Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients

App-based support for breast cancer patients to reduce psychological distress during therapy and survivorship - a multicentric randomized controlled trial

Introduction

The negative impact of unmanaged psychological distress on quality of life and outcome in breast cancer survivors has been demonstrated. Fortunately, studies indicate that distress can effectively be addressed and even prevented using evidence-based interventions. In Germany prescription-based mobile health apps, known as DiGAs (digital health applications), that are fully reimbursed by health insurances, were introduced in 2020. In this study, the effectiveness of an approved breast cancer DiGA was investigated: The personalized coaching app PINK! Coach supports and accompanies breast cancer patients during therapy and follow-up.

Methods

PINK! Coach was specifically designed for breast cancer (BC) patients from the day of diagnosis to the time of Follow-up (aftercare). The app offers individualized, evidence-based therapy and side-effect management, mindfulness-based stress reduction, nutritional and psychological education, physical activity tracking, and motivational exercises to implement lifestyle changes sustainably in daily routine. A prospective, intraindividual RCT (DRKS00028699) was performed with n = 434 patients recruited in 7 German breast cancer centers from September 2022 until January 2023. Patients with BC were included independent of their stage of diseases, type of therapy and molecular characteristics of the tumor. Patients were randomized into one of two groups: The intervention group got access to PINK! over 12 weeks; the control group served as a waiting-list comparison to "standard of care." The primary endpoint was psychological distress objectified by means of Patient Health Questionnaire-9 (PHQ-9). Subgroups were defined to investigate the app's effect on several patient groups such as MBC vs. EBC patients, patients on therapy vs. in aftercare, patients who received a chemotherapy vs. patients who did not.

Results

Efficacy analysis of the primary endpoint revealed a significant reduction in psychological distress (least squares estimate -1.62, 95% confidence interval [1.03; 2.21]; p<0.001) among intervention group patients from baseline to T3 vs, control group. Subgroup analysis also suggested improvements across all clinical situations.

Conclusion

Patients with breast cancer suffer from psychological problems including anxiety and depression during and after therapy. Personalized, supportive care with the app PINK! Coach turned out as a promising opportunity to significantly improve psychological distress in a convenient, accessible, and low-threshold manner for breast cancer patients independent of their stage of disease (EBC/MBC), therapy phase (aftercare or therapy) or therapy itself (chemotherapy/other therapy options). The app is routinely available in Germany as a DiGA. Clinical Trial Registration: DRKS Trial Registry (DRKS00028699).

The effect of mindfulness-based interventions on biomarkers in cancer patients and survivors: A systematic review

Various reviews and meta-analyses have shown the positive effects of mindfulness-based interventions (MBIs) on the mental health of cancer patients and survivors. Some studies have also investigated the impact of MBIs on physiological markers of health in oncology, but a systematic review has not been conducted in this field. The current paper aims to fill this gap in the literature. Following preferred reporting items for systematic reviews and meta-analyses 2020 guidelines, data were obtained from the databases of Pubmed, Scopus, Web of Science in May 2022. Twenty-five studies were included. Globally, 35 biomarkers were employed in these studies and were categorized 8 groups (cortisol; blood pressure (BP), heart rate, and respiratory rate; C-reactive protein; telomere length and telomerase activity (TA); genetic signature; cytokines and hormones; leucocyte activation; leucocyte count and cell subpopulation analysis). In seven of these categories of biomarkers, positive effects of MBIs were observed. The most promising results were obtained for cortisol, BP, TA and pro-inflammatory gene expression. However, the generally low number of studies per single biomarker limits the possibility to draw reliable conclusions. The present review presents a comprehensive state-of-the-art for MBIs in oncology on biomarkers, confirming MBIs' potential for improving physiological health in cancer patients and survivors besides those already shown in literature on psychological well-being.

Changes in Stress Reduction Following a 28-Day Prostate Cancer Patient Empowerment Program (PC-PEP) among Prostate Cancer Survivors

Prostate cancer (PCa) survivors often experience post-treatment challenges that impact their well-being and mental health. The Prostate Cancer Patient Empowerment Program (PC-PEP) aims to address these issues through a comprehensive intervention, involving daily meditation/breathing exercises, physical activity, pelvic floor exercises, emotional connection strategies, and peer support. This study presents a secondary analysis of a Phase 2 feasibility study that evaluated the effects of a 28-day PC-PEP intervention on stress reduction. Thirty patients with PCa from the Maritimes, Canada, underwent pre- and post-intervention assessments to measure brainwave activity (delta, theta, alpha, beta, and gamma) using the Muse™ headband, and heart rate variability (HRV) using the HeartMath® Inner Balance™ as indicators of stress reduction. A statistically significant Time × Sensor Scalp Assessment Time interaction emerged for all brain waves. Amplitudes were generally higher during the first half of the meditation assessment time but became comparable afterward. A statistically significant Time × Sensor Scalp Location × Sensor Scalp Assessment Time interaction also emerged for alpha waves, indicating higher prefrontal lobe amplitudes than temporal lobe amplitudes from pre- to post-assessment. There were no statistically significant differences in HRV metrics from pre- to post-intervention, except for a marginally significant achievement score, indicating increased HRV coherence post-intervention. The findings suggest that the stress reduction component of PC-PEP successfully improved outcomes related to decreased stress. These results have implications for the development of future iterations of PC-PEP interventions, aiming to optimize participant benefits.

Aged brain and neuroimmune responses to COVID-19: post-acute sequelae and modulatory effects of behavioral and nutritional interventions

Advanced age is one of the significant risk determinants for coronavirus disease 2019 (COVID-19)-related mortality and for long COVID complications. The contributing factors may include the age-related dynamical remodeling of the immune system, known as immunosenescence and chronic low-grade systemic inflammation. Both of these factors may induce an inflammatory milieu in the aged brain and drive the changes in the microenvironment of neurons and microglia, which are characterized by a general condition of chronic inflammation, so-called neuroinflammation. Emerging evidence reveals that the immune privilege in the aging brain may be compromised. Resident brain cells, such as astrocytes, neurons, oligodendrocytes and microglia, but also infiltrating immune cells, such as monocytes, T cells and macrophages participate in the complex intercellular networks and multiple reciprocal interactions. Especially changes in microglia playing a regulatory role in inflammation, contribute to disturbing of the brain homeostasis and to impairments of the neuroimmune responses. Neuroinflammation may trigger structural damage, diminish regeneration, induce neuronal cell death, modulate synaptic remodeling and in this manner negatively interfere with the brain functions.In this review article, we give insights into neuroimmune interactions in the aged brain and highlight the impact of COVID-19 on the functional systems already modulated by immunosenescence and neuroinflammation. We discuss the potential ways of these interactions with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and review proposed neuroimmune mechanisms and biological factors that may contribute to the development of persisting long COVID conditions. We summarize the potential mechanisms responsible for long COVID, including inflammation, autoimmunity, direct virus-mediated cytotoxicity, hypercoagulation, mitochondrial failure, dysbiosis, and the reactivation of other persisting viruses, such as the Cytomegalovirus (CMV). Finally, we discuss the effects of various interventional options that can decrease the propagation of biological, physiological, and psychosocial stressors that are responsible for neuroimmune activation and which may inhibit the triggering of unbalanced inflammatory responses. We highlight the modulatory effects of bioactive nutritional compounds along with the multimodal benefits of behavioral interventions and moderate exercise, which can be applied as postinfectious interventions in order to improve brain health.

A randomized comparison of group mindfulness and group cognitive behavioral therapy vs control for couples after prostate cancer with sexual dysfunction

BACKGROUND

Sexual dysfunction is the most common and most distressing consequence of prostate cancer (PCa) treatment and has been shown to directly affect the sexual function and quality of life of survivors' partners. There are currently no established therapies to treat the emotional and psychological burden that sexual issues impose on the couple after PCa.

AIM

Our study examined the impact of 2 therapies-cognitive behavioral therapy (CBT) and mindfulness therapy-on sexual, relational, and psychological outcomes of PCa survivor and partner couples.

METHODS

PCa survivors (n = 68) who self-reported current sexual problems after PCa treatments and their partners were randomized to 4 consecutive weeks of couples' mindfulness therapy, couples' CBT, or no treatment (control).

OUTCOMES

Couples' sexual distress, survivors' sexual satisfaction, and couples' relationship satisfaction, quality of life, psychological symptoms (anxiety and depression), and trait mindfulness were measured at baseline, 6 weeks after treatment, and 6 months after treatment.

RESULTS

Sexual distress and sexual satisfaction were significantly improved 6 weeks after the CBT and mindfulness interventions as compared with the control group, but only sexual distress remained significantly improved at 6 months. Relationship satisfaction decreased and more so for partners than survivors. There were increases in domains of quality of life for survivors vs their partners 6 months after treatments and an overall increase in general quality of life for couples 6 weeks after mindfulness. There were no significant changes in psychological symptoms and trait mindfulness. Qualitative analysis showed that the mindfulness intervention led to greater personal impact on couple intimacy after the study had ended.

CLINICAL IMPLICATIONS

CBT and mindfulness can be effective treatments for helping couples adapt to and cope with changes to their sexual function after PCa treatments and could help improve the most common concern for PCa survivors-that is, couples' sexual intimacy-after cancer, if added to routine clinical care.

STRENGTHS AND LIMITATIONS

We used established standardized treatment manuals and highly sensitive statistical methodology and accounted for covariable factors and moderators of primary outcomes. Due to difficulty in recruitment, we had a smaller control group than treatment, reducing our power to detect between-group differences. Our sample was mostly White, heterosexual, and affluent, thereby limiting the generalizability.

CONCLUSION

This is the first randomized clinical trial to test and demonstrate benefits among PCa survivors and partners' sexual outcomes after CBT and mindfulness as compared with a nontreatment control group.

Four-year follow-up on fatigue and sleep quality of a three-armed partly randomized controlled study in breast cancer survivors with cancer-related fatigue

Cancer-related fatigue (CRF) is a frequent long-term symptom in non-metastasized breast cancer patients (BC). This 4-year follow-up intended to compare the long-term effects of a 10-week multimodal therapy (MT: sleep education, psychoeducation, eurythmy- and painting therapy) and combination therapy [CT: MT plus aerobic training (AT)] to AT-control. BC-patients were randomized or allocated by preference to three arms in a comprehensive cohort study. Primary outcome was a composite score including Pittsburgh Sleep Quality Index (PSQI) and Cancer Fatigue Scale (CFS-D), captured at baseline, after 10 weeks of intervention (T1), 6 months later (T2), and after 4 years (T3). We exploratively tested for superiority of MT and CT versus AT after 4 years (T3) based on the statistical model of the main analysis. Of 126 (65 randomized) BC-patients included, 105 started treatments and 79 were re-assessed for long-term effects (T3). MT and CT were superior over AT after 4 years regarding PSQI/CFS-D and PSQI sum-score, respectively (all p < 0.05), but not for CFS-D. The multimodal and combination treatment for breast cancer patients with CRF indicates sustainable long-term superiority over aerobic training for the outcomes sleep quality and combined sleep quality/fatigue. A confirmative randomized controlled trial is warranted.

Feasibility, acceptability, and preliminary effects of mindfulness training on antenatal blood pressure

BACKGROUND

Hypertensive disorders of pregnancy (HDP) are one of the greatest causes of perinatal morbidity and mortality. Mindfulness training (MT) significantly reduces blood pressure in non-pregnant adults, yet MT has not been tested to reduce blood pressure in the prenatal period.

OBJECTIVES

The objectives of this pilot randomized clinical trial were to test the feasibility, acceptability, and effects of MT on rates of HDP among pregnant participants at risk for HDP. Exploratory analyses examined effects of MT on antenatal blood pressure.

STUDY DESIGN

Participants were randomized to an 8-week phone-delivered MT intervention or usual care. Feasibility was defined by MT completion. Acceptability was defined by participants' satisfaction with the intervention. HDP outcomes were collected by medical chart review. Antenatal blood pressure values were extracted from medical records.

RESULTS

Twenty-nine participants were randomized to phone-based MT (N = 15) or usual care (N = 14). 73% participants completed >5 MT sessions, indicating that MT was feasible. One hundred percent of participants indicated they were "satisfied" or "very satisfied" with the intervention, suggesting the intervention was acceptable. Rates of HDP were lower in the MT vs. usual care condition (9% vs. 29%; OR: 0.25, 95% C.I.: 0.02-2.65) although this did not reach statistical significance. Systolic and diastolic blood pressure levels were significantly lower at follow up among those randomized to MT vs. usual care.

CONCLUSIONS

Results from this pilot trial suggest that prenatal MT is feasible and acceptable and may be a useful adjunctive preventative treatment for HDP among at-risk pregnant patients.

CLINICALTRIALS

gov identifier is NCT03679117.

Psychological interventions for women with non-metastatic breast cancer

BACKGROUND

Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015.

OBJECTIVES

To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer.  SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles.

SELECTION CRITERIA

Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes.

MAIN RESULTS

We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months.  Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies.

AUTHORS' CONCLUSIONS

Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.

Dimensions of the health benefits of wellness tourism: A review

The benefits of wellness tourism have been recently noted by researchers and industry representatives. This study examined the health dimensions of these benefits posited by a large array of interdisciplinary studies from 2002 up to the present. Open coding was used to conduct an inductive evaluation to classify these health benefits. Results showed four main dimensions, namely, physical fitness, psychological fitness, quality of life (QOL), and environmental health; however, these dimensions need further investigation. Physiological health benefits can also be demonstrated through future experiments, which can further focus on empirical research on the psychological benefits and its overall effect on the QOL. This study contributes to the current literature by providing novel theoretical foundations and subsequently aids practitioners to understand customers better and convey their marketing messages to tourists more effectively.

"A Hippo Out of Water": A Qualitative Inquiry of How Cancer Survivors' Experienced In-Person and Remote-Delivered Mind-Body Therapies

Background

Mind-body therapies (MBTs) are an effective treatment option for people living with and surviving from cancer to help manage unwanted physical and psychological symptoms and side-effects related to treatment and the illness itself. Many of these structured MBTs, such as Mindfulness Based Cancer Recovery (MBCR) and tai chi/qigong (TCQ) programs are common; however, COVID-19 caused most research intervention trials and clinical programs to halt completely, or rapidly adapt an online modality. The Mindfulness and Tai Chi for Cancer Health (MATCH) study, a large-scale study that compared MBCR to a structured TCQ program for treating psychological and physical health outcomes for cancer survivors, adapted to an online, Zoom delivered, program at the outset of COVID-19.

Objectives

Study objectives were to explore the experiences of MATCH study participants who took the MBCR or TCQ program completely in-person, those who took the program completely online (over zoom), and participants who had to shift from in-person to online delivery midway through their series of TCQ classes.

Methods

Semi-structured interviews were conducted with 13 participants following participation in either the MBCR or TCQ program of the MATCH study.

Results

We derived four themes from the data: 1) attending to personal needs, 2) functional, interpersonal, and COVID19-related challenges, 3) unique engagement styles based on mode of delivery, and 4) ease of transitioning to remote delivery. We found that thematic outcomes were variable and largely based on individual preference, such as valuing more autonomy online, or appreciating the interpersonal connection of being in-person. Our results further indicated that the process of shifting from in-person to online within a short time-period was a relatively seamless transition that had minimal impact on participant experience.

Conclusions

Insights from this study highlight the benefits of digital mind-body therapies for cancer survivors that extend beyond the acute effects of COVID19.

"Following the Breath:" A Trauma-Informed Intervention for Educator Wellness in Rural Montana

Given the prevalence of mental health issues for both educators and adolescents in rural Montana, this project is designed to help mitigate the impact of stressors by providing coping strategies linked to improvements in overall mental health outcomes for teachers, which may ultimately lead to improved co-regulation of students and classroom climate. The immediate goal of this pilot study was to measure physical and mental health outcomes of educators resulting from a remotely-delivered trauma-informed yoga intervention. Findings suggest improvements in participants' depression and anxiety levels, trauma symptoms, sleep quality, and non-significant changes in heart rate variability and cortisol levels.

Biomarker opportunities in the treatment of cancer-related depression

Depression comorbid with cancer is common and associated with a host of negative health outcomes. The inflammatory basis of depression is a growing area of research in cancer, focused on how stressors transduce into inflammation and contribute to the emergence of depression. In this review, we synthesize inflammatory biomarker associations with both depression and the currently available pharmacotherapies and psychotherapies in cancer, underscoring the need for expanding research on anti-inflammatory agents with antidepressant effects. Modulation of inflammatory neuroimmune pathways can slow tumor progression and reduce metastases. Biomarkers associated with depression in cancer may help with diagnosis and treatment monitoring, as well as inform research on novel drug targets to potentially improve cancer survival.

Mindfulness Meditation Interventions for Long COVID: Biobehavioral Gene Expression and Neuroimmune Functioning

Some individuals infected with SARS CoV-2 have developed Post-Acute Sequelae of SARS CoV-2 infection (PASC) or what has been referred to as Long COVID. Efforts are underway to find effective treatment strategies for those with Long COVID. One possible approach involves alternative medical interventions, which have been widely used to treat and manage symptoms of a variety of medical problems including post-viral infections. Meditation has been found to reduce fatigue and unrefreshing sleep, and for those with post-viral infections, it has enhanced immunity, and reduced inflammatory-driven pathogenesis. Our article summarizes the literature on what is known about mindfulness meditation interventions, and reviews evidence on how it may apply to those with Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Evidence is reviewed suggesting effective and sustainable outcomes may be achieved for symptomatology and underlying pathology of post-viral fatigue (PASC and ME/CFS).

The implementation of an online mindfulness-based program for pediatric patients at a tertiary hospital in South America: a feasibility study protocol

Background

The prevalence of chronic and complex pediatric health conditions has quickly risen over the last decades. Chronic and complex health conditions make pediatric patients and their families more susceptible to many distressing events during their lifespan. Mindfulness-based interventions have become a popular intervention for individuals living with chronic illnesses and have been adapted for pediatric populations with good results, including online versions. This study intends to report an implementation protocol of an online mindfulness-based program for adolescents to address an important gap in stress relief and health promotion for pediatric patients.

Methods

In this article, we describe the rationale and design of an implementation study of an online mindfulness-based program for pediatric patients at a tertiary pediatric hospital in South America. Participants will be recruited during one year to participate in an eight-session online mindfulness-based program. To assess our primary aim of feasibility, we will exam recruitment, retention and participation rates. Participants will also complete a symptomatology evaluation (i.e., depression, anxiety, and stress symptoms) at baseline and immediately at post-treatment and fidelity will be evaluated by a structured questionnaire.

Discussion

This study will be the first known to assess the implementation of an online mindfulness-based program for a pediatric population at a tertiary pediatric center in South America under real-life conditions. This study will establish the feasibility of a novel intervention aimed at promoting mental health and positive coping strategies among pediatric patients with chronic and complex health conditions. Evidence from this study would be useful to patients, families, clinicians, and policymakers and will help to devise strategies of health promotion for the pediatric population, as well as serve as a model for a future trial to examine efficacy of the proposed intervention.

Trial registration

This research has been registered at Ensaiosclinicos.gov.br, identifier RBR-23trp87. Registered 25 February 2022—retrospectively registered.

Nighttime salivary cortisol as a biomarker of stress and an indicator of worsening quality of life in patients with head and neck cancer: A cross‐sectional study

Background

Aim

Methods

Results

Conclusion

Planning and developing a web-based intervention for active surveillance in prostate cancer: an integrated self-care programme for managing psychological distress

Objectives

To outline the planning, development and optimisation of a psycho-educational behavioural intervention for patients on active surveillance for prostate cancer. The intervention aimed to support men manage active surveillance-related psychological distress.

Methods

The person-based approach (PBA) was used as the overarching guiding methodological framework for intervention development. Evidence-based methods were incorporated to improve robustness. The process commenced with data gathering activities comprising the following four components:

• A systematic review and meta-analysis of depression and anxiety in prostate cancer

• A cross-sectional survey on depression and anxiety in active surveillance

• A review of existing interventions in the field

• A qualitative study with the target audience

The purpose of this paper is to bring these components together and describe how they facilitated the establishment of key guiding principles and a logic model, which underpinned the first draft of the intervention.

Results

The prototype intervention, named PROACTIVE, consists of six Internet-based sessions run concurrently with three group support sessions. The sessions cover the following topics: lifestyle (diet and exercise), relaxation and resilience techniques, talking to friends and family, thoughts and feelings, daily life (money and work) and information about prostate cancer and active surveillance. The resulting intervention has been trialled in a feasibility study, the results of which are published elsewhere.

Conclusions

The planning and development process is key to successful delivery of an appropriate, accessible and acceptable intervention. The PBA strengthened the intervention by drawing on target-user experiences to maximise acceptability and user engagement. This meticulous description in a clinical setting using this rigorous but flexible method is a useful demonstration for others developing similar interventions.

Trial registration and Ethical Approval

ISRCTN registered: ISRCTN38893965. NRES Committee South Central – Oxford A. REC reference: 11/SC/0355

Mindfulness-based stress reduction increases stimulated IL-6 production among lonely older adults: A randomized controlled trial

Loneliness is a potent psychosocial stressor that predicts poor health and mortality among older adults, possibly in part by accelerating age-related declines in immunocompetence. Mindfulness interventions have shown promise for reducing loneliness and improving markers of physical health. In a sample of lonely older adults, this two-arm parallel trial tested whether mindfulness training enhances stimulated interleukin-6 (IL-6) production, a measure of innate immune responsivity. Lonely older adults (65-85 years; N = 190) were randomized to an 8-week Mindfulness-Based Stress Reduction (MBSR) or control Health Enhancement Program (HEP) intervention. Lipopolysaccharide (LPS)-stimulated production of IL-6 was measured in vitro by blinded outcome assessors at pre-intervention, post-intervention, and 3-month follow-up. Mixed-effects linear models tested time (pre, post, follow-up) by condition (MBSR vs. HEP) effects. As predicted, a significant time × condition effect on stimulated IL-6 production was observed across pre, post, and follow-up timepoints. Significant MBSR vs. HEP differences emerged from pre- to post-intervention (p =.009, d = 0.38) and from pre-intervention to 3-month follow-up (p =.017, d = 0.35), with larger increases in IL-6 production following MBSR compared to HEP. No study-related adverse events were reported. Results show that mindfulness training may be effective for boosting innate immunocompetence among lonely older adults. Given that immunocompetence tends to decline with age, mindfulness training may help to counteract the effects of aging and psychosocial stress on infection risk and recovery from injury.

Exploring the past, present, and future of the mindfulness field: A multitechnique bibliometric review

This paper provides an overview of the mindfulness literature up until the end of 2020 by (a) uncovering its underlying intellectual structure, (b) identifying the most influential and popular themes, and (c) presenting new directions for future research on mindfulness. To this end, a systematic quantitative review based on bibliometric methods was conducted, which is perhaps less prone to researcher bias and can complement existing meta-analyses and qualitative (narrative) structured reviews as an objective approach. Three bibliometric techniques—document co-citation analysis, co-word (co-occurrence and content) analysis, and bibliographic coupling—were applied to explore the past, present, and future of mindfulness research. The co-citation analysis showed that measurement, mechanisms, mindfulness-based interventions, and examinations of the efficacy of mindfulness interventions are among the key theoretical knowledge bases from which the field of mindfulness is derived. The content analysis demonstrated the beneficial effects of mindfulness meditation for physical and mental health conditions. The bibliographic coupling revealed novel directions in cognitive behavioral therapy, emotion regulation, the application of mindfulness practice to children and adolescents, mindfulness at work, and the role of mindfulness in positive psychology. The large sample of articles that was analyzed allowed us to provide a broader and more objective overview than possible with other forms of literature reviews. The combination of the three bibliometric techniques granted deeper insights into the complex multidisciplinary field of mindfulness, along with specific suggestions for future research.

The Effect of Mindfulness Yoga in Children With School Refusal: A Study Protocol for an Exploratory, Cluster-Randomized, Open, Standard Care-Controlled, Multicenter Clinical Trial

Background

School refusal occurs in about 1–2% of young people. Anxiety and depression are considered to be the most common emotional difficulties for children who do not attend school. However, at present, no definitive treatment has been established for school refusal, although interventions such as cognitive behavioral therapy have been used. This paper reports a protocol for a cluster-randomized controlled trial of a mindfulness yoga intervention for children with school refusal.

Methods

This study is a multicenter, exploratory, open cluster-randomized controlled trial. This study will recruit children aged 10–15 years with school refusal. After a 2-week baseline, participants for each cluster will be randomly assigned to one of two groups: with or without mindfulness yoga for 4 weeks. Mindfulness yoga will be created for schoolchildren for this protocol and distributed to the participants on DVD. The primary outcome is anxiety among children with school refusal using the Spence Children's Anxiety Scale-Children.

Discussion

For this study, we developed a mindfulness yoga program and protocol, and examine whether mindfulness yoga can improve anxiety in children with school refusal. Our mindfulness yoga program was developed based on the opinions of children of the same age, and is a program that children can continue to do every day without getting bored. In this way, we believe that we can contribute to the smooth implementation of support to reduce the anxiety of children with school refusal, and to the reduction of the number of children who refuse to go to school.

Which Aspects of Psychological Resilience Moderate the Association between Deterioration in Sleep and Depression in Patients with Prostate Cancer?

This study aimed to investigate the moderating effect of psychological resilience on sleep-deterioration-related depression among patients with prostate cancer, in terms of the total score and individual symptoms. From a survey of 96 patients with prostate cancer, 55 who reported a deterioration in their sleep quality since diagnosis and treatment completed the Zung Self-Rating Depression Scale, Connor–Davidson Resilience Scale, and the Insomnia Severity Index. Moderation analysis was conducted for the scale total scores and for the ‘core’ symptoms of each scale within this sample, based on data analysis. Interaction analysis was used to identify key associations. The moderation analysis suggested that psychological resilience moderated the depressive effect of sleep deterioration that patients reported occurred after their diagnosis and treatment and did so at the total and ‘core’ symptom levels of being able to see the humorous side of things and to think clearly when under pressure, but there was an interaction between this moderating effect, the strength of psychological resilience, and severity of sleep deterioration. Although it appears to be a successful moderator of depression arising from sleep deterioration that was reported by patients with prostate cancer, the effectiveness of psychological resilience is conditional upon the severity of patients’ sleep difficulties and the strength of their psychological resilience. Implications for the application of resilience training and concomitant therapies for patients with prostate cancer with sleep difficulties and depression are discussed.

The Association of Spirituality with Anxiety and Depression in Stroke Survivor-Caregiver Dyads: An Actor-Partner Interdependence Model

BACKGROUND

Although several authors have analyzed the effects of spirituality on stroke survivors' physical functioning and on their own caregiver's outcomes, such as quality of life, only few authors have explored the interaction between spirituality and anxiety and depression using a dyadic approach.

OBJECTIVES

The aim of this study was to analyze the influence of spirituality in the stroke survivor-caregiver dyad and specifically on anxiety and depression in both parties.

METHODS

A total of 217 stroke survivor-caregiver dyads were enrolled at discharge from several rehabilitation hospitals in central and southern Italy. The actor-partner interdependence model was used to analyze the dyadic data. To verify the differences in the effects between survivors and caregivers, comparisons were made between the χ 2 values of the model in which actor and partner effects were constrained to be equal.

RESULTS

The average age of stroke survivors and their caregivers at baseline was 71.2 and 52.7 years, respectively. Among the stroke survivors, there were slightly more men than women, whereas 65% of the caregivers were women. Most stroke survivors had had an ischemic stroke. Four statistically significant actor effects were identified. Higher survivors' and caregivers' spirituality was associated with higher survivor and caregiver anxiety. The only significant partner effect that was identified was the association between stroke survivor spirituality and caregiver depression.

CONCLUSIONS

This study highlights the importance of studying spirituality in the population with stroke. Spirituality seems to play an important protective role in both stroke survivors' and caregivers' depression but not in anxiety.

Chronic Pain and Emotional Stroop: A Systematic Review

Chronic pain is an unpleasant sensory and emotional experience that persists for more than 3 months and is often accompanied by symptoms such as depression, fatigue, sleep disturbances, and cognitive impairment. Emotional dysregulation may also be involved in its etiology. Emotions are known to modulate the experience of pain by influencing cognition and behavior (emotional awareness, emotional expression and experience, and verbalizations). A useful task to explore emotional processing and emotional dysregulation is the emotional Stroop task. Despite the large number of studies using this task, their objectives are diverse; it is necessary to integrate them. The main objective of the present systematic review was to determine the extent of the abnormalities in behavioral performance (including attentional biases) and/or brain alterations in patients with chronic pain during the emotional Stroop task. This systematic review was conducted in accordance with the Cochrane Collaboration guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The protocol was previously registered in the Prospective Register of Systematic Reviews (PROSPERO) international database. The selected articles were extracted from the PubMed, Scopus, and Web of Science databases. Fifteen studies were identified as eligible for systematic review. The studies reported alterations in brain regions related to pain and emotional regulation, as well as attentional bias and higher response time latencies (related to the words’ emotional load) in patients with chronic pain. The results confirm the validity of the emotional Stroop task to measure emotions and selective attention. As attentional bias towards negative information is often seen in chronic pain patients, and given the relation between selective attention and greater activation of the brain areas associated with pain and emotional processing, this type of task plays a crucial role in research on emotional and attentional processes among chronic pain patients. Further, attentional bias towards negative information has been associated with higher levels of pain. Taken together, the results suggest the need for cognitive training and an emotional approach to chronic pain therapies, especially targeting attentional biases and negative mood.

Stress-Relieving Video Game and Its Effects: A POMS Case Study

Stress is the response or a change in our bodies to environmental factors like challenges or demands that are physical and emotional. The main cause of stress is illnesses and it is gaining more interest, a hot topic for many researchers. Stress can be brought about by a wide range of normal life occasions that are hard to avoid. Stress generally refers to two things: first, the psychological perception of pressure and the body’s response to it. On the other hand, it involves multiple systems, from metabolism to muscles to memory. Many methods and tools are being developed to reduce stress in humans. Stress can be a short-term issue or a long-term problem, depending on what changes in your life. The emphasis of this article is to reduce the effects of stress by developing a stress-releasing game and verifying its results through the Profile of Mood States (POMS) and POMS-2 survey. Games are associated with stress levels; hence, parameters like sounds, visuals, and colors associated with reducing stress are used to develop a game for the stress reduction in the players. The survey research aims to determine that the purpose-built game will affect the player's stress level using a reliable psychological survey paper. The survey collected a variety of information from its participants over six months. Different aspects of a person’s psychology and reactions are recorded in this scenario by calculating the mean, standard deviation, degree of freedom, zero-error, and probability-value%. The POMS and POMS-2 results are obtained from the custom-built game, and these are found to be effective in reducing stress.

Comparison of conventional (face-to-face) and online approach in mindfulness-based chronic disease self-management interventions for older adults

Background: To compare the effectiveness between conventional (face-to-face) and online public health approaches focused on mental health, self-efficacy of health management and quality of life of older adults.

Design and methods: Participants will be 65+ residents of the city of Rijeka and the wider urban area and will be divided into three groups. The first group consists of participants who will be included in the conventional (face-to-face) form of public health intervention, the second group consists of participants who will be involved in online public health intervention and the third group consists of participants from the control group. A total of 450 participants will participate in a pretest-posttest non-equivalent groups design research, with 150 participants per group. A series of questionnaires will be administered to evaluate effect of the interventions on mental health, self-efficacy of health management and quality of life. Results of this research will provide insight into the effectiveness of the electronic way of implementing chronic disease self-management interventions compared to conventional (face-to-face) which can be useful to policy makers and public authorities in the organization and implementation of health policies.

Expected impact of the study for public health: This research will contribute to the definition, implementation and adaptation of future public health interventions related to mental health, selfefficacy of health management and quality of life in the context of various epidemiological situations such as the current one caused by the COVID-19 pandemic.

The modulatory role of internet-supported mindfulness-based cognitive therapy on extracellular vesicles and psychological distress in people who have had cancer: a protocol for a two-armed randomized controlled study

Background

Mindfulness-based interventions (MBIs) have been used in oncology contexts as a promising tool with numerous benefits for various health-related and psychosocial outcomes. Despite the increasing popularity of MBIs, few randomized controlled trials (RCTs) have examined their effects upon biological parameters. Specifically, no previous study has examined the effects of MBIs on extracellular vesicles (EVs), which are potentially important markers of health, disease, and stress. Moreover, the lack of RCTs is even more limited within the context of technology-mediated MBIs and long-term effects.

Methods

The current study protocol presents a two-arm, parallel, randomized controlled study investigating the effects of internet-supported mindfulness-based cognitive therapy (MBCT) compared with treatment as usual (TAU). Primary outcomes are psychological distress and EV cargo of distressed participants with previous breast, colorectal, or prostate cancer diagnoses. Secondary outcomes are self-reported psychosocial and health-related measures, and additional biological markers. Outcomes will be assessed at baseline, 4 weeks after baseline (mid-point of the intervention), 8 weeks after baseline (immediately post-intervention), 24 weeks after baseline (after booster sessions), and 52 weeks after baseline. Our goal is to recruit at least 111 participants who have been diagnosed with breast, prostate, or colorectal cancer (cancer stage I to III), are between 18 and 65 years old, and have had primary cancer treatments completed between 3 months and 5 years ago. Half of the participants will be randomized to the TAU group, and the other half will participate in an 8-week online MBCT intervention with weekly group sessions via videoconference. The intervention also includes asynchronous homework, an online retreat after the fifth week, and 4 monthly booster sessions after completion of the 8-week programme.

Discussion

This study will allow characterizing the effects of internet-based MBCT on psychosocial and biological indicators in the context of cancer. The effects on circulating EVs will also be investigated, as a possible neurobiological pathway underlying mind-body intervention effects.

Trial registration

ClinicalTrials.govNCT04727593 (date of registration: 27 January 2021; date of record verification: 6 October 2021).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06045-x.

Determinants of quality of life in individuals with chronic low back pain: a systematic review

OBJECTIVE

Chronic low back pain (CLBP) is a prominent medical condition that can affect an individual at some point in their life time which could lead to poor quality of life (QOL). Low back pain has affected approximately 577 million individuals globally by 2017. The aim of the current systematic review is to synthesise the existing evidence on the factors influencing the QOL in individuals with CLBP and to identify strategies to improve their QOL.

METHOD

PubMed, ScienceDirect, PsychNet and Google Scholar were used to extract studies reporting quantitative relationships between QOL and its possible determinants in individuals having CLBP and the intervention strategies to improve QOL.

RESULTS

10,851 studies were initially identified and twenty-six studies which met the inclusion criteria were selected for the review. 21 studies reported relationship between QOL and potential determinants and five studies assessed the influence of interventions on QOL. Determinants were classified as kinesiophobia, fear avoidance belief, or pain belief; occupation-related factors; pain and disability; activity; personal factors including age, gender, employment status; and other psychological factors including anxiety, quality of sleep, and health locus of control. Intervention strategies including MBSR, Pilates method and Back School Programme improved QOL in individuals with CLBP.

CONCLUSION

Psychosocial factors as well as the physical status of the individual contributed to the QOL in individuals having CLBP.

Biobehavioral Pathways and Cancer Progression: Insights for Improving Well-Being and Cancer Outcomes

The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.

Mindfulness-based online intervention on mental health among undergraduate nursing students during coronavirus disease 2019 pandemic in Beijing, China: A randomized controlled trial

OBJECTIVE

To evaluate the effect of mindfulness intervention on improving mental health among undergraduate nursing students during the coronavirus disease 2019 (COVID-19) pandemic in China.

METHODS

An online mindfulness intervention course named Mindfulness Living With Challenge (MLWC) was developed by the research team, and a randomized controlled trial using MLWC among Chinese undergraduate nursing students was carried out. A total of 120 undergraduate nursing students were randomized into control (60 students) and intervention groups (60 students) via a WeChat mini program. Self-administered questionnaire surveys were conducted at pre- and post-intervention, measuring depression, anxiety, stress, mindfulness, and perceived social support. After intervention, the acceptance of the online mindfulness course among participants was assessed by employing the theory of technology acceptance model (TAM).

RESULTS

Among the enrolled 120 participants, 86.67% (52/60) and 93.33% (56/60) of the intervention and control groups remained completed the trial and the questionnaire surveys. Compared with the control group, the reduction of anxiety and stress symptoms, as well as the improvement of mindfulness level and perceived social support in the MLWC intervention group were statistically significant (P < 0.05), while the change in depression was not statistically significant. The scores of the four dimensions in TAM ranged from (5.88 ± 0.94) to (5.91 ± 0.97).

CONCLUSION

Online mindfulness intervention implemented in this study is effective in improving mental health among undergraduate nursing students, and they were interested in this intervention.

CLINICAL TRIAL REGISTRATION

[www.ClinicalTrials.gov], identifier [ChiCTR2 200058103].

Psychosocial Stress and Age Influence Depression and Anxiety-Related Behavior, Drive Tumor Inflammatory Cytokines and Accelerate Prostate Cancer Growth in Mice

Prostate cancer (PCa) prevalence is higher in older men and poorer coping with psychosocial stressors effect prognosis. Yet, interactions between age, stress and PCa progression are underexplored. Therefore, we characterized the effects of age and isolation combined with restraint (2 h/day) for 14 days post-tumor inoculation on behavior, tumor growth and host defense in the immunocompetent, orthotopic RM-9 murine PCa model. All mice were tumor inoculated. Isolation/restraint increased sympathetic and hypothalamic-pituitary-adrenal cortical activation, based on elevated serum 3-methoxy-4-hydroxyphenylglycol/norepinephrine ratios and corticosterone levels, respectively. Elevated zero maze testing revealed age-related differences in naïve C57Bl/6 mice, and increased anxiety-like behavior in tumor-bearing mice. In open field testing, old stressed mice were less active throughout the 30-min test than young non-stressed and stressed, and old non-stressed mice, suggesting greater anxiety in old stressed mice. Old (18 month) mice demonstrated more depression-like behavior than young mice with tail suspension testing, without effects of isolation/restraint stress. Old mice developed larger tumors, despite similar tumor expression of tumor vascular endothelial growth factor or transforming growth factor-beta1 across age. Tumor chemokine/cytokine expression, commonly prognostic for poorer outcomes, were uniquely age- and stress-dependent, underscoring the need for PCa research in old animals. Macrophages predominated in RM-9 tumors. Macrophages, and CD4⁺ and CD4⁺FoxP3⁺ T-cell tumor infiltration were greater in young mice than in old mice. Stress increased macrophage infiltration in old mice. Conversely, stress reduced intratumoral CD4⁺ and CD4⁺FoxP3⁺ T-cell numbers in young mice. CD8⁺ T-cell infiltration was similar across treatment groups. Our findings support that age- and psychological stress interacts to affect PCa outcomes by interfering with neural-immune mechanisms and affecting behavioral responses.

Implications for Systemic Approaches to COVID-19: Effect Sizes of Remdesivir, Tocilizumab, Melatonin, Vitamin D3, and Meditation

Introduction

COVID-19 poses a chronic threat to inflammatory systems, reinforcing the need for efficient anti-inflammatory strategies. The purpose of this review and analysis was to determine the efficacy of various interventions upon the inflammatory markers most affected by COVID-19. The focus was on the markers associated with COVID-19, not the etiology of the virus itself.

Methods

Based on 27 reviewed papers, information was extracted on the effects of COVID-19 upon inflammatory markers, then the effects of standard treatments (Remdesivir, Tocilizumab) and adjunctive interventions (vitamin D₃, melatonin, and meditation) were extracted for those markers. These data were used to approximate effect sizes for the disease or interventions via standardized mean differences (SMD).

Results

The data that were available indicated that adjunctive interventions affected 68.4% of the inflammatory markers impacted by COVID-19, while standard pharmaceutical medication affected 26.3%.

Discussion

Nonstandard adjunctive care appeared to have comparable or superior effects in comparison to Remdesivir and Tocilizumab on the inflammatory markers most impacted by COVID-19. Alongside standards of care, melatonin, vitamin D₃, and meditation should be considered for treatment of SARS-COV-2 infection and COVID-19 disease.

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Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond

The intersecting negative effects of structural racism, COVID-19, climate change, and chronic diseases disproportionately affect racial and ethnic minorities in the US and around the world. Urban populations of color are concentrated in historically redlined, segregated, disinvested, and marginalized neighborhoods with inadequate quality housing and limited access to resources, including quality greenspaces designed to support natural ecosystems and healthy outdoor activities while mitigating urban environmental challenges such as air pollution, heat island effects, combined sewer overflows and poor water quality. Disinvested urban environments thus contribute to health inequity via physical and social environmental exposures, resulting in disparities across numerous health outcomes, including COVID-19 and chronic diseases such as cancer and cardiovascular diseases (CVD). In this paper, we build off an existing conceptual framework and propose another conceptual framework for the role of greenspace in contributing to resilience and health equity in the US and beyond. We argue that strategic investments in public greenspaces in urban neighborhoods impacted by long term economic disinvestment are critically needed to adapt and build resilience in communities of color, with urgency due to immediate health threats of climate change, COVID-19, and endemic disparities in chronic diseases. We suggest that equity-focused investments in public urban greenspaces are needed to reduce social inequalities, expand economic opportunities with diversity in workforce initiatives, build resilient urban ecosystems, and improve health equity. We recommend key strategies and considerations to guide this investment, drawing upon a robust compilation of scientific literature along with decades of community-based work, using strategic partnerships from multiple efforts in Milwaukee Wisconsin as examples of success.

The Role of Expectations and Endogenous Opioids in Mindfulness-Based Relief of Experimentally Induced Acute Pain

OBJECTIVE

Expectations contribute to cognitive pain modulation through opioidergically mediated descending inhibition. Mindfulness meditation reduces pain independent of endogenous opioids, engaging unique corticothalamocortical mechanisms. However, it remains unknown whether expectations for pain relief predict mindfulness-induced analgesia and if these expectations are modified by endogenous opioids.

METHODS

In this secondary analysis of previously published work, 78 pain-free participants (mean age, 27 ± 7 years; 50% women) were randomized to a four-session mindfulness meditation or book listening regimen. Expectations for intervention-induced pain relief were assessed before and after each intervention. Pain ratings were examined after meditation or rest (control group) during noxious heat (49°C) and intravenous administration of saline placebo or the opioid antagonist naloxone (0.15 mg/kg bolus + 0.1 mg kg-1 h-1 infusion.

RESULTS

Mindfulness significantly lowered pain during saline and naloxone infusion. Higher expected pain relief from mindfulness predicted lower pain intensity (r(40) = -0.41, p = .009). The relationship between meditation-related expectations and pain intensity reductions was exhibited during naloxone (r(20) = -0.76, p < .001) but not saline (r(20) = -0.22, p = .36). Expectations for book listening-based analgesia did not significantly predict pain changes during saline (r(20) = -0.37, p = .11) or naloxone (r(18) = 0.26, p = .30) in the control group.

CONCLUSIONS

These novel findings demonstrate a significant role for expectations in mindfulness-based pain relief. However, this role was minimal during saline and stronger during opioid blockade, despite similar pain reductions. This supports growing evidence that mindfulness engages multiple mechanisms to reduce pain, suggesting that mindfulness might be an effective pain-reducing technique even for individuals with low expectations for pain relief.

Streaming mindfulness: Well-being and mindfulness among subscribers to a video streaming service

OBJECTIVE

Internet and smartphone technology have advanced the dissemination of mindfulness practices and philosophy. This study explored how individuals interact with Spectiv, a subscription-based video streaming service (VSS) that advertises content for meditation, and measured levels of mindfulness and well-being. We hypothesized that users engaging with Spectiv for longer sessions and on a regular basis would report higher levels of mindfulness and well-being.

METHOD

A 46-question online survey was developed and distributed to all active subscribers of Spectiv (N = 119). The survey included two validated scales: (1) The Cognitive and Affective Mindfulness Scale, and (2) The Warwick-Edinburgh Mental Well-being Scale. A series of one-way ANOVAs were performed, along with a simple linear regression and descriptive statistics.

RESULTS

Users reported relaxation as the most common activity. Levels of mindfulness and well-being were significantly higher for users whose session-duration lasted 2 hours (p = .01) and 3 hours (p = .03). Users engaging with the VSS daily had significant levels of both mindfulness (p < .001) and well-being (p < .001). There was no difference between subscription length and mindfulness and well-being. Mindfulness was found to be a significant positive predictor of well-being (p < .0001).

CONCLUSION

VSS could be valuable to facilitating mindfulness. Users engaging with a VSS for longer durations and more frequently may be more likely to experience benefits. Future research using controlled designs such as randomized control trials and feasibility studies should be conducted to determine if VSS can maintain or increase levels of mindfulness and well-being.

Effects of a 12-week yoga versus a 12-week educational film intervention on symptoms of restless legs syndrome and related outcomes: an exploratory randomized controlled trial

STUDY OBJECTIVES

To assess the effects of a yoga versus educational film (EF) program on restless legs syndrome (RLS) symptoms and related outcomes in adults with RLS.

METHODS

Forty-one community-dwelling, ambulatory nonpregnant adults with moderate to severe RLS were randomized to a 12-week yoga (n = 19) or EF program (n = 22). In addition to attending classes, all participants completed practice/treatment logs. Yoga group participants were asked to practice at home 30 minutes per day on nonclass days; EF participants were instructed to record any RLS treatments used on their daily logs. Core outcomes assessed pretreatment and posttreatment were RLS symptoms and symptom severity (International RLS Study Group Scale (IRLS) and RLS ordinal scale), sleep quality, mood, perceived stress, and quality of life (QOL).

RESULTS

Thirty adults (13 yoga, 17 EF), aged 24 to 73 (mean = 50.4 ± 2.4 years), completed the 12-week study (78% female, 80.5% white). Post-intervention, both groups showed significant improvement in RLS symptoms and severity, perceived stress, mood, and QOL-mental health (P ≤ .04). Relative to the EF group, yoga participants demonstrated significantly greater reductions in RLS symptoms and symptom severity (P ≤ .01), and greater improvements in perceived stress and mood (P ≤ .04), as well as sleep quality (P = .09); RLS symptoms decreased to minimal/mild in 77% of yoga group participants, with none scoring in the severe range by week 12, versus 24% and 12%, respectively, in EF participants. In the yoga group, IRLS and RLS severity scores declined with increasing minutes of homework practice (r = .7, P = .009 and r = .6, P = .03, respectively), suggesting a possible dose-response relationship.

CONCLUSIONS

Findings of this exploratory RCT suggest that yoga may be effective in reducing RLS symptoms and symptom severity, decreasing perceived stress, and improving mood and sleep in adults with RLS.

CLINICAL TRIAL REGISTRATION

Registry: Clinicaltrials.gov; Title: Yoga vs. Education for Restless Legs: a Feasibility Study; Identifier: NCT03570515; URL: https://clinicaltrials.gov/ct2/show/NCT03570515.

Mindfulness-based interventions for psychological wellbeing and quality of life in men with prostate cancer: A systematic review and meta-analysis

OBJECTIVE

Mindfulness-based interventions (MBIs) are increasingly being encouraged for managing treatment-related symptoms but much less is known about the extent to which mindfulness is effective in relieving the psychosocial distress experienced by men with prostate cancer. A systematic review was conducted to synthesise the literature on MBIs for psychological wellbeing and quality of life improvement in men with prostate cancer.

METHODS

Embase, CINAHL, MEDLINE, PsycINFO, PsycArticles and Web of Science were searched up to 7th November 2020. Included studies were assessed for quality using appropriate appraisal tools. Homogeneous study results were pooled in a meta-analysis while narrative synthesis was used to summarise the findings from heterogeneous results. Effect size was expressed as Cohen's d (95% confidence intervals) and statistical significance (p-value) was set at 0.05.

RESULTS

Four studies comprising three randomised trials and one non-randomised study met the inclusion criteria. MBIs for men with prostate cancer showed small to moderate effect for improving psychological outcomes. The pooled result of quality of life and post-traumatic growth in study participants showed moderate (d = -0.29 [-1.29, 0.71], p = 0.57) and large (d = 0.77 [-0.33,1.88], p = 0.000) effects, respectively.

CONCLUSION

MBI is potentially promising for psychological outcomes, quality of life and post-traumatic growth symptoms improvement in men with prostate cancer but recommendations cannot be made based on current evidence due to limited research and inadequate methodological rigour of published literature. Robust research is needed to draw a reliable conclusion about its sustained effect in men with advanced disease.

Results of the Optimune trial: A randomized controlled trial evaluating a novel Internet intervention for breast cancer survivors

INTRODUCTION

After the acute treatment phase, breast cancer patients often experience low quality of life and impaired mental health, which could potentially be improved by offering cognitive behavioural therapy (CBT) and addressing exercise and dietary habits. However, CBT and other behavioural interventions are rarely available beyond the acute treatment phase. Internet-based interventions could bridge such treatment gaps, given their flexibility and scalability. In this randomized controlled trial (RCT), we investigated the effects of such an intervention ("Optimune") over three months.

METHODS

This RCT included 363 female breast cancer survivors (age range = 30-70), recruited from the community, who had completed the active treatment phase. Inclusion criteria were: breast cancer diagnosis less than 5 years ago and acute treatment completion at least 1 month ago. Participants were randomly assigned to (1) an intervention group (n = 181), in which they received care as usual (CAU) plus 12-month access to Optimune immediately after randomization, or (2) a control group (n = 182), in which they received CAU and Optimune after a delay of 3 months. Primary endpoints were quality of life (QoL), physical activity, and dietary habits at three months. We hypothesized that intervention group participants would report better QoL, more physical activity, and improved dietary habits after 3 months.

RESULTS

Intention-to-treat (ITT) analyses revealed significant effects on QoL (d = 0.27, 95% CI: 0.07-0.48) and dietary habits (d = 0.36, 95% CI: 0.15-0.56), but the effect on physical exercise was not significant (d = 0.30; 95% CI: 0.10-0.51).

DISCUSSION

These findings suggest the effectiveness of Optimune, a new CBT-based Internet intervention for breast cancer survivors, in facilitating improvements in quality of life and dietary habits. Efforts to disseminate this intervention more broadly may be warranted.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03643640. Registered August 23rd 2018, https://clinicaltrials.gov/ct2/show/NCT03643640.

Neoadjuvant Chemotherapy in Breast Cancer: An Advanced Personalized Multidisciplinary Prehabilitation Model (APMP-M) to Optimize Outcomes

Neoadjuvant chemotherapy is increasingly being employed in the management of breast cancer patients. Efforts and resources have been devoted over the years to the search for an optimal strategy that can improve outcomes in the neoadjuvant setting. Today, a multidisciplinary approach with the application of evidence-based medicine is considered the gold standard for the improvement of oncological results and patient satisfaction. However, several clinical complications and psychological issues due to various factors can arise during neoadjuvant therapy and undermine outcomes. To ensure that health care needs are adequately addressed, clinicians must consider that women with breast cancer have a high risk of developing "unmet needs" during treatment, and often require a clinical intervention or additional care resources to limit possible complications and psychological issues that can occur during neoadjuvant treatment. This work describes a multidisciplinary model developed at "Fondazione Policlinico Universitario Agostino Gemelli" (FPG) in Rome in an effort to optimize treatment, ease the application of evidence-based medicine, and improve patient quality of life in the neoadjuvant setting. In developing our model, our main goal was to adequately meet patient needs while preventing high levels of distress.

The mediating effect of social support on the relationship between perceived stress and quality of life among shidu parents in China

BACKGROUND

"Loss-of-only-child family" refers to the family in which the only child died and the mother has passed her child-bearing age. The parents who are unable to reproduce or do not foster other children are known as "shidu parents" in China. This study aimed to estimate the quality of life (QOL) and the mediating role of social support between perceived stress and QOL in Chinese shidu parents.

METHODS

502 shidu parents were recruited in Shenyang city. Shidu parents were asked to complete a questionnaire including the MOS item short from health survey (SF-36), the perceived stress scale-10 (PSS-10) and the functional social support questionnaire (FSSQ). Hierarchical linear regression was performed to assess the associations among perceived stress, social support and QOL. Asymptotic and resampling strategies were used to explore the mediating role of social support.

RESULTS

The mean score of PCS and MCS was 64.83 ± 22.66 and 59.36 ± 21.83, respectively. Perceived stress was found to be negatively associated with both PCS (β =  - 0.21, p < 0.001) and MCS (β =  - 0.28, p < 0.001), while social support was positively associated with both PCS (β = 0.32, p < 0.001) and MCS (β = 0.32, p < 0.001). For shidu parents, the proportion of mediation of social support between perceived stress and QOL was 36.85% for PCS and 29.45% for MCS, respectively.

CONCLUSIONS

Perceived stress was associated with QOL and social support had a partially mediating effect between perceived stress and QOL in Chinese shidu parents. Low PCS and MCS of shidu parents highlight the need of timely developing interventions to reduce stress and reinforce social support to further improve their QOL.

On chip optofluidic low-pressure monitoring device

We present an on chip optofluidic surface deformable liquid Dove prism (LDP) based low-fluid flow pressure monitoring device. The unique design of the device in combination with liquid and soft solid enabled by the total internal reflection of light makes the sensor highly sensitive and compatible with the integration of a microfluidic and/or Lab-on-a-chip device. A layer-by-layer soft lithographic (LSL) and 3D printing technique are exploited to make the device. We have used Polydimethylsiloxane (PDMS) as the layer material and two variety of liquids (a) immersion oil (IO) and (b) di-iodomethane (DI) as refracting medium to construct the LDP sensor. Optical ray tracing simulation is performed to optimize the sensor. The pressure sensor shows sensitivity as high as ±28.5 mV per 50 Pa pressure with an error ± 2.5 mV and repeatability of ~99.56% at full scale. We have shown the applicability of the sensor by capturing and analyzing respiratory pressure signals of some human subjects at numerous conditions.

Knowledge Mapping of Acupuncture for Cancer Pain: A Scientometric Analysis (2000-2019)

Objective

This study aimed to demonstrate the state of the present situation and trends concerning the global use of acupuncture for cancer pain in the past 20 years.

Methods

Searched the Web of Science database from 2000 to 2019 related to acupuncture for cancer pain, and then used CiteSpace to conduct scientometric analysis to acquire the knowledge mapping.

Results

Yearly output has increased year by year, and the growth rate has become faster after 2012. According to the cluster analysis of institutions, authors, cited references, and keywords, 4, 4, 15, and 14 categories were obtained, respectively. The most productive countries, institutions, and authors are the USA, Mem Sloan Kettering Cancer Center, and Mao JJ, whose frequencies are 196, 24, and 17, respectively. However, the most important of them are Australia, Univ. Maryland, and Bao T, owing to their highest centrality, they are 0.90, 0.21, and 0.09 separately. Moreover, cited references that contributed to the most co-citations are Crew KD (2010), however, the most key cited reference is Roscoe JA (2003). Keywords such as acupuncture, pain, breast cancer, palliative care, and quality of life are the most frequently used. But auricular acupuncture is the crucial keyword. In the cluster analysis of institutions, authors, cited references, and keywords, the more convincing research categories are multiple myeloma, placebo effect, neck malignancies, and early breast cancer, with S values of 0.990, 0.991, 0.990, and 0.923, respectively. Therefore, they can be regarded as research hotspots in this field.

Conclusion

Based on the scientometric analysis in the past 20 years, the knowledge mapping of the country, institution, author, cited reference, and the keyword is gained, which has an important guiding significance for quickly and accurately positioning the trend in this field.

Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples' Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach

Introduction

Sexual health and intimacy are consistently reported among the top unmet supportive care needs of prostate cancer (PC) survivors. With an aging population and advances in PC detection and treatment, the need for better PC sexual health interventions is acute.

Aim

Examine the feasibility of a mindfulness-based therapy group aimed at improving sexual intimacy for couples following PC treatments.

Methods

A 4-session mindfulness-based group intervention was developed for PC survivors (mean age 65.6 yrs) and their partners (mean age 61.4 yrs). A mixed-methods approach was adopted to account for small sample sizes (N = 14 couples). Findings will guide future treatment refinement via participants’ lived experiences.

Main Outcome Measures

Quantitative outcomes assessed pretreatment, immediately after treatment, and 6 months later included relationship adjustment, sexual satisfaction, sexual function, depression, anxiety, and mindfulness. Qualitative outcomes used Grounded Theory Approach following posttreatment exit interviews.

Results

Effect sizes 6 months posttreatment indicated moderate improvements in overall sexual satisfaction and large increases in mindfulness in PC survivors, small decreases in sexual intimacy reported by partners, and small increases in anxiety in PC survivors and partners. Qualitative outcomes revealed 6 themes: (i) PC treatments must view PC as a couple’s disease; (ii) PC treatments must consider the impact of illness on individuals and the couple; (iii) Mindfulness was a valued treatment modality; (iv) Individual factors contribute to outcomes, and therefore, must be considered; (v) Multiple perceived mechanisms for change exist; (vi) Group format is a therapeutic element of the process.

Conclusion

An acceptance-based approach to sexual intimacy needs among PC survivors and their partners is feasible. While this small-scale preliminary study suggests that mindfulness may address some currently unmet needs among this population, randomized clinical trials are needed.

JA Bossio, CS Higano, LA Brotto. Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples’ Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach. Sex Med 2021;9:100310.

Protocol for a Nested Randomized Controlled Trial to Evaluate the Feasibility and Preliminary Efficacy of the Mindfulness Based Health Promotion Program on the Quality of Life of Older Adults Assisted in Primary Care-"The MBHP-Elderly Study"

Introduction: Population aging is a global phenomenon that has grown rapidly and progressively all over the world. Interventions that promote health must be studied and implemented to make the aging process be with quality of life. Depression and anxiety are the most common mental health conditions that compromise the quality of life on the elderly and it can cause damage to the autonomy and activities of daily life. Mindfulness training has been shown to improve psychological health and quality of life on adults. Studies involving Mindfulness-Based Interventions (MBIs) with older people are scarce in the literature, but they have been increasing in recent years showing promising results for healthy aging. This trial will investigate the feasibility and preliminary efficacy of an MBI on the quality of life of elderly assisted in the Primary Care.

Materials and Methods: A cohort-nested randomized controlled trial with 3 assessment points (baseline, post-intervention and 1-year follow up) will be conducted to compare a MBI program (Mindfulness-Based Health Promotion) to a cognitive stimulation control-group in a Primary Care facility. One-hundred and two older adults will be recruited from a cohort of this facility and they will be randomized and allocated into an intervention group (N = 76) and the control group (N = 76). The primary outcome evaluated will be the improvement of quality of life assessed by the WHOQOL-BREF and WHOQOL-OLD. The secondary outcomes will be cognitive function, psychological health, sleep quality, self-compassion, and religiosity. Qualitative data will be assessed by focus group and the word free evocation technique. The feasibility of the program will also be evaluated by adherence and unwanted effects questionnaires.

Discussion: This cohort-nested clinical trial will be the first mixed-methods study with 3 assessment points which will study the feasibility and preliminary efficacy of a mindfulness-based program for older people in Latin America population. If the findings of this study confirm the effectiveness of this program in this population it will be possible to consider it as intervention that might be implemented as public policy addressed to older people in healthcare systems.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03048708. Registered retrospectively on October 11th 2018.

Cognitive Behavioral Therapy and Mindfulness-Based Cognitive Therapy for Depressive Disorders

Recently, the importance of cognitive behavioral therapy (CBT) in the treatment of depression is gradually emerging. Particularly, mindfulness meditation has various approaches related to dialectical behavioral therapy (DBT), acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), and evidence has been provided that they alleviate depressive symptoms. In particular, as MBCT increases the level of evidence in the treatment of repetitive depressive disorders, guidelines are being recommended to prevent recurrence. Mindfulness may also contribute to improving the patient's symptoms as well as improving the therapeutic relationship with the therapist. For both mindful patients and therapists, positive awareness of internal experiences can be a good way to enrich the mind and overcome depressive disorders.

A Model of an Integrative Approach to Breast Cancer Patients

BACKGROUND

Breast cancer (BC) survivors have physical and psychological needs that require convincing responses by health care providers. The quality of life issue and clinical unmet needs are among the main reasons pushing a number of patients toward "natural" therapies that are often misleading and alternative to mainstream cancer care. Integrative Oncology (IO) tries to respond to many of those needs, by combining lifestyle counseling, body-mind activities, and complementary evidence-informed therapies with anticancer standard treatments.

METHODS

In our model at Fondazione Policlinico Gemelli (FPG), every woman diagnosed with a BC waiting for surgery or candidate to neoadjuvant chemotherapy undergoes a preliminary psycho-oncological distress evaluation and a brief lifestyle interview. Anthropometric measurements, body composition analysis, and individual levels of physical activity are recorded. Patients are given evidence based recommendations about the advisable diet and physical activity in a prehabilitation setting. A physician provides patients with information about integrative care plans to treat symptoms related to the disease or its treatments. Therapeutic approaches include acupuncture, mindfulness-based protocols, qigong, massage therapy, and classes of music/art therapy.

RESULTS

Between September 2018 and February 2020, the Center for Integrative Oncology at FPG has carried out 1249 lifestyle counseling sessions, 1780 acupuncture treatments, 1340 physiotherapy sessions, 3261 psycho-oncological consultations, 218 herbal medicine counseling sessions. Moreover, 90 BC patients completed the mindfulness based stress reduction (MBSR) protocol and 970 patients participated in qigong, art therapy, and music therapy classes.

CONCLUSIONS

Our integrative approach aims to achieve a person-centered medicine by improving symptoms management, adherence to oncological protocols, and eventually overall quality of life.

Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Stress and coping in women with breast cancer:unravelling the mechanisms to improve resilience

Breast cancer diagnosis, surgery, adjuvant therapies and survivorship can all be extremely stressful. In women, concerns about body image are common as a result of the disease and can affect interpersonal relationships, possibly leading to social isolation, increasing the likelihood for mood disorders. This is particularly relevant as women are at greater risk to develop anxiety and depressive symptoms in response to highly stressful situations. Here we address the mechanisms and the pathways activated as a result of stress and contributing to changes in the pathophysiology of breast cancer, as well as the potential of stress management factors and interventions in buffering the deleterious effects of chronic stress in a gender perspective. An improved understanding of the biological mechanisms linking stress-management resources to health-relevant biological processes in breast cancer patients could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve cancer outcomes, ultimately offering a unique opportunity to improve contemporary cancer treatments.

Benefits of mindful compassion for staff, patients and carers

AIMS AND OBJECTIVE

This study intended to examine the long-term effect on the emotional wellbeing and behaviour change of staff, patients and carers who attended a one-day Macmillan course on mindful compassion.

METHODS

People who attended mindful compassion study days in 2016 and 2017 were invited to participate in an online questionnaire in 2019.

RESULTS

Nearly 50% (99) of the 200 people who received the invitation completed the survey. Immediately after the course, 38.78% practised mindful compassion as and when required, 28.57% practised when possible, 15.31% practised daily, 13.27% practised 3-4 times a week and 3.5% were not practising. More than half (56%) used mindful compassion to help with home and work life, relationships and family. Two or three years after the course, when asked again, 15.31% of those who answered still practised daily, 11.22% practised 3-4 times a week, 23.47% practised as and when possible and 42.86% did so as needed; 7.14% had not continued practising.

CONCLUSION

Training in mindful compassion benefits patients and carers. In both the short and long terms, mindful compassion was found to reduce anxiety, aid sleep, improve pain management and help people feel more empowered, calm and relaxed. It also helped people cope with stressful situations, gave them time for themselves and enabled them to become much more focused.

No effect of mindfulness-based cancer recovery on cardiovascular or cortisol reactivity in female cancer survivors

Psychosocial stress in cancer survivors may contribute to compromised quality of life and negative cancer outcomes, which can be exacerbated by poor coping skills and emotional reactivity. Mindfulness based interventions (MBIs) have shown effectiveness in reducing stress, improving quality of life and coping skills in cancer survivors. We tested whether an MBI would also improve reactivity to an acute laboratory stress task. A total of 77 women with a cancer diagnosis were recruited for a waitlist-controlled trial of Mindfulness-Based Cancer Recovery (MBCR). Participants completed a laboratory-based psychosocial stress paradigm (the Trier Social Stress Test-TSST) pre- and post-intervention, throughout which cortisol and cardiovascular profiles were measured. Neither cortisol nor cardiovascular reactivity to the TSST was changed pre-to post intervention, either between or within groups. Blunted cortisol, but not cardiovascular, reactivity was observed across both groups, which may have contributed to the lack of intervention effect. Previous research suggests that diurnal cortisol is blunted following cancer treatment; the current findings suggest this blunting may also occur during exposure to acute stress.