculated as the sum of anxiety, depression, anger, vigor, fatigue, and confusion symptoms.
They found that the mindfulness program produced marked and significant reductions in mood disturbance and stress symptoms and increases in social support that were significantly greater than the Supportive Expressive Group Therapy (SET). Both groups increased in mindfulness but were not significantly different. Mediation analysis revealed that MBCR relative to SET reduced mood disturbance in part directly and in part indirectly by increasing social support which in turn reduced mood disturbance. Similarly, MBCR relative to SET reduced stress symptoms in part directly and in part indirectly by increasing social support which in turn reduced stress symptoms. This is an excellent study as it was randomized and the comparison condition was an active control which received appropriate treatment. This is a much stronger design than the typical wait-list no treatment control, excluding placebo effects and attentional effects as alternative explanations.
These results are interesting and suggest that the effectiveness of mindfulness treatments for mood disturbance and stress in cancer patients are due in part to mindfulness training increasing the amount of social support that the patient receives. Family and friends, if supportive, can do wonders to reduce the stress and emotional consequences of a cancer diagnosis. Mindfulness training by enhancing the social support improves mood and relieves stress. But, the results also show that mindfulness training itself produces reductions in emotional problems and the symptoms of stress independent of its effects on social support. This is not surprising as the ability of mindfulness training to improve emotional regulation and stress responding are well documented. So, it is clear that mindfulness training invokes a number of beneficial processes that assist the cancer sufferer in dealing with their illness.
So, improve mood and stress symptoms in breast cancer survivors with mindfulness.
“A brief mindfulness-based intervention has a positive short-term effect on psychological and behavioral measures as well as proinflammatory signal markers in younger breast cancer survivors” – Julienne Bower
CMCS – Center for Mindfulness and Contemplative Studies
This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch
Study Summary
Schellekens, M. P. J., Tamagawa, R., Labelle, L. E., Speca, M., Stephen, J., Drysdale, E., … Carlson, L. E. (2017). Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators. Journal of Behavioral Medicine, 40(3), 414–422. http://doi.org/10.1007/s10865-016-9799-6
Abstract
Despite growing evidence in support of mindfulness as an underlying mechanism of mindfulness-based interventions (MBIs), it has been suggested that nonspecific therapeutic factors, such as the experience of social support, may contribute to the positive effects of MBIs. In the present study, we examined whether change in mindfulness and/or social support mediated the effect of Mindfulness-Based Cancer Recovery (MBCR) compared to another active intervention (i.e. Supportive Expressive Group Therapy (SET)), on change in mood disturbance, stress symptoms and quality of life. A secondary analysis was conducted of a multi-site randomized clinical trial investigating the impacts of MBCR and SET on distressed breast cancer survivors (MINDSET). We applied the causal steps approach with bootstrapping to test mediation, using pre- and post-intervention questionnaire data of the participants who were randomised to MBCR (n = 69) or SET (n = 70). MBCR participants improved significantly more on mood disturbance, stress symptoms and social support, but not on quality of life or mindfulness, compared to SET participants. Increased social support partially mediated the impact of MBCR versus SET on mood disturbance and stress symptoms. Because no group differences on mindfulness and quality of life were observed, no mediation analyses were performed on these variables. Findings showed that increased social support was related to more improvement in mood and stress after MBCR compared to support groups, whereas changes in mindfulness were not. This suggests a more important role for social support in enhancing outcomes in MBCR than previously thought.