Mindfulness-Based Stress Reduction Therapy for Patients With Distress 

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Mindfulness-based cancer recovery was shown to be superior to supportive-expressive group therapy “for decreasing symptoms of stress and also for improving overall quality of life and social support” among women who had stage I to III breast cancer and were assessed as experiencing distress, researchers reported in the Journal of Clinical Oncology. “Improvements were clinically meaningful,” the study authors stated. 

Mindfulness-based cancer recovery included meditation and yoga; Supportive expressive group therapy included expression of emotions and group support. Both are “well-validated group interventions for cancer support,” the authors noted, “but the two have never been directly compared.” The current trial did that, randomizing 271 patients, in a 2:2:1 allocation ratio to either mindfulness-based cancer recovery, supportive-expressive group therapy, or a 1-day stress management control program. The study participants had to have completed all treatments except hormonal or trastuzumab (Herceptin) therapy at least 3 months before. 

Similarities and Differences

The similarities between interventions were the group format, size, structure, and contact hours. Differences between the two groups were in content, focus, and theoretical underpinnings. The focus of supportive-expressive group therapy was on group support and emotional expression, whereas the focus of mindfulness-based cancer recovery was on mindfulness meditation, yoga practice, and sustaining mindful awareness in day-to-day life.

“Women in mindfulness-based cancer recovery improved more over time on stress symptoms compared with women in both the supportive-expressive group therapy (P = .009) and control (P = .024) groups. Per-protocol analyses showed greater improvements in the mindfulness-based cancer recovery group in quality of life compared with the control group (P = .005) and in social support compared with the supportive-expressive group therapy group (P = .012),” the researchers reported. 

In addition, diurnal salivary cortisol slopes, as measured from saliva samples collected by participants for 3 days before randomization and 3 days after intervention completion, were maintained over time for both interventions but become flatter for the control group. “Because abnormal or flattened cortisol profiles have been related to both poorer psychological functioning and shorter survival time in breast, lung, and renal cell carcinoma, this finding may point to the potential for these psychosocial interventions to improve biologic processes related to both patient-reported outcomes and more objective indices. More work is needed to fully understand the clinical meaning of these parameters in primary breast cancer,” the researchers wrote.

Mindfulness-based cancer recovery helps facilitate development of positive emotional regulation strategies such as acceptance and gently extinguishes unhelpful strategies including worry, rumination, and experiential avoidance. As participants allow graduated exposure to feared thoughts and feelings during meditation practice, cultivated in an accepting and nonjudgmental environment, feared stimuli lose much of their power. The result is often a sense of heightened control, calm, peace, and serenity, even in the face of the many uncontrollable elements of cancer,” the authors stated. 

“Given this continually growing evidence of efficacy,” of mindfulness-based cancer recovery, the authors concluded, “cancer treatment centers should consider providing such interventions to needy patients as a routine part of comprehensive clinical care.” ■

Carlson LE, et al: J Clin Oncol 31:3119-3126, 2013.