Psychological processes and symptom outcomes in cancer survivors following a mindfulness-based stress reduction intervention

Abstract

Mindfulness-based interventions targeting psychological and physical symptoms in cancer survivors have been shown to be efficacious. However, little is known about theory-based psychological processes through which mindfulness-based interventions may decrease symptoms. The present study is a secondary analysis of data from a mindfulness-based stress reduction (MBSR) pilot trial targeting cancer-related fatigue (CRF) in cancer survivors. Thirty-five persistently fatigued cancer survivors were recruited from a university hospital and various community clinics in Indianapolis, Indiana. Participants were randomized to either a 7-week MBSR intervention for CRF or a waitlist control (WC) condition. Measures were administered at pre-intervention, post-intervention, and 1-month follow-up and included levels of mindfulness, acceptance, and self-compassion as well as the symptom outcomes of fatigue interference, sleep disturbance, and distress. I hypothesized that MBSR would lead to increased levels of five facets of mindfulness (i.e., observing, describing, acting with awareness, nonjudging of inner experience, nonreactivity to inner experience), self-compassion, and acceptance as compared to the WC condition. Using a linear mixed modeling approach, significant group by time interactions were only found for observing, acting with awareness, nonjudging, and self-compassion, such that the MBSR group showed steady increases in these processes over time, whereas the WC group’s scores remained relatively stable. In addition, I examined whether positive changes in the five facets of mindfulness were associated with reductions in the three symptoms using multiple linear regression. This hypothesis was partially supported; acting with awareness was the only facet of mindfulness to show a modest association with a decrease in fatigue, but this result fell short of statistical significance. In addition, decreased sleep disturbance was predicted by increases in acting with awareness and nonjudging, while decreased distress was predicted by increases in observing, acting with awareness, nonjudging, and nonreactivity. Results point to specific psychological processes that may be targeted to maximize the efficacy of future MBSR interventions for cancer survivors.