Mindfulness based stress reduction provides psychological benefit and restores immune function of women newly diagnosed with breast cancer: A randomized trial with active control

Psychological intervention to treat distress: An emerging frontier in cancer prevention and therapy

Psychological distress, such as chronic depression and anxiety, is a topical problem. In the context of cancer patients, prevalence rates of psychological distress are four-times higher than in the general population and often confer worse outcomes. In addition to evidence from epidemiological studies confirming the links between psychological distress and cancer progression, a growing body of cellular and molecular studies have also revealed the complex signaling networks which are modulated by psychological distress-derived chronic stress during cancer progression. In this review, aiming to uncover the intertwined networks of chronic stress-driven oncogenesis and progression, we summarize physiological stress response pathways, like the HPA, SNS, and MGB axes, that modulate the release of stress hormones with potential carcinogenic properties. Furthermore, we discuss in detail the mechanisms behind these chronic stimulations contributing to the initiation and progression of cancer through direct regulation of cancer hallmarks-related signaling or indirect promotion of cancer risk factors (including obesity, disordered circadian rhythms, and premature senescence), suggesting a novel research direction into cancer prevention and therapy on the basis of psychological interventions.

Mindfulness interventions for offsetting health risk following early life stress: Promising directions

Early life stress (ELS), common to childhood maltreatment, socioeconomic disadvantage, and racial discrimination, is thought to create a proinflammatory phenotype that increases risk for poor health in adulthood. Systemic change is needed to address the root causes of ELS, but a substantial number of adults are already at increased health risk by virtue of ELS exposure. Interventions that target stress pathways have the potential to interrupt the trajectory from ELS to inflammatory disease risk in adulthood. Mindfulness-based interventions (MBIs), which train acceptance toward present-moment experience, have shown promise for reducing stress and improving a variety of stress-sensitive health outcomes. Although MBIs have primarily been conducted in more advantaged populations, evidence suggests that they may be uniquely effective for improving mental health and health-related quality of life among those with a history of ELS. Whether these effects extend to physical health remains unknown. To shed light on this question, I review evidence that MBIs influence inflammatory markers in at-risk samples, explore the promise of MBIs for improving stress-related health outcomes in diverse at-risk populations, and describe adaptations to MBIs that may increase their acceptability and efficacy in populations exposed to ELS. This prior work sets the stage for well-controlled RCTs to evaluate whether MBIs influence stress and inflammatory pathways among those exposed to ELS and for pragmatic and implementation trials focused on disseminating MBIs to reach these at-risk populations. Overall, the evidence assembled here shows the potential of MBIs for offsetting physical health risk related to ELS.

Effects of Stress Psychological Intervention on the Cardiopulmonary Function, Negative Emotion, Self-Efficacy, and Quality of Life in Patients with Acute Respiratory Failure

Objective

To investigate the changes in cardiopulmonary function, negative emotion, self-efficacy, and quality of life in patients with acute respiratory failure (ARF) after stress psychological intervention.

Methods

A prospective study was conducted on 104 patients with ARF admitted to our hospital from March 2019 to March 2021. According to the random number method, the patients were divided into a control group (n = 52) and an experimental group (n = 52). Routine intervention was implemented in the control group, and stress psychological intervention was implemented in the experimental group on the basis of the control group. The cardiopulmonary function, negative emotion, self-efficacy, and quality of life in the two groups were compared.

Results

The left ventricular ejection fractions and fraction shortening in the experimental group were higher than those in the control group, as well as the left ventricular mass index was lower than that in the control group (P < 0.05). The first forced expiratory volume (FEV₁), forced vital capacity (FVC), and FEV₁/FVC in the experimental group were higher than those in the control group (P < 0.05). The Self-Rating Anxiety Scale scores and Self-Rating Depression Scale scores in the experimental group were lower than those in the control group (P < 0.05). The General Self-Efficacy Scale scores of the experimental group were higher than those of the control group (P < 0.05). The Concise Health Measurement Scale scores of the experimental group were higher than those of the control group (P < 0.05).

Conclusion

Stress psychological intervention in patients with ARF can improve cardiopulmonary function, reduce negative emotions, improve self-efficacy, and improve quality of life.

Recent trends in the management of depression in persons with cancer

PURPOSE OF REVIEW

Depression is a prevalent comorbidity in cancer that significantly increases the risk for numerous negative health outcomes. This review updates the current evidence base for management of depression in cancer, highlighting new research directions based on the inflammatory hypothesis of depression.

RECENT FINDINGS

Research on pharmacotherapy and psychotherapy for depression in cancer has shown mixed efficacy partly because of methodological issues arising from the phenomenology of depression in cancer. After decades of stagnancy, more recent high-quality clinical trials are beginning to provide an evidence base to guide treatment. Inflammatory cytokine-associated depression is a subtype of depression that may have particular relevance in cancer, opening new avenues to explore therapeutic targets and biobehavioral impacts of interventions, which may improve cancer outcomes.

SUMMARY

The continuum of severity in cancer-related depression is important to consider in management approaches. Choice of treatment should be personalized to the patient and their symptom profile as there is currently insufficient evidence to recommend any particular medication or psychotherapy over another. Psychological interventions should be considered first line for mild-to-moderate depression, and pharmacological treatment added for more severe depression, which can be optimally delivered within a collaborative care model.

VIDEO ABSTRACT

http://links.lww.com/YCO/A62.

The Effect of Mindfulness-Based Stress Reduction Group Counseling on Psychological and Inflammatory Responses of the Women With Breast Cancer

Introduction: Breast cancer is common among women and reduces their quality of life. The current study aimed to investigate the effectiveness of mindfulness-based stress reduction group counseling in alleviating psychological responses such as anxiety, depression, stress, and regulating laboratory tests including cortisol and C-reactive protein (CRP) in women with breast cancer. Methods: This randomized clinical trial was conducted based on convenience sampling. Participants were divided into 2 groups (control and intervention groups) with block randomization. The intervention group received mindfulness-based stress reduction group counseling during 8 weeks. The participants completed the Beck anxiety inventory, Beck-II depression inventory, and perceived stress scale before and after the intervention and their blood samples were taken to check their cortisol and CRP. Results: After the intervention, the MBSR group had significantly lower anxiety compared with the control group (P < .001). No significant difference was found between the 2 groups in the reduction of perceived stress and depression (P < .05). In addition, no significant difference was found between the 2 groups in CRP and cortisol levels after the intervention (P > .05). Conclusion: The present study showed the effectiveness of mindfulness-based cognitive therapy in improving anxiety rather than the stress, depression, and inflammatory laboratory factors such as cortisol and CRP in women with breast cancer. Therefore, the psychological symptoms of these patients can be improved at different stages of treatment by providing this type of training.

The effects of mindfulness-based intervention on sleep disturbance and benzodiazepine hypnotics use in patients hospitalized with cancer: A systematic review and meta-analysis

Previous studies have reported discrepant outcomes for mindfulness-based intervention (MBI) to improve sleep quality or reduce the benzodiazepines (BZDs) use in cancer patients; therefore, a meta-analysis was required to examine the relationships. The MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials et al. were searched by independent reviewers from date of inception to January 2020 to examine the associations between MBI and sleep disturbance or BZDs use among cancer patients. Randomized controlled studies that reported the effect of MBI on sleep disturbance or BZDs use in cancer patients aged over 18 years were included. Standardized mean differences with 95% CIs were calculated to estimate effect size. If P ≥ 0.1, I² < 50%, the fixed effect model was used for meta-analysis, while if P < 0.1, I² ≥ 50%, the random effects model was used. Fourteen studies of 1659 participant were identified in the meta-analysis. Overall, sleep disturbance was significantly relieved in MBI group (SMD = 0.37, 95% CI 0.19 to 0.55, P < 0.001), and the effect could sustain to follow up duration (SMD = 0.35, 95% CI 0.02 to 0.69, P < 0.001). Only three studies reported that MBI could decrease the BZDs use in hospitalized cancer patients. Our findings indicate that MBI were effective in alleviating sleep disturbance in a short time, and may be associated with therapeutic benefits for BZDs use. Further randomized controlled studies are needed to examine the effectiveness of MBI for BZDs use in cancer patients.

Sleep and endocrine therapy in breast cancer

Sleep disturbances and insomnia are common among breast cancer survivors, and can have a significant effect on quality of life and numerous other significant outcomes. Among risks for sleep disturbance is the introduction of anti-estrogen endocrine therapies. The possible contributing factors to sleep disturbance in endocrine therapy are complex, and include pre-existing sleep disorders, the effects of chemotherapy and other treatments, and concurrent symptoms such as hot flashes. In addition, sleep disturbance in menopause, the natural downregulation of reproductive hormones in older age, is a common occurrence, and can offer a model for understanding the high prevalence of sleep problems in breast cancer survivors on endocrine therapy, as well as suggesting possible treatments such as behavioral interventions and pharmaceuticals. Altogether, significantly more research is needed to better understand and address sleep disturbance in breast cancer survivors on endocrine therapy in order to support quality of life and treatment adherence.

A study of mindfulness-based stress-reduction training effects on menopause-specific quality of life in postmenopausal women: A randomized controlled trial

OBJECTIVES

Physical and psychological changes in most postmenopausal women tend to lower their quality of life. Various medical/psychological interventions have been applied to improve the postmenopausal quality of life. This study set out to investigate the effect of Mindfulness Based Stress Reduction (MBSR) training on the Menopause-specific quality of life (MENQOL).

METHODS

This RCT was conducted on 66 postmenopausal women aged 47-62 in Iran. Participants were randomly assigned to either the MBSR or the control group. The menopause--specific quality of life was assessed in two groups via MENQOL questionnaire prior to, immediately and three months after the intervention.

RESULTS

The findings revealed a significant improvements in MENQOL (P < 0.001),as well as physical(P = 0.001), psychosocial(P = 0.001) and sexual(P < 0.001)dimensions of the intervention groups compared to the control group, immediately and 3 months after the intervention.

CONCLUSION

MBSR program can be safely applied to improve menopausal women's quality of life and curb the postmenopausal symptoms.

TRIAL REGISTRATION NUMBER

IRCT2015072523344N1.

Effects of mindfulness-based interventions on fatigue in cancer survivors: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis was designed to determine the efficacy of mindfulness-based interventions (MBIs) in improving fatigue-related outcomes in adult cancer survivors. Randomized controlled trials (RCTs) were identified from PubMed, MEDLINE, PsycINFO, CINAHL, Web of Science, and EMBASE databases and reference lists of included studies. Separate random-effects meta-analyses were conducted for fatigue and vitality/vigor. Twenty-three studies reporting on 21 RCTs (N = 2239) met inclusion criteria. MBIs significantly reduced fatigue compared to controls at post-intervention (g = 0.60, 95 % CI [0.36, 0.83]) and first follow-up (g = 0.42, 95 % CI [0.20, 0.64]). Likewise, MBIs significantly improved vitality/vigor at post-intervention (g = 0.39, 95 % CI [0.25, 0.52]) and first follow-up (g = 0.35, 95 % CI [0.03, 0.67]). The evidence grade was low due to risk of bias, substantial heterogeneity, and publication bias among studies. MBIs show promise in improving fatigue and vitality/vigor in cancer survivors. More rigorous trials are needed to address current gaps in the evidence base.

Cultural adaptations of psychological interventions for prevalent sleep disorders and sleep disturbances: A systematic review of randomized controlled trials in the United States

Psychological interventions for sleep-wake disorders have medium-to-large effect sizes, however whether behavioral randomized controlled trials (RCTs) targeted underserved populations or addressed contextual and cultural factors is unknown. We conducted a systematic review to: (a) examine sociodemographic characteristics of behavioral RCTs for prevalent sleep-wake disorders and sleep disturbances that targeted undeserved adults, (b) identify types of cultural adaptations (surface-level, deep-level), and (c) describe intervention effectiveness on primary sleep outcomes. Overall, 6.97% of RCTs (56 studies) targeted underserved groups (veterans, women, racial/ethnic minorities, low socioeconomic status, disability status); 64.29% made surface-level and/or deep-level cultural adaptations. There was a lack of racial/ethnic, socioeconomic, sexual orientation, and linguistic diversity. Most cultural adaptations were made to behavioral therapies, and cognitive behavioral therapy for insomnia (CBT-I). Surface-level cultural adaptations to the delivery modality and setting were most common. Deep-level cultural adaptations of the content and core intervention components were also typical. Intervention effectiveness varied by type of adapted intervention and participant population. RCTs of adapted CBT-I interventions among participants with a definite sleep disorder or sleep disturbance showed consistent significant reductions in adverse sleep outcomes versus control. These findings have important implications for the use of cultural adaptations to address behavioral sleep medicine disparities.

To stress or not to stress: Brain-behavior-immune interaction may weaken or promote the immune response to SARS-CoV-2

The COVID-19 pandemic continues to strongly affect people with health disadvantages, creating a heavy burden on medical systems and societies worldwide. Research is growing rapidly and recently revealed that stress-related factors such as socio-economic status, may also play a pivotal role. However, stress research investigating the underlying psychoneuroimmune interactions is missing. Here we address the question whether stress-associated neuroendocrine-immune mechanisms can possibly contribute to an increase in SARS-CoV-2 infections and influence the course of COVID-19 disease. Additionally, we discuss that not all forms of stress (e.g. acute versus chronic) are detrimental and that some types of stress could attenuate infection-risk and -progression. The overall aim of this review is to motivate future research efforts to clarify whether psychosocial interventions have the potential to optimize neuroendocrine-immune responses against respiratory viral infections during and beyond the COVID-19 pandemic. The current state of research on different types of stress is summarized in a comprehensive narrative review to promote a psychoneuroimmune understanding of how stress and its mediators cortisol, (nor)adrenaline, neuropeptides and neurotrophins can shape the immune defense against viral diseases. Based on this understanding, we describe how people with high psychosocial stress can be identified, which behaviors and psychosocial interventions may contribute to optimal stress management, and how psychoneuroimmune knowledge can be used to improve adequate care for COVID-19 and other patients with viral infections.

The mindfulness-based stress reduction program for improving sleep quality in cancer survivors: A systematic review and meta-analysis

INTRODUCTION

This study aims to evaluate the efficacy and effectiveness of a mindfulness-based stress reduction (MBSR) program in improving sleep in cancer survivors.

METHODS

Four electronic databases (Cochrane Library, EMBASE, PubMed, and PsycARTICLES) were searched for randomized controlled trials evaluating the effects of MBSR on the sleep of cancer survivors from their inception to May 2020. The primary outcome was sleep quality measured by validated questionnaires such as the Insomnia Severity Index and Pittsburgh Sleep Quality Index. The secondary outcomes were sleep parameters obtained from a sleep diary, polysomnography, and actigraphy. The included studies were critically appraised by the Cochrane risk of bias tool and meta-analyzed.

RESULTS

Ten studies were included, and nine studies were analyzed quantitatively. MBSR significantly improved sleep quality compared to usual care (standardized mean difference -0.29, 95 % confidence interval -0.55 to -0.04, I² = 58 %). However, there were no favorable results with sleep parameters. Compared to active controls, MBSR presented mixed results with sleep quality according to the outcomes and negative results with sleep parameters.

CONCLUSION

This review suggests that MBSR helps cancer survivors improve sleep quality. Our results support the possibility of using MBSR for cancer survivors. However, its efficacy and effectiveness in improving sleep quality and sleep parameters are inconclusive because the number of included studies was few with inconsistent results. Further studies with high methodological quality are required to establish conclusive evidence about the efficacy and effectiveness of MBSR in improving sleep quality and sleep parameters in cancer survivors.

The science of hope

Hope is a contextual term that has different connotations depending on the setting. We analyse the concept of hope with respect to its applicability for oncology. We review studies that present hope as a direct or secondary mediator of outcome. We posit that an individual's level of hope is often determined by innate personality characteristics and environmental factors, but can also be physiologically influenced by immune modulators, neurotransmitters, affective states, and even the underlying disease process of cancer. We argue that hope can be a therapeutic target and review evidence showing the effects of hope-enhancing therapies. Given the potential for hope to alter oncological outcomes in patients with cancer and the opportunity for improvement in quality of life, we suggest further research directions in this area.

Chronic Stress Promotes Cancer Development

Stress is an inevitable part of life. Chronic stress on account of reasons like adversity, depression, anxiety, or loneliness/social isolation can endanger human health. Recent studies have shown that chronic stress can induce tumorigenesis and promote cancer development. This review describes the latest progress of research on the molecular mechanisms by which chronic stress promotes cancer development. Primarily, chronic stress activates the classic neuroendocrine system [the hypothalamic-pituitary-adrenal (HPA) axis] and the sympathetic nervous system (SNS) and leads to a decline and dysfunction of the prefrontal cortex and the hippocampus under stress. Stress hormones produced during the activation of both the HPA axis and the SNS can promote tumorigenesis and cancer development through a variety of mechanisms. Chronic stress can also cause corresponding changes in the body's immune function and inflammatory response, which is significant because a long-term inflammatory response and the decline of the body's immune surveillance capabilities are implicated in tumorigenesis. Stress management is essential for both healthy people and cancer patients. Whether drugs that limit the signaling pathways downstream of the HPA axis or the SNS can suppress chronic stress-induced cancers or prolong patient survival deserves further study.

Biological mechanism study of meditation and its application in mental disorders

In recent years, research on meditation as an important alternative therapy has developed rapidly and been widely applied in clinical medicine. Mechanism studies of meditation have also developed progressively, showing that meditation has great impact on brain structure and function, and epigenetic and telomere regulation. In line with this, the application of meditation has gradually been expanded to mental illness, most often applied for major depressive disorders and substance-related and addictive disorders. The focus of this paper is to illustrate the biological mechanisms of meditation and its application in mental disorders.

The effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis

BACKGROUND

To examine the effectiveness and safety of yoga of women with sleep problems by performing a systematic review and meta-analysis.

METHODS

Medline/PubMed, ClinicalKey, ScienceDirect, Embase, PsycINFO, and the Cochrane Library were searched throughout the month of June, 2019. Randomized controlled trials comparing yoga groups with control groups in women with sleep problems were included. Two reviewers independently evaluated risk of bias by using the risk of bias tool suggested by the Cochrane Collaboration for programming and conducting systematic reviews and meta-analyses. The main outcome measure was sleep quality or the severity of insomnia, which was measured using subjective instruments, such as the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), or objective instruments such as polysomnography, actigraphy, and safety of the intervention. For each outcome, a standardized mean difference (SMD) and confidence intervals (CIs) of 95% were determined.

RESULTS

Nineteen studies in this systematic review included 1832 participants. The meta-analysis of the combined data conducted according to Comprehensive Meta-Analysis showed a significant improvement in sleep (SMD = - 0.327, 95% CI = - 0.506 to - 0.148, P < 0.001). Meta-analyses revealed positive effects of yoga using PSQI scores in 16 randomized control trials (RCTs), compared with the control group in improving sleep quality among women using PSQI (SMD = - 0.54; 95% CI = - 0.89 to - 0.19; P = 0.003). However, three RCTs revealed no effects of yoga compared to the control group in reducing insomnia among women using ISI (SMD = - 0.13; 95% CI = - 0.74 to 0.48; P = 0.69). Seven RCTs revealed no evidence for effects of yoga compared with the control group in improving sleep quality for women with breast cancer using PSQI (SMD = - 0.15; 95% CI = - 0.31 to 0.01; P = 0.5). Four RCTs revealed no evidence for the effects of yoga compared with the control group in improving the sleep quality for peri/postmenopausal women using PSQI (SMD = - 0.31; 95% CI = - 0.95 to 0.33; P = 0.34). Yoga was not associated with any serious adverse events.

DISCUSSION

This systematic review and meta-analysis demonstrated that yoga intervention in women can be beneficial when compared to non-active control conditions in term of managing sleep problems. The moderator analyses suggest that participants in the non-breast cancer subgroup and participants in the non-peri/postmenopausal subgroup were associated with greater benefits, with a direct correlation of total class time with quality of sleep among other related benefits.

Immune dysregulation among students exposed to exam stress and its mitigation by mindfulness training: findings from an exploratory randomised trial

Psychological distress persisting for weeks or more promotes pro-inflammatory immune dysregulation, a risk factor for a range of chronic diseases. We have recently shown that mindfulness training reduces distress among university students. Here we present an exploratory trial to study immune dysregulation in a cohort of students who were exposed to progressively greater stress as the exam period approached, and to explore whether mindfulness training mitigated this dysregulation. Healthy University of Cambridge students were randomised to join an 8-week mindfulness course (N = 27), or to mental health support as usual (N = 27). Psychological distress, immune cell proportions, cytokines, CRP and serum cortisol were measured at baseline and during the exam period. Increased distress was associated with statistically significant increases in the proportion of B cells, regardless of trial arm (*p = 0.027). There were no other associations between any of the measured parameters, distress or mindfulness. Our finding that the proportion of B cells increases with psychological distress supports the findings of other studies. However, we found no evidence that mindfulness training is able to buffer the effects of psychological distress on healthy participants' immune system. In order to detect these effects, should they exist, larger randomised trials will be required.

A Specific Type of Tibetan Medicine Meditation for Women with Breast Cancer: A Pilot Survey

BACKGROUND

Breast cancer is one of the most common tumors in the world and is associated with high psychological distress such as depression, anxiety, and stress. Meditation is efficacious to reduce psychological distress, but there are no studies which have evaluated a specific type of Tibetan medicine meditation in patients with breast cancer. The present research aimed to understand the effect a specific type of Tibetan medicine meditation on psychological distress in a sample of women with breast cancer.

METHODS

Sixty-two women with breast cancer were enrolled. We instructed the patients in Tibetan medicine meditation (five sessions). We administered the Profile of Mood States at baseline and follow-up, after five sessions of Tibetan medicine meditation.

RESULTS

The mean age of the sample was 51.08 years (SD = 11.74). There was a significant decrease in scores between baseline and follow-up in anxiety-tension (F = 23.188, p < 0.001), depression-dejection (F = 19.082, p < 0.001), anger-hostility (F = 18.732, p < 0.001), fatigue (F = 17.883, p < 0.001), and confusion (F = 15.479, p < 0.001), and there was an increase in the vigor subscale, but it was not statistically significant (F = 1.422, p = 0.234).

CONCLUSIONS

This study shows for the first time that a specific form of Tibetan medicine meditation is efficacious in decreasing the psychological distress in women with breast cancer and can be an important complementary therapy to oncological care.