Objective
Mindfulness‐based interventions (MBIs) are increasingly used within psycho‐oncology. Since the publication of the most recent comprehensive meta‐analysis on MBIs in cancer in 2012, the ...number of published trials has more than doubled. We therefore conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs), testing the efficacy of MBIs on measures of psychological distress (primary outcome) and other health outcomes in cancer patients and survivors.
Methods
Two authors conducted independent literature searches in electronic databases from first available date to 10 October 2018, selected eligible studies, extracted data for meta‐analysis, and evaluated risk of bias.
Results
Twenty‐nine independent RCTs (reported in 38 papers) with 3274 participants were included. Small and statistically significant pooled effects of MBIs on combined measures of psychological distress were found at post‐intervention (Hedges's g = 0.32; 95%CI: 0.22‐0.41; P < .001) and follow‐up (g = 0.19; 95%CI: 0.07‐0.30; P < .002). Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain (g: 0.20 to 0.51; p: <.001 to.047). Larger effects of MBIs on psychological distress were found in studies (a) adhering to the original MBI manuals, (b) with younger patients, (c) with passive control conditions, and (d) shorter time to follow‐up. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.
Conclusions
MBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.
One third of cancer patients and survivors experience psychological distress. Previous studies have shown that online mindfulness-based cognitive therapy (eMBCT) supports cancer patients and ...survivors in managing distress. Lack of peer support and asynchronicity during online interventions have been reported as barriers for treatment adherence and can result in higher drop-out rates. Considering this, two new formats of eMBCT were created. The primary objective of the Buddy trial is to evaluate the (cost) effectiveness of blended and unguided eMBCT versus care as usual (CAU) on psychological distress among cancer patients and survivors. Secondary objectives include evaluating effects on other psychological outcomes and investigating working mechanisms and treatment effect moderators.
The Buddy trial is a parallel three-armed randomized controlled trial. Participants will be randomly assigned to blended therapist-assisted eMBCT, unguided individual eMBCT or CAU. Eligible participants will be Dutch-speaking adult cancer patients or survivors with access to internet. The primary outcome will be psychological distress scores as assessed by the Hospital Anxiety and Depression scale immediately post-treatment. Secondary outcome measures include fear of cancer recurrence (FCRI), fatigue (CIS-F), rumination (RRQ), mindfulness skills (FFMQ), decentering (EQ), self-compassion (SCS-SF), positive mental health (MHCSF), health related quality of life (EQ-5D), and costs associated with psychiatric illness (TiC-P). Outcome measures will be evaluated at baseline, mid-treatment, immediately post-treatment, and three-, six-, and nine-months follow-up. Possible mediators, such as engagement with interventions (TWEETS), and moderators will be also analyzed.
There is room to improve eMBCT for cancer patients prior to implementation to ensure adherence and scalability. Blended and unguided eMBCT may reduce psychological distress and improve quality of life and be easily accessible to cancer patients and survivors. Trial registration clinicaltrials.gov, NCT05336916, registered on April 20th, 2022. https://clinicaltrials.gov/ct2/show/NCT05336916 .
Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in ...any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative Correction Open Access Published:13 February 2023 Correction to: effect of blended and unguided online delivery of mindfulness-based cognitive therapy versus care as usual on distress among cancer patients and survivors: protocol for the three-arm parallel randomized controlled Buddy trial Nasim Badaghi ORCID: orcid.org/0000-0002-7529-34481, Mette van Kruijsbergen1, Judith Prins2, Saskia Kelders3,4, Linda Cillessen1, Félix Compen1, Rogier Donders5, Linda Kwakkenbos1,6 & … Anne Speckens1 Show authors BMC Psychology volume 11, Article number: 43 (2023) Cite this article 67 Accesses Metrics details The Original Article was published on 25 January 2023 BMC Psychology (2023) 11:21 https://doi.org/10.1186/s40359-023-01052-2 Following publication of the original article 1, the authors flagged that a 'model consent form’ completed in the Dutch language had been erroneously added to Figure 2.
Medical specialists experience high levels of stress. This has an impact on their well-being, but also on quality of their leadership. In the current mixed method study, the feasibility and ...effectiveness of a course Mindful Leadership on burnout, well-being and leadership skills of medical specialists were evaluated.
This is a non-randomized controlled pre-post evaluation using self-report questionnaires administered at 3 months before (control period), start and end of the training (intervention period). Burn-out symptoms, well-being and leadership skills were assessed with self-report questionnaires. Semi-structured interviews were used to qualitatively evaluate barriers and facilitators for completion of the course.
From September 2014 to June 2016, 52 medical specialists participated in the study. Of these, 48 (92%) completed the course. Compared to the control period, the intervention period resulted in greater reductions of depersonalization (mean difference = - 1.2, p = 0.06), worry (mean difference = - 4.3, p = 0.04) and negative work-home interference (mean difference = - 0.2, p = 0.03), and greater improvements of mindfulness (mean difference = 0.5, p = 0.04), life satisfaction (mean difference = 0.4, p = 0.01) and self-reported ethical leadership (mean difference = 0.1, p = 0.02). Effect sizes were generally small to medium (0.3 to 0.6) and large for life satisfaction (0.8). Appreciation of course elements was a major facilitator and the difficulty of finding time a major barrier for participating.
A 'Mindful Leadership' course was feasible and not only effective in reducing burnout symptoms and improving well-being, but also appeared to have potential for improving leadership skills. Mindful leadership courses could be a valuable part of ongoing professional development programs for medical specialists.
Background
Mindfulness‐based interventions have a positive impact on pain, craving, and well‐being in both patients with chronic pain and those with opioid use disorder (OUD). Although data are ...limited, mindfulness‐based cognitive therapy (MBCT) might be a promising treatment for patients with chronic noncancer pain combined with OUD. The aim of this qualitative study was to explore the feasibility and process of change during MBCT in this particular population.
Methods
In this qualitative pilot study, 21 patients who were hospitalized for rotation to buprenorphine/naloxone as agonist treatment for chronic pain and OUD were offered MBCT. Semistructured interviews were conducted to explore experienced barriers and facilitators to MBCT. Patients who participated in MBCT were also interviewed on their perceived process of change.
Results
Of 21 patients invited to participate in MBCT, 12 initially expressed interest but only four eventually participated in MBCT. The timing of the intervention, group format, somatic complaints, and practical difficulties were identified as the main barriers to participation. Facilitating factors included having a positive attribution toward MBCT, an intrinsic motivation to change, and practical support. The four MBCT participants mentioned several important mechanisms of change, including reduction of opioid craving and improved coping with pain.
Conclusions
MBCT offered in the current study was not feasible for the majority of patients with pain and OUD. Changing the timing of MBCT by providing it at an earlier stage of the treatment and offering MBCT in an online format may facilitate participation.
Aim: Mindfulness-based interventions (MBIs) are increasingly used in cancer patients and survivors. Since the publication of the last comprehensive reviews, the number of published trials has ...increased considerably, and we therefore conducted a comprehensive, updated systematic review and meta-analysis of the effects of randomized controlled trials (RCTs) of MBIs on psychological distress, physical health outcomes, and quality of life (QpL) in cancer patients and survivors. In addition, the moderating effects of various between-study differences were examined. Methods: Two independent researchers conducted literature searches in PubMed, PsycINFO, Web of Science, and C1NAHL, selected eligible studies, extracted data, and evaluated risk of bias. Results: A total of 38 papers reporting results of 29 RCTs with 3274 participants were included. The results revealed a pooled post-intervention effect of MBIs on combined measures of psychological distress corresponding to a small effect size (ES) (Hedges's g = 0.32; p < .001). The ES at follow-up was smaller, but remained statistically significant (g = 0.19; p = .002). Both effects were robust against possible publication bias. Metaregression revealed statistically significantly larger ESs in studies with 1) younger patients, 2) with few or no changes of the original MBI manuals, 3) with passive control conditions, and 4) with shorter time to follow-up. Changes in mindfulness skills were associated with post-treatment effects (p = 0.49; p = .015). Conclusion: Although the effects are generally small, MBIs appear efficacious in reducing psychological distress in cancer patients and survivors. We found evidence for publication bias, however, results remained robust after adjustment for this potential bias.
Objective
The aims were to describe and develop a measure of the concept of the active self as self‐direction and to assess the extent to which clients in a mental healthcare setting were becoming ...self‐directive instead of being directed by their therapist.
Methods
A panel of experts was formed to discuss the concept self‐direction and to formulate a tentative model of self‐direction. An initial questionnaire was constructed. A cross‐section of clients completed the questionnaire to evaluate its validity and reliability with exploratory factor analysis.
Results
A 31‐item questionnaire was constructed that included six factors that measured actorship, commitment, demoralization, readiness, understanding, and monitoring progress and two broader underlying factors called gaining control and loss of control.
Conclusion
The developed questionnaire measures the degree to which people are experiencing self‐direction in their lives, and their capability of solving their problems.
•MBCT is effective in reducing recurrent depressive symptoms, but there is room for improvement.•As one of the working mechanisms of MBCT, cultivating (self-)compassion may be fruitful as a ...sequential treatment in clinical populations with recurrent depressive symptoms.•MBCL is effective in reducing depressive symptoms, with a continued improvement at 6-months follow-up. (Self) compassion appears to mediate the effect.•To optimise the (sequential) treatment trajectory, replicating our study in a prospective sequential trial is needed. Ideally, this includes a controlled sample for follow-up to confirm consolidation of treatment gains.
Introduction: Mindfulness-Based Cognitive Therapy (MBCT) has been shown to reduce depressive symptoms in patients with recurrent or chronic depression. However, sequential, follow-up interventions are needed to further improve outcome for this group of patients. One possibility is to cultivate mechanisms thought to support recovery from depression, such as (self-)compassion. The current study examined the efficacy of mindfulness-based compassionate living (MBCL) in recurrently depressed patients who previously received MBCT, and consolidation effects of MBCL at follow-up.
Methods: Part one is a randomized controlled trial (RCT) comparing MBCL in addition to treatment as usual (TAU) with TAU alone. The primary outcome measure was severity of depressive symptoms. Possible mediators and moderators of treatment outcome were examined. Part two is an uncontrolled study of both intervention- and control group on the consolidation of treatment effect of MBCL over the course of a 6-months follow-up period.
Results: Patients were recruited between July 2013 and December 2014 (N = 122). MBCL participants (n = 61) showed significant improvements in depressive symptoms (Cohen's d = 0.35), compared to those who only received TAU (n = 61). The results at 6-months follow-up showed a continued improvement of depressive symptoms.
Limitations: As MBCL was not compared with an active control condition, we have little information about the possible effectiveness of non-specific factors.
Conclusion: MBCL appears to be effective in reducing depressive symptoms in a population suffering from severe, prolonged, recurrent depressive symptoms. To optimise the (sequential) treatment trajectory, replication of the study in a prospective sequential trial is needed.
Registered at ClinicalTrials.gov:NCT02059200
Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) ...has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs.
This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions.
This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of MBCT or eMBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form.
The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=-.39; P=.21). Therapeutic alliance increased over time in both conditions (F
=16.46; Wilks λ=0.732; P<.001). This increase did not differ between eMBCT and MBCT (F
=0.114; P=.74). Therapeutic alliance at week 2 predicted a decrease in psychological distress (B=-.12; t
=-2.656; P=.01) and an increase in mental well-being (B=.23; t
=2.651; P=.01) at posttreatment. The relationship with reduction of psychological distress differed between treatments: a weaker early therapeutic alliance predicted higher psychological distress at posttreatment in MBCT but not in eMBCT (B=.22; t
=2.261; P=.03).
A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT.
ClinicalTrials.gov NCT02138513; https://clinicaltrials.gov/ct2/show/NCT02138513.
Aim: The main goal of the present study was to examine whether therapeutic alliance is a predictor of the reduction of psychological distress and the increase of well-being at posttreatment in eMBCT ...compared to MBCT. Methods: The present study was part of a large multicentre RCT (n = 245) on the effectiveness of (e)MBCT for distressed cancer patients. To test development of the therapeutic alliance during eMBCT and MBCT repeated measures ANOVA's were used. To examine whether therapeutic alliance predicts outcome and whether this differs between conditions, separate hierarchical linear regression models were conducted. Results: Level of therapeutic alliance increased significantly over time but did not differ significantly between eMBCT and MBCT (p = .783). Therapeutic alliance at week 2 predicted reduction of psychological distress (B = -0.126, t= -2.656, p = .009) and increase of well-being (B = 0.234, t = 2.651, p = .009) at post treatment. Therapeutic alliance at 2 also moderated reduction of psychological distress at post treatment, R2 = 0.470, F 33.41 (3113), p < 001. Experiencing limited early therapeutic alliance in group-based MBCT directly affects treatment outcome aversely, however not in eMBCT (p = .004). Conclusion: Therapeutic alliance can develop in eMBCT as well as in MBCT. Therapeutic alliance predicts reduction of psychological distress and increase of well-being at post treatment. It seemed that high early therapeutic alliance is necessary to reach treatment effect in MBCT, however, not in eMBCT.
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