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Open Access 01-06-2017

Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators

Authors: Melanie. P. J. Schellekens, Rie Tamagawa, Laura E. Labelle, Michael Speca, Joanne Stephen, Elaine Drysdale, Sarah Sample, Barbara Pickering, Dale Dirkse, Linette Lawlor Savage, Linda E. Carlson

Published in: Journal of Behavioral Medicine | Issue 3/2017

Abstract

Despite growing evidence in support of mindfulness as an underlying mechanism of mindfulness-based interventions (MBIs), it has been suggested that nonspecific therapeutic factors, such as the experience of social support, may contribute to the positive effects of MBIs. In the present study, we examined whether change in mindfulness and/or social support mediated the effect of Mindfulness-Based Cancer Recovery (MBCR) compared to another active intervention (i.e. Supportive Expressive Group Therapy (SET)), on change in mood disturbance, stress symptoms and quality of life. A secondary analysis was conducted of a multi-site randomized clinical trial investigating the impacts of MBCR and SET on distressed breast cancer survivors (MINDSET). We applied the causal steps approach with bootstrapping to test mediation, using pre- and post-intervention questionnaire data of the participants who were randomised to MBCR (n = 69) or SET (n = 70). MBCR participants improved significantly more on mood disturbance, stress symptoms and social support, but not on quality of life or mindfulness, compared to SET participants. Increased social support partially mediated the impact of MBCR versus SET on mood disturbance and stress symptoms. Because no group differences on mindfulness and quality of life were observed, no mediation analyses were performed on these variables. Findings showed that increased social support was related to more improvement in mood and stress after MBCR compared to support groups, whereas changes in mindfulness were not. This suggests a more important role for social support in enhancing outcomes in MBCR than previously thought.

Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45. doi:10.1177/1073191105283504 CrossRefPubMed

Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15, 329–342. doi:10.1177/1073191107313003 CrossRefPubMed

Baron, R. M., & Kenny, D. A. (1986). The moderator mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi:10.1037/0022-3514.51.6.1173 CrossRefPubMed

Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress and Health, 26, 359–371. doi:10.1002/smi.1305 CrossRef

Brady, M. J., Cella, D. F., Mo, F., Bonomi, A. E., Tulsky, D. S., Lloyd, S. R., et al. (1997). Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. Journal of Clinical Oncology, 15, 974–986.CrossRefPubMed

Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848. doi:10.1037/0022-3514.84.4.822 CrossRefPubMed

Carlson, L. E., & Brown, K. W. (2005). Validation of the mindful attention awareness scale in a cancer population. Journal of Psychosomatic Research, 58, 29–33. doi:10.1016/j.jpsychores.2004.04.366 CrossRefPubMed

Carlson, L. E., Doll, R., Stephen, J., Faris, P., Tamagawa, R., Drysdale, E., et al. (2013). Randomized controlled trial of Mindfulness-Based Cancer Recovery versus Supportive Expressive Group Therapy for distressed survivors of breast cancer (MINDSET). Journal of Clinical Oncology, 31, 3119–3126.CrossRefPubMed

Carlson, L. E., & Speca, M. (2010). Mindfulness-Based Cancer Recovery. Oakland, CA: New Harbinger.

Carlson, L. E., Speca, M., Faris, P., & Patel, K. D. (2007). One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of Mindfulness-Based Stress Reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior, and Immunity, 21, 1038–1049. doi:10.1016/j.bbi.2007.04.002 CrossRefPubMed

Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2003). Mindfulness-Based Stress Reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65, 571–581. doi:10.1097/01.psy.0000074003.35911.41 CrossRefPubMed

Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2004). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology, 29, 448–474. doi:10.1016/s0306-4530(03)00054-4 CrossRefPubMed

Carlson, L. E., & Thomas, B. C. (2007). Development of the Calgary symptoms of stress inventory (C-SOSI). International Journal of Behavioral Medicine, 14, 249–256.CrossRefPubMed

Cassileth, B. R., Lusk, E. J., Brown, L. L., & Cross, P. A. (1986). Psychosocial status of cancer patients and next of kin. Journal of Psychosocial Oncology, 3, 99–105. doi:10.1300/J077v03n03_08 CrossRef

Chiesa, A. (2011). Improving psychotherapy research: The example of mindfulness based interventions. World Journal of Methodology, 1, 4.CrossRefPubMedPubMedCentral

Classen, C. C., Butler, L. D., Koopman, C., Miller, E., DiMiceli, S., Giese-Davis, J., et al. (2001). Supportive-expressive group therapy and distress in patients with metastatic breast cancer: A randomized clinical intervention trial. Archives of General Psychiatry, 58, 494–501.CrossRefPubMed

Classen, C. C., Diamond, S., Soleman, A., Fobair, P., Spira, J., & Spiegel, D. (1993). Brief Supportive-Expressive Group Therapy for women with primary breast cancer: A treatment manual. Stanford, CA: Stanford University School of Medicine.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: L. Erlbaum.

Compen, F. R., Bisseling, E. M., Van der Lee, M. L., Adang, E. M. M., Donders, A. R. T., & Speckens, A. E. M. (2015). Study protocol of a multicenter randomized controlled trial comparing the effectiveness of group and individual internet-based Mindfulness-Based Cognitive Therapy with treatment as usual in reducing psychological distress in cancer patients: The BeMind study. BMC Psychology, 3, 27.CrossRefPubMedPubMedCentral

Cramer, H., Lauche, R., Paul, A., & Dobos, G. (2012). Mindfulness-based stress reduction for breast cancer-a systematic review and meta-analysis. Current Oncology, 19, E343–E352. doi:10.3747/co.19.1016 CrossRefPubMedPubMedCentral

Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239. doi:10.1111/j.1467-9280.2007.01882.x CrossRefPubMedPubMedCentral

Garland, S. N., Carlson, L. E., Stephens, A. J., Antle, M. C., Samuels, C., & Campbell, T. S. (2014). Mindfulness-Based Stress Reduction compared with Cognitive Behavioral Therapy for the treatment of insomnia comorbid with cancer: A randomized, partially blinded, noninferiority trial. Journal of Clinical Oncology, 32, 449–457. doi:10.1200/JCO.2012.47.7265 CrossRefPubMed

Giese-Davis, J., Koopman, C., Butler, L. D., Classen, C. C., Cordova, M., Fobair, P., et al. (2002). Change in emotion-regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy. Journal of Consulting and Clinical Psychology, 70, 916–925.CrossRefPubMed

Grossman, P., & Van Dam, N. T. (2011). Mindfulness, by any other name…: Trials and tribulations of sati in western psychology and science. Contemporary Buddhism, 12, 219–239. doi:10.1080/14639947.2011.564841 CrossRef

Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. doi:10.1016/j.cpr.2015.01.006 CrossRefPubMed

Johannsen, M., O’Connor, M., O’Toole, M. S., Jensen, A. B., Højris, I., & Zachariae, R. (2016). Efficacy of Mindfulness-Based Cognitive Therapy on late post-treatment pain in women treated for primary breast cancer: A randomized controlled trial. Journal of Clinical Oncology. doi:10.1200/jco.2015.65.0770 PubMed

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacourt.

Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. doi:10.1146/annurev.clinpsy.3.022806.091432 CrossRefPubMed

Kissane, D. W., Grabsch, B., Clarke, D. M., Smith, G. C., Love, A. W., Bloch, S., et al. (2007). Supportive-Expressive Group Therapy for women with metastatic breast cancer: Survival and psychosocial outcome from a randomized controlled trial. Psycho-Oncology, 16, 277–286. doi:10.1002/pon.1185 CrossRefPubMed

Labelle, L. E., Campbell, T. S., Faris, P., & Carlson, L. E. (2014). Mediators of Mindfulness-Based Stress Reduction (MBSR): Assessing the timing and sequence of change in cancer patients. Journal of Clinical Psychology. doi:10.1002/jclp.22117 PubMed

Lengacher, C. A., Reich, R. R., Paterson, C. L., Ramesar, S., Park, J. Y., Alinat, C., et al. (2016). Examination of broad symptom improvement resulting from Mindfulness-Based Stress Reduction in breast cancer survivors: A randomized controlled trial. Journal of Clinical Oncology. doi:10.1200/jco.2015.65.7874 PubMed

Mackenzie, M. J., Carlson, L. E., Munoz, M., & Speca, M. (2007). A qualitative study of self-perceived effects of Mindfulness-Based Stress Reduction (MBSR) in a psychosocial oncology setting. Stress and Health, 23, 59–69. doi:10.1002/smi.1120 CrossRef

MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104. doi:10.1037//1082-989x.7.1.83 CrossRefPubMedPubMedCentral

MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99–128. doi:10.1207/s15327906mbr3901_4 CrossRefPubMedPubMedCentral

Malpass, A., Carel, H., Ridd, M., Shaw, A., Kessler, D., Sharp, D., et al. (2012). Transforming the perceptual situation: A meta-ethnography of qualitative work reporting patients’ experiences of mindfulness-based approaches. Mindfulness, 3, 60–75.CrossRef

McNair, D. A., Lorr, M., & Droppelman, L. F. (1971). Profile of mood states. San Diago, CA.: Educational and Industrial Testing Service.

Moyer, A., Goldenberg, M., Hall, M. A., Knapp-Oliver, S. K., Sohl, S. J., Sarma, E. A., et al. (2012). Mediators of change in psychosocial interventions for cancer patients: A systematic review. Behavioral Medicine, 38, 90–114. doi:10.1080/08964289.2012.695412 CrossRefPubMedPubMedCentral

Piet, J., Wurtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80, 1007–1020.CrossRefPubMed

Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods Instruments & Computers, 36, 717–731. doi:10.3758/bf03206553 CrossRef

Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891. doi:10.3758/brm.40.3.879 CrossRefPubMed

Reblin, M., & Uchino, B. N. (2008). Social and emotional support and its implication for health. Current Opinion in Psychiatry, 21, 201–205. doi:10.1097/YCO.0b013e3282f3ad89 CrossRefPubMedPubMedCentral

Schellekens, M. P. J., Jansen, E. T. M., Willemse, H. H. M. A., van Laarhoven, H. W. M., Prins, J. B., & Speckens, A. E. M. (2016). A qualitative study on Mindfulness-Based Stress Reduction for breast cancer patients: How women experience participating with fellow patients. Supportive Care in Cancer, 24, 1813–1820. doi:10.1007/s00520-015-2954-8 CrossRefPubMed

Schroevers, M. J., Tovote, A., Snippe, E., & Fleer, J. (2016). Group and individual Mindfulness-Based Cognitive Therapy (MBCT) are both effective: A pilot randomized controlled trial in depressed people with a somatic disease. Mindfulness. doi:10.1007/s12671-016-0575-z

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-Based Cognitive Therapy for depression: A new approach to preventing relapse. New York: Guilford Press.

Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32, 705–714. doi:10.1016/0277-9536(91)90150-B CrossRefPubMed

Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445. doi:10.1037//1082-989x.7.4.422 CrossRefPubMed

Speca, M., Carlson, L. E., Goodey, E., & Angen, M. (2000). A randomized, wait-list controlled clinical trial: The effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62, 613–622.CrossRefPubMed

Tovote, K. A., Fleer, J., Snippe, E., Peeters, A. C., Emmelkamp, P. M., Sanderman, R., et al. (2014). Individual Mindfulness-Based Cognitive Therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: Results of a randomized controlled trial. Diabetes Care, 37, 2427–2434.CrossRefPubMed

van den Hurk, D. G. M., Schellekens, M. P. J., Molema, J., Speckens, A. E. M., & van der Drift, M. A. (2015). Mindfulness-Based Stress Reduction for lung cancer patients and their partners: Results of a mixed methods pilot study. Palliative Medicine,. doi:10.1177/0269216315572720 PubMedPubMedCentral

Wahbeh, H., Lane, J. B., Goodrich, E., Miller, M., & Oken, B. S. (2014). One-on-one mindfulness meditation trainings in a research setting. Mindfulness (N Y), 5, 88–99. doi:10.1007/s12671-012-0155-9 CrossRef

Wurtzen, H., Dalton, S. O., Elsass, P., Sumbundu, A. D., Steding-Jensen, M., Karlsen, R. V., et al. (2013). Mindfulness significantly reduces self-reported levels of anxiety and depression: Results of a randomised controlled trial among 336 Danish women treated for stage I-III breast cancer. European Journal of Cancer, 49, 1365–1373. doi:10.1016/j.ejca.2012.10.030 CrossRefPubMed

Zhang, M. F., Wen, Y. S., Liu, W. Y., Peng, L. F., Wu, X. D., & Liu, Q. W. (2016). Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: A meta-analysis. Med, 94, e0897. doi:10.1097/md.0000000000000897 CrossRef

Title: Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators
Authors: Melanie. P. J. Schellekens
Rie Tamagawa
Laura E. Labelle
Michael Speca
Joanne Stephen
Elaine Drysdale
Sarah Sample
Barbara Pickering
Dale Dirkse
Linette Lawlor Savage
Linda E. Carlson
Publication date: 01-06-2017
Publisher: Springer US
Published in: Journal of Behavioral Medicine / Issue 3/2017
Print ISSN: 0160-7715
Electronic ISSN: 1573-3521
DOI: https://doi.org/10.1007/s10865-016-9799-6

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Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators

Abstract

Keynote webinar | Spotlight on medication adherence

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Abstract

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