Abstract
Mindfulness-based stress reduction (MBSR) is increasingly employed in psychosocial care for patients diagnosed with cancer. As the benefits of MBSR mount, one area left unexplored is the potential impact it may hold for women’s self-identities, after they have been diagnosed with breast cancer. Given the symbolic nature of the breast, a woman’s sense of self is often disrupted as she is faced with changes to her physical body, impacting how she conceives of herself personally, socially, relationally, and sexually. Couple’s interventions are proving to have significant effects in regard to sexual outcomes, when issues of self-identity, including body image and sexuality are addressed. Mindfulness practice has been identified as beneficial for both individuals and couples in cancer care and may offer a useful approach for couple-based interventions to address self-identity and body image. The following paper reviews the current research on the implications of breast cancer for a woman’s sense of self, or self-identity, as well as highlights ways in which intimate relationships are impacted. Mindfulness is explored as a possible psychosocial intervention to help couples cope with women’s altered self-identities.
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Al-Ghazal, S. K., Fallowfield, L., & Blamey, R. W. (2000). Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. European Journal of Cancer, 36, 1938–1943.
Baer, R. A. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology Scientific Practice, 10, 125–143.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.
Barnes, S., Brown, K. W., Krusemark, E., Campbell, W. K., & Rogge, R. D. (2007). The role of mindfulness in romantic relationship satisfaction and responses to relationship stress. Journal of Marital and Family Therapy, 33, 482–500.
Barsky, J. L., Friedman, M. A., & Rosen, R. C. (2006). Sexual dysfunction and chronic illness: the role of flexibility in coping. Journal of Sex and Marital Therapy, 32, 235–253.
Barsky-Reese, J. (2011). Coping with sexual concerns after cancer. Current Opinion in Oncology, 23, 1–9.
Barsky-Reese, J., Keefe, F. J., Somers, T. J., & Abernethy, A. P. (2010). Coping with sexual concerns after cancer: the use of flexible coping. Support Cancer Care, 18, 785–800.
Batchelor, D. (2001). Hair and cancer chemotherapy: consequences and nursing care—a literature study. European Journal of Cancer Care, 10(3), 147–163.
Baucom, D. H., Porter, L. S., Kirby, J. S., Gremore, T. M., Wiesenthal, N., Aldridge, W., Fredman, S. J., Stanton, S. E., Scott, J. L., Halford, K. W., & Keefe, F. J. (2009). A couple-based intervention for female breast cancer. Psycho-oncol, 18, 276–283.
Birnie, K., Garland, S. N., & Carlson, L. E. (2010). Psychological benefits for cancer patients and their partners in mindfulness-based stress reduction (MBSR). Psycho-Oncology, 19, 1004–1009.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: a proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.
Bonadonna, R. (2000). Experiencing impermanence: toward a theory of living mindfully with cancer (dissertation). Charleston, SC: Nursing, Medical University of South Carolina.
Brotto, L. A., & Heiman, J. R. (2007). Mindfulness in sex therapy: Applications for women with sexual difficulties following gynaecologic cancer. Sexual and Relationship Therapy, 22, 3-11.
Bukovic, D., Fajdic, J., Hrgovic, Z., et al. (2005). Sexual dysfunction in breast cancer survivors. Onkologie, 28, 29–34.
Burwell, S. R., Case, D.L., Kaelin, C., & Avis, N. E. (2006). Sexual problems in younger women after breast cancer surgery. Journal of Clinical Oncology, 24, 2815–2821.
Canadian Cancer Society. (2008). Cancer in Canada: fast facts. http://www.quebec.cancer.ca/quebec/communiques/Stats08_FicheFaitsBref_en.pdf. Accessed 15 Aug 2009
Carmody, J., Olendzki, N., Baer, R. A., & Lykins, E. L. B. (2009). An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 65, 613–626.
Carson, S. H., & Langer, E. J. (2006). Mindfulness and self-acceptance. Journal of Rational-Emotive and Cognitive Behaviour Therapy, 24, 29–43.
Carson, J. W., Carson, K. M., Gil, K. M., & Baucom, D. H. (2004). Mindfulness-based relationship enhancement. Behaviour Therapy, 35, 471–497.
Carver, C. S., Pozo-Kaderman, C., Price, A. A., Noriega, V., Harris, S. D., Derhagopian, R. P., et al. (1998). Concern about aspects of body image and adjustment to early stage breast cancer. Psychosomatic Medicine, 60, 168–178.
DeFrank, J. T., Bahn Mehta, C., Stein, K. D., & Baker, F. (2007). Body image dissatisfaction in cancer survivors. Oncology Nursing Forum, 34, 625-E41.
Dizon, D. S. (2009). Quality of life after breast cancer: survivorship and sexuality. The Breast Journal, 15, 500–504.
Dobkin, P. L. (2008). Mindfulness-based stress reduction: what processes are at work? Complementary Therapies in Clinical Practice, 14, 8–16.
Dow, K. H., & Lafferty, P. (2000). Quality of life, survivorship, and psychosocial adjustment of young women with breast cancer after breast-conserving surgery and radiation therapy. Oncology Nursing Forum, 27, 1555–1564.
Dow, K. H., Ferrell, B., Leigh, S., Ly, J., & Gulasekaram, P. (1996). An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Research and Treatment, 39, 261–273.
Esplen, M. J. (2007). Distress, body image, sexuality and self-identity and implications for treatment. In L. Elit (Ed.), Women and cancer (pp. 181–202). Inc: Nova.
Fobair, P., Stewart, S. L., Chang, S., D’Onofrio, C., Banks, P. J., & Bloom, J. R. (2006). Body image and sexual problems in young women with breast cancer. Psycho-Oncology, 15, 579–594.
Freitas, B. A. (1998). Coping: Altered body image and alopecia. In F. K. Itano & K. N. Taoka (Eds.). Core Curriculum for Oncology, Nursing, 3rd ed. (pp. 54–59). W.B. Saunders, Pennsylvania.
Ganz, P. A. (2008). Psychological and social aspects of breast cancer. Oncology, 22, 642–646.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice Hall.
Halford, W. K., Kelly, A., & Markman, H. J. (1997). The concept of a healthy marriage. In W. K. Halford & H. J. Markman (Eds.), Clinical handbook of marriage and couples intervention. (pp. 3–12). Chichester, England: Wiley.
Harcourt, D., & Rumsey, N. (2004). Mastectomy patients’ decision-making for or against immediate breast reconstruction. Psycho-Oncology, 13, 106–115.
Harcourt, D., Russell, C., Hughes, J., White, C., Nduka, C., & Smith, R. (2011). Patient satisfaction in relation to nipple reconstruction: The important of information provision. Journal of Plastic, Reconstructive and Aesthetic Surgery, 64, 494–499.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford.
Holmberg, S. K., Scott, L. S., Alexy, W., & Fife, B. L. (2001). Relationship issues of women with breast cancer. Cancer Nursing, 24, 53–60.
Kabat-Zinn, J. (1994). Wherever you go there you are: mindfulness meditation in everyday life. New York: Hyperion.
Kalaitzi, C., Papadopoulos, V. P., Michas, K., Vlasis, K., Skandalakis, P., & Filippou, D. (2007). Combined brief psychosexual intervention after mastectomy: effects on sexuality, body image, and psychological well-being. Journal of Surgical Oncology, 96, 235–240.
Kieviet-Stijnen, A., Visser, A., Garssen, B., & Hudig, W. (2008). Mindfulness-based stress reduction training for oncology patients: patients’ appraisal and changes in well-being. Patient Education and Counseling, 72, 436–442.
Kornblith, A. B., Herndon, J. E., II, Weiss, R. B., et al. (2003). Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer, 98, 679–689.
Leckie, M. S., & Thompson, E. (1979). Symptoms of stress inventory. Seattle, WA: University of Washington.
Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: a meta-analysis. Psycho-Oncology, 18, 571–579.
Lengacher, C. A., Johnson-Mallard, V., Post-White, J., Moscoso, M. M., Jacobsen, P. B., Klein, T. W., & Kip, K. E. (2009). Randomized controlled trial of mindfulness-based stress and reduction (MBSR) for survivors of breast cancer. Psycho-Oncology, 18, 1261–1272.
Mackenzie, M. J., Carlson, L. E., Munoz, M., & Speca, M. (2007). A qualitative study of self-perceived effects of mindfulness-based stress reduction (MBSR) in a psychosocial oncology setting. Stress and Health, 23, 59–69.
Margolis, G. J., Goodman, R. L., Rubin, A., & Pajac, T. M. (1989). Psychological factors in the choice of treatment for breast cancer. Psychosomatics, 30, 192–198.
Matchim, Y., & Armer, J. M. (2007). Measuring the psychological impact of mindfulness meditation oh health among patients with cancer: a literature review. Oncology Nursing Forum, 34, 1059–1060.
Mathieson, C. M., & Stam, H. J. (1995). Renegotiating identity: cancer narratives. Sociology of Health and Illness, 17, 283–306.
McCann, L., Illingworth, N., Wengstrom, Y., Hubbard, G., & Kearney, N. (2010). Women’s perspectives and experiences: transitional experiences of women with breast cancer within the first year following diagnosis. Journal of Clinical Nursing, 19, 1969–1976.
McNair, D. A., Lorr, M., & Droppelman, L. F. (1971). Profile of mood states. San Diego, CA: Educational and Industrial Testing Service.
Mock, V. (1993). Body image in women treated for breast cancer. Nursing research, 42, 153–157.
Moreira, H., & Canavarro, M. C. (2010). A longitudinal study about body image and psychosocial adjustment of breast cancer patients during the course of the disease. European Journal of Oncology Nursing, 14, 263–270.
Ogle, J. P., & Ullstrup, K. (2006). Breast cancer as an embodied life event: a synthesis of research and theory and future directions for intervention and future work. Illness, Crisis and Loss, 14, 223–244.
Ott, M. J., Norris, R. L., & Bauer-Wu, S. M. (2006). Mindfulness meditation for oncology patients: a discussion and critical review. Integrative Cancer Therapies, 5, 98–108.
Payne, S. (2007). Living with advanced cancer. In M. Feuerstein (Ed.), Handbook of cancer survivorship (pp. 429–448). New York: Springer.
Pelusi, J. (2006). Sexuality and body image. The American Journal of Nursing, 106, 32–38.
Phillips, R. L., & Slaughter, J. R. (2000). Depression and sexual desire. American Family Physician, 6, 782–786.
Pikler, V., & Winterowd, C. (2003). Racial and body image differences in coping for women diagnosed with breast cancer. Health Psychology, 22, 632–637.
Piot-Ziegler, C., Sassi, M. L., Raffoul, W., & Delaloye, J. F. (2010). Mastectomy, body deconstruction, and impact on identity: a qualitative study. British Journal of Health Psychology, 15, 479–510.
Reaby, L. L., Hort, L. K., & Vandervord, J. (1994). Body image, self-concept, and self-esteem in women who had a mastectomy and either wore an external breast prosthesis or had breast reconstruction and women who had not experienced mastectomy. Health Care for Women International, 15, 361–375.
Rosenblatt, L. (2006). Being the monster: women’s narrative of body and self after treatment for breast cancer. Medical Humanities, 32, 53–56.
Rowland, J. H. (2008). What are cancer survivors telling us? Cancer, 14(6), 361–368.
Schmid-Buchi, S., Halfens, R. J. G., Dassen, T., & van den Borne, B. (2008). A review of psychosocial needs of breast-cancer patients and their relatives. Journal of Clinical Nursing, 17, 2895–2909.
Scott, J. L., & Kayser, K. (2009). A review of couple-based interventions for enhancing women’s sexual adjustment and body image after cancer. Cancer Journal, 15, 48–56.
Shapiro, S. L., & Carlson, L. E. (2009). The art and science of mindfulness: integrating mindfulness into psychology and the helping professions. Washington, DC: American Psychological Association Publications.
Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386.
Speca, M., Carlson, L. E., Goodey, E., & Angen, M. (2000). A randomized, wait-list controlled clinical trial: the effect of a mindfulness-based stress reduction program on mood and symptoms of stress in cancer patients. Psychosomatic Medicine, 62, 613–622.
Speer, J. J., Hillenberg, B., Sugrue, D. P., Blacker, C., Kresge, C. L., Decker, V. B., & Decker, D. A. (2005). Study of sexual functioning determinants in breast cancer survivors. The Breast Journal, 11, 440–447.
Spence, J. (2001). Flying on one wing. In M. Banim, E. Green, & A. Guy (Eds.), Through the wardrobe: women’s relationship with their clothes (pp. 173–188). New York: Berg.
Synontt, A. (1993). The body social: symbolism, self and society. NY: Routledge.
Thomas-MacLean, R. (2004). Memories of treatment: the immediacy of breast cancer. Qualitative Health Research, 14, 628–643.
Ucok, O. (2005). The meaning of appearance in surviving breast cancer. Human Studies, 28, 291–316.
Wachs, K., & Cordova, J. V. (2007). Mindful relating: exploring mindfulness and emotion repertoires in intimate relationships. Journal of Marital and Family Therapy, 33, 464–481.
Wellisch, D. K., Shain, W. S., Noone, R. B., & Little, J. W., III. (1985). Psychosocial correlates of immediate versus delayed reconstruction of the breast. Plastics and Reconstructive Surgery, 76, 713–718.
White, C. (2000). Body image dimensions and cancer: a heuristic cognitive behavioral model. Psycho-Oncology, 9, 183–192.
Zimmerman, T., Scott, J. L., & Heinrichs, N. (2009). Individual and dyadic predictors of body image in woman with breast cancer. Psycho-Oncology, 19, 1061–1068.
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Johnston, D. Mindfulness: A Proposed Couple-Based Intervention for the Altered Self-Identity of Breast Cancer Survivors. Mindfulness 3, 282–290 (2012). https://doi.org/10.1007/s12671-012-0093-6
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DOI: https://doi.org/10.1007/s12671-012-0093-6