Stress and Response to Treatment: Insights From a Pilot Study Using a 4-week Contemplative Self-Healing Meditation Intervention for Posttraumatic Stress in Breast Cancer.

Along with symptoms of anxiety and depression, many breast cancer survivors experience symptoms of posttraumatic stress disorder (PTSD) that may worsen in the setting of other stressful life events. The aim of this pilot study was to evaluate whether a 4-week version of our Contemplative Self-Healing program would have different effects in reducing PTSD symptoms between breast cancer survivors with or without chronic stress at baseline. PTSD symptoms were measured using the Impact of Events scale (IES). A linear mixed model analysis was used to evaluate within patients changes in IES score. Results showed that breast cancer patients who were experiencing chronic stress reported greater improvement in IES score than those without chronic stress. Our preliminary findings shed light on the need to evaluate life stressors in breast cancer patients. Evaluating chronic stress may be essential in predicting which cancer patients may benefit most from a psychological intervention.

Contemplative self healing in women breast cancer survivors: a pilot study in underserved minority women shows improvement in quality of life and reduced stress.

BACKGROUND: Among underserved, largely minority women who were breast cancer survivors, this pilot project was designed to evaluate the quality of life outcomes of a 20 week Contemplative Self-Healing Program. METHODS: Women previously treated for stage I-III breast cancer were assessed before and after the 20 week program with the FACT-G, FACT-B, FACIT-Spirituality, ECOG, and the Impact of Events Scale. They participated in a 20-week intervention involving guided meditation and cognitive-affective-behavioral learning. RESULTS: With an average age of 63, 62% of the participants were African-American or Latino. With an average of 5.4 years since the diagnosis of breast cancer, 72% had an ECOG performance status of 1. 57% were currently working. Their baseline FACT-G was 80.5 ± 15.1, and their baseline Impact of Events Scale was 26.3 ± 18.9. The within-patient improvement on the FACT-G was 4.6 ± 10.9 (p = .01); in parallel the FACT-B improved by 2.8 ± 12.8 points (p = .03). The Impact of Events Scale improved by 6.6 ± 15.5 points (p = .01). There was significant within-patient improvement on both the avoidance scale (3.8 ± 9.2) and on the intrusion scale (2.9 ± 7.9). Patients who attended more sessions and conducted more home practice had greater improvements in quality of life. CONCLUSION: Persons receiving a 20-session contemplative self healing intervention showed improved quality of life, with a clinically and statistically significant increase in the FACT-G. In addition, this population showed a significant reduction in post-traumatic stress symptoms assessed by the Impact of Events Scale. TRIAL REGISTRATION: Clinical Trials Gov NCT00278837.

Induction of murine embryonic stem cell differentiation by medicinal plant extracts.

Epidemiological evidence indicates that diets high in fruits and vegetables provide a measure of cancer chemoprevention due to phytochemical constituents. Natural products are a rich source of cancer chemotherapy drugs, and primarily target rapidly cycling tumor cells. Increasing evidence indicates that many cancers contain small populations of resistant, stem-like cells that have the capacity to regenerate tumors following chemotherapy and radiation, and have been linked to the initiation of metastases. Our goal is to discover natural product-based clinical or dietary interventions that selectively target cancer stem cells, inducing differentiation. We adapted an alkaline phosphatase (AP) stain to assay plant extracts for the capacity to induce differentiation in embryonic stem (ES) cells. AP is a characteristic marker of undifferentiated ES cells, and this represents a novel approach to screening medicinal plant extracts. Following a survey of approximately 100 fractions obtained from 12 species of ethnomedically utilized plants, we found fractions from 3 species that induced differentiation, decreasing AP and transcript levels of pluripotency markers (Nanog, Oct-4, Rex-1). These fractions affected proliferation of murine ES, and human embryonal, prostate, and breast carcinoma cells in a dose-dependent manner. Several phytochemical constituents were isolated; the antioxidant phytochemicals ellagic acid and gallic acid were shown to affect viability of cultured breast carcinoma cells.

The effect of a contemplative self-healing program on quality of life in women with breast and gynecologic cancers.

Stress-related symptoms-intense fear, avoidance, intrusive thoughts--are common among breast and gynecologic cancer patients after chemotherapy and radiation. The objective of this pilot study was to determine the impact of a 20-week contemplative self-healing program among breast and gynecologic cancer survivors on self-reported quality of life (QOL), the main outcome. Assessments were performed at the first session and at 20 weeks, including QOL (FACIT-G, FACIT subscales, SF-36), anxiety, and depression (HADS). Biologic markers of immune function were obtained. A 20-week program was implemented: the initial 8 weeks addressed open-mindfulness, social-emotional self-care, visualization, and deep breathing followed by 12 weeks of exposing stress-reactive habits and developing self-healing insights. Daily practice involved CD-guided meditation and manual contemplations. Sixty-eight women were enrolled, and 46 (68%) completed the program. Participants had significant within-patient changes on FACIT-G, improving by a mean of 6.4 points. In addition, they reported clinically important improvement in emotional and functional domains and social, role-emotional, and mental health status domains on SF-36. Biologic data revealed significant improvement in maximum AM cortisol and a reduction in resting heart rate at 20 weeks. These findings suggest a contemplative self-healing program can be effective in significantly improving QOL and reducing distress and disability among female breast and gynecologic cancer survivors.

A program in contemplative self-healing: stress, allostasis, and learning in the Indo-Tibetan tradition.

This paper reviews current behavioral health interventions and introduces a self-healing program based on the Indo-Tibetan tradition. While most work on behavior change emphasizes cognition and motivation, this review highlights stress-reactivity as a rate-limiting resistance to learning. Surveying cognitive-behavioral theories, it finds these limited in modeling stress-reactivity. Reviewing current interventions that address stress by integrating relaxation, mindfulness, imagery, or movement with cognitive-behavioral education, it attributes their limited effectiveness to the limits of their model of stress and their strategy of eclectically mixing techniques. Next, the article explores the Indic model of stress-cessation and self-healing assumed by mindfulness practice, concluding that it more fully reflects current findings on stress and learning. It reviews the theory and practice of mindfulness and of two less known contemplative "vehicles" preserved in Tibet, using more advanced techniques and insights better suited to lay lifestyles and secular cultures. It suggests that the Tibetan tradition of integrating all three vehicles of contemplative insight and skill in one self-healing practice should maximize coherence and effectiveness while minimizing confounding variables caused by eclecticism. Finally, the paper introduces an intervention that integrates mindfulness with techniques of cognitive analysis, affect modulation, motivational imagery, and reinforcing breathing, tailored over centuries into a complete, threefold path of self-healing. A pilot study of this intervention in women treated for breast and other gynecologic cancers suggests that the whole spectrum of Indo-Tibetan mind/body practices can be readily mastered and effectively used by Westerners to reduce stress and enhance learning and quality of life.

Prospective study of new participants in a community-based mind-body training program.

BACKGROUND: Mind-body practices such as yoga are widely popular, but little is known about how such exercises impact health-related quality of life. OBJECTIVE: To measure changes in health-related quality of life associated with 3 months of mind-body training as practiced in community-based settings. DESIGN: Prospective cohort study. SETTING: Eight centers for practice of mind-body training. PARTICIPANTS: One hundred ninety-four English-speaking adults who had taken no more than 10 classes at the centers prior to enrollment in the study. One hundred seventy-one (88%) returned the 3-month follow-up questionnaire. INTERVENTION: Administration of the SF-36 questionnaire at the start of training and after 3 months. MEASUREMENTS AND MAIN RESULTS: At baseline, new participants in mind-body training reported lower scores than U.S. norms for 7 of 8 domains of the SF-36: mental health, role emotional, social, vitality, general health, body pain, and role physical (P <.002 for all comparisons). After 3 months of training, within-patient change scores improved in all domains (P <.0001), including a change of +15.5 (standard deviation +/-21) in the mental health domain. In hierarchical regression analysis, younger age (P=.0003), baseline level of depressive symptoms (P=.01), and reporting a history of hypertension (P=.0054) were independent predictors of greater improvement in the SF-36 mental health score. Five participants (2.9%) reported a musculoskeletal injury. CONCLUSIONS: New participants in a community-based mind-body training program reported poor health-related quality of life at baseline and moderate improvements after 3 months of practice. Randomized trials are needed to determine whether benefits may be generalizable to physician-referred populations.