Supportive Care in Cancer

, Volume 15, Issue 8, pp 949–961

A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients

  • Sheila N. Garland
  • Linda E. Carlson
  • Sarah Cook
  • Laura Lansdell
  • Michael Speca
Original Article

Abstract

Goals of work

The aim of this study was to compare a mindfulness-based stress reduction (MBSR) program and a healing through the creative arts (HA) program on measures of post-traumatic growth (PTGI-R), spirituality (FACIT-Sp), stress (SOSI), and mood disturbance (POMS) in cancer patients.

Materials and methods

A sample of cancer outpatients (MBSR, n = 60; HA, n = 44) with a variety of diagnoses chose to attend either an 8-week MBSR program or a 6-week HA program and were assessed pre- and post-intervention. The majority of participants were female, married, and had breast cancer.

Main results

Repeated measures analysis of variance indicated that participants in both groups improved significantly over time on overall post-traumatic growth (p = 0.015). Participants in the MBSR group improved on measures of spirituality more than those in the HA group (p = 0.029). Participants in the MBSR group also showed more improvement than those in HA on measures of anxiety (POMS, p = 0.038), anger (POMS, p = 0.004), overall stress symptoms (SOSI, p = 0.041), and mood disturbance (POMS, p = 0.023). Several main effects of time were also observed in both groups. These results were found despite attrition in both groups.

Conclusions

Both programs may improve facilitation of positive growth after traumatic life experiences for those who choose to participate. MBSR may be more helpful than HA in enhancing spirituality and reducing stress, depression, and anger.

Keywords

Mindfulness-based stress reduction Meditation Creative therapy Post-traumatic growth Spirituality Cancer 

References

  1. 1.
    Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gotzsche PC, Lang T (2001) The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 134:663–694PubMedGoogle Scholar
  2. 2.
    Andrykowski MA, Curran SL, Studts JL, Cunningham L, Carpenter JS, McGrath PC, Sloan DA, Kenady DE (1996) Psychosocial adjustment and quality of life in women with breast cancer and benign breast problems: a controlled comparison. J Clin Epidemiol 49:827–834PubMedCrossRefGoogle Scholar
  3. 3.
    Antoni MH, Lehman JM, Kilbourn KM, Boyers AE, Culver JL, Alferi SM, Yount SE, McGregor BA, Arena PL, Harris SD, Price AA, Carver CS (2001) Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol 20:20–32PubMedCrossRefGoogle Scholar
  4. 4.
    Baer RA (2003) Mindfulness training as clinical intervention: a conceptual and empirical review. Clin Psych Science Pract 10:125–143CrossRefGoogle Scholar
  5. 5.
    Bishop SR (2002) What do we really know about mindfulness-based stress reduction? Psychosom Med 64:71–83PubMedGoogle Scholar
  6. 6.
    Bower JE, Segerstrom SC (2004) Stress management, finding benefit, and immune function: positive mechanisms for intervention effects on physiology. J Psychosom Res 56:9–11PubMedCrossRefGoogle Scholar
  7. 7.
    Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D (1999) A case for including spirituality in quality of life measurement in oncology. Psychooncology 8:417–428PubMedCrossRefGoogle Scholar
  8. 8.
    Brennan J (2001) Adjustment to cancer—coping or personal transition? Psychooncology 10:1–18PubMedCrossRefGoogle Scholar
  9. 9.
    Calhoun LG, Tedeschi RG (1999) Facilitating post-traumatic growth: a clinician’s guide. Erlbaum, Mahwah, New JerseyGoogle Scholar
  10. 10.
    Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, MacRae JH, Martin M, Pelletier G, Robinson J, Simpson JS, Speca M, Tillotson L, Bultz BD (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304PubMedGoogle Scholar
  11. 11.
    Carlson LE, Garland SN (2005) Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med 12:278–285PubMedCrossRefGoogle Scholar
  12. 12.
    Carlson LE, Speca M, Patel KD, Goodey E (2003) Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med 65:571–581PubMedCrossRefGoogle Scholar
  13. 13.
    Carlson LE, Speca M, Patel KD, Goodey E (2004) Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrostrone-Sulftate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 29:448–474PubMedCrossRefGoogle Scholar
  14. 14.
    Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M (2001) The effects of a mindfulness meditation based stress reduction program on mood and symptoms of stress in cancer outpatients: six month follow-up. Support Care Cancer 9:112–123PubMedCrossRefGoogle Scholar
  15. 15.
    Carver CS, Antoni MH (2004) Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychol 23:595–598PubMedCrossRefGoogle Scholar
  16. 16.
    Cordova MJ, Cunningham LL, Carlson CR, Andrykowski MA (2001) Posttraumatic growth following breast cancer: a controlled comparison study. Health Psychol 20:176–185PubMedCrossRefGoogle Scholar
  17. 17.
    Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E (1999) Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psychooncology 8:429–438PubMedCrossRefGoogle Scholar
  18. 18.
    Cruess DG, Antoni MH, McGregor BA, Kilbourn KM, Boyers AE, Alferi SM, Carver CS, Kumar M (2000) Cognitive-behavioral stress management reduces serum cortisol by enhancing benefit finding among women being treated for early stage breast cancer. Psychosom Med 62:304–308PubMedGoogle Scholar
  19. 19.
    Des Jarlais DC, Lyles C, Crepaz N (2004) Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 94:361–366PubMedGoogle Scholar
  20. 20.
    Efficace F, Marrone R (2002) Spiritual issues and quality of life assessment in cancer care. Death Stud 26:743–756PubMedCrossRefGoogle Scholar
  21. 21.
    Grossman P, Niemann L, Schmidt S, Walach H (2004) Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res 57:35–43PubMedCrossRefGoogle Scholar
  22. 22.
    Helgeson VS, Reynolds KA, Tomich PL (2006) A meta-analytic review of benefit finding and growth. J Consult Clin Psychol 74:797–816PubMedCrossRefGoogle Scholar
  23. 23.
    Kabat-Zinn J (1990) Full catastrophe living: using the wisdom of your body and mind to face stress, pain and illness. Delacourt, New YorkGoogle Scholar
  24. 24.
    Katz RC, Flasher L, Cacciapaglia H, Nelson S (2001) The psychosocial impact of cancer and lupus: a cross validation study that extends the generality of “benefit-finding” in patients with chronic disease. J Behav Med 24:561–571PubMedCrossRefGoogle Scholar
  25. 25.
    Kroepfer R (2000) Drawing on the spirit: embracing spirituality in pediatrics and pediatric art therapy. Art Therapy J Am Art Ther Assoc 17:188–194Google Scholar
  26. 26.
    Lampic C, Wennberg A, Schill JE, Glimelius B, Brodin O, Sjoden PO (1994) Coping, psychosocial well-being and anxiety in cancer patients at follow-up visits. Acta Oncologica 33:887–894PubMedGoogle Scholar
  27. 27.
    Lechner SC, Antoni MH (2004) Posttraumatic growth and group-based interventions for persons dealing with cancer: what have we learned so far? Psychol Inq 15:35–41Google Scholar
  28. 28.
    Lechner SC, Zakowski SG, Antoni MH, Greenhawt M, Block K, Block P (2003) Do sociodemographic and disease-related variables influence benefit-finding in cancer patients? Psychooncology 12:491–499PubMedCrossRefGoogle Scholar
  29. 29.
    Leckie MS, Thompson E (1979) Symptoms of stress inventory. University of Washington, Seattle, WashingtonGoogle Scholar
  30. 30.
    Linley PA, Joseph S (2004) Positive change following trauma and adversity: a review. J Trauma Stress 17:11–21PubMedCrossRefGoogle Scholar
  31. 31.
    MacKenzie M, Carlson LE, Munoz M, Speca M (2007) A grounded theory approach to understanding self perceived benefits of an ongoing mindfulness-based stress reduction (MBSR) program on cancer patients. Stress Health 23:59–69CrossRefGoogle Scholar
  32. 32.
    Mackenzie MJ, Carlson LE, Speca M (2005) Mindfulness-based stress reduction (MBSR) in oncology: rationale and review. Evid Based Integr Med 2:139–145CrossRefGoogle Scholar
  33. 33.
    McGregor BA, Antoni MH, Boyers A, Alferi SM, Blomberg BB, Carver CS (2004) Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. J Psychosom Res 56:1–8PubMedCrossRefGoogle Scholar
  34. 34.
    McNair DA, Lorr M, Droppelman LF (1971) Profile of mood states. Educational and Industrial Testing Service, San Diego, CaliforniaGoogle Scholar
  35. 35.
    Moadel A, Morgan C, Fatone A, Grennan J, Carter J, Laruffa G, Skummy A, Dutcher J (1999) Seeking meaning and hope: self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. Psychooncology 8:378–385PubMedCrossRefGoogle Scholar
  36. 36.
    Mulkins AL, Verhoef MJ (2004) Supporting the transformative process: experiences of cancer patients receiving integrative care. Integr Cancer Ther 3:230–237PubMedCrossRefGoogle Scholar
  37. 37.
    Mytko JJ, Knight SJ (1999) Body, mind and spirit: towards the integration of religiosity and spirituality in cancer quality of life research. Psychooncology 8:439–450PubMedCrossRefGoogle Scholar
  38. 38.
    Ott MJ, Norris RL, Bauer-Wu SM (2006) Mindfulness meditation for oncology patients. Integr Cancer Ther 5:98–108PubMedCrossRefGoogle Scholar
  39. 39.
    Parry C, Chesler MA (2005) Thematic evidence of psychosocial thriving in childhood cancer survivors. Qual Health Res 15:1055–1073PubMedCrossRefGoogle Scholar
  40. 40.
    Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D (2002) Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy-Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med 24:49–58PubMedCrossRefGoogle Scholar
  41. 41.
    Predeger E (1996) Womanspirit: a journey into healing through art in breast cancer. Advan Nurs Sci 18:48–58Google Scholar
  42. 42.
    Schulz U, Mohamed NE (2004) Turning the tide: benefit finding after cancer surgery. Soc Sci Med 59:653–662PubMedCrossRefGoogle Scholar
  43. 43.
    Sears SR, Stanton AL, Danoff-Burg S (2003) The yellow brick road and the emerald city: benefit finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychol 22:487–497PubMedCrossRefGoogle Scholar
  44. 44.
    Sellick SM, Crooks DL (1999) Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psychooncology 8:315–333PubMedCrossRefGoogle Scholar
  45. 45.
    Smith JE, Richardson J, Hoffman C, Pilkington K (2005) Mindfulness-Based Stress Reduction as supportive therapy in cancer care: systematic review. J Adv Nurs 52:315–327PubMedCrossRefGoogle Scholar
  46. 46.
    Speca M, Carlson LE, Goodey E, Angen M (2000) A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med 62:613–622PubMedGoogle Scholar
  47. 47.
    Tedeschi RG, Calhoun LG (1996) The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress 9:455–471PubMedGoogle Scholar
  48. 48.
    Thornton AA (2002) Perceiving benefits in the cancer experience. J Clin Psychol Med Settings 2:153–165CrossRefGoogle Scholar
  49. 49.
    Tomich PL, Helgeson VS (2004) Is finding something good in the bad always good? Benefit finding among women with breast cancer. Health Psychol 23:16–23PubMedCrossRefGoogle Scholar
  50. 50.
    Victora CG, Habicht JP, Bryce J (2004) Evidence-based public health: moving beyond randomized trials. Am J Public Health 94:400–405PubMedCrossRefGoogle Scholar
  51. 51.
    Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Sheila N. Garland
    • 2
  • Linda E. Carlson
    • 1
    • 2
    • 3
  • Sarah Cook
    • 2
  • Laura Lansdell
    • 2
  • Michael Speca
    • 4
  1. 1.Department of OncologyUniversity of CalgaryCalgaryCanada
  2. 2.Department of PsychologyUniversity of CalgaryCalgaryCanada
  3. 3.Alberta Cancer Board–Holy Cross SiteDepartment of Psychosocial ResourcesCalgaryCanada
  4. 4.Department of Oncology, Division of Psychosocial OncologyUniversity of CalgaryCalgaryCanada

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