Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients

[Complementary and integrative medicine in cancer-related fatigue]

The majority of cancer patients experience fatigue during the course of their illness. Fatigue should not be seen as an inevitable consequence of cancer and its treatment. Cancer-related fatigue (CRF) is a multidimensional symptom complex that is influenced by a variety of factors. Complementary medicine approaches offer potentially promising strategies to address this fatigue and can therefore be a valuable addition to conventional therapies.In this narrative review, complementary medicine treatment approaches for tumor-associated fatigue are presented according to the historical development and current scientific evidence. The focus is on methods with the highest current evidence based on the recommendations of national and international guidelines. Therapeutic approaches from mind-body medicine, such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), yoga, tai chi, and qigong, as well as acupuncture, acupressure, moxibustion, and phytotherapeutic treatment approaches are presented.In Germany, the complementary therapies listed here are not generally covered by health insurances. However, a few clinics have developed comprehensive programs in mind-body medicine, for which cost coverage has already been obtained. As a result, complementary medical treatments for cancer-related fatigue that adhere to national and international guidelines are typically available only as private services or within the framework of study participation.

Perceived Stress, but Not Rumination, Mediates the Relationship Between Trait Mindfulness and Sleep Quality in Young Adults

Objective

Poor sleep among young adults is prevalent, yet the mediating variables are largely understudied, and there is limited relevant work utilizing objective sleep measures. The present study investigated the mediating effects of perceived stress and rumination in the relationship between trait mindfulness and subjective and objective sleep quality in young adults.

Methods

A total of 170 healthy adults (aged 18-37, M = 20.8, SD = 2.9) self-reported on trait mindfulness, perceived stress, and rumination. The primary (N = 140) and secondary (N = 30) samples both completed the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality. The secondary sample (N = 30) additionally provided sleep diaries, as well as wrist-worn actigraphy data for assessing objective sleep quality. A mediation analysis was conducted to assess the effect of trait mindfulness on sleep quality with perceived stress and rumination as mediators.

Results

Trait mindfulness was positively associated with better subjective sleep quality; this was fully mediated by perceived stress, b = -0.08, 95% CI [-.12, -0.06]. Rumination was negatively associated with subjective sleep quality but did not mediate the relationship between trait mindfulness and sleep quality, b = -0.01, 95% CI [-.03, 0.02]. Only trait mindfulness was correlated with diary-based sleep ratings, and none of the measures were associated with actigraphy-based sleep quality.

Conclusion

This study indicates that perceived stress is an important mediator in the relationship between trait mindfulness and subjective sleep quality among young adults, rather than rumination. These findings have implications for mindfulness-based therapeutic approaches to address the high prevalence of sleep disorders among young adults, adding mechanistic detail to the literature.

Mindfulness Is Associated with Lower Depression, Anxiety, and Post-Traumatic Stress Disorder Symptoms and Higher Quality of Life in Patients with an Implantable Cardioverter-Defibrillator-A Cross-Sectional Study

Several studies suggested the efficacy of dispositional mindfulness and mindfulness-based interventions in reducing anxiety and depression in cardiovascular diseases. However, data on the impact of mindfulness on the psychological well-being of patients with an implantable cardioverter-defibrillator (ICD) are scarce. In this study, 422 patients with an ICD were prospectively recruited. Logistic regression was applied to determine associations between dispositional mindfulness (Freiburg Mindfulness Inventory), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), adjusting for age, sex, educational status, number of ICD shocks after ICD implantation, and physical activity. The PROCESS regression path analysis modelling tool was used to identify indirect mediating effects of dispositional mindfulness on depression, anxiety, and PTSD symptoms and quality of life (QoL; EuroQol group 5-dimension questionnaire). Participants presented high baseline QoL (mean 1.06 to 1.72) and medium-high mindfulness scores (mean 40.85 points). Higher mindfulness scores were associated with lower levels of anxiety (OR 0.90, 95% CI 0.86 to 0.95, 0.001), depression (OR 0.93, 95% CI 0.88 to 0.98, p = 0.006), and PTSD symptoms (OR 0.94, 95% CI 0.89 to 0.98, p = 0.011). Furthermore, greater mindfulness partially mediated the relationship between anxiety (indirect effect 0.10, 95% CI 0.02 to 0.21), depression (indirect effect 0.08, 95% CI 0.01 to 0.17), or PTSD (indirect effect 0.04, 95% CI 0.01 to 0.17) as independent variables and the QoL as the dependent variable. This study suggests that greater dispositional mindfulness is associated with less anxiety, depression, and PTSD symptoms. Mindfulness might also increase the QoL in ICD patients by mitigating the impact of those with psychological distress.

Radiotherapy-induced fatigue in Palestinian breast cancer survivors

Background

No study has investigated the cancer-related fatigue (CRF) among Palestinian breast cancer survivors. Our purpose is to assess, compare, and correlate CRF in breast cancer survivors undergoing radiotherapy (RT) with study variables.

Methods

CRF in breast cancer survivors was assessed using Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-F) (version 4). The sample consisted of 148 breast cancer survivors undergoing RT. Data was collected between 1 May 2021 and 1 September 2021. The means and standard deviations of the questionnaire using one-way ANOVA, and Pearson correlation coefficient were reported.

Results

Respondents ages ranged from 20 to >65 years old and was divided into four groups: (20-35, 36-50, 51-65, and >65 years, respectively). The total fatigue mean was 2.88 and the SD was 0.84, indicating an intermediate fatigue level among breast cancer survivors. Study survivors with higher education were more likely to be fatigued (F =7.68, P-value =0.001). Divorced survivors were more prone to fatigue compared to married survivors (F =5.83, P-value= 0.001). Finally, survivors who do not have children were more vulnerable to exhaustion compared to those with children (F =7.35, P-value =0.001). Also, younger survivors were more prone to fatigue, compared to older survivors (F =5.29, P-value = 0.002). Results also showed a positive relationship between each of the variables; the number of children (R =0.221, P-value =0.007), age (R =0.311, P-value =0.000), and duration of treatment (R =0.290, P-value =0.000), which means that the greater the number of children, the younger the age, or the longer the duration of treatment, the more fatigue is reported in breast cancer survivors.

Conclusions

Fatigue is frequently observed in breast cancer survivors undergoing RT. It can limit RT treatment continuity. Therefore, early detection of fatigue can help survivors adhere to RT treatment and achieve better clinical results.

Comprehensive Review of Breast Cancer Consequences for the Patients and Their Coping Strategies: A Systematic Review

BACKGROUND

Women with breast cancer usually face multiple short-term and long-term problems in dealing with their acute and chronic symptoms during and after cancer treatment. However, serious gaps remain in addressing these issues in clinical and public health practice.

METHODS

According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature search from 2000-2021 in electronic databases, including Medline, PubMed, Embase, Scopus, Web of Knowledge, and Google Scholar databases using predefined keywords.

RESULTS

The review identified several significant and interconnected problems in breast cancer patient's treatment and supportive care. The results revealed that these issues are very common among breast cancer patients, and specific attention and serious measures are needed to address these problems. Despite implementing different protocols and programs for covering and addressing these problems, serious gaps still exist in supporting breast cancer patients during clinical and follow-up care.

CONCLUSION

Developing innovative and holistic approaches and programs based on the multifactorial assessment of symptoms are suggested for addressing and covering the multidimensional requirements of this population. Consequently, thorough evaluation, education, treatment, and referrals should be provided for the most common sequelae of these patients by including appropriate medication, exercise, counselling, occupational therapy, and complementary therapies. The present study provides a more comprehensive source of information about breast cancer patient's medical and supportive needs in comparison with individual studies on symptom experiences.

Effectiveness and cost-effectiveness of an integrated digital psychological intervention (EmoEase) in Chinese chronic obstructive pulmonary disease patients: Study protocol of a randomized controlled trial

Background

Mental health problems in patients with chronic obstructive pulmonary disease (COPD) are common and frequently neglected. Digital psychological interventions may reduce mental health problems, but their effectiveness has not been evaluated in the Chinese COPD population. In this study, we will develop an integrated digital psychological intervention (EmoEase) and evaluate its effectiveness and cost-effectiveness in enhancing the mental wellbeing of patients with COPD in China.

Methods

This study is a multicenter, two-arm, randomized controlled trial (RCT) with a parallel-group design to enroll at least 420 patients with COPD with age over 35 years. Participants will be assigned to receive either usual care (control group) or usual care + EmoEase (intervention group). Assessments will take place at baseline (T0) and 4 weeks (T1), 8 weeks (T2), and 16 weeks (T3) after baseline, and participants will be asked to complete questionnaires and physical measurements. The primary outcome measure will assess mental wellbeing using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Secondary outcome measures will assess mental health, physical health, COPD symptoms, health risk behaviors, socioeconomic indicators, and healthcare utilization and expenditure. Analyses will utilize an intention-to-treat approach.

Discussion

This is the first RCT to examine the value of EmoEase, a novel digital psychological intervention for patients with COPD. If this intervention is effective and cost-effective, it could be rapidly scaled up to provide mental healthcare for patients with COPD in China.

Trial registration

ClinicalTrials.gov Identifier: NCT06026709. Date of first submission: 30 August 2023. https://clinicaltrials.gov/study/NCT06026709.

Palliative Care and Care Partner Support in Neuro-oncology

ABSTRACT

The journey for a patient with a brain tumor and their loved ones can be extremely challenging due to the high burden of physical symptoms and the emotional distress caused by the diagnosis. Optimizing quality of life by addressing symptoms and reducing this emotional distress can improve treatment tolerance and outcomes and alleviate care partner distress and burden. Symptoms in patients with central nervous system (CNS) tumors can vary in onset and intensity, ranging from headaches, seizures, and focal weakness to emotional distress and cognitive dysfunction. Additionally, care partners may demonstrate distress due to the high burden of care and need appropriate support structures and access to resources to alleviate this stress. Evidence-based recommendations are unfortunately limited given the lack of high-quality research in this area, but patients living with CNS tumors and their loved ones can benefit from early and routine symptom identification and management, compassionate and transparent communication, and practical guidance for the future. These principles are part of palliative care, a field of medicine focused on alleviating suffering in patients with serious, chronic illness. Clinicians involved in the care of patients with CNS tumors must be educated in these important primary palliative care principles. This article focuses on key symptom management, strategies for high-quality communication, a discussion of advance care planning, and an overview of end-of-life care.

A coping model for school psychological counsellors: A qualitative study

This study analyzed the coping processes of psychological counsellors working in high schools in Turkey in the face of the challenges experienced in counselling sessions. The study used a qualitative research design: grounded theory. Semistructured interviews conducted with 33 high school counsellors were analyzed following Strauss and Corbin's analysis guidelines to create a coping model. The core category in the model was 'coping' while 'actions/reactions' explained what counsellors do to cope. Finally, 'environmental factors' and 'personal factors' influenced their coping processes. The findings are discussed in light of the existing literature to provide suggestions for school counsellors to develop self-care/coping strategies, increase their resilience and decrease their burnout.

Determinants of Cancer-Related Fatigue among Cancer Patients: A Systematic Review

Objectives: This systematic review aims to assess and explore various determinants of cancer- related fatigue. Methods: A systematic search of various determinants of Cancer-related fatigue (CRF) was performed in different databases like PubMed, Google Scholar, Science Direct and Clinical Key dating from 1990 to September 2020. Results: A total of 6115 studies were screened and 95 articles related to determinants of fatigue were retained. Various modifiable and non-modifiable determinants including socio-demographic, clinical, treatment related, plasma biomarker related, genetic, behavioural, concurrent symptoms related and psychological determinants were identified. Depression was one of the significant factors reported in 28% of studies, followed by pain, (17%), performance status (16%), chemotherapy and anxiety (15%). Conclusion: It is recommended that nurses and clinicians should anticipate, identify and take appropriate interventions to manage those modifiable factors. Ultimately, managing the modifiable factors helps in the comprehensive care of cancer patients.

Effects of mindfulness-based interventions on fatigue and psychological wellbeing in women with cancer: A systematic review and meta-analysis of randomised control trials

BACKGROUND

Cancer diagnosis and treatment can cause fatigue, stress and anxiety which can have a detrimental effect on patients, families and the wider community. Mindfulness-based interventions appear to have positive effects on managing these cancer-related symptoms.

OBJECTIVE

To investigate the efficacy of mindfulness on cancer related fatigue (CRF) and psychological well-being in female cancer patients.

METHODS

Five databases (CINHAL, Ovid Medline, Ovid Psych Info, Scopus, and Cochrane), and two trial registers (WHO and Clinicaltrials.gov) were searched for randomised control trials from inception to April 2021 and updated in August 2022. Meta-analysis was performed using Review Manager 5.4. The standardised mean difference (SMD) and 95% confidence intervals (CI) were used to determine the intervention effect. Subgroup analysis was performed for adaptation to types of mindfulness, length of intervention and types of comparator used.

RESULTS

Twenty-one studies with a total of 2326 participants were identified. Mindfulness significantly improved CRF (SMD -0.81, 95% CI -1.17 to -0.44), depression (SMD-0.74, 95% CI -1.08 to -0.39) and anxiety (SMD -0.92, 95% CI -1.50 to -0.33). No effect was observed for quality of life (SMD 0.32, 95% CI -0.13-0.87) and sleep (SMD -0.65, 95% CI -1.34-0.04). Subgroup analysis revealed that there was little difference in SMD for adapted type of mindfulness (p = 0.42), wait list control compared to active comparator (p = 0.05) or length of intervention (p = 0.29).

CONCLUSION

Mindfulness appears to be effective in reducing CRF and other cancer related symptoms in women. Adaptations to mindfulness delivery did not have negative impact on results which may aid delivery in the clinical settings.

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.

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.

What Next After MBSR/MBCT? An Open Trial of an 8-Week Follow-on Program Exploring Mindfulness of Feeling Tone (vedanā)

Objectives

The effectiveness of mindfulness-based programs (MBPs) has been established in many randomized controlled trials. However, effect sizes are often modest, and there remains ample scope to improve their effectiveness. One approach to this challenge is to offer a “follow-on” course to people who have completed an MBP and are interested in further skill development. We developed and tested a new 8-week course for this purpose based on awareness of feeling tone (vedanā), an understudied aspect of mindfulness in many current MBPs, incorporating new developments in neuroscience and trauma sensitivity. We examined its effectiveness and the frequency and severity of unpleasant experience and harm.

Methods

In an open trial, 83 participants, 78 of whom had previously taken part in an MBP (majority MBSR or MBCT), completed the program in nine groups. Participants completed questionnaires before and after and gave qualitative written feedback at completion.

Results

Participants reported significantly reduced depression (d = 0.56), stress (d = 0.36), and anxiety (d = 0.53) and increased well-being (d = 0.54) and mindfulness (d = 0.65) with 38% meeting criteria for reliable change on anxiety and depression. As expected, about three-quarters of participants reported some unpleasant experiences associated with mindfulness practice during the course, but none reported harm. Five participants showed “reliable deterioration” (an increase) in either depression or anxiety, but four of these five also gave anonymous qualitative feedback describing benefits of the course.

Conclusions

Findings support the added value of a follow-on course based on the exploration of feeling tone for participants who have a range of previous mindfulness experience.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-01929-0.

Efficacy of New Mindfulness-Based Swinging Technique Intervention: A Pilot Randomised Controlled Trial Among Women With Breast Cancer

Objective

Combining 3rd-wave-therapies with Cognitive-Behavioural-Therapy (CBT) has increased in recent years. Usually these therapies require longer sessions which therefore increases the psychotherapy drop-out rate for cancer patients for multiple medical reasons. This inspired intervention of a shorter 20 min-long mindfulness-therapy (MBST) to be developed for Breast-Cancer-patients (BC).

Method

This pilot randomised controlled trial was to assess the immediate-outcome of the MBST-intervention for its efficacy for BC-patients by using the Pearson Chi-square test, Fisher-Freeman-Halton exact test, and McNemar test for categorical variables; Mann-Whitney U and Wilcoxon test for the continuous variables. The Emotion Thermometer, State Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Self-Efficacy for Managing Chronic Disease, and Beck's Hopelessness Scale were used for measuring the intervention outcomes. One hundred seventy-three BC patients were randomly assigned in two-groups (equal-mean-age, p = 0.417). Control-Group (CG, n = 82) received cognitive-disputation-technique a form-of-CBT, and Intervention-Group (IG, n = 74) received MBST. The directives are given to IG: psychoeducation about Mindfulness, and to imagine themselves swinging-in a peaceful environment. When the patients imagine their swing going up, they physically take a deep-breath, and when going down they physically release their breath, and this process is repeated.

Result

Outcomes post-treatment showed significant higher-improvement in IG in all the assessed-measurements, with large-effect-size: anxiety (p < 0,05, r = 0,67) and depression-levels (p < 0,05, r = 0,71); anxiety-trait (p < 0,05; r = 0,79) reduced, it increases self-efficacy for managing-disease (p < 0,05, r = 0,82) as-well-as hopefulness (p < 0,05, r = 0,61) and saturation-level measured by pulse-meter/oximeter (p < 0,05, r = 0,51).

Conclusion

MBST is an efficacious intervention to reduce psychotherapy session time for immediate relief from clinical anxiety and hopelessness as well as increase self-efficacy and improve tranquillity for BC-women. It may have a particular clinical significance for supporting patient's adherence to treatment. Although in this pilot sample MBST was found to be effective for short-term-outcome, its efficacy for longer-term-outcome should be examined in future trials. Additionally, breathing laps can be increased possibly for a greater result on rise of saturation levels of patients.

Can the Standard Configuration of a Cardiac Monitor Lead to Medical Errors under a Stress Induction?

The essential factor that enables medical patient monitoring is the vital signs monitor, whereas the key in communication with the monitor is the user interface. The way the data display on the monitors is standard, and it is often not changed; however, vital signs monitors are now configurable. Not all the data have to be displayed concurrently; not all data are necessary at a given moment. There arises a question: is the standard monitor configuration sufficient, or can it lead to mistakes related to delays in perceiving parameter changes? Some researchers argue that mistakes in life-saving activities is not mainly due to medical mistakes but due to poorly designed patient life monitor interfaces, among other reasons. In addition, it should be emphasized that the activity that saves the patient’s life is accompanied by stress, which is often caused by the chaos occurring in the hospital emergency department. This raises the following question: is the standard user interface, which they are used to, still effective under stress conditions? Therefore, our primary consideration is the measure of reaction speed of medical staff, which means the perception of the changes of vital signs on the patient’s monitor, for stress and stressless situations. The paper attempts to test the thesis of the importance of the medical interface and its relation to medical mistakes, extending it with knowledge about the difference in speed of making decisions by the medical staff with regard to the stress stimulus.

Insomnia as an Unmet Need in Chronic Hematologic Cancer Patients: A study design of a randomized controlled trial evaluating a consumer-based meditation app for treatment of sleep disturbance (Preprint)

Background

To address the need for long-term, accessible, nonpharmacologic interventions targeting sleep in patients with chronic hematological cancer, we propose the first randomized controlled trial to determine the effects of a consumer-based mobile meditation app, Calm, on sleep disturbance in this population.

Objective

This study aims to test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group in improving the primary outcome of self-reported sleep disturbance, as well as secondary sleep outcomes, including sleep impairment and sleep efficiency; test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group on inflammatory markers, fatigue, and emotional distress; and explore free-living use during a 12-week follow-up period and the sustained effects of Calm in patients with chronic hematological cancer.

Methods

In a double-blinded randomized controlled trial, we will recruit 276 patients with chronic hematological cancer to an 8-week app-based wellness intervention—the active, daily, app-based meditation intervention or the health education podcast app control group, followed by a 12-week follow-up period. Participants will be asked to use their assigned app for at least 10 minutes per day during the 8-week intervention period; complete web-based surveys assessing self-reported sleep disturbance, fatigue, and emotional distress at baseline, 8 weeks, and 20 weeks; complete sleep diaries and wear an actigraphy device during the 8-week intervention period and at 20 weeks; and complete blood draws to assess inflammatory markers (tumor necrosis factor-α, interleukin-6, interleukin-8, and C-reactive protein) at baseline, 8 weeks, and 20 weeks.

Results

This project was funded by the National Institutes of Health National Cancer Institute (R01CA262041). The projects began in April 2022, and study recruitment is scheduled to begin in October 2022, with a total project duration of 5 years. We anticipate that we will be able to achieve our enrollment goal of 276 patients with chronic hematological cancers within the allotted project time frame.

Conclusions

This research will contribute to broader public health efforts by providing researchers and clinicians with an evidence-based commercial product to improve sleep in the long term in an underserved and understudied cancer population with a high incidence of sleep disturbance.

Trial Registration

ClinicalTrials.gov NCT05294991; https://clinicaltrials.gov/ct2/show/NCT05294991

International Registered Report Identifier (IRRID)

PRR1-10.2196/39007

Did Mindful People Do Better during the COVID-19 Pandemic? Mindfulness Is Associated with Well-Being and Compliance with Prophylactic Measures

This paper investigates the relationship between mindfulness and well-being within the context of compliance with prophylactic measures in the time of COVID-19. We conducted a large-scale survey among a representative sample of the French population. We measured mindfulness, using the Mindful Attention Awareness Scale, and the extent to which respondents were impacted by COVID-19 in terms of their mood and quality of sleep, as well as how they complied with prophylactic measures. Our results suggest that more mindful individuals were less negatively impacted by COVID-19 with regard to their sleep and mood. Concerning the prophylactic measures, we obtained mixed results: more mindful participants were more likely to respect lockdowns, physical distancing and to cough in their sleeves, but did not wash their hands, wear masks or avoid touching their face more often than less mindful individuals.

Mindfulness-based strengths practice improves well-being and retention in undergraduates: a preliminary randomized controlled trial

ObjectiveWith high rates of mental health concerns on college campuses, effective positive psychology interventions could greatly improve student well-being and academic outcomes. Participants: Working undergraduates (N = 52). Methods: This preliminary, randomized controlled trial investigated the effects of the 8-week Mindfulness-based strengths practice (MBSP) on Seligman's five domains of well-being, as measured by the PERMA-Profiler, Workplace PERMA-Profiler, and student retention in working undergraduates. Results: Students in the MBSP intervention had significantly higher well-being, engagement, meaning, and health following the MBSP program (P < 0.0042). No such changes were observed in the control group. Students in the intervention group also had modestly higher retention rates in the following academic year than those in the control group. Conclusions: This study provides the first evidence to date that an MBSP program can improve college student well-being and retention.

Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study

OBJECTIVE

Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment.

METHOD

In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care.

RESULTS

On the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies.

CONCLUSIONS

Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being.

Mindfulness as a Protective Factor Against Depression, Anxiety and Psychological Distress During the COVID-19 Pandemic: Emotion Regulation and Insomnia Symptoms as Mediators

Objectives

Research has linked mindfulness to improved mental health, yet the mechanisms underlying this relationship are not well understood. This study explored the mediating role of emotion regulation strategies and sleep in the relationship between mindfulness and symptoms of depression, anxiety and psychological distress during the COVID-19 pandemic.

Methods

As detailed in this study’s pre-registration (osf.io/k9qtw), a cross-sectional research design was used to investigate the impact of mindfulness on mental health and the mediating role of emotion regulation strategies (i.e., cognitive reappraisal, rumination and suppression) and insomnia. A total of 493 participants from the general population answered an online survey and were included in the final analysis. The online survey consisted of the short form of the Five-Facets Mindfulness Questionnaire (FFMQ-SF), the Impact of Event Scale-revised (IES-R), the Generalised Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-8), the Emotion Regulation Questionnaire (ERQ), the short form of the Rumination Response Scale (RSS-SF), and the Insomnia Severity Index (ISI).

Results

Structural equation modelling revealed that mindfulness was related to lower symptoms of depression, anxiety and psychological distress, both directly and indirectly. Mindfulness was negatively associated with rumination and insomnia. As hypothesised, models revealed that the associations between mindfulness and depression, anxiety and psychological distress were significantly mediated by its negative associations with rumination and insomnia. Our findings also demonstrated that rumination was related to increased insomnia symptoms, which in turn was associated with increased mental health problems, indicating a mediated mediation. Mindfulness was also positively associated with cognitive reappraisal and negatively associated with suppression, which were, respectively, negatively and positively associated with depressive symptoms, and thus functioned as specific mediators of the association between mindfulness and depression.

Conclusion

Our findings suggest that rumination and insomnia operate transdiagnostically as interrelated mediators of the effects of mindfulness on mental health, whereas cognitive reappraisal and suppression function as specific mediators for depression. These insights emphasise the importance of targeting emotion regulation and sleep in mindfulness interventions for improving mental health. Limitations and implications for practice are discussed.

Randomized Waitlist-Control Trial of a Web-Based Stress-Management and Resiliency Program for Adolescent and Young Adult Cancer Survivors: Protocol for the Bounce Back Study

Background

The emotional health of adolescent and young adult (AYA) cancer survivors is compromised both during and after cancer treatment. Targeted programs designed to support AYAs’ ability to cope with stress in the years following treatment completion are lacking. Mind-body programs may ameliorate the negative psychological and emotional effects of stress and assist AYAs with managing the psychosocial challenges of early survivorship.

Objective

Our randomized waitlist-control trial aims to assess the feasibility, acceptability, and preliminary efficacy of a virtual group program (Bounce Back) to promote stress management and resiliency among posttreatment AYAs.

Methods

Bounce Back is a stress management and resiliency program delivered via videoconference by a trained mental health clinician. Sessions were adapted from an evidence-based mind-body program (Stress Management and Resiliency Training - Relaxation Response Resiliency Program [SMART-3RP]) grounded in relaxation response elicitation, mindfulness, cognitive behavioral therapy, and positive psychology. Seventy-two AYAs (diagnosed with cancer between ages 14 years and 29 years and had completed cancer treatment within the last 5 years) were randomly assigned to the Bounce Back program or waitlist-control group and completed assessments at baseline, 3 months postbaseline, and 6 months postbaseline. The primary aim of the study is to determine the feasibility and acceptability of the Bounce Back program. Descriptive statistics, including means, frequencies, and ranges supplemented by qualitative exit interview feedback will be used to characterize the sample and to summarize feasibility and acceptability. The exploratory aims are to evaluate the preliminary effects of the program on stress coping and psychosocial outcome measures (ie, anxiety, depression) collected across the 3 time points.

Results

This study was funded by the National Cancer Institute in July 2017. Study procedures were approved by the Dana-Farber Harvard Cancer Center Institutional Review Board in October 2018 (Protocol 18-428). The randomized trial was conducted from July 2019 to March 2021. Quantitative data collection is complete, and qualitative exit interview data collection is ongoing. Results are expected to be published in peer-reviewed journals and presented at local, national, or international meetings in the coming years.

Conclusions

Few evidence-based programs exist that tackle the key transitional issues faced by AYA cancer survivors. Future analyses will help us determine the feasibility and acceptability of the Bounce Back program and its impact on AYA stress coping and psychological well-being.

Trial Registration

ClinicalTrials.gov NCT03768336; https://clinicaltrials.gov/ct2/show/NCT03768336

International Registered Report Identifier (IRRID)

DERR1-10.2196/34033

Feasibility and Possible Effects of Mindful Walking and Moderate Walking in Breast Cancer Survivors: A Randomized Controlled Pilot Study With a Nested Qualitative Study Part

INTRODUCTION

Breast cancer (BC) survivors often suffer from disease- and therapy-related long-term side-effects. The study aim was to explore the feasibility, adherence, and individual experiences as well as possible effects of 2 different walking interventions in BC patients.

METHODS

This randomized controlled, pragmatic pilot trial included a qualitative study component. BC patients were randomized to either mindful walking (MFW) with mindfulness exercises and walking or moderate walking (MW) alone in weekly group sessions over 8 weeks. After 8 and 16 weeks, satisfaction, and self-perceived effectiveness as well as different health-related outcomes including health-related (WHOQOL-BREF) and disease-specific quality of life (FACT-G), perceived stress (PSQ) and cancer-related fatigue (CFS-D) were assessed. ANCOVA was used to evaluate differences in study outcomes. Qualitative data included 4 focus group interviews including 20 patients and were analyzed using a directed qualitative content analysis approach.

RESULTS

Altogether, 51 women (mean age 55.8 years (SD 10.9)) were randomized (n = 24 MFW; n = 27 MW). Both groups would recommend the course to other BC patients (MFW 88.9%; MW 95.2%) and showed possible improvements from baseline to week 8, without statistically significant difference between groups: WHOQOL-BREF (MFW: adjusted mean 65.4 (95% confidence interval (CI), 57.1-73.7); MW: 61.6 (53.6-69.6)); FACT-G (MFW: 76.0 (71.5-80.5); MW: 73.0 (68.5-77.4)); PSQ (MFW: 45.3 (40.5-50.1); MW: 45.4 (40.8-50.0)); CFS-D (MFW: 24.3 (20.8-27.8); MW: 25.5 (22.1-28.8)). Improvements lasted until the 16-weeks follow-up. The qualitative analysis suggested that MFW primarily promoted mindfulness, self-care, and acceptability in BC patients, whereas MW activated and empowered the patients as a result of the physical exercise.

CONCLUSION

Both study interventions were positively evaluated by patients and showed possible pre-post effects in disease-specific health-related outcomes without differences between groups. The qualitative analysis results indicate that different resources and coping strategies were addressed by the 2 study interventions.

TRIAL REGISTRATION

DKRS00011521; prospectively registered 21.12.2016; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011521.

The effect of a single session of 30-min mindful breathing in reducing fatigue among patients with haematological cancer - a randomised controlled trial

BACKGROUND

Patients with haematological cancer had considerable symptom burden, in which fatigue was the most prevalent. Almost 70% of haematological cancer patients reported fatigue.

METHODS

We conducted a parallel-group, non-blinded, randomised control trial at the haemato-oncology unit of University Malaya Medical Centre, from 1st October 2019 to 31st May 2020. Patients included were ≥ 18 years, had histopathological diagnosis of haematological cancer, and fatigue score of ≥4 based on the fatigue subscale of Edmonton Symptom Assessment System (ESAS). Patients allocated to the intervention group received standard care plus a guided 30-min mindful breathing session, while those in control group received standard care. The study outcomes include fatigue severity according to the fatigue subscale of ESAS, visual analogue scale of 0 - 10, and Functional Assessment of Chronic Illness Therapy Fatigue Scale Version 4, at minute 0 and minute 30.

RESULTS

Of 197 patients screened, 80 were eligible and they were equally randomised into 30-min mindful breathing versus standard care. Lymphoma (58.9%) was the commonest haematological malignancy, followed by multiple myeloma (13.8%), acute leukaemia (11.3%), myeloproliferative neoplasm (6.3%), chronic leukaemia (5.0%) and myelodysplastic syndrome (5.0%). There was no difference in the demographic and clinical characteristics between the 2 groups. At minute 0, both arms of patients had similar ESAS-fatigue score (median, 5) and FACIT-fatigue score (mean ± SD, 24.7 ± 10.6 for intervention group versus 24.7 ± 9.7 for control group). At minute 30, intervention group had lower ESAS-fatigue score (median, 3 versus 5) and FACIT-fatigue score (mean ± SD, 17.1 ± 10.5 versus 24.8 ± 11.3) compared to control group. Both the ESAS-fatigue score reduction (median, - 2 versus 0, p = 0.002) and FACIT-fatigue score reduction (mean ± SD, - 6.7 versus + 0.8; p < 0.001) for the intervention group were statistically significant. The calculated effect size Cohen's d was 1.4 for between-group comparison of differences in total FACIT-fatigue score.

CONCLUSIONS

Our results provide evidence that a single session of 30-min mindful breathing was effective in reducing fatigue in haematological cancer patients. On top of all the currently available methods, 30-min mindful breathing can prove a valuable addition.

TRIAL REGISTRATION

NCT05029024 , date of registration 15th August 2021. (Retrospectively registered).

The effect of interpersonal psychotherapy on quality of life among breast cancer patients with common mental health disorder: a randomized control trial at Tikur Anbessa Specialized Hospital

PURPOSE

To determine the effect of interpersonal psychotherapy on anxiety, depression, and quality of life among breast cancer patients with mental health disorders at Tikur Anbessa Specialized Hospital, Ethiopia.

METHODS

A two-arm parallel randomized controlled trial study was conducted among 114 (n = 57 intervention, and n = 57 control group) breast cancer patients with common mental health disorder at the oncology center of Tikur Anbessa Specialized Hospital. The hospital anxiety and depression measurement scale was used to assess depression and anxiety disorder and a 30-item quality of life questionnaire was used to assess the quality of life. General linear model analysis was done, confounding factors were controlled, and p < 0.05 was used to declare statistical significance.

RESULTS

Patients in the intervention group showed a significant improvement in the anxiety (coefficient - 3.68; 95% CI - 5.67, - 1.69; p < 0.001), depression (coefficient - 3.22; 95% CI - 4.7, - 1.69; p < 0.001), physical functioning (coefficient 10.55; 95% CI 3.13, 17.98; p = 0.006), health-related quality of life (coefficient 21.85; 95% CI 14.1, 29.59; p < 0.001), insomnia (coefficient - 19.56; 95% CI - 31.87, - 7.25; p = 0.002), and fatigue (coefficient - 11.37; 95% CI - 21.49, - 1.24; p = 0.028) respectively.

CONCLUSIONS

The adapted Ethiopian version of interpersonal psychotherapy had improved anxiety, depression, and some domains of health-related quality of life. Hence, health programmers should consider incorporating it as a treatment option in oncology centers.

TRIAL REGISTRATION NUMBER

PACTR202011629348967 granted on 20 November 2020 which was retrospectively registered.

A Qualitative Investigation of the Psychological Experiences of COVID-19 Patients Receiving Inpatient Care in Isolation

Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. Still, little is known about the psychological experiences of patients who received inpatient isolation treatment in order to improve the well-being of these patients. We randomly recruited 10 COVID-19 patients who received inpatient isolation treatment at a designated hospital in Wuhan from February to March 2020 and were discharged after recovery. The data were collected via a semi-structured interview over WeChat video and analyzed them using Calaizzi's descriptive phenomenological method. COVID-19 patients experienced significant psychological stress during hospitalization that continued after recovery and discharge. This can be categorized into three themes: (1) negative emotions experienced; (2) uncertainty of treatment provided; and (3) worries about readjusting to daily life. The insight into a patient's psychological experiences can support the timely implementation of personalized nursing interventions within hospitals and the community to improve the patient's mental well-being and recovery trajectory.

Consider the Source: Examining Attrition Rates, Response Rates, and Preliminary Effects of eHealth Mindfulness Messages and Delivery Framing in a Randomized Trial with Young Adult Cancer Survivors

Purpose: Young adults with cancer often experience stress, depression, and anxiety. Mindfulness meditation is an effective intervention for these outcomes, and maintenance support may be needed for long-term improvements. eHealth technologies provide a promising delivery strategy for maintenance interventions. Methods: Following an 8-week mindfulness-based stress reduction (MBSR) course, 62 young adult cancer survivors were randomized to 8 weeks of instructor-framed messages, peer-framed messages, or no messages. On average, participants were 33.6 years old. The majority of participants were college-educated Caucasian females. We examined attrition rates between participants who received messages and those who did not, and compared response rates from different perceived sources. In addition, we evaluated the preliminary effects of eHealth support on mindfulness and associated outcomes. Results: No significant differences in attrition or message response rates across groups were observed. Repeated measures models revealed significant group by time interactions on perceived stress, anxiety, and depression. There were no differences between the groups that received eHealth messages and the group that did not. There was a significant difference in anxiety symptoms from post-MBSR to post-messaging between messaging groups. Individuals who received instructor-framed messages reported increased symptoms of anxiety over time. Conclusion: Attrition and response rates did not differ across groups, suggesting that eHealth may be a feasible strategy for providing maintenance support. However, further evaluation of feasibility, acceptability, and optimal content and dose of such an intervention is needed. Additionally, young adult cancer survivors may be more likely to benefit from eHealth interventions that are not delivered by authority figures.

Improvements in Health Might Contradict Adherence to Mobile Health Interventions: Findings from a Self-Care Cancer App Study

Background: Cancer patients often suffer from high levels of distress. Mobile health (mHealth) applications might be an innovative way to deliver mindfulness and relaxation interventions for cancer patients. However, data about the implementation of apps in health care are lacking. Adherence to mHealth interventions is an important indicator for a successful implementation and might be needed to maximize treatment effects. However, the decrease in distress might reduce the motivation of patients to engage in such self-care tools in the long run. Therefore, the aim of this analysis was to investigate the association between the course of distress over time and the adherence to a relaxation self-care app in cancer patients. Methods: We developed an app for cancer patients (CanRelax) and 83 patients who participated in the prospective observational study used the app at least once. The evaluation was guided by the RE-AIM framework, and this analysis focused on the implementation of the app. Patients were grouped into five subgroups according to their course of distress over 10 weeks (Distress Thermometer). These subgroups of patients were compared with each other to identify different user groups. Findings: About half of the patients were adherent over 10 weeks. However, a decrease in distress was associated with lower adherence to the app intervention, whereas patients with moderate distress or an increase in distress showed more adherence. Conclusion: Adherence to an app intervention might be also driven by patients' distress level. A decrease in distress might reduce patients' motivation to continue with a self-care intervention. The interplay between adherence and treatment outcomes should be explored in upcoming mHealth trials to get a better understanding for the implementation of such interventions. Encouraging patients to continue self-care interventions is a major challenge in integrative medicine if they are delivered digitally. The Clinical Trial Registration number: DRKS00010481.

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 Effectiveness of Mindfulness-Based-Stress-Reduction for Military Cadets on Perceived Stress

This study aimed to develop a program of mindfulness-based stress reduction for military cadets (MBSR-MC). On the basis of a pretest-posttest design, participants were assigned to either a control or an experimental group to examine the effectiveness of MBSR-MC. First, 60 volunteering cadets of National Defense University were randomly assigned to the MBSR-MC group (n = 30) and the control group (n = 30). In the pretest, all participants were required to complete the Taiwanese version of the Five Facet Mindfulness Questionnaire (T-FFMQ) and a perceived stress scale (PSS). Subsequently, the MBSR-MC group participated in the 8-week MBSR-MC program, whereas the control group did not receive any experimental treatment. One week following the completion of the program, a posttest consisted of the same questions as the pretest was conducted. Statistical analysis showed that (1) Comparing with the control group, the MBSR-MC group showed superior performance in three subscales of T-FFMQ, namely Acting with awareness, Non-judgment, and Non-reactivity. However, no significant difference was found in the remaining two facets: Observing and Describing. (2) The perceived stress score of the MBSR-MC group was significantly lower than that of the control group. Furthermore, an analysis of mediating effect showed that Acting with awareness, Non-judgment, and Non-reactivity were mediating variables of the relationship between MBSR-MC and perceived stress. The aforementioned results indicated that MBSR-MC training significantly increased military cadets' Acting with awareness, Non-judgment, and Non-reactivity, thereby significantly reducing their perceived stress. Therefore, this study supported the effectiveness of the MBSR-MC program on perceived stress.

Chronic difficulties are associated with poorer psychosocial functioning in the first year post-diagnosis in epithelial ovarian cancer patients

OBJECTIVE

Ovarian cancer is characterized by poor prognosis, high levels of distress, disturbed sleep, and compromised quality of life (QOL). Although life stressors have been shown to significantly impact physical and psychological health in cancer populations, no studies have used a high-resolution stress assessment to differentiate effects of acute versus chronic stressors among women with ovarian cancer. We addressed this issue in the present prospective longitudinal study by examining how acute and chronic stress exposure in the year pre-diagnosis relate to depressive symptoms, sleep quality, and QOL over the first year post-diagnosis in women with ovarian cancer.

METHODS

One hundred thirty-seven women completed the Life Events and Difficulties Schedule within a month of initial treatment for suspected ovarian cancer. Depressive symptoms, sleep, and QOL were measured pre-treatment, at six months, and one-year post-diagnosis. Mixed models were used to examine associations of acute and chronic stress pre-diagnosis with (a) change in psychosocial outcomes over the first year post-diagnosis and (b) levels of psychosocial outcomes across all time points.

RESULTS

Both the number and severity of chronic difficulties (but not acute life events) were related to significantly greater depression, and poorer sleep quality and QOL, across all time-points. In contrast, these stress indices were unrelated to changes in psychosocial functioning over time.

CONCLUSIONS

Chronic but not acute stress exposure predicted average levels of depression, sleep, and QOL in the first year post-diagnosis among women with ovarian cancer. Assessing stressors and designing interventions for reducing stress may thus be beneficial for ovarian cancer patients.

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.

Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial

The objective of this randomized controlled trial was to test whether a commercially available, mindfulness meditation mobile app, (i.e., Calm app), was effective in reducing fatigue (primary outcome), pre-sleep arousal, and daytime sleepiness (secondary outcomes) in adults with sleep disturbance (Insomnia Severity Index Score >10) as compared to a wait-list control group. Associations between the use of the Calm app (i.e., adherence to the intervention) and changes in sleep quality was also explored in the intervention group only. Adults with sleep disturbance were recruited (N = 640). Eligible and consenting participants (N = 263) were randomly assigned to the intervention (n = 124) or a wait-list control (n = 139) group. Intervention participants were asked to meditate using the Calm app ≥10 minutes/day for eight weeks. Fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, mid- (4-weeks) and post-intervention (8-weeks) in both groups, whereas sleep quality was evaluated only in the intervention group. Findings from intent-to-treat analyses suggest the use of the Calm app for eight weeks significantly decreased daytime fatigue (p = .018) as well as daytime sleepiness (p = .003) and cognitive (p = .005) and somatic (p < .001) pre-sleep arousal as compared to the wait-list control group. Within the intervention group, use of the Calm app was associated with improvements in sleep quality (p < .001). This randomized controlled trial demonstrates that the Calm app can be used to treat fatigue, daytime sleepiness, and pre-sleep arousal in adults with sleep disturbance. Given that the Calm app is affordable and widely accessible, these data have implications for community level dissemination of a mobile app to improve sleep-related symptoms associated with sleep disturbance. Trial registration: ClinicalTrials.gov NCT04045275.

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.

Insomnia in Patients with Borderline Personality Disorder

OBJECTIVE

Both sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction.

METHODS

Articles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process.

RESULTS

Sleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5-45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms.

CONCLUSION

Recognising and managing sleep disorders in patients with BPD may help alleviate the disorder's symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.

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.

Interpretations of mindfulness practices in organizations: A multi-level analysis of interpretations on an organizational, group, and individual level

Organizations increasingly experiment with spiritual and wellness practices in contemporary work contexts. Particularly, mindfulness practices play a dominant role in this movement. Rooted in spirituality and applied in clinical psychology, mindfulness is explained as a tool for dealing with workplace demands. Despite the increasing interest in mindfulness practices and the critical debate on their appropriation in the business context, knowledge on how organizational members interpret these practices, is underdeveloped. This inhibits a comprehensive understanding of what these practices are meant to achieve, and what they imply for organizational members. Viewing organizations as interpretive systems, we investigate how organizational members interpret mindfulness practices on the organizational, group, and individual level. Our qualitative study reveals the multiple interpretations of mindfulness practices existing in organizations. On an organizational level, mindfulness practices are interpreted as generalizable human resource development tools, aimed at boosting performance. Yet, mindfulness produces uncertainties in the organizational level interpretation. On a group level, mindfulness practices are interpreted as a means to enhance group efficiency via improved personal relationships; however, they are also associated with creating dysfunctional group dynamics. On an individual level, practicing mindfulness is interpreted as a tool for self-actualization. Even so, individuals associate the risk of negative social ramifications with the practice. We show the multiple meanings of mindfulness in organizations. This informs the critical debate among organizational scholars and explains the multitude of applications. Further, the paper offers a balanced view on benefits as well as unintended consequences, in relation to former applications and interpretations of the concept.

Acute effects of aerobic exercise and relaxation training on fatigue in breast cancer survivors: A feasibility trial

OBJECTIVE

This three-armed randomized controlled feasibility trial tested the acceptability and acute effects of aerobic exercise and technology-guided mindfulness training (relative to standalone interventions) on cancer-related fatigue among breast cancer survivors (BCS).

METHODS

BCS recruited from Central Illinois completed pre- and post-testing using established measures and were randomized to one of three groups (combined aerobic exercise with guided-mindfulness relaxation, aerobic exercise only, and relaxation only), conducted in three 90 min sessions over the course of 7 days in a fitness room and research office on a university campus.

RESULTS

We enrolled 40 BCS (M_age = 57.33 ± 8.75), M_BMI = 27.38 ± 5.27, M_fatigue = 4.56 ± 1.81 as measured by the Piper Fatigue Scale. More favorable post-intervention evaluations were reported by the combined group, compared to aerobic exercise or relaxation only (p < 0.05). Reductions in fatigue favoring the combined group (p = 0.05) showed a modest effect size (Cohen's d = 0.91) compared to aerobic exercise only.

CONCLUSIONS

These findings provide preliminary evidence for the feasibility of combining evidence-based techniques to address fatigue among BCS. The combined approach, incorporating mobile health technology, presents an efficacious and well-received design. If replicated in longer trials, the approach could provide a promising opportunity to deliver broad-reaching interventions for improved outcomes in BCS. Preregistered-ClinicalTrials NCT03702712.

Sleep disturbance in adults with sickle cell disease: relationships with executive and psychological functioning

Sleep disturbance is common among children with sickle cell disease (SCD) and is related to neurocognitive difficulties. However, research on sleep disturbances and related variables among adults with SCD is extremely limited. The present study examined the relationship between sleep, executive functioning, and emotional functioning among 62 adults (29 females; M age = 32 years, SD = 7.79) with SCD preparing to undergo a stem cell transplant. Participants were administered a neurocognitive evaluation that included objective and subjective measures of executive functioning, and they completed PROMIS self-report measures of anxiety, depression, and pain intensity. Results showed that about 17% of participants endorsed clinically significant sleep disruptions, while 16.1% and 8% endorsed clinically significant symptoms of anxiety and depression, respectively. Sleep disturbance in these adults was not significantly correlated with objective or subjective measures of executive functioning. Moreover, anxiety, but not depression, was a significant mediator between self-reported sleep difficulties and both objective and subjective measures of executive functioning while controlling for pain intensity. Future research on sleep interventions will be essential for ameliorating the effects of sleep disturbance on executive functioning and anxiety among adults with SCD.

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.

Progressive Muscle Relaxation and Mindfulness Meditation on Neuropathic Pain, Fatigue, and Quality of Life in Patients With Type 2 Diabetes: A Randomized Clinical Trial

PURPOSE

To examine the effects of progressive muscle relaxation and mindfulness meditation on the severity of diabetic peripheral neuropathic pain (DPNP), fatigue, and quality of life in patients with type 2 diabetes.

DESIGN

An assessor-blinded prospective randomized controlled trial.

METHODS

Participants were randomly assigned to the relaxation group (RG; n = 28), meditation group (MG; n = 25), or control group (CG; n = 24). The mean age of participants was 64.2 ± 8.1 years in the RG, 61.6 ± 8.0 years in the MG, and 64.1± 6.6 years in the CG. Patients in the intervention groups performed progressive muscle relaxation or mindfulness meditation at their home for 12 weeks, 20 min daily. The CG received only an attention-matched controlled education on pancreas anatomy and diabetes. Data collection was performed at baseline and at weeks 12 and 14 using the VAS, FACIT Fatigue Scale (FACIT-F), and Neuropathic Pain Impact on Quality of Life Questionnaire (NePIQoL).

FINDINGS

VAS scores were significantly lower in the RG and MG at week 12 (p < .05) and were statistically significant in the RG at week 14. Additionally, fatigue severity decreased significantly in the RG at weeks 12 and 14, compared to that in the CG (p < .05). While no significant difference was found in the quality of life scores between the study groups at weeks 12 and 14 (p > .05), a significant improvement in quality of life scores in the RG were provided at week 12 compared to those at baseline and week 14 (p < .05).

CONCLUSIONS

Both progressive muscle relaxation and mindfulness meditation had a positive impact on providing pain relief in patients with DPNP. Moreover, progressive muscle relaxation also appeared to have a beneficial effect on fatigue.

CLINICAL RELEVANCE

Based on the results, progressive muscle relaxation and mindfulness meditation can be recommended as supportive therapies for the management of DPNP.

The mediation role of work-life balance stress and chronic fatigue in the relationship between workaholism and depression among Chinese male workers in Hong Kong

BACKGROUND AND AIMS

Few studies have tested the underlying mechanisms in the association between workaholism and depression. This study aims to investigate the potential mediation effects of work-life balance stress and chronic fatigue and depression among Chinese male workers in Hong Kong.

METHODS

A population-based study among male workers in Hong Kong (n = 1,352) was conducted. The self-reported scales of assessing workaholism, work-life balance stress, chronic fatigue and depressive symptoms were included in the questionnaire. Path analysis was conducted to test the proposed mediation model.

RESULTS

Workaholism was directly and indirectly associated with depression through work-life balance stress and chronic fatigue, respectively. The association between work-life balance stress and chronic fatigue was statistically significant in the correlation analysis but not in the path analysis. As high as 30.5% of the participants were classified as having probable chronic fatigue, while 8.4% of the participants were classified as having probable depression.

DISCUSSION

Workaholism is a stressor that may induce negative consequences on well-being and health among male workers in Hong Kong. Interventions to help workers with time and stress management and fatigue reduction may be beneficial for their mental health. Theoretical and practical implications are discussed.

Application of Mindfulness-Based Psychological Interventions in Infertility

Living mindfully helps one gain a deeper understanding into realities of life. It enables people to witness suffering, desire, attachments, and impermanence without any fear, anxiety, anger, or despair. This is considered the hallmark of true psychological insight. As a skill, mindfulness can be inculcated by anyone. Mindfulness helps in attending, getting aware and understanding experiences in a compassion and open-minded way. Research suggests that applying mindfulness in daily life has been known to tame our emotional mind and enabled people to perceive things “as they are” without ascribing expectations, judgments, cynicism, or apprehensions to them. This review unravels the therapeutic power of mindfulness meditation in the context of infertility distress. It serves to integrate the evidence on the effectiveness of mindfulness-based psychological interventions to improve the emotional well-being and biological outcomes in Infertility.

Mindfulness-based stress reduction can alleviate cancer- related fatigue: A meta-analysis

OBJECTIVES

The purpose of this meta-analysis was to critically evaluate the effects of mindfulness-based stress reduction (MBSR) on cancer-related fatigue (CRF).

METHODS

A systematic search of eight databases (Web of Science, Pubmed, Cochrane Library, Spring link, CNKI, Wanfang, VIP, CBM) was performed, to find randomized controlled trials (RCTs) from inception to January 2019. Using Cochrane Collaboration criteria, two reviewers critically and independently assessed the risk of bias and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3.

RESULTS

In all, fifteen RCTs were included in the systematic review, fourteen of which, consisting of 3008 patients (MBSR, 1502; control, 1506), were included in the meta-analysis. MBSR had a significant effect on fatigue in cancer patients, particularly among lung cancer patients. The meta-analysis also indicated that MBSR could significantly mitigate CRF compared with usual care or no intervention. 8 weeks of MBSR, supervised by experts, had a large effect on CRF.

CONCLUSIONS

MBSR is effective for CRF management and can be recommended as a beneficial complementary therapy for CRF patients.

Effects of mindfulness-based stress reduction combined with music therapy on pain, anxiety, and sleep quality in patients with osteosarcoma

Objectives:

To evaluate the effects of mindfulness-based stress reduction (MBSR) combined with music therapy (MT) on clinical symptoms in patients with osteosarcoma.

Methods:

Patients diagnosed with osteosarcoma were assessed for eligibility. A total of 101 patients were ultimately randomized into the intervention and control groups. Both groups received routine care. Eight sessions of MBSR and MT psychotherapy were conducted in the intervention group, while the control group received no psychological intervention. Patients were assessed regarding pain, anxiety, and sleep quality at two distinct stages: before and after the intervention.

Results:

There were no significant differences in sociodemographic and clinical parameters between the intervention and control groups at baseline. The intervention program significantly alleviated psychological and physiological complications in patients with osteosarcoma. Specifically, the study revealed that 8 weeks of the combined MBSR/MT intervention effectively reduced pain and anxiety scores and improved the quality of sleep in patients.

Conclusion:

MBSR combined with MT significantly alleviated clinical symptoms, and could be considered a new, effective psychotherapeutic intervention for patients with osteosarcoma.

Anticholinergic Burden, Sleep Quality and Health Outcomes in Malaysian Aged Care Home Residents

The use of anticholinergic medications by residents in aged care homes is associated with increased risk of adverse effects. These include cognitive impairment, sleep disturbances, and falls, and necessitate increased healthcare visits and the associated burden on healthcare systems. The objective of this study was to investigate associations between anticholinergic burden and health outcomes such as independence in activities for daily living, frailty, quality of life, and sleep quality. The study was conducted among residents in Malaysian aged care homes, aged 60 years and above. Anticholinergic burden was calculated using the Anticholinergic Cognitive Burden (ACB) scale. Health outcome measures included independence, assessed using the Katz Activities for Daily Living scale (Katz ADL); quality of life, assessed using the Older People’s Quality of Life Questionnaire (OPQOL); frailty, assessed using the Groningen Frailty Index (GFI); and sleep quality, measured using the Pittsburg Sleep Quality Index (PSQI). Just over one-third (36%) of the study population was exposed to at least one medication with anticholinergic effect. An increased anticholinergic cognitive burden was associated with frailty (p = 0.031), sleep latency (p = 0.007), and sleep disturbances (p = 0.015). Further studies are required to assess the effect of prolonged exposure to anticholinergic medications on health outcomes.

Mindfulness-Based stress reduction in early palliative care for people with metastatic cancer: A mixed-method study

OBJECTIVES

To explore the impact of a Mindfulness-Based Stress Reduction (MBSR) intervention for people with metastatic cancer integrated in Early Palliative Care (EPC).

DESIGN

Mixed-method study.

SETTINGS/LOCATION

EPC Service integrated with Oncology Unit, Carpi General Hospital, Italy from January to October 2017. The MBSR intervention took place inside the hospital.

SUBJECTS

Study participation was offered to 25 consecutive people referred to the EPC service.

INCLUSION CRITERIA

people with metastatic cancer between 18 and 75 years old; informed consent.

EXCLUSION CRITERIA

Performance Status <60% according to Karnofsky scale; active psychiatric disorder. 20 patients were included in the study.

INTERVENTION

The adapted program consists of 8 meetings for 2.5 h once a week, a 4.5 h session between the 6th and 7th weeks and 0.5 h home practice daily. The following mindfulness practices were included during the training: formal sitting meditation, body scan, light yoga, walking meditation, and Aikido exercises. Participants were provided with materials for home practice. A qualified MBSR instructor conducted the program. Sessions were attended by a clinical psychologist and a physician trained in meditation, together with the palliative nurse as facilitators.

OUTCOME MEASURES

Feasibility and acceptability were assessed on 16 participants. In addition, pre-post measures of cancer pain and mood state were collected. Semi-structured, in-depth interviews were conducted on a subset of 8 participants at the end of the study and analysed using the Interpretative-Phenomenological approach.

RESULTS

MBSR attendance to meetings and adherence to home practice were 75%. MBSR intervention helped participants to develop an accepting attitude in respect to metastatic cancer disease helping them to face anxiety and cancer pain. MBSR improves self-regulation of mood state engendering feelings of compassion MBSR program supports participants in questioning and reconnecting with their values and spiritual beliefs.

CONCLUSIONS

A Mindfulness intervention integrated into EPC setting is feasible, well accepted and could help metastatic cancer patients to control cancer pain together with an opportunity of emotional and spiritual relief.