RESUMO
MBSR(BC) is known to have a positive impact on psychological and physical symptoms among breast cancer survivors (BCS). The cognitive mechanisms of "how" MBSR(BC) works was addressed in a recent study that found that there was strong consistent evidence that reduced emotional reactivity is a mediator and moderate consistent evidence that mindfulness, rumination, and worry were mediators. The purpose of this study, as part of a larger R01 trial, was to test whether positive effects achieved from the MBSR(BC) program were mediated through changes in increased mindfulness, decreased fear of breast cancer recurrence, and perceived stress. Female BCS > 21 years diagnosed with Stage 0-III breast cancer were randomly assigned to a 6-week MBSR(BC) or a Usual Care (UC)regimen. Potential mediators of 6- and 12-week outcomes were identified by analysis of covariance (ANCOVA), followed by formal mediational analyses of main effects of MBSR(BC) on 6- and 12-week outcomes, including percentage of total effects explained. Among 322 BCS (167 MBSR(BC) and 155 UC), fear of recurrence and perceived stress, but not mindfulness, mediated reductions in anxiety and fatigue at weeks 6 and 12, partially supporting our hypothesis of cognitive mechanisms of MBSR(BC). TRIAL REGISTRATION: Registration Number: NCT01177124 http://www.ClinicalTrials.gov.
Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Atenção Plena , Neoplasias da Mama/terapia , Feminino , Humanos , Estresse Psicológico/terapia , Sobreviventes , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement. METHODS: A single group, pre-posttest design was implemented among female stages 0-III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress-reducing intervention that combines sitting and walking meditation, body scan, and yoga and is designed to deliver weekly 2-hour sessions for 6 weeks using an iPad. RESULTS: The mean age of the 15 enrolled BCS was 57 years; one participant was non-Hispanic black, and 14 were non-Hispanic white. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post-mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue, and quality of life (P's < .05). Effect sizes for improvements of multiple symptoms ranged from medium to large. CONCLUSIONS: These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer.
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Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Atenção Plena/métodos , Estresse Psicológico/psicologia , Adulto , Ansiedade/psicologia , Depressão/psicologia , Fadiga/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida/psicologia , Estresse Psicológico/prevenção & controle , Resultado do Tratamento , YogaRESUMO
OBJECTIVE: The purpose of this study was to investigate the effects of mindfulness-based stress reduction for breast cancer survivors (MBSR(BC)) on multiple measures of objective and subjective sleep parameters among breast cancer survivors (BCS). METHODS: Data were collected using a two-armed randomized controlled design among BCS enrolled in either a 6-week MBSR(BC) program or a usual care (UC) group with a 12-week follow-up. The present analysis is a subset of the larger parent trial (ClinicalTrials.gov Identifier: NCT01177124). Seventy-nine BCS participants (mean age 57 years), stages 0-III, were randomly assigned to either the formal (in-class) 6-week MBSR(BC) program or UC. Subjective sleep parameters (SSP) (i.e., sleep diaries and the Pittsburgh Sleep Quality Index (PSQI)) and objective sleep parameters (OSP) (i.e., actigraphy) were measured at baseline, 6 weeks, and 12 weeks after completing the MBSR(BC) or UC program. RESULTS: Results showed indications of a positive effect of MBSR(BC) on OSP at 12 weeks on sleep efficiency (78.2% MBSR(BC) group versus 74.6% UC group, p = 0.04), percent of sleep time (81.0% MBSR(BC) group versus 77.4% UC group, p = 0.02), and less number waking bouts (93.5 in MBSR(BC) group versus 118.6 in the UC group, p < 0.01). Small nonsignificant improvements were found in SSP in the MBSR(BC) group from baseline to 6 weeks (PSQI total score, p = 0.09). No significant relationship was observed between minutes of MBSR(BC) practice and SSP or OSP. CONCLUSIONS: These data suggest that MBSR(BC) may be an efficacious treatment to improve objective and subjective sleep parameters in BCS.
Assuntos
Neoplasias da Mama/psicologia , Carcinoma/psicologia , Atenção Plena/métodos , Distúrbios do Início e da Manutenção do Sono/terapia , Sono , Estresse Psicológico/terapia , Actigrafia , Idoso , Neoplasias da Mama/complicações , Carcinoma/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Autorrelato , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/psicologia , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Resultado do TratamentoRESUMO
To investigate the mechanism(s) of action of mindfulness based stress reduction (MBSR(BC)) including reductions in fear of recurrence and other potential mediators. Eighty-two post-treatment breast cancer survivors (stages 0-III) were randomly assigned to a 6-week MBSR(BC) program (n = 40) or to usual care group (UC) (n = 42). Psychological and physical variables were assessed as potential mediators at baseline and at 6 weeks. MBSR(BC) compared to UC experienced favorable changes for five potential mediators: (1) change in fear of recurrence problems mediated the effect of MBSR(BC) on 6-week change in perceived stress (z = 2.12, p = 0.03) and state anxiety (z = 2.03, p = 0.04); and (2) change in physical functioning mediated the effect of MBSR(BC) on 6-week change in perceived stress (z = 2.27, p = 0.02) and trait anxiety (z = 1.98, p = 0.05). MBSR(BC) reduces fear of recurrence and improves physical functioning which reduces perceived stress and anxiety. Findings support the beneficial effects of MBSR(BC) and provide insight into the possible cognitive mechanism of action.
Assuntos
Neoplasias da Mama/psicologia , Medo/psicologia , Atenção Plena , Estresse Psicológico/prevenção & controle , Estresse Psicológico/terapia , Neoplasias da Mama/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Resultado do TratamentoRESUMO
To investigate prevalence and severity of symptoms and symptom clustering in breast cancer survivors who attended MBSR(BC). Women were randomly assigned into MBSR(BC) or Usual Care (UC). Eligible women were ≥ 21 years, had been diagnosed with breast cancer and completed treatment within 18 months of enrollment. Symptoms and interference with daily living were measured pre- and post-MBSR(BC) using the M.D. Anderson Symptom Inventory. Symptoms were reported as highly prevalent but severity was low. Fatigue was the most frequently reported and severe symptom among groups. Symptoms clustered into 3 groups and improved in both groups. At baseline, both MBSR(BC) and the control groups showed similar mean symptom severity and interference; however, after the 6-week post-intervention, the MBSR(BC) group showed statistically-significant reduction for fatigue and disturbed sleep (P < 0.01) and improved symptom interference items, compared to the control group. For the between-group comparisons, 11 of 13 symptoms and 5 of 6 interference items had lower means in the MBSR(BC) condition than the control condition. These results suggest that MBSR(BC) modestly decreases fatigue and sleep disturbances, but has a greater effect on the degree to which symptoms interfere with many facets of life. Although these results are preliminary, MBSR intervention post-treatment may effectively reduce fatigue and related interference in QOL of breast cancer survivors.
Assuntos
Neoplasias da Mama/psicologia , Meditação/psicologia , Relações Metafísicas Mente-Corpo , Estresse Psicológico/terapia , Sobreviventes/psicologia , Adulto , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Resultado do Tratamento , Yoga/psicologiaRESUMO
OBJECTIVES: Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period. METHODS: We conducted a randomized controlled trial of 84 female BC survivors (Stages 0-III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6-week Mindfulness-Based Stress Reduction (MBSR) program designed to self-regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF-36). RESULTS: Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two-sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning. CONCLUSIONS: Among BC survivors within 18 months of treatment completion, a 6-week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care.
Assuntos
Ansiedade/terapia , Neoplasias da Mama/psicologia , Depressão/terapia , Acontecimentos que Mudam a Vida , Meditação , Qualidade de Vida/psicologia , Papel do Doente , Sobreviventes/psicologia , Atividades Cotidianas/psicologia , Adaptação Psicológica , Adulto , Idoso , Ansiedade/psicologia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Terapia Combinada , Depressão/psicologia , Medo , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/psicologia , Estadiamento de Neoplasias , Inventário de Personalidade , Apoio SocialRESUMO
Breast cancer survivors (BCS) often experience psychological and physiological symptoms after cancer treatment. Mindfulness-based stress reduction (MBSR), a complementary and alternative therapy, has reduced subjective measures of stress, anxiety, and fatigue among BCS. Little is known, however, about how MBSR affects objective markers of stress, specifically the stress hormone cortisol and the pro-inflammatory cytokine interleukin-6 (IL-6). In the present study, BCS ( N = 322) were randomly assigned to a 6-week MBSR program for BC or usual-care control. Measurements of cortisol, IL-6, symptoms, and quality of life were obtained at orientation and 6 weeks. Cortisol and IL-6 were also measured prior to and after the MBSR(BC) class Weeks 1 and 6. The mean age of participants was 56.6 years and 69.4% were White non-Hispanic. Most had Stage I (33.8%) or II (35.7%) BC, and 35.7% had received chemotherapy and radiation. Cortisol levels were reduced immediately following MBSR(BC) class compared to before the class Weeks 1 and 6 (Wilcoxon-signed rank test; p < .01, d = .52-.56). IL-6 was significantly reduced from pre- to postclass at Week 6 (Wilcoxon-signed rank test; p < .01, d = .21). No differences were observed between the MBSR(BC) and control groups from baseline to Week 6 using linear mixed models. Significant relationships with small effect sizes were observed between IL-6 and both symptoms and quality of life in both groups. Results support the use of MBSR(BC) to reduce salivary cortisol and IL-6 levels in the short term in BCS.
Assuntos
Neoplasias da Mama/fisiopatologia , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Hidrocortisona/análise , Interleucina-6/sangue , Atenção Plena , Estresse Psicológico/terapia , Adulto , Idoso , Biomarcadores , Feminino , Florida , Humanos , Pessoa de Meia-Idade , Saliva/químicaRESUMO
Resumen El propósito del presente estudio es examinar la validez de constructo y consistencia interna del Inventario Peruano de Mindfulness y Ecuanimidad. Basado en el análisis factorial y la Teoria de Respuesta al Item (Modelo de Crédito Parcial y el Método de Escalabilidad de Mokken), se examinó la magnitud de los parâmetros y se estimò la varianza de cada uno de los items para contribuir en el constructo general de mindfulness. La muestra del estudio está compuesta por 602 adultos, estudiantes de tres instituciones acadêmicas de educación superior de Lima, Chiclayo y Chimbote en el Perú. Los resultados de estos análisis indican una estructura unidimensional del instrumento, en función a ocho items representados por los atributos de atención, consciencia, aceptación, juicio de valor, y ecuanimidad. Los indicadores de ajuste del modelo de factores oblicuos para los items seleccionados fueron satisfactorios: CEI = .982, RMSEA = .043 (IC90% = .029, .056), SRMR = .048, SB--2 (gl: 35) = 73.415 (p > 0.05).
Abstract The main purpose of this study is to report the construct validity and internal consistency of the Peruvian Inventory of Mindfulness and Equanimity. Based on the factor analysis and the Item response Theory (the Partial Credit Model and the Mokken Scale Analysis), the parameters magnitude was examined, and we estimated the variance of each item of the instrument that contribute to the general construct of mindfulness. The analyses were carried out on a sample of 602 adults, students from three educational institutions at the university level in the cities of Lima, Chiclayo, and Chimbote in Peru. The results of all the analyses performed on this peruvian sample suggest a unidimensional structure of this inventory, based on the eight items selected that include the abilities of attention, consciousness, acceptance, judgment, and equanimity. The goodness of fit index and adjusted goodness of fit index for the oblique factors were satisfactory: CEI = .982, RMSEA = .043 (lC90% = .029, .056), SRMR = .048, SB- -2 (gl: 35) = 73.415 (p > 0.05).
RESUMO
PURPOSE: The purpose of this substudy of a large randomized controlled trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction (Breast Cancer) (MBSR[BC]) program compared to usual care (UC) in normalizing blood levels of pro-inflammatory cytokines among breast cancer survivors (BCS). METHOD: A total of 322 BCS were randomized to either a 6-week MBSR(BC) program or a UC. At baseline and 6 and 12 weeks, 10 ml of venous blood and demographic and clinical data were collected and/or updated. Plasma cytokines (interleukin [IL]-1ß, IL-6, IL-10, tumor necrosis factor [TNF] α, transforming growth factor [TGF] ß1, soluble tumor necrosis factor receptor [sTNFR] 1) were assayed. Linear mixed models were used to assess cytokine levels across three time points (baseline and 6 and 12 weeks) by group (MBSR[BC] vs. UC). RESULTS: Of the six measured cytokines, three were nondetectable at rates greater than 50% (IL-10, IL-1ß, TGF-ß1) and, because of overall low prevalence, were not analyzed further. For the remaining cytokines (TNFα, IL-6, sTNFR1), results showed that TNFα and IL-6 increased during the follow-up period (between 6 and 12 weeks) rather than during the MBSR(BC) training period (between baseline and 6 weeks), while sTNFR1 levels did not change significantly across the 12-week period. CONCLUSIONS: Study results suggest that MBSR(BC) affects cytokine levels in BCS, mainly with increases in TNFα and IL-6. The data further suggest that B-cell modulation may be a part of immune recovery during breast cancer management and that increases in TNFα and IL-6 may be markers for MBSR(BC)-related recovery.
Assuntos
Biomarcadores/sangue , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/psicologia , Citocinas/sangue , Inflamação/sangue , Atenção Plena , Estresse Psicológico/prevenção & controle , Estresse Psicológico/fisiopatologia , Adulto , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
CONTEXT: Breast cancer survivors (BCS) face adverse physical and psychological symptoms, often co-occurring. Biologic and psychological factors may link symptoms within clusters, distinguishable by prevalence and/or severity. Few studies have examined the effects of behavioral interventions or treatment of symptom clusters. OBJECTIVES: The aim of this study was to identify symptom clusters among post-treatment BCS and determine symptom cluster improvement following the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR(BC)) program. METHODS: Three hundred twenty-two Stage 0-III post-treatment BCS were randomly assigned to either a six-week MBSR(BC) program or usual care. Psychological (depression, anxiety, stress, and fear of recurrence), physical (fatigue, pain, sleep, and drowsiness), and cognitive symptoms and quality of life were assessed at baseline, six, and 12 weeks, along with demographic and clinical history data at baseline. A three-step analytic process included the error-accounting models of factor analysis and structural equation modeling. RESULTS: Four symptom clusters emerged at baseline: pain, psychological, fatigue, and cognitive. From baseline to six weeks, the model demonstrated evidence of MBSR(BC) effectiveness in both the psychological (anxiety, depression, perceived stress and QOL, emotional well-being) (P = 0.007) and fatigue (fatigue, sleep, and drowsiness) (P < 0.001) clusters. Results between six and 12 weeks showed sustained effects, but further improvement was not observed. CONCLUSION: Our results provide clinical effectiveness evidence that MBSR(BC) works to improve symptom clusters, particularly for psychological and fatigue symptom clusters, with the greatest improvement occurring during the six-week program with sustained effects for several weeks after MBSR(BC) training. TRIAL REGISTRATION: Name and URL of Registry: ClinicalTrials.gov. Registration number: NCT01177124.
Assuntos
Neoplasias da Mama/psicologia , Atenção Plena/métodos , Qualidade de Vida/psicologia , Estresse Psicológico/terapia , Sobreviventes/psicologia , Neoplasias da Mama/complicações , Cognição/fisiologia , Fadiga/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this randomized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program in improving psychological and physical symptoms and quality of life among breast cancer survivors (BCSs) who completed treatment. Outcomes were assessed immediately after 6 weeks of MBSR(BC) training and 6 weeks later to test efficacy over an extended timeframe. PATIENTS AND METHODS: A total of 322 BCSs were randomly assigned to either a 6-week MBSR(BC) program (n = 155) or a usual care group (n = 167). Psychological (depression, anxiety, stress, and fear of recurrence) and physical symptoms (fatigue and pain) and quality of life (as related to health) were assessed at baseline and at 6 and 12 weeks. Linear mixed models were used to assess MBSR(BC) effects over time, and participant characteristics at baseline were also tested as moderators of MBSR(BC) effects. RESULTS: Results demonstrated extended improvement for the MBSR(BC) group compared with usual care in both psychological symptoms of anxiety, fear of recurrence overall, and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference (P < .01). Overall effect sizes were largest for fear of recurrence problems (d = 0.35) and fatigue severity (d = 0.27). Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC). CONCLUSION: The MBSR(BC) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC) training, with generally small to moderate overall effect sizes.
Assuntos
Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Atenção Plena/métodos , Estresse Psicológico/terapia , Sobreviventes/psicologia , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Psicometria , Qualidade de Vida , Estresse Psicológico/etiologia , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Antecedentes: el presente artículo presenta una revisión empírica de la integración de mindfulness e inteligencia emocional. Mindfulness es un modelo de intervención cognitiva que facilita la toma de consciencia con la experiencia en el momento presente, favoreciendo la autorregulación emocional. Igualmente, la inteligencia emocional ha sido conceptualizada como una constelación de habilidades relacionadas con la percepción, entendimiento y un adecuado manejo de las emociones propias y de los demás. Ambos marcos conceptuales están asociados con un buen sentido de bienestar y desarrollo personal. Estado del arte: se presenta una revisión de la evidencia científica preliminar publicada en la literatura psicológica y de educación, examinando los efectos mediadores de ambos constructos en el proceso de regulación emocional y calidad de vida individual. Conclusiones: los reportes de los estudios evaluados indican que la interacción de mindfulness disposicional e inteligencia emocional ofrece beneficios significativos en los estados de bienestar de las personas. De igual manera, se reportó que la inteligencia emocional es un mediador entre mindfulness e incrementos en las emociones positivas. El propósito del presente artículo de revisión es identificar un modelo integrador en la regulación de la emociones, incluyendo los «ingredientes activos¼ que influyen en los estados de bienestar y la forma en que la práctica de mindfulness contribuye al aumento de las habilidades de la inteligencia emocional.
Background: this article presents an empirical review of the integration of mindfulness and emotional intelligence. Mindfulness is a cognitive intervention model that helps people to develop awareness of their experience in the present moment favoring emotional self-regulation. Similarly, emotional intelligence has been conceptualized as a constellation of abilities related to the perception, understanding and adequate management of emotions within and among people. Both conceptual models are associated with a good sense of well-being and personal development. State of the art: this paper reviews the preliminary scientific evidence published in psychology and education literature, and examines the mediating effects of these two constructs in the process of emotional regulation and quality of life of individuals. Conclusions: the study results indicate that the interaction of mindfulness and emotional intelligence offers important benefits for people's well- being. It was also reported that emotional intelligence acts as mediator between mindfulness and greater positive emotions. The purpose of this review article is to identify a model of integration for emotional regulation that includes «active ingredients¼ to influence well-being and the way in which the practice of mindfulness contributes to increase the abilities of emotional intelligence.
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Mindfulness-based stress reduction (MBSR) reduces symptoms of depression, anxiety, and fear of recurrence among breast cancer (BC) survivors. However, the effects of MBSR (BC) on telomere length (TL) and telomerase activity (TA), known markers of cellular aging, psychological stress, and disease risk, are not known. This randomized, wait-listed, controlled study, nested within a larger trial, investigated the effects of MBSR (BC) on TL and TA. BC patients (142) with Stages 0-III cancer who had completed adjuvant treatment with radiation and/or chemotherapy at least 2 weeks prior to enrollment and within 2 years of completion of treatment with lumpectomy and/or mastectomy were randomly assigned to either a 6-week MBSR for BC program or a usual care. Assessments of TA and TL were obtained along with psychological measurements at baseline, 6 weeks, and 12 weeks after completing the MBSR(BC) program. The mean age of 142 participants was 55.3 years; 72% were non-Hispanic White; 78% had Stage I or II cancer; and 36% received both chemotherapy and radiation. In analyses adjusted for baseline TA and psychological status, TA increased steadily over 12 weeks in the MBSR(BC) group (approximately 17%) compared to essentially no increase in the control group (approximately 3%, p < .01). In contrast, no between-group difference was observed for TL (p = .92). These results provide preliminary evidence that MBSR(BC) increases TA in peripheral blood mononuclear cells from BC patients and have implications for understanding how MBSR(BC) may extend cell longevity at the cellular level.
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Neoplasias da Mama/psicologia , Atenção Plena , Estresse Psicológico/terapia , Telomerase/metabolismo , Idoso , Sequência de Bases , Neoplasias da Mama/enzimologia , Neoplasias da Mama/terapia , Terapia Combinada , Primers do DNA , Feminino , Humanos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , GravidezRESUMO
OBJECTIVES: This randomized controlled trial was conducted to examine immune recovery following breast cancer (BC) therapy and evaluate the effect of mindfulness-based stress reduction therapy (MBSR) on immune recovery with emphasis on lymphocyte subsets, T cell activation, and production of T-helper 1 (Th1; interferon [IFN]-γ) and T-helper 2 (Th2; interleukin-4 [IL-4]) cytokines. METHOD: Participants who completed the study consisted of 82 patients diagnosed with Stage 0-III BC, who received lumpectomy and adjuvant radiation ± chemotherapy. Patients were randomized into an MBSR(BC) intervention program or a control (usual care) group. Immune cell measures were assessed at baseline and within 2 weeks after the 6-week intervention. The numbers and percentages of lymphocyte subsets, activated T cells, and Th1 and Th2 cells in peripheral blood samples were determined by immunostaining and flow cytometry. RESULTS: Immune subset recovery after cancer treatment showed positive associations with time since treatment completion. The B and natural killer (NK) cells were more susceptible than T cells in being suppressed by cancer treatment. Women who received MBSR(BC) had T cells more readily activated by the mitogen phytohemagglutinin (PHA) and an increase in the Th1/Th2 ratio. Activation was also higher for the MBSR(BC) group if <12 weeks from the end of treatment and women in MBSR(BC) <12 weeks had higher T cell count for CD4(+). CONCLUSION: MBSR(BC) promotes a more rapid recovery of functional T cells capable of being activated by a mitogen with the Th1 phenotype, whereas substantial recovery of B and NK cells after completion of cancer treatment appears to occur independent of stress-reducing interventions.
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Neoplasias da Mama/sangue , Contagem de Linfócitos , Estresse Psicológico/terapia , Idoso , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Citometria de Fluxo , Humanos , Subpopulações de Linfócitos , Pessoa de Meia-IdadeRESUMO
La depresión en adolescentes es una problemática multicausal y predictora de problemas sociales y otros trastornos. Por ello, es considerada un problema de salud pública. El objetivo de la presente investigación es realizar una revisión sistemática de las características de los artículos científicos publicados en revistas peruanas y no peruanas sobre depresión en adolescentes peruanos. La búsqueda se realizó en las bases de datos Scielo, Latindex, Redalyc, Scopus, PubMed y a través de Google, utilizando combinación de palabras clave relacionadas al constructo, la muestra y su procedencia. La unidad de análisis estuvo conformada por 21 artículos. En los estudios destaca la inconsistencia en el reporte y sustento bibliográfico del diseño de investigación, del procedimiento de muestreo y de las propiedades psicométricas de los instrumentos; también, de la utilización de instrumentos que no han sido evaluados en nuestro contexto y de puntos de corte obtenidos en muestras de otros países. Debido a ello, se puede afirmar que los estudios no cumplen en su totalidad con los estándares de publicación propuestos por la American Psychological Association.
Depression in adolescents is a multicausal phenomenon and a predictor of social problems and other disorders. Thus, it is considered a public health problem. This investigation aims to systematically review the characteristics of the scientific articles about depression in Peruvian adolescents published in Peruvian and non- Peruvian journals. The search was performed in the databases of Scielo, Latindex, Redalyc, Scopus, PubMed, and through Google, using a combination of keywords related to the construct, the sample and its origin. The unit of analysis consisted of 21 articles. The reviewed articles showed inconsistency in the reporting and bibliographic support of the research designs, sampling procedures, psychometric properties of the instruments, instruments used to assess the construct which were not evaluated in our context, and cut-off points obtained in other countries samples. Therefore, we can state that the reviewed articles do not fully comply with the publication standards proposed by the American Psychological Association.
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PURPOSE: To investigate whether a mindfulness-based stress reduction program for cancer (MBSR-C) improved psychological and physical symptoms, quality of life (QOL), and stress markers among advanced-stage cancer patients and caregivers. DESIGN: A pilot within-subject design was used. METHOD: Patients previously diagnosed with advanced-stage breast, colon, lung, or prostate cancer and on treatment were recruited from the Moffitt Cancer Center and Research Institute. Twenty-six patient-caregiver dyads completed a modified 6-week, self-study MBSR-C program based on the Kabat-Zinn model. Psychological and physical symptoms and QOL were compared pre- and post-MBSR-C sessions. Salivary cortisol and interleukin-6 were assessed pre- and post-MBSR-C session at 1, 3, and 6 weeks. FINDINGS: Following the 6-week MBSR program, patients showed improvements in stress and anxiety (p < .05); caregivers' psychological and QOL also improved but were not statistically significant. Both patients and caregivers had decreases in cortisol at Weeks 1 and 3 (p < .05) but not at Week 6. Similar to cortisol levels at Week 6, salivary interleukin-6 levels were lower overall (before/after an MBSR-C session), compared with Week 1 for patients and caregivers. CONCLUSIONS: MBSR-C may be a beneficial intervention for reducing stress, anxiety, cortisol levels, and symptoms in advanced-stage cancer patients and may also benefit caregivers.
Assuntos
Cuidadores/psicologia , Relações Metafísicas Mente-Corpo , Neoplasias/psicologia , Qualidade de Vida/psicologia , Saliva/química , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Adulto , Idoso , Biomarcadores/análise , Neoplasias da Mama/psicologia , Feminino , Humanos , Hidrocortisona/análise , Interleucina-6/sangue , Neoplasias Pulmonares/psicologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/complicações , Neoplasias/patologia , Projetos Piloto , Neoplasias da Próstata/psicologia , Autocuidado/métodos , Estresse Psicológico/etiologia , Estresse Psicológico/metabolismoRESUMO
El propósito principal del presente estudio fue verificar la estructura factorial de las dos escalas que componen el Inventario Multicultural de la Expresión de la Ira y Hostilidad desde una perspectiva confirmatoria. Se utilizó el Análisis Factorial Confirmatorio en una muestra de 264 participantes provenientes de una universidad privada de Lima, Perú. El muestreo fue no probabilístico e incluyó estudiantes (25%), personal docente (17.8%) y personal administrativo (57.2%). La confiabilidad del instrumento fue evaluada mediante los modelos congenérico, tau-equivalente y paralelo para cada una de las seis subescalas del instrumento, así como también calculada en base al coeficiente alfa de Cronbach con intervalos de confianza.
The main purpose of this study was to verify the factorial structure of the two scales that make up the Multicultural Inventory of Expression of Anger and Hostility from a confirmatory perspective. We performed the Confirmatory Factor Analysis with a non-probability sample of 264 participants from a private university in Lima, Peru. The sampling included university students (25%), faculty members (17.8%) and administrative staff (57.2%). The reliability of the instrument was evaluated using the congeneric, tau-equivalent and parallel models for each of the six subscales of the instrument, as well as calculated based on Cronbach's alpha coefficient with confidence intervals. Results: Factor analysis performed in the present Peruvian sample identified four dimensions for the Anger Expression Scale (Anger-In, Anger-Out, Anger/Control In, and Anger/Control-Out) and two factors for the Hostility Scale (impulsive reaction to anger; and temperament), which substantially verified the factor structure of previous studies conducted in Latin American samples. The congeneric modelindicates an appropriate fit for each of the subscales of anger and hostility. Based on the results of the Confirmatory Factor Analysis performed in the present study, the factorial structure of both scales of the Multicultural Anger Expression and Hostility Inventory is robust and shows substantial empirical evidence of construction validity and internal consistency of the instrument.
RESUMO
PURPOSE: To assess the feasibility of whether mindfulness-based stress reduction (MBSR) has a positive effect on breast cancer survivors' psychological status, psychosocial characteristics, symptoms, and quality of life (QOL) during the critical transition period from end of treatment to resumption of daily activities. DESIGN: Single-group, quasi-experimental, pretest-posttest design. METHOD: A sample of 19 women who completed breast cancer treatment with lumpectomy, radiation, and/or chemotherapy was recruited from the Moffitt Cancer Center and Research Institute, a National Cancer Institute- designated cancer center, and the University of South Florida. The authors assessed the feasibility, compliance, and whether an 8-week MBSR program positively influenced changes in psychological status (fear of recurrence, perceived stress, anxiety, depression), psychosocial characteristics (optimism, social support, spirituality), physical symptoms, and QOL. FINDINGS: Seventeen women (89.5%) completed the study. The mean age was 57 years; the majority of participants (94%) were White. The estimated compliance rate for the program was 67%. Paired t tests indicated significant improvements fear of recurrence, perceived stress, anxiety, depression, and QOL through MBSR participation. CONCLUSIONS: Participants enrolled in the MBSR classes generally were compliant. Significant improvement in psychological status, symptoms, and QOL can be achieved with MBSR use in this population.
Assuntos
Neoplasias da Mama/psicologia , Saúde Holística , Meditação/métodos , Qualidade de Vida/psicologia , Espiritualidade , Estresse Psicológico/psicologia , Sobreviventes/psicologia , Adulto , Neoplasias da Mama/reabilitação , Emoções , Estudos de Viabilidade , Feminino , Enfermagem Holística/métodos , Humanos , Saúde Mental , Pessoa de Meia-Idade , Relações Metafísicas Mente-Corpo , Apoio Social , Resultado do TratamentoRESUMO
Presentamos un resumen y una breve historia del creciente campo de Intervenciones Basadas en mindfulness o conciencia plena. En los últimos tiempos, existe un gran interés en este modelo terapéutico para reducir la vulnerabilidad al estrés crónico y distrés emocional. Mindfulness requiere intencionalmente enfocar nuestra atención a las experiencias que ocurren en el momento presente. A medida que la investigación avanza en esta temática, es vital definir cuidadosamente la estructura de mindfulness y comprender mejor sus mecanismos de acción neurocognitiva. Este informe presenta un marco conceptual que enfatiza el papel central de control atencional y mecanismos de sostenibilidad para desarrollar las habilidades de conciencia plena. También, repasamos la estructura de mindfulness y la autorregulación de las emociones; luego describimos brevemente nuestra investigación relacionada con nuestro programa de Reducción del Estrés en Cáncer de Mama basado en Mindfulness (MBSR-AC) en la University of South Florida. Se presenta, a partir de esta premisa, un modelo propuesto que explica nuestros mecanismos cognitivos basados en la lógica del modelo de biocomportamental.
We are presenting an overview and a brief history of the growing field of Mindfulness Based Interventions. There has been a significant interest in this therapeutic model to reduce vulnerability to chronic stress and emotional distress in recent times. Mindfulness requires intentionally bringing our attention to the experiences that occur in the present moment. As the research advances in this line of inquiry, it is vital to carefully define the construct of Mindfulness and better understand its neurocognitive mechanisms of action. This review presents conceptual framework that emphasizes the central role of attentional control and sustainability mechanisms to build mindfulness skills. We also review the construct of Mindfulness and self-regulation of emotions; then describe briefly our research related to our Mindfulness Based-Stress Reduction Breast Cancer (MBSR-BC) program at the University of South Florida. With this premise, we present a model explaining our proposed cognitive mechanisms based on the Logic of the Biobehavioral Model.