Test of mindfulness and hope components in a psychological intervention for women with cancer recurrence

Abstract

Objective: Psychological interventions can attenuate distress and enhance coping for those with an initial diagnosis of cancer, but there are few intervention options for individuals with cancer recurrence. To address this gap, we developed and tested a novel treatment combining Mindfulness, Hope Therapy, and biobehavioral components.

Method: An uncontrolled, repeated measures design was used. Women (N = 32) with recurrent breast or gynecologic cancers were provided 20 treatment sessions in individual (n = 12) or group (n = 20) formats. On average, participants were middle aged (M = 58) and Caucasian (81%). Independent variables (i.e., hope and mindfulness) and psychological outcomes (i.e., depression, negative mood, worry, and symptoms of generalized anxiety disorder) were assessed pre-treatment and 2, 4, and 7 months later. Session-by-session therapy process (positive and negative affect, quality-of-life) and mechanism (use of intervention-specific skills) measures were also included.

Results: Distress, anxiety, and negative affect decreased, whereas positive affect and mental-health-related quality-of-life increased over the course of treatment, as demonstrated in mixed-effects models with the intent-to-treat sample. Both hope and mindfulness increased, and use of mindfulness skills was related to decreased anxiety.

Conclusions: This treatment was feasible to deliver and was acceptable to patients. The trial serves as preliminary evidence for a multi-component intervention tailored to treat difficulties specific to recurrent cancer. The blending of the components was novel as well as theoretically and practically consistent. A gap in the literature is addressed, providing directions for testing interventions designed for patients coping with the continuing stressors and challenges of cancer recurrence.

Figure 1

Study flow.

Figure 2

Graphs showing significant linear effects (ps≤.01) for anxiety symptoms (PSWQ-A; Fig. 2a) and emotional distress (POMS; Fig.2b) from pre to post treatment. In both cases, the change was a symptom decline from baseline that was maintained through months 4 and 7.

Figure 3

Graphs showing significant linear effects for session-by-session change, with a significant increase in positive affect (p = .02; Fig. 3a) and a significant decline in negative affect (p<.001; Fig 3b).