Behavioral Measurement of Mindfulness: Preliminary Examination of its Validity and Change Following a Mindfulness-Based Intervention for Adults with Advanced Cancer and their Family Caregivers

Abstract

Mindfulness-based interventions (MBIs) have demonstrated efficacy in reducing symptoms in survivors of early-stage cancer and have shown promise in adults with advanced cancer and their family caregivers. These interventions may be especially helpful for coping with advanced cancer because acceptance and a greater focus on present-moment experiences are central to the adjustment process. Mindfulness may be a potential mechanism underlying MBI’s health effects, yet suboptimal assessment of mindfulness hinders examination of this hypothesis. Widely used self-report measures of mindfulness require participants to have high self-awareness and comprehend a complex skill and show limited responsiveness to MBIs. Behavioral assessment of mindfulness may address the limitations of self-report measures. The goal of the current study was to obtain preliminary evidence of the validity of a behavioral measure of mindfulness, Levinson and colleagues’ breath counting task, and its responsiveness to MBI among patients and caregivers coping with advanced cancer. Fifty-five patient-caregiver dyads were recruited from a university hospital and community clinics in Indiana. Dyads were randomized to either a 6-week MBI or a usual care control condition. Measures were administered at baseline prior to intervention (week 0), at the end of the 6-week intervention period (week 6), and 1-month post-intervention (week 10). Measures included the breath counting task, self-reported mindfulness, avoidant coping, and distress. Linear mixed modeling was used to determine whether the MEANING intervention led to increased behavioral and self-reported mindfulness compared to the usual care group. Caregivers in the MEANING condition showed improved behavioral mindfulness relative to caregivers in usual care, whereas patients in both the MEANING and usual care conditions showed relatively stable behavioral mindfulness over time. Additionally, there was no evidence that the MEANING intervention impacted behavioral mindfulness to a greater extent than self-reported mindfulness. To further examine the behavioral mindfulness measure’s validity, its relations with self-reported mindfulness, avoidant coping, and distress were examined at all time points. For both patients and caregivers, correlations between behavioral and self-reported mindfulness were small or nearly zero and were not uniformly positive. In the MEANING condition, correlations showed mostly small changes over time, and in the control condition, correlations generally showed little change over time. In addition, for patients and caregivers, most correlations between behavioral mindfulness and distress and avoidant coping were approaching zero or small. Results support the feasibility of the breath counting task in adults with advanced cancer and their caregivers, but provide limited support for its validity. The task warrants further evaluation in populations coping with chronic illness.