Innovating Mindfulness-Based Stress Reduction (MBSR) Delivery in Cancer Care: Enhancing Accessibility and Engagement

IntroductionMedical students face an enormous amount of stress (Dyrbye LN et al. Ann Intern Med 2008; 149: 334-41). They suffer from higher rates of depression, anxiety, and suicide compared to the general population. Despite experiencing more mental health problems, there is a lack of research exploring ways to improve their mental health. Although there are a few small sample studies investigating the effectiveness of Mindfulness-Based Stress Reduction (MBSR) on medical students, there is no study comparing its effectiveness against an active intervention group in the literature (van Dijk I et al. Acad Med 2017; 92: 1012-1021)ObjectivesWe aimed to compare the effects of the Mindfulness-Based Stress Reduction (MBSR) and the Cognitive Behavioural Based Stress Reduction (CBSR) group interventions on depressive and anxious symptoms and perceived stress of medical students.Methods323 medical students applied to participate in one of the group interventions and were assessed with the Mini International Neuropsychiatric Interview. Of these, 253 (77% female, mean age=21.9 ± 2.9 years) were allocated into online MBSR (n=127) and online CBSR (n=126) groups after randomization. Their anxiety and depressive symptoms and perceived stress levels were assessed at baseline and after 8 weeks of interventions. 33,2% of participants (MBSR: n=39; CBSR: n=45) completed the protocol by attending five or more sessions. Both intention-to-treat (ITT) analysis and per-protocol (PP) analysis were used to assess outcomes. In the ITT analysis, we used multiple imputation to address missing values. All assessments and group interventions were done online.ResultsIn the ITT analysis, both MBSR and CBSR were found to be slight to moderately effective in reducing symptoms of depression (MBSR: d=.50; CBSR: d=.40), anxiety (MBSR:d=.73; CBSR: d=.52), and perceived stress (MBSR: d=.48; CBSR: d=.42), but they were no superior to each other. In the PP analysis, both interventions moderately to strongly improved the symptoms of depression (MBSR: d=1.03; CBSR: d=.74), anxiety (MBSR: r=-.74; CBSR: r=-.72), and perceived stress (MBSR: r=-.80; CBSR: r=-.68). While there was no statistically significant difference between them in reducing depressive symptoms and perceived stress, MBSR was found to be significantly more effective than CBSR in reducing anxiety symptoms (u=469, z=-2.756, p=0.006).ConclusionsBoth MBSR and CBSR improve symptoms of depression and anxiety in medical students after 8 weeks of interventions. Completing the protocol or attending more sessions may increase the effectiveness of the interventions. While the interventions did not show superiority to each other in terms of effectiveness in reducing depressive symptoms and perceived stress, MBSR appears to be more effective in reducing anxiety symptoms compared to CBSR in the group that completed the protocol.Disclosure of InterestNone Declared

Online mindfulness-based vs. cognitive-behavioural stress reduction for medical students: A randomized controlled trial.

The objective of this pilot study was to compare the effects of two mind-body interventions: mindfulness-based stress reduction (MBSR) and cognitive-behavioral stress reduction (CBSR). Fifty (50) subjects were recruited from the community and took part in MBSR (n = 36) and CBSR (n = 14) courses. Participants self-selected into MBSR or CBSR courses taught at different times. There were no initial differences between the MBSR and CBSR subjects on demographics, including age, gender, education, and income. MBSR was an 8-week course using meditation, gentle yoga, and body scanning exercises to increase mindfulness. CBSR was an 8-week course using cognitive and behavioral techniques to change thinking and reduce distress. Perceived stress, depression, psychological well-being, neuroticism, binge eating, energy, pain, and mindfulness were assessed before and after each course. Pre-post scores for each intervention were compared by using paired t tests. Pre-post scores across interventions were compared by using a general linear model with repeated measures. SETTINGS/LOCATIONS: Weekly meetings for both courses were held in a large room on a university medical center campus. MBSR subjects improved on all eight outcomes, with all of the differences being significant. CBSR subjects improved on six of eight outcomes, with significant improvements on well-being, perceived stress, and depression. Multivariate analyses showed that the MBSR subjects had better outcomes across all variables, when compared with the CBSR subjects. Univariate analyses showed that MBSR subjects had better outcomes with regard to mindfulness, energy, pain, and a trend for binge eating. While MBSR and CBSR may both be effective in reducing perceived stress and depression, MBSR may be more effective in increasing mindfulness and energy and reducing pain. Future studies should continue to examine the differential effects of cognitive behavioral and mindfulness-based interventions and attempt to explain the reasons for the differences.

Background : Despite their efficacy at controlling joint inflammation, current treatments of rheumatoid arthritis (RA) leave up to 40% of patients into non-remission. Non-remission, frequently due to persistently negative self-reported impact of RA, was found to be associated with significant persistent depressive symptoms 6-7 months after initiation of arthritis treatment. Mindfulness-Based Stress Reduction (MBSR) is proposed to improve depressive symptoms and RA-related clinical outcomes. To pave the way for an eventual randomized controlled trial, a feasibility and acceptability study of MBSR has been realized. Methods: A standardized 8-week MBSR program was offered to groups of patients with controlled inflammatory disease but high levels of depressive symptoms.Qualitative interviews based on a theoretical framework of acceptability were conducted. Change in depressive symptoms (CES-D tool), fatigue and pain (SF-36), anxiety (GAD-7), pain, disease activity (PtVAS and SDAI scores) was measured over a 6-month period. Results: 27 patients have been recruited (3 distinct MBSR groups). Factors leading to a higher rate of success in recruitment were identified. Despite the small sample, the intervention was found to have a clear impact on depressive symptoms (p=0.004), anxiety (p=0.005), and social functioning (from the SF-36; p=0.04). Patients reported that MBSR gave them the opportunity to control their reactions in face of stressful situations.Perceptions were almost uniformly positive towards MBSR, and most appear to have integrated some part of the intervention in their daily life. Conclusions: Although recruitment was challenging, a MBSR trial on depressed patients with controlled inflammatory disease was found acceptable and feasible within this population. Preliminary clinical results showed positive impacts of such intervention.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Background:Mindfulness-based stress reduction (MBSR) alleviates depression and anxiety in adults with autism spectrum disorder (ASD); however, underlying therapeutic neural mechanisms and mindfulness-specific effects have yet to be elucidated.Methods:We randomly assigned adults with ASD to MBSR or social support/education (SE). They completed questionnaires that assessed depression, anxiety, mindfulness traits, autistic traits and executive functioning abilities as well as a self-reflection functional MRI task. We used repeated-measures analysis of covariance (ANCOVA) to evaluate behavioural changes. To identify task-specific connectivity changes, we performed a generalized psychophysiological interactions (gPPI) functional connectivity (FC) analysis on regions of interest (ROIs; insula, amygdala, cingulum and prefrontal cortex [PFC]). We used Pearson correlations to explore brain–behaviour relationships.Results:Our final sample included 78 adults with ASD — 39 who received MBSR and 39 who received SE. Mindfulness-based stress reduction uniquely improved executive functioning abilities and increased mindfulness traits, whereas both MBSR and SE groups showed reductions in depression, anxiety and autistic traits. Decreases specific to MBSR in insula–thalamus FC were associated with anxiety reduction and increased mindfulness traits, including the trait “nonjudgment;” MBSR-specific decreases in PFC–posterior cingulate connectivity correlated with improved working memory. Both groups showed decreased amygdala–sensorimotor and medial–lateral PFC connectivity, which corresponded with reduced depression.Limitations:Larger sample sizes and neuropsychological evaluations are needed to replicate and extend these findings.Conclusion:Together, our findings suggest that MBSR and SE are similarly efficacious for depression, anxiety and autistic traits, whereas MBSR produced additional salutary effects related to executive functioning and mindfulness traits. Findings from gPPI identified shared and distinct therapeutic neural mechanisms, implicating the default mode and salience networks. Our results mark an early step toward the development of personalized medicine for psychiatric symptoms in ASD and offer novel neural targets for future neurostimulation research.Clinical Trial Registration:ClinicalTrials.gov identifier NCT04017793.

An Introduction to the Buddhist Underpinnings of Mindfulness-Based Interventions: Buddha-Nature and Intrinsic Goodness

Mindfulness-based interventions for women victims of interpersonal violence: A systematic review

The novel coronavirus infection has substantially increased over the last year causing a global pandemic. The rate of infection is persistently rising which has forced many authorities to promote stay at home orders. Individuals may experience an increase in anxiety due to spending longer durations at home, working from home, lacking direct social interactions with friends and family, monetary losses, and potentially getting infected from the virus. Increased anxiety for prolonged periods is linked to elevated blood pressure, heart attacks, and strokes. To evaluate the influence of the pandemic on psychological health, we conducted a study on effects of mindfulness based stress reduction (MBSR) and stress management education (SME). To analyze the effects of the pandemic on mental health of our participants, we compared a group which was not affected by the pandemic (NPG) to a group that was affected by the pandemic (PG). The primary aim of this study was to compare the effects of 8‐weeks active intervention of MBSR and SME in NPG and PG on state‐trait anxiety and decentering. 36 adults participated in the study. All the participants were randomly enrolled in either 8‐weeks of MBSR or SME training. The NPG had 19 participants with 10 in MBSR and 9 in the SME group. The PG had 17 participants with 8 in MBSR and 9 in SME group. The MBSR group had weekly group sessions of ~2.5h on body scanning, meditation and light yoga while the SME group had concurrent sessions on nutrition, sleep, and stress management. Both the groups also did home practice daily for ~45 minutes. The NPG met in person for each of the 8 weeks, but the PG completed the last 4‐weeks of the course online due to a stay‐at‐home mandate at the time in Michigan. All the participants filled out a questionnaire on state anxiety, trait anxiety and decentering before and after the 8‐weeks. A ReANOVA was used to compare the differences across the 8 weeks, with condition (PG vs. NPG) as a between‐subjects factor. The results showed that there was a significant increase in decentering in PG after the 8‐weeks (treatment x condition and time x condition both p<0.03). The SME participants (Δ5.6±1.5 a.u., p=0.007) and MBSR participants (Δ3.5±0.7 a.u., p=0.002) significantly improved their ability to decenter during the pandemic. State anxiety did not change across the 8‐weeks of SME or MBSR in either the NPG or PG. Trait anxiety was reduced across the 8‐week intervention groups (time p=0.043) with MBSR participants decreasing by (Δ3.4±2.8 a.u.) and SME participants decreasing by (Δ0.9±1.7 a.u.). In this small cohort of adults, the 8‐week MBSR and SME interventions helped to reduce trait anxiety, and significantly improved the ability to decenter (disconnect from emotions) during the global pandemic. In addition, there was not an increase in state‐anxiety during the pandemic, which may be at least partially due to active participation in MBSR and SME. These are encouraging results that indicate MBSR and SME can positively influence psychological health, and to help disconnect from emotions during an unprecedented global health crisis.

Patient access to mindfulness-based stress reduction (MBSR), a complementary and integrative health approach that is proven to reduce chronic pain, can be increased via community pharmacy-based implementation. However, the general public’s awareness and preferences regarding MBSR as a treatment option for chronic pain, including provider roles (pharmacist vs. non-pharmacist), are unclear. Therefore, the purpose of this study was to assess the U.S. general public’s knowledge, attitudes, barriers, and programmatic preferences regarding MBSR for chronic pain management, particularly in the community pharmacy setting. A cross-sectional, anonymous online survey was distributed to U.S. adults ≥18 years via the Amazon Mechanical Turk (MTurk) online survey platform. The survey instrument was informed by Anderson’s framework for health service utilization. Measures were assessed using multiple-choice and 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Primary outcome measures included: (1) knowledge and awareness of MBSR (12-items); (2) confidence in seeking out MBSR for pain (5-items); (3) barriers to receiving MBSR (11-items); (4) beliefs about MBSR in general (12-items); (5) beliefs about community pharmacy-delivered MBSR (15-items); and (6) preferences for MBSR classes/programs (6-items). Outcomes were analyzed using descriptive statistics, and influential factors associated with mean beliefs regarding community pharmacy-delivered MBSR for chronic pain management were assessed via multiple linear regression. Of the 302 survey respondents, the majority were white (79.1%) and female (50.7%), with a mean age of 44.65 years. Respondents’ self-rated MBSR knowledge (mean [SD] scale score: 2.30 [0.68]) and confidence (2.65 [0.87]) were low, although perceived barriers to access were low overall (2.22 [0.53]). Beliefs regarding the use of MBSR for treatment of chronic pain were positive in general (3.67 [0.71]), but more negative regarding community pharmacy-delivered MBSR (2.38 [0.56]). Confidence in seeking out MBSR (β = 0.297, 95% CI = 0.219 to 0.375; p < 0.001) and current opioid use (β = 0.419, 95% CI = 0.147 to 0.690; p = 0.003) were positively associated with beliefs regarding pharmacy-delivered MBSR, while annual household income (β = −0.124, 95% CI = −0.244 to −0.004; p = 0.043) and level of bodily pain (β = −0.149, 95% CI = −0.291 to −0.008; p = 0.039) exerted statistically significant negative influences. Respondents preferred a hybrid MBSR class format including both online and in-person components (29.7%) as well as both group and individual session options (43.7%). In conclusion, further education is necessary to increase the public’s perception of community pharmacies as a resource for complementary and integrative health.

Cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) are thought to help patients with social anxiety disorder (SAD) via distinct emotion-regulation mechanisms. However, no study has compared the effects of CBGT and MBSR on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD. To investigate the effects of CBGT and MBSR on reappraisal and acceptance in patients with SAD and to test whether treatment-associated brain changes are associated with social anxiety symptoms 1 year posttreatment. In this randomized clinical trial, a total of 108 unmedicated adults diagnosed with generalized SAD were randomly assigned to 12 weeks of CBGT, MBSR, or waitlist. The final sample included 31 patients receiving CBGT, 32 patients receiving MBSR, and 32 waitlist patients. Data were collected at the psychology department at Stanford University from September 2012 to December 2014. Data were analyzed from February 2019 to December 2020. CBGT and MBSR. Changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year posttreatment. Of 108 participants, 60 (56%) were female. The mean (SD) age was 32.7 (8.0) years. Self-reported race and ethnicity data were collected to inform the generalizability of the study to the wider population and to satisfy the requirements of the National Institutes of Health. From the categories provided by the National Institutes of Health, 47 participants selected White (43.5%), 42 selected Asian (38.9%) 10 selected Latinx (9.3%), 1 selected Black (1%), 1 selected Native American (1%), and 7 selected more than 1 race (6.5%). CBGT and MBSR were associated with a significant decrease in negative emotion (partial η2 range, 0.38 to 0.53) with no significant between-group differences when reacting (β, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92 = -0.37; P = .71), reappraising (β, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92 = -1.67; P = .10), or accepting (β, -0.05; SE, 0.08; 95% CI, -0.20 to 0.11; t92 = -0.59; P = .56). There was a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising (CBGT = 0.031; MBSR = 0.037) and accepting (CBGT = 0.012; MBSR = 0.077) negative self-beliefs. CBGT and MBSR did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses. Reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment. The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks. Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies. ClinicalTrials.gov Identifier: NCT02036658.

Mindfulness-based Stress Reduction in Addition to Usual Care Is Associated with Improvements in Pain, Fatigue, and Cognitive Failures Among Veterans with Gulf War Illness

Objectives: To assess the feasibility, acceptability, and effects of Mindfulness Based Stress Reduction (MBSR) live online during the COVID-19 shutdown. Design: Mixed-methods study using a sequential explanatory design. Settings/location: Cohorts 1-4 took place in-person and Cohorts 5-6 took place over Zoom following the onset of the COVID-19 pandemic. Subjects: Participants were paying members of the general public enrolled in one of six live MBSR courses. Interventions: All MBSR courses followed the standard 8-week MBSR curriculum, led by experienced instructors. Outcome measures: Feasibility measured via class attendance, acceptability measured via the adapted Treatment Satisfaction Survey, and MBSR course effects measured by a focus group with Cohort 5, and the following assessments completed by all cohorts: Perceived Stress Scale-10, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9 and the 36-item Short Form Survey. Results: 73 adults participated in six live MBSR courses (48 in the four in-person courses; 25 in the two online courses). Most of the participants identified as white, non-Hispanic, middle-aged females, with annual household income >$100,000. Course completion, defined as at least 6/8 classes attended, did not differ between in-person and online cohorts (84.1% versus 67.6%, respectively, p = 0.327). Participants in Cohort 5 who completed the course (n = 10) rated it as very important and useful for stress coping, and reported high likelihood of continuing their mindfulness practice (all ratings: between 8 and 10 on a 1-10 Likert scale), with open-ended responses corroborating their numerical ratings. Focus group (n = 6) responses indicated that online MBSR was positively received, reduced perceived loss of control, and improved quality of life and morale during the pandemic. Conclusions: Delivering MBSR live online can be feasible and acceptable for the general public, and is potentially beneficial, including during the social upheaval of the COVID-19 pandemic. Online delivery could help expand access to MBSR and address health inequities.

Caregiving for a dementia patient is associated with an increased risk for emotional distress, depression, dementia, physical health problems and death. Targeting caregivers as the recipients of interventions may greatly improve patient care. Mindfulness Based Stress Reduction (MBSR) is a clinical intervention based on simple meditation practices which have been shown to reduce stress and improve chronic disease outcomes for many different psychological and medical problems. We explored the effectiveness of MBSR at reducing caregiver stress, as measured by psychological and biological markers. We found that MBSR is an effective means to improve the psychological health status of caregivers for dementia patients. Interestingly, we found some of our caregiver participants benefited from MBSR while others did not. Moreover, we identified multiple biomarkers for which contents in the circulating blood were correlated with psychological indices of stress reduction following MBSR and other biomarkers for which baseline blood contents prior to MBSR were predictive of the likelihood of positive response to MBSR. Our observations provide a window into the mechanisms underlying the health benefits of MBSR intervention and provide a logical basis for developing a personalized medicine approach for applying MBSR intervention to a diverse population of caregivers. Supported by discretionary funding to GMP

Background: Data on the effects of mindfulness-based stress reduction (MBSR) positive psychological traits and experiential avoidance (EA) among cancer patients are lacking. Objective: This randomized controlled trial (RCT) aimed to: (1) compare the efficacy between MBSR and treatment-as-usual (TAU) control groups in increasing posttraumatic growth (PTG), hope, and optimism and reducing EA across time measurements (T0, T1, and T2) among head and neck cancer (HNC) patients and (2) evaluate the mediation effects of hope, optimism, and EA on the relationship between MBSR and PTG. Methods: A total of 80 HNC participants were randomized to MBSR (n = 40) and TAU (n = 40) groups with the researchers and data analyst blinded, and the group allocation of the participants was concealed. A one-hour MBSR session was conducted once a week, with 45 minutes of home assignments, for six weeks in the MBSR group. The outcomes across time measurements were compared using a mixed linear model following intention-to-treat (ITT) analysis. Mediation effects of hope, optimism, and EA on the relationship between MBSR and PTG were assessed with PROCESS. Results: MBSR significantly increased the degree of optimism from T0 to T1 (mean difference = 1.825, 95% CI = 0.907–2.743, SE = 0.381, p < .001) with a medium effect size (d = 0.563) and from T1 to T2 (mean difference = 1.650, 95% CI = 0.829–2.470, SE = 0.328, p < .001) with a medium effect size (d = 0.630). Initially, MBSR did not increase the degree of hope from T0 to T1 (p = .677), but it significantly increased hope from T1 to T2 (mean difference = 2.524, 95% CI = 1.676–3.373, SE = 0.340, p < .001) with a medium effect size (d = 0.735). Conversely, MBSR did not sustain the changes in the degree of PTG and EA beyond T1. EA partially mediated the relationship between MBSR and PTG, but not hope and optimism. Conclusion: MBSR can be recommended as part of the treatment regimen for HNC patients. Trial registration: ClinicalTrials.gov identifier: NCT04800419.