Month: May 2020

Reduce Inflammation with Yoga

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Reduce Inflammation with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga is an incredible resource to combat stress and promote healthy habits in body and mind. Many people cite stress reduction as their reason to practice yoga, and research has their back – reducing stress helps reduce inflammation.” – Amy Tenney

 

The immune system is designed to protect the body from threats like stress, infection, injury, and toxic chemicals. One of its tools is the Inflammatory response. This response works quite well for short-term infections and injuries. But when inflammation is protracted and becomes chronic, it can itself become a threat to health. It can produce autoimmune diseases such as colitis, Chron’s disease, arthritis, heart disease, increased cancer risk, lung disease, sleep disruption, gum disease, decreased bone health, psoriasis, and depression.

 

Needless to say, chronic inflammation can create major health problems. Indeed, the presence of chronic inflammation is associated with reduced longevity. So, it is important for health to control the inflammatory response, allowing it to do its job in fighting off infection but reducing its activity when no external threat is apparent. Of course, it is far better to prevent chronic inflammation in the first place than to treat it later. Mind-body techniques such as yoga have been shown to reduce the inflammatory response. The research is accumulating, so it is reasonable to summarize what has been discovered.

 

In today’s Research News article “Impact of Yoga on Inflammatory Biomarkers: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700894/), Djalilova and colleagues review and summarize the published research literature on the effects of yoga practice on biomarkers of inflammation in adults. They found 15 published studies with 10 randomized controlled trials, including a total of 957 participants. Yoga practice was majority Hatha yoga and occurred from 8 weeks to 6 months.

 

They found that 11 of the 15 studies reported significant decreases in inflammatory biomarkers IL-6, CRP, and TNF-α. These reductions occurred in patients with cancer, cardiovascular disease, chronic stress, arthritis, and hypertension. The studies that did not see improvements included less than 1000 minutes of practice. All but 1 study with practice between 1000 to 4500 minutes found significant improvements in inflammation.

 

Hence, the published research found yoga to be a safe and effective treatment to reduce the inflammatory response in patients with a wide variety of medical conditions. It appears that at least a total of 1000 minutes of practice is required for effectiveness. It is not known what the mechanisms might be by which yoga practice reduces inflammation. But, it can be speculated that it may do so by reducing stress effects, as stress is known to promote inflammation, or it may work by improving autonomic nervous system activity that is also known to promote inflammation.

 

Regardless of the mechanism, the published research to date supports the use of yoga practice to reduce inflammation in patients with a wide variety of diseases. Since, inflammation generally exacerbates the symptoms of their diseases, yoga practice may then improve their symptoms, reduce their suffering, increase longevity, and improve their quality of life.

 

So, reduce inflammation with yoga.

 

“A number of studies have suggested that yoga and meditation – along with other mind/body activities – can reduce inflammation as well as influence some immunological markers of stress.” – Andrew Weil

 

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

 

Djalilova, D. M., Schulz, P. S., Berger, A. M., Case, A. J., Kupzyk, K. A., & Ross, A. C. (2019). Impact of Yoga on Inflammatory Biomarkers: A Systematic Review. Biological research for nursing, 21(2), 198–209. https://doi.org/10.1177/1099800418820162

 

Abstract

Background:

Many chronic conditions, including heart disease, cancer, and rheumatoid arthritis, are associated with underlying chronic inflammatory processes. Literature reviews have analyzed a variety of integrative therapies and their relationships with chronic inflammation. This systematic review is unique in reporting solely on yoga’s relationship with inflammation. Its purpose was to synthesize current literature examining the impact of yoga interventions on inflammatory biomarkers in adults with chronic inflammatory–related disorders.

Method:

Searches of several electronic databases were conducted. Inclusion criteria were (a) English language, (b) sample age >18 years old, (c) yoga interventions involving postures with or without yoga breathing and/or meditation, and (d) measured inflammatory biomarkers.

Results:

The final review included 15 primary studies. Of these, seven were rated as excellent and eight as average or fair. There was considerable variability in yoga types, components, frequency, session length, intervention duration, and intensity. The most common biomarkers measured were interleukin-6 (n = 11), C-reactive protein (n = 10), and tumor necrosis factor (n = 8). Most studies reported positive effects on inflammatory biomarkers (n = 11) from baseline to post yoga intervention. Analysis of the dose showed higher total dose (>1,000 min) resulted in greater improvements in inflammation.

Conclusion:

This review suggests that yoga can be a viable intervention to reduce inflammation across a multitude of chronic conditions. Future studies with detailed descriptions of yoga interventions, measurement of new and well-established inflammatory biomarkers, and larger sample sizes are warranted to advance the science and corroborate results.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700894/

 

Reduce Aggression with Mindfulness

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Reduce Aggression with Mindfulness

 

By John M. de Castro, Ph.D.

 

“young adults who participated in an app-based meditation training were less aggressive after receiving critical feedback, but not less angry. It suggests that being mindful doesn’t interfere with experiencing emotions, but changes how one responds to them.” – AMRA

 

The human tendency to lash out with aggression when threatened was adaptive for the evolution of the species. It helped promote the survival of the individual, the family, and the tribe. In the modern world, however, this trait has become more of a problem than an asset. It results in individual violence and aggression such as physical abuse, fights, road rage, and even murders, and in societal violence such as warfare. It may even be the basis for the horrors of terrorism and mass murder. Obviously, there is a need in modern society to control these violent and aggressive urges.

 

Aggression may, at least in part, be amplified by anger rumination; an uncontrollable, repetitive thinking about anger and its sources. This can produce a downward spiral where people repeatedly think about their anger which, in turn, reinforces the anger making it worse and worse. It is like a record that’s stuck and keeps repeating the same lyrics. It’s replaying a dispute in the individual’s mind. It’s going over their anger, again and again. Fortunately, rumination may be interrupted by mindfulness and mindfulness may improve the individual’s ability to regulate their emotions. This may, in part, be a mechanism by which mindfulness training reduces aggression and hostility. Hence, mindfulness may be an antidote to violent and aggressive urges by interrupting anger rumination and improving emotion regulation.

 

In today’s Research News article “Emotion regulation mediates relationships between mindfulness facets and aggression dimensions.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916265/), Garofalo and colleagues recruited adult prisoners and a community sample of adult nonoffenders. They then had them complete measures of mindfulness, emotion regulation, and aggressiveness.

 

Correlational analysis revealed that in both the offender and nonoffender samples, the higher the levels of mindfulness, the higher the levels of emotion regulation and the lower the levels of aggressiveness. In addition, the higher the levels of emotion regulation the lower the levels of aggressiveness. Further, structural equation modelling revealed that in both the offender and nonoffender samples that emotion regulation mediated the relationship between mindfulness and aggressiveness. That is, the mindfulness was not associated with aggressiveness directly but rather mindfulness was associated with higher levels of emotion regulation which, in turn, was associated with lower levels of aggressiveness.

 

These findings are correlational and as such causation cannot be determined. But, prior research has shown a causal connection between mindfulness and higher levels of emotion regulation and that emotion regulation has a causal connection to lower aggressiveness and that mindfulness has a causal connection to lower aggressiveness. So, it is likely that the present findings are the results of causal links between mindfulness, emotion regulation, and aggressiveness.

 

Hence, the present results suggest that being mindful goes along with having better ability to regulate emotions and that goes along with less aggressiveness. Emotion regulation is not suppression of emotions rather it is the ability to feel the emotions but not let them dictate behavior; feeling emotions but remaining in control. Thus, the results suggest that aggressiveness may result from uncontrolled reactions to emotions and that mindfulness by improving emotion regulation reduces these responses.

 

It is interesting that the results were exactly the same for both prisoners and nonoffender adults. This suggests that there is nothing special about the mechanisms controlling aggressiveness in prisoners. Rather it would appear that prisoners have a lower level of emotion regulation. This implies that improving mindfulness and emotion regulation in prisoners would lead to greater control and less violence and aggression.

 

So, reduce aggression in with mindfulness.

 

“When any emotion rises up, we tend to first get caught up in it and then act it out, through speech or action. This couldn’t be truer for the heightened emotion of anger. Meditation, though, can teach us how to change a rash, reactive mindset into a more considered, responsive, and productive one.” – Headspace

 

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

 

Garofalo, C., Gillespie, S. M., & Velotti, P. (2020). Emotion regulation mediates relationships between mindfulness facets and aggression dimensions. Aggressive behavior, 46(1), 60–71. doi:10.1002/ab.21868

 

Abstract

Recent years have witnessed an increase of research on socio‐affective factors that can explain individual differences in aggressive tendencies across community and offender populations. Specifically, mindfulness and emotion regulation have emerged as important factors, which could also constitute important prevention and treatment targets. Yet, recent studies have advanced the possibility that mindfulness may also have a “dark” side, being associated with increased levels of aggression‐related variables, especially when accounting for the variance associated with emotion regulation. The present study sought to elucidate relationships among mindfulness, emotion regulation, and aggression dimensions (i.e., verbal and physical aggression, anger, and hostility) across violent offender (N = 397) and community (N = 324) samples. Results revealed expected associations between both mindfulness and emotion regulation and aggression dimensions, such that greater impairments in mindfulness and emotion regulation were related to increased levels of aggression across samples. Further, analyses of indirect effects revealed that a latent emotion dysregulation factor accounted for (i.e., mediated) relationships between mindfulness facets and aggression dimensions in both samples. Previously reported positive associations between the residual variance in mindfulness scales (i.e., controlling for emotion regulation) and aggression‐related variables were not replicated in the current samples. Taken together, findings suggest that mindfulness and emotion regulation have unequivocal relations with lower levels of aggression, and should therefore be considered as relevant targets for prevention and treatment programs aimed at reducing aggressive tendencies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916265/

 

Improve Sleep in Insomniacs with Meditation

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Improve Sleep in Insomniacs with Meditation

 

By John M. de Castro, Ph.D.

 

“Given the absence of side effects and the positive potential benefits of mindfulness that extend beyond sleep, we encourage people with chronic insomnia, particularly those unable or unwilling to use sleep medications, to consider mindfulness training.” – Cynthia Gross

 

Modern society has become more around-the-clock and more complex producing considerable pressure and stress on the individual. The advent of the internet and smart phones has exacerbated the problem. The resultant stress can impair sleep. Indeed, it is estimated that over half of Americans sleep too little due to stress. As a result, people today sleep 20% less than they did 100 years ago. Not having a good night’s sleep has adverse effects upon the individual’s health, well-being, and happiness. It has been estimated that 30 to 35% of adults have brief symptoms of insomnia, 15 to 20% have a short-term insomnia disorder, and 10% have chronic insomnia

 

Insomnia is more than just an irritant. Sleep deprivation is associated with decreased alertness and a consequent reduction in performance of even simple tasks, decreased quality of life, increased difficulties with memory and problem solving, increased likelihood of accidental injury including automobile accidents, and increased risk of dementia and Alzheimer’s disease. It also can lead to anxiety about sleep itself. This is stressful and can produce even more anxiety about being able to sleep. About 4% of Americans revert to sleeping pills. But these do not always produce high quality sleep and can have problematic side effects. So, there is a need to find better methods to treat insomnia. Mindfulness-based practices have been reported to improve sleep amount and quality and help with insomnia. It makes sense to explore the effectiveness of different meditation techniques for insomnia.

 

In today’s Research News article “Heartfulness meditation improves sleep in chronic insomnia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034439/), Thimmapuram and colleagues recruited adults who were diagnosed with chronic insomnia. They were instructed on sleep hygiene and received instruction in heartfulness meditation once per week for 8 weeks. Heartfulness meditation included relaxation and directing attention to the light in the heart and be open to any experience. They were instructed to practice the meditation in the morning for 20 minutes and in the evening for 5 minutes. They were measured before and after training for insomnia severity.

 

They found that in comparison to baseline after heartfulness meditation there was a large significant decrease in insomnia severity. Whereas all participants were taking some form of medication for insomnia before the training, afterwards 75% of the patients had ceased taking the drugs while a further 12.5% reduced dosage.

 

The study did not contain a control group and as such the results must be interpreted with caution. However, prior well-controlled studies have demonstrated that mindfulness training improves sleep and reduces insomnia. So, it is likely that the heartfulness meditation practice was responsible for the improvements in the present study. This study extends the types of mindfulness practices that are effective for insomnia with heartfulness meditation.

 

So, improve sleep in insomniacs with meditation.

 

“If insomnia is at the root of your sleepless nights, it may be worth trying meditation. The deep relaxation technique has been shown to increase sleep time, improve sleep quality, and make it easier to fall (and stay) asleep.” – SleepFoundation

 

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

 

Thimmapuram, J., Yommer, D., Tudor, L., Bell, T., Dumitrescu, C., & Davis, R. (2020). Heartfulness meditation improves sleep in chronic insomnia. Journal of community hospital internal medicine perspectives, 10(1), 10–15. https://doi.org/10.1080/20009666.2019.1710948

 

ABSTRACT

Background: Chronic insomnia is characterized by disturbed sleep that occurs despite adequate opportunity and circumstances to sleep. Many patients with chronic insomnia have comorbid mental illnesses or medical illnesses that contribute and precipitate insomnia. Hallmark of chronic insomnia treatment includes non-pharmacological measures such as Cognitive Behavioral Therapy for Insomnia (CBT-I). Pharmacologic treatment (sedative or hypnotic agents) has been disappointing because of poor efficacy and numerous undesirable side effects. Other new therapies including meditation have been proven to be effective.

Objective: This study investigates the effectiveness of Heartfulness meditation coupled with sleep hygiene to treat chronic insomnia. Methods: In this prospective pre-post design cohort study, 32 adult patients with chronic primary insomnia engaged in Heartfulness meditation along with appropriate sleep hygiene for eight weeks. Insomnia Severity Index (ISI) scores, usage of sedative or hypnotic agents were measured at baseline and at the end of the eight-week period.

Results: There was a significant decrease in the mean ISI scores from 20.9 to 10.4 (p < 0.001) after eight weeks of Heartfulness meditation. Twenty four of 32 patients were initially on sedative or hypnotic medications. At week eight, 21 of 24 patients (87.5%) were off these medications or the dosage was reduced (p < 0.001).

Conclusion: This study demonstrated statistical improvements in the measures of ISI in patients undergoing a Heartfulness meditation program. Heartfulness meditation may facilitate the taper and eventual cessation of sedative hypnotics in patients suffering from chronic insomnia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034439/

 

Yoga Practitioners have Better Physical and Psychological Health

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Yoga Practitioners have Better Physical and Psychological Health

 

By John M. de Castro, Ph.D.

 

“Multiple studies have confirmed the many mental and physical benefits of yoga. Incorporating it into your routine can help enhance your health, increase strength and flexibility and reduce symptoms of stress, depression and anxiety.” – Rachel Link

 

Yoga practice has been shown to have a myriad of benefits for psychological and physical health, social, and spiritual well-being. It is both an exercise and a mind-body practice that stresses both mental attention to present moment movements, breath control, and flexibility, range of motion, and balance. One way to look at the benefits of yoga practice is to look at the mental and physical health of yoga practitioners.

 

In today’s Research News article “Yoga practice in the UK: a cross-sectional survey of motivation, health benefits and behaviours.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044896/ ), Cartwright and colleagues performed an online survey of yoga practitioners in the UK. They were asked to answer questions regarding yoga practice, meditation practice, body size, health, well-being, psychological health, smoking, diet, alcohol intake, fruit/vegetable intake, exercise apart from yoga, satisfaction with life, perceived stress, yoga impacts on health, and yoga related injuries.

 

They found that in comparison to the norms for the UK the yoga practitioners were higher in overall health, fruit/vegetable intake, exercise apart from yoga, happiness, and satisfaction with life, and lower in body size, smoking, alcohol intake, and perceived stress. The yoga practitioners believed that yoga practice improved their physical and mental health, stress levels, strength, flexibility, and sleep. Correlation analysis revealed that the higher the frequency of yoga practice the higher the levels of well-being, satisfaction with life, and happiness and the lower the levels of perceived stress.

 

These are interesting results but it should be kept in mind that the findings may represent differences in the people who chose to engage in a yoga practice rather than due to yoga practice itself. Regardless, the survey revealed that yoga practitioners are generally physically and psychologically healthy, engage in healthier behaviors, and believe that yoga practice is responsible for these benefits. Previous controlled studies have revealed that yoga practice improves the physical and psychological health of the participants. So, it is reasonable to conclude that the survey results are due, at least in part, to the beneficial effects of yoga practice.

 

So, improve physical and psychological health with yoga practice.

 

“On a physical level, yoga helps improve flexibility, strength, balance, and endurance. And on a psychological level, yoga can help you cultivate mindfulness as you shift your awareness to the sensations, thoughts, and emotions that accompany a given pose or exercise.” – Linda Schlamadinger McGrath

 

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

 

Cartwright, T., Mason, H., Porter, A., & Pilkington, K. (2020). Yoga practice in the UK: a cross-sectional survey of motivation, health benefits and behaviours. BMJ open, 10(1), e031848. https://doi.org/10.1136/bmjopen-2019-031848

 

Abstract

Objectives

Despite the popularity of yoga and evidence of its positive effects on physical and mental health, little is known about yoga practice in the UK. This study investigated the characteristics of people who practise yoga, reasons for initiating and maintaining practice, and perceived impact of yoga on health and well-being.

Design, setting and participants

A cross-sectional online anonymous survey distributed through UK-based yoga organisations, studios and events, through email invites and flyers. 2434 yoga practitioners completed the survey, including 903 yoga teachers: 87% were women, 91% white and 71% degree educated; mean age was 48.7 years.

Main outcome measures

Perceived impact of yoga on health conditions, health outcomes and injuries. Relationships between yoga practice and measures of health, lifestyle, stress and well-being.

Results

In comparison with national population norms, participants reported significantly higher well-being but also higher anxiety; lower perceived stress, body mass index and incidence of obesity, and higher rates of positive health behaviours. 47% reported changing their motivations to practise yoga, with general wellness and fitness key to initial uptake, and stress management and spirituality important to current practice. 16% of participants reported starting yoga to manage a physical or mental health condition. Respondents reported the value of yoga for a wide range of health conditions, most notably for musculoskeletal and mental health conditions. 20.7% reported at least one yoga-related injury over their lifetime. Controlling for demographic factors, frequency of yoga practice accounted for small but significant variance in health-related regression models (p<0.001).

Conclusion

The findings of this first detailed UK survey were consistent with surveys in other Western countries. Yoga was perceived to have a positive impact on physical and mental health conditions and was linked to positive health behaviours. Further investigation of yoga’s role in self-care could inform health-related challenges faced by many countries.

Strengths and limitations of this study:

  • This is the first comprehensive survey to assess the practice and perceived impact of yoga on health, lifestyle-related behaviours and well-being in the UK.
  • The survey design captures the significant number of practitioners who take up yoga to manage a physical or mental health condition, and identifies health conditions for which yoga is rated as most helpful in self-management.
  • Despite the large sample, it was self-selected and unlikely to be representative of all yoga practitioners.
  • The results relied on retrospective and self-report data which may be subject to memory bias and social desirability.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044896/

 

Mindfulness Reduces Fatigue with Breast Cancer Patients Directly and Indirectly by Improving Psychological Health

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Mindfulness Reduces Fatigue with Breast Cancer Patients Directly and Indirectly by Improving Psychological Health

 

By John M. de Castro, Ph.D.

 

“Women who were more mindful tended to have lower symptoms of metastatic breast cancer, including pain severity and interference, fatigue, psychological distress, and sleep disturbance.” – Lauren Zimmaro

 

Because of great advances in treatment, many patients today are surviving cancer. But 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. Also, cancer survivors can have to deal with a heightened fear of reoccurrence. This is particularly true with metastatic cancer. So, safe and effective treatments for the symptoms in cancer and the physical and psychological effects of the treatments are needed.

 

Mindfulness training has been shown to help with general cancer recovery . Mindfulness practice have been shown to improve the residual symptoms in cancer survivors. So, it’s reasonable to further explore the potential benefits of mindfulness practice to relieve fatigue in patients who have survived breast cancer.

 

In today’s Research News article “The relation between mindfulness and the fatigue of women with breast cancer: path analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011601/), Ikeuchi and colleagues recruited adult women who had undergone surgery for breast cancer and 6 or more months had passed since their last cancer treatment. They completed self-report measures of fatigue, mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance.

 

They found that the higher the levels of mindfulness the lower the levels of fatigue, anxiety, depression, pain, loneliness, and sleep disturbance and the higher the levels of anxiety, depression, pain, loneliness, and sleep disturbance the higher the levels of fatigue. They then applied path modelling to examine the relationships of the variables. They found that high levels of mindfulness were not only directly associated with low levels of fatigue but also indirectly associated by way of high mindfulness being associated with low levels of anxiety, depression, pain, loneliness, and sleep disturbance. These variables that were, in turn, associated with fatigue levels.

 

These results are correlational and as such caution must be exercised in inferring causation. Previous research, though, has demonstrated that mindfulness is causally related to lower levels of fatigue, anxiety, depression, pain, loneliness, and sleep. So, the present correlative results probably are due to these causal connections. Given this inference, then, the results suggest that mindfulness lowers fatigue in breast cancer patients by directly lowering fatigue and also by improving the psychological and physical health of the patients which also improves fatigue levels.

 

These results are important. After cancer treatment there are substantial and troubling residual physical and psychological symptoms. The findings suggest that mindfulness may be an important means to improve these symptoms and markedly improve the quality of life of patients who have been treated for breast cancer.

 

So, mindfulness reduces fatigue with breast cancer patients directly and indirectly by improving psychological health.

 

“mindfulness meditation can reduce stress and anxiety in the general population as well as in breast cancer survivors.” – Kathleen Doheny

 

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

 

Ikeuchi, K., Ishiguro, H., Nakamura, Y., Izawa, T., Shinkura, N., & Nin, K. (2020). The relation between mindfulness and the fatigue of women with breast cancer: path analysis. BioPsychoSocial medicine, 14, 1. https://doi.org/10.1186/s13030-020-0175-y

 

Abstract

Background

Although fatigue is a common and distressing symptom in cancer survivors, the mechanism of fatigue is not fully understood. Therefore, this study aims to investigate the relation between the fatigue and mindfulness of breast cancer survivors using anxiety, depression, pain, loneliness, and sleep disturbance as mediators.

Methods

Path analysis was performed to examine direct and indirect associations between mindfulness and fatigue. Participants were breast cancer survivors who visited a breast surgery department at a university hospital in Japan for hormonal therapy or regular check-ups after treatment. The questionnaire measured cancer-related-fatigue, mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance. Demographic and clinical characteristics were collected from medical records.

Results

Two-hundred and seventy-nine breast cancer survivors were registered, of which 259 answered the questionnaire. Ten respondents with incomplete questionnaire data were excluded, resulting in 249 participants for the analyses. Our final model fit the data well (goodness of fit index = .993; adjusted goodness of fit index = .966; comparative fit index = .999; root mean square error of approximation = .016). Mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance were related to fatigue, and mindfulness had the most influence on fatigue (β = − .52). Mindfulness affected fatigue not only directly but also indirectly through anxiety, depression, pain, loneliness, and sleep disturbance.

Conclusions

The study model helps to explain the process by which mindfulness affects fatigue. Our results suggest that mindfulness has both direct and indirect effects on the fatigue of breast cancer survivors and that mindfulness can be used to more effectively reduce their fatigue. It also suggests that health care professionals should be aware of factors such as anxiety, depression, pain, loneliness, and sleep disturbance in their care for fatigue of breast cancer survivors.

Trial registration

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011601/