Does self-report mindfulness mediate the effect of Mindfulness-Based Stress Reduction (MBSR) on spirituality and posttraumatic growth in cancer patients?

This longitudinal waitlist-controlled study evaluated the effects of Mindfulness-Based Stress Reduction (MBSR) on spirituality, posttraumatic growth (PTG), and mindfulness in cancer patients. The study also assessed whether increased mindfulness mediated the effects of MBSR on spirituality and PTG. Patients were either registered for immediate participation in MBSR (n = 135), or were naturally waiting for the next program (n = 76). Participants completed questionnaires pre-, mid-, and post-MBSR, or waiting period. Hierarchical linear modeling (HLM) was employed to assess changes over time as a function of condition (MBSR vs. waitlist). Mediation was tested using linear regression and bootstrapping. MBSR participants demonstrated increased spirituality, PTG, and mindfulness, relative to controls. Change in all mindfulness facets mediated the effect of MBSR on spirituality and PTG. The development of mindfulness skills through MBSR may facilitate a sense of meaning, peacefulness, connectedness, and personal growth in cancer patients. This investigation contributes to an emerging focus on determining ‘how’ mindfulness-based interventions work.

[1]  Gregory T. Smith,et al.  Using Self-Report Assessment Methods to Explore Facets of Mindfulness , 2006, Assessment.

[2]  N. Adler,et al.  Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting , 2008 .

[3]  C. Carver,et al.  Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. , 2004, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[4]  Diana Adler,et al.  Using Multivariate Statistics , 2016 .

[5]  Z. Segal,et al.  Mindfulness: A Proposed Operational Definition , 2004 .

[6]  E. Altmaier,et al.  Finding Benefit from Cancer. , 2007 .

[7]  J. Moskowitz,et al.  Self-report Mindfulness as a Mediator of Psychological Well-being in a Stress Reduction Intervention for Cancer Patients—A Randomized Study , 2010, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[8]  David P Mackinnon,et al.  Confidence Limits for the Indirect Effect: Distribution of the Product and Resampling Methods , 2004, Multivariate behavioral research.

[9]  D. Cella,et al.  A case for including spirituality in quality of life measurement in oncology , 1999, Psycho-oncology.

[10]  Julia H. Rowland,et al.  Cancer Survivorship: Resilience Across the Lifespan , 2005 .

[11]  L. Carlson,et al.  Psychological benefits for cancer patients and their partners participating in mindfulness‐based stress reduction (MBSR) , 2010, Psycho-oncology.

[12]  J. Hébert,et al.  The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial , 2011, Breast Cancer Research and Treatment.

[13]  P. Reed.  An emerging paradigm for the investigation of spirituality in nursing. , 1992, Research in nursing & health.

[14]  A. Lutz,et al.  Attention regulation and monitoring in meditation , 2008, Trends in Cognitive Sciences.

[15]  H. Lynch,et al.  Psychologic Aspects of Cancer Genetic Testing: A Research Update for Clinicians , 1997 .

[16]  S. Ersser,et al.  Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[17]  S. Raudenbush,et al.  Effects of study duration, frequency of observation, and sample size on power in studies of group differences in polynomial change. , 2001, Psychological methods.

[18]  M. Lau,et al.  Mechanisms of Mindfulness: A Buddhist Psychological Model , 2011 .

[19]  Anthony S. Bryk,et al.  Hierarchical Linear Models: Applications and Data Analysis Methods , 1992 .

[20]  A. Feingold.  Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. , 2009, Psychological methods.

[21]  S. West,et al.  A comparison of methods to test mediation and other intervening variable effects. , 2002, Psychological methods.

[22]  J. Kabat-Zinn,et al.  Full catastrophe living : using the wisdom of your body and mind to face stress, pain, and illness , 1990 .

[23]  L. Carlson,et al.  A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients , 2007, Supportive Care in Cancer.

[24]  J. Lindy,et al.  Assessing long-term effects of trauma: diagnosing symptoms of avoidance and numbing. , 1999, The American journal of psychiatry.

[25]  L. Carlson,et al.  Mindfulness-Based Stress Reduction in Oncology: Evaluating Mindfulness and Rumination as Mediators of Change in Depressive Symptoms , 2010 .

[26]  P. Shrout,et al.  Mediation in experimental and nonexperimental studies: new procedures and recommendations. , 2002, Psychological methods.

[27]  Sarah E Lillie,et al.  The interaction of post‐traumatic growth and post‐traumatic stress symptoms in predicting depressive symptoms and quality of life , 2008, Psycho-oncology.

[28]  J. Laurenceau,et al.  Some methodological and statistical issues in the study of change processes in psychotherapy. , 2007, Clinical psychology review.

[29]  A. Jha,et al.  Mindfulness training modifies subsystems of attention , 2007, Cognitive, affective & behavioral neuroscience.

[30]  T. Toneatto,et al.  Do Mindfulness Meditation Participants Do Their Homework? And Does It Make a Difference? A Review of the Empirical Evidence , 2009, Journal of Cognitive Psychotherapy.

[31]  S. Schwabish.  Cognitive Adaptation Theory as a Means to PTSD Reduction Among Cancer Pain Patients , 2011, Journal of psychosocial oncology.

[32]  M. Cordova,et al.  Posttraumatic growth following breast cancer: a controlled comparison study. , 2001, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[33]  R. Tedeschi,et al.  The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma , 1996, Journal of traumatic stress.

[34]  Kristopher J Preacher,et al.  Effect size measures for mediation models: quantitative strategies for communicating indirect effects. , 2011, Psychological methods.

[35]  A. Hayes.  Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium , 2009 .

[36]  J. Carmody,et al.  Mindfulness, spirituality, and health-related symptoms. , 2008, Journal of psychosomatic research.

[37]  H. Coelho,et al.  The Art and Science of Mindfulness. Integrating Mindfulness into Psychology and the Helping Professions , 2010 .

[38]  Kristopher J Preacher,et al.  Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models , 2008, Behavior research methods.

[39]  R. Baer,et al.  MEASURING MINDFULNESS , 2011 .

[40]  E. Garland.  The Meaning of Mindfulness: A Second-Order Cybernetics of Stress, Metacognition, and Coping , 2007 .

[41]  R. Tedeschi,et al.  TARGET ARTICLE: "Posttraumatic Growth: Conceptual Foundations and Empirical Evidence" , 2004 .

[42]  D. Mackinnon.  Introduction to Statistical Mediation Analysis , 2008 .

[43]  L. Carlson,et al.  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 , 2000, Psychosomatic medicine.

[44]  R. Bränström,et al.  Experiences of a Mindfulness-Based Stress-Reduction Intervention Among Patients With Cancer , 2011, Cancer nursing.

[45]  C H Mallinckrodt,et al.  ACCOUNTING FOR DROPOUT BIAS USING MIXED-EFFECTS MODELS , 2001, Journal of biopharmaceutical statistics.

[46]  Stephen Joseph,et al.  Positive Change Following Trauma and Adversity: A Review , 2004, Journal of traumatic stress.

[47]  D. Cella,et al.  Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy—spiritual well-being scale (FACIT-Sp) , 2002, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[48]  L. Carlson,et al.  Mindfulness-based cancer recovery : a step-by-step MBSR approach to help you cope with treatment & reclaim your life , 2010 .

[49]  B. A. Wallace,et al.  Mental balance and well-being: building bridges between Buddhism and Western psychology. , 2006, The American psychologist.

[50]  A Lawrence Gould,et al.  COMPARISON OF ALTERNATIVE STRATEGIES FOR ANALYSIS OF LONGITUDINAL TRIALS WITH DROPOUTS , 2002, Journal of biopharmaceutical statistics.

[51]  K. Carroll,et al.  Now you see it, now you don't: a comparison of traditional versus random-effects regression models in the analysis of longitudinal follow-up data from a clinical trial. , 1997, Journal of consulting and clinical psychology.

[52]  L. Carlson,et al.  High levels of untreated distress and fatigue in cancer patients , 2004, British Journal of Cancer.

[53]  Matthew S. Fritz,et al.  PSYCHOLOGICAL SCIENCE Research Article Required Sample Size to Detect the Mediated Effect , 2022 .

[54]  M. Silverman,et al.  The impact of trauma exposure on the cognitive schemas of a sample of paramedics. , 2000, International journal of emergency mental health.

[55]  L. Carlson,et al.  A qualitative study of self-perceived effects of Mindfulness-based Stress Reduction (MBSR) in a psychosocial oncology setting , 2007 .

[56]  N. Adler,et al.  Cancer Care for the Whole Patient , 2008 .

[57]  Matthew J. Goodman,et al.  Randomized controlled trial of mindfulness‐based stress reduction (MBSR) for survivors of breast cancer , 2009, Psycho-oncology.

[58]  C. Carver,et al.  Curvilinear associations between benefit finding and psychosocial adjustment to breast cancer. , 2006, Journal of consulting and clinical psychology.

[59]  L. Carlson,et al.  Impact of Mindfulness-Based Stress Reduction (MBSR) on attention, rumination and resting blood pressure in women with cancer: A waitlist-controlled study , 2012, Journal of Behavioral Medicine.

[60]  S. Lelorain,et al.  Long Term Posttraumatic Growth After Breast Cancer: Prevalence, Predictors and Relationships with Psychological Health , 2010, Journal of Clinical Psychology in Medical Settings.

[61]  V. Follette,et al.  Mindfulness and trauma: implications for treatment , 2006 .

[62]  J. Carmody,et al.  How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. , 2009, Journal of clinical psychology.

[63]  A. Kazdin.  Mechanisms of Change in Psychotherapy: Advances, Breakthroughs, and Cutting-Edge Research (Do Not Yet Exist). , 2006 .

[64]  Matthew S. Fritz,et al.  Mediation analysis. , 2019, Annual review of psychology.

[65]  H. Kraemer,et al.  Mediators and moderators of treatment effects in randomized clinical trials. , 2002, Archives of general psychiatry.

[66]  Kristopher J Preacher,et al.  SPSS and SAS procedures for estimating indirect effects in simple mediation models , 2004, Behavior research methods, instruments, & computers : a journal of the Psychonomic Society, Inc.

[67]  L. Carlson,et al.  Exploring self‐compassion and empathy in the context of mindfulness‐based stress reduction (MBSR) , 2010 .

[68]  P. Lissoni,et al.  A spiritual approach in the treatment of cancer: relation between faith score and response to chemotherapy in advanced non-small cell lung cancer patients. , 2008, In vivo.

[69]  Patrick E. McKnight,et al.  Strengthening research methodology: Psychological measurement and evaluation. , 2006 .

[70]  M. Antoni,et al.  Posttraumatic Growth and Group-Based Interventions for Persons Dealing With Cancer: What Have We Learned So Far? , 2004 .

[71]  R. Ryan,et al.  Mindfulness: Theoretical Foundations and Evidence for its Salutary Effects , 2007 .

[72]  Ruth A. Baer,et al.  Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program , 2008, Journal of Behavioral Medicine.

[73]  E. Danielson,et al.  Existential concerns among patients with cancer and interventions to meet them: an integrative literature review , 2009, Psycho-oncology.

[74]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[75]  G. Schwartz,et al.  Intentional systemic mindfulness: an integrative model for self-regulation and health. , 2000, Advances in mind-body medicine.