Written expressive disclosure in adults with irritable bowel syndrome: A randomized controlled trial.

BACKGROUND: The benefits of written expressive disclosure (WED) to health are documented in a variety of healthy and clinical populations. This study investigates the effect of WED on health-related outcomes in irritable bowel syndrome (IBS). METHODS: Adults (N = 189) meeting Rome III criteria for IBS were randomly assigned to write about their: (1) deepest thoughts and feelings about the most stressful life event of the past five years (n = 67), (2) deepest thoughts and feelings about their IBS (n = 61) or (3) daily activities in an objective manner (control condition; n = 61). Participants completed four 20-min writing sessions over 2-6 weeks. Gastrointestinal (GI) symptoms, healthcare utilization, health-related quality of life (HR-QOL), pain catastrophizing, and pain self-efficacy were assessed at baseline, one month post-writing completion, and three months post-writing completion. RESULTS: A significant group (combined WED vs. control) X time interaction was detected for healthcare utilization, F(1,147) = 6.16, p = 0.014, η2 = 0.04. Specifically, number of GI-related medical appointments significantly increased from baseline to 3-month follow-up in the control group, while no significant change was observed in the combined WED group. Among the WED group, individuals assigned to write about their IBS experienced greater improvements in pain self-efficacy than those assigned to write about a life stressor, F(1,92) = 3.89, p = 0.024, η2 = 0.08. GI symptom severity, HR-QOL, and pain catastrophizing improved significantly across groups over time, with no significant between-group differences. CONCLUSION: Writing about one's deepest thoughts and feelings about IBS may increase pain self-efficacy and reduce healthcare utilization compared to control writing in adults with IBS.

Insomnia and Fatigue Symptom Trajectories in Breast Cancer: A Longitudinal Cohort Study.

Objective: Insomnia and fatigue are common, although not inevitable, during breast cancer. This study is one of the first aiming to describe distinct trajectory classes of insomnia and fatigue symptoms, and their correlates, from diagnosis through treatment.Methods: This longitudinal cohort study was conducted at a comprehensive cancer center and community oncology practices. Participants (N = 460) were women diagnosed with any stage of breast cancer in the previous 4 months. Primary outcomes for this ancillary study of the existing cohort were self-reported insomnia and fatigue symptoms assessed repeatedly across 12 months.Results: Four distinct classes of insomnia symptoms emerged: persistently very high, clinically elevated symptoms (13.7%); high, clinically elevated symptoms (65.9%); stable low (17.2%) or very low (2.6%) symptoms. Five fatigue symptom classes included high, increasing fatigue (9.6%), two recovery classes starting at high (26.3%), or moderate (18.0%) severity at diagnosis, stable low (33.3%) or very low (12.2%) classes. In multivariate analyses, higher depressive symptoms, anxiety, and chronic life stress were associated with being in the very high insomnia class versus the low symptom class. Oncologic factors were not associated with insomnia class membership. Receiving chemotherapy was linked significantly to high and recovery fatigue symptom classes versus the low class. Higher chronic life stress was associated with more persistent fatigue symptoms.Conclusions: Distinct classes of insomnia and fatigue symptoms were evident; 79.6% of the women had clinically elevated, persistent insomnia symptoms, 53.9% had elevated fatigue. A substantial minority evidenced low symptoms, suggesting targeted or stepped-care approaches to symptom management.

Spirituality and depressive symptoms in a multiethnic sample of cancer survivors.

OBJECTIVE: This study aimed to (a) examine the relationships of 3 facets of spirituality (i.e., meaning, peace, faith), and their interaction, with depressive symptoms among Black, Latino, and White cancer survivors; and (b) test fear of cancer recurrence (FCR) and social support (SS) as mediators of these relationships. METHOD: Data were analyzed from the American Cancer Society's Study of Cancer Survivors-I, a longitudinal population-based study of cancer survivors' quality of life. A national sample of Black (n = 194), Latino (n = 90), and White (n = 2,775) survivors of the top 10 incident cancers completed measures 1 year (Time 1, T1), 2 years (Time 2, T2), and 9 years (Time 3, T3) postdiagnosis. RESULTS: After controlling for T1 depressed mood and demographic and medical characteristics, T1 lower meaning and lower peace, but not faith, predicted greater depressive symptoms at T3 in the total sample. A significant interaction showed that higher faith predicted greater depressive symptoms specifically in the context of lower meaning. Race/ethnicity did not affect these relationships. FCR at T2 partially mediated the relationships of T1 meaning and peace with T3 depressive symptoms, and SS partially mediated the relationship between T1 meaning and T3 depressive symptoms. CONCLUSIONS: Cancer survivors with greater meaning and peace appear better able to integrate the cancer experience into their lives. An interaction between T1 meaning and faith on T3 depressive symptoms replicated previous findings. Future research should treat spirituality as a multidimensional construct and focus on identifying and influencing malleable mechanisms of the associations between spirituality and mental health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single-arm pilot study.

OBJECTIVE: Apply the National Institutes of Health (NIH) Stage Model to design and test an intervention to prevent depression in breast cancer patients at risk for depression. METHODS: We identified mindful emotion awareness, along with approach and avoidance strategies for cancer-related coping and emotion regulation, as targets for a preventive intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Patients' preferences for individual, in-person, and time-efficient sessions informed the design. Patients at risk for depression received a 6-week, 5-hour intervention with daily exercises. Intervention targets were assessed at baseline, before each session, and 4-weeks post intervention. Mixed effects analysis of variance (ANOVA) assessed change over the follow-up period, controlling for age, partnered status, and disease stage. RESULTS: Fifty-five percent (40/72) of women screened within 6 months of diagnosis had elevated depression risk. Of these, 24 (60%) signed consent. Sixteen received intervention after five were excluded for current depressive disorder, cognitive impairment, or death. Three dropped out. Ninety-eight percent attendance and 77% practice days indicated feasibility. Effect sizes (Cohen's d) corrected for regression to the mean (RTM) were 0.82 for cancer-related acceptance coping, 0.65 for cancer-related emotional expression, and 0.32 and 0.42 for decreased cancer-related avoidance coping and depressive symptoms, respectively. Effect sizes for variables lacking data to correct for RTM were 1.0, 0.7, and 0.5 for decreased rumination, experiential avoidance, and fear of depression, respectively, and 1.3, 0.6, and 0.4 for increased cognitive flexibility, distress tolerance, and describing/not judging emotions, respectively. CONCLUSIONS: The feasibility of this intervention and malleability of its targets support its further investigation.

Effects of mindfulness training on emotional and physiologic recovery from induced negative affect.

OBJECTIVE: Mindfulness training has been shown to improve psychological well-being and physical health. One proposed pathway for the positive effects of mindfulness training is through the development of new emotion regulation strategies, such as the ability to experience emotions by observing and accepting them without judgment. Theoretically, this should facilitate recovery from negative emotional states; however, this has rarely been examined empirically. The goal of the current study was to determine whether mindfulness training is associated with more efficient emotional and cardiovascular recovery from induced negative affect. METHODS: The current study tested emotional and cardiovascular recovery from induced negative affect during a personal recall task in women randomly assigned to 6-weeks of mindfulness training (n=39) compared to women assigned to a wait-list control condition (n=32). During baseline, task, and post-task rest, blood pressure and heart rate were monitored at fixed intervals and heart rate variability (HRV) and pre-ejection period (PEP) were monitored continuously. This study was embedded within a randomized trial that evaluated the effects of mindfulness training in a sample of younger breast cancer survivors, a group in need of access to effective psychosocial intervention as they can experience high stress, anxiety, and physical symptoms for many years in to survivorship. RESULTS: In response to the personal recall task, women in both the intervention and control groups showed significant increases in sadness, anxiety, and anger, with the intervention group reaching higher levels of sadness and anger than controls. Further, the intervention group showed a significantly steeper decline in sadness and anger, as well as steeper initial decline in diastolic blood pressure compared to women in the wait list control condition. Groups did not differ in their self-reported feelings of anxiety, or in blood pressure, heart rate, or pre-ejection period (PEP) responses to the task. The control group demonstrated an increase in heart rate variability (HRV) during the task (indexed by the root mean square of successive differences in heart rate; RMSSD) while the intervention group remained flat throughout the task. CONCLUSION: Compared to the control group, women in the intervention group experienced greater negative emotions when recalling a difficult experience related to their breast cancer, and demonstrated an efficient emotional and blood pressure recovery from the experience. This suggests that mindfulness training may lead to an enhanced emotional experience coupled with the ability to recovery quickly from negative emotional states.

Preparedness and Cancer-Related Symptom Management among Cancer Survivors in the First Year Post-Treatment.

BACKGROUND: Many cancer survivors feel unprepared for the physical and psychosocial challenges that accompany the post-treatment care transition (i.e., re-entry phase), including management of cancer-related symptoms. Few studies have investigated personal and contextual factors associated with the extent of preparedness for re-entry or how they are related to cancer-related symptom management. PURPOSE: Data from the American Cancer Society's Cancer Survivor Transition Study examined (1) characteristics of breast, prostate, and colorectal cancer survivors (n = 1188) within the first year of completing treatment who are most and least prepared for re-entry; and (2) how preparedness level and other characteristics are related to cancer-related symptom management. METHODS: Stanton and colleagues' [1] conceptual model of survivorship guided the selection of interpersonal/environmental, individual, and disease/treatment-related characteristics as potential contributors to levels of preparedness and cancer-related symptom management using regression tree and multivariate linear regression analyses. RESULTS: Survivors, on average, felt moderately prepared for the transition to post-treatment care. Lowest levels of preparedness were found among survivors with relatively high depressive symptoms, low perceived quality of oncology-provided survivorship care, and limited discussion about potential side effects with a health professional. Poorer symptom management was associated with younger age, having more comorbid conditions, and lower preparedness, social support, and spirituality. CONCLUSION: Survivors who feel unprepared for the transition to post-treatment care report poorer cancer-related symptom management. Identification of factors associated with low perceived preparedness and poor cancer-related symptom management will assist in risk stratification and development of tailored interventions to meet the needs of cancer survivors during re-entry.

Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors.

OBJECTIVE: Mindfulness meditation reduces psychological distress among individuals with cancer. However, mechanisms for intervention effects have not been fully determined. This study tested emotion regulation strategies as mediators of intervention effects in a sample of younger women treated for breast cancer, a group at risk for psychological distress. We focused on two distinct strategies targeted by the intervention-rumination and self-kindness-and further examined the broader construct of mindfulness as a potential mediator. METHOD: Women (n = 71) with Stage 0-III breast cancer diagnosed at or before age 50 who had completed cancer treatment were randomly assigned to a 6-week mindfulness intervention or wait-list control group. Assessments occurred at study entry, postintervention, and a 3-month follow-up. RESULTS: In single mediator analyses, increases in self-kindness (CIB [-7.83, -1.93]), decreases in rumination (CIB [-5.05, -.31]), and increases in mindfulness (CIB [-6.58, -.82]) each mediated reductions in depressive symptoms from pre- to postintervention. Increases in self-kindness also mediated reductions in perceived stress (CIB [-5.37, -.62]) from pre- to postintervention, and increases in self-kindness (CIB [-5.67, -.22]) and in mindfulness (CIB [-5.51, -.16]) each mediated intervention effects on perceived stress from preintervention to 3-month follow-up. In multiple mediator analysis, only self-kindness mediated intervention effects on depressive symptoms from pre- to postintervention (CIB [-6.41, -.61]), and self-kindness and mindfulness together mediated intervention effects on perceived stress from preintervention to follow-up (CIB [-6.77, -.35]). CONCLUSIONS: Self-kindness played a consistent role in reducing distress in younger women with breast cancer. The efficacy of this understudied emotion regulation strategy should be evaluated in other clinical populations. (PsycINFO Database Record

Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial.

BACKGROUND: Premenopausal women diagnosed with breast cancer are at risk for psychological and behavioral disturbances after cancer treatment. Targeted interventions are needed to address the needs of this vulnerable group. METHODS: This randomized trial provided the first evaluation of a brief, mindfulness-based intervention for younger breast cancer survivors designed to reduce stress, depression, and inflammatory activity. Women diagnosed with early stage breast cancer at or before age 50 who had completed cancer treatment were randomly assigned to a 6-week Mindful Awareness Practices (MAPS) intervention group (n = 39) or to a wait-list control group (n = 32). Participants completed questionnaires before and after the intervention to assess stress and depressive symptoms (primary outcomes) as well as physical symptoms, cancer-related distress, and positive outcomes. Blood samples were collected to examine genomic and circulating markers of inflammation. Participants also completed questionnaires at a 3-month follow-up assessment. RESULTS: In linear mixed models, the MAPS intervention led to significant reductions in perceived stress (P = .004) and marginal reductions in depressive symptoms (P = .094), as well as significant reductions in proinflammatory gene expression (P = .009) and inflammatory signaling (P = .001) at postintervention. Improvements in secondary outcomes included reduced fatigue, sleep disturbance, and vasomotor symptoms and increased peace and meaning and positive affect (P < .05 for all). Intervention effects on psychological and behavioral measures were not maintained at the 3-month follow-up assessment, although reductions in cancer-related distress were observed at that assessment. CONCLUSIONS: A brief, mindfulness-based intervention demonstrated preliminary short-term efficacy in reducing stress, behavioral symptoms, and proinflammatory signaling in younger breast cancer survivors.

Facets of spirituality as predictors of adjustment to cancer: relative contributions of having faith and finding meaning.

Spirituality is a multidimensional construct, and little is known about how its distinct dimensions jointly affect well-being. In longitudinal studies (Study 1, n = 418 breast cancer patients; Study 2, n = 165 cancer survivors), the authors examined 2 components of spiritual well-being (i.e., meaning/peace and faith) and their interaction, as well as change scores on those variables, as predictors of psychological adjustment. In Study 1, higher baseline meaning/peace, as well as an increase in meaning/peace over 6 months, predicted a decline in depressive symptoms and an increase in vitality across 12 months in breast cancer patients. Baseline faith predicted an increase in perceived cancer-related growth. Study 2 revealed that an increase in meaning/peace was related to improved mental health and lower cancer-related distress. An increase in faith was related to increased cancer-related growth. Both studies revealed significant interactions between meaning/peace and faith in predicting adjustment. Findings suggest that the ability to find meaning and peace in life is the more influential contributor to favorable adjustment during cancer survivorship, although faith appears to be uniquely related to perceived cancer-related growth.