Mindfulness

, Volume 1, Issue 1, pp 28–40

Mindfulness-Based Stress Reduction in Oncology: Evaluating Mindfulness and Rumination as Mediators of Change in Depressive Symptoms

  • Laura E. Labelle
  • Tavis S. Campbell
  • Linda E. Carlson
Original Paper

Abstract

Mindfulness-Based Stress Reduction (MBSR), an 8-week group psychosocial intervention, has received increasing research support for its efficacy in oncology settings. Changes associated with MBSR participation for people with cancer include improved psychological functioning and quality of life. However, as with other populations, it remains unclear which components of MBSR bring about change and whether targeted constructs are critical in changing outcomes. We propose a mediation model to be tested as a first step towards understanding program mechanisms. Specifically, changes in mindfulness and rumination were hypothesized to mediate the impact of MBSR participation on symptoms of depression in people living with cancer. A waitlist-controlled study of MBSR participation in 77 women who had completed cancer treatment was conducted to test this model. Pre- to post-program, MBSR participants improved significantly more on depressive symptoms and mindfulness and decreased more on rumination scores compared to waiting controls. Decreases in rumination mediated the impact of MBSR on depressive symptoms, but mindfulness scores did not. Methodological recommendations are presented to promote research that will further elucidate the mechanisms of action of MBSR. Mediation analyses will inform the next generation of randomized controlled trials and may lead to program modifications that will maximize the effectiveness and efficiency of mindfulness-based interventions in cancer settings.

Keywords

Mindfulness-based stress reduction Meditation Oncology Intervention Mediation Mechanisms 

References

  1. Adler, N. E., Page, A., National Institute of Medicine, & Committee on Psychosocial Services to Cancer Patients / Families in a Community Setting. (2008). Cancer care for the whole patient: Meeting psychosocial health needs. Washington DC: National Academies Press.Google Scholar
  2. Amato, J. J., Williams, M., Greenberg, C., Bar, M., Lo, S., & Tepler, I. (1998). Psychological support to an autologous bone marrow transplant unit in a community hospital: A pilot experience. Psycho-Oncology, 7(2), 121–125.PubMedCrossRefGoogle Scholar
  3. Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (center for epidemiologic studies depression scale). American Journal of Preventive Medicine, 10(2), 77–84.PubMedGoogle Scholar
  4. Astin, J. A. (1997). Stress reduction through mindfulness meditation: effects on psychological symptomatology, sense of control, and spiritual experiences. Psychotherapy and Psychosomatics, 66, 97–106.PubMedCrossRefGoogle Scholar
  5. Baer, R. A. (2003). Mindfulness training as clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10, 125–143.CrossRefGoogle Scholar
  6. Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15, 329–342.PubMedCrossRefGoogle Scholar
  7. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRefGoogle Scholar
  8. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J. F., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science & Practice, 11, 230–241.CrossRefGoogle Scholar
  9. Boey, K. W. (1999). Cross-validation of a short form of the CES-D in Chinese elderly. International Journal of Geriatric Psychiatry, 14(8), 608–617.PubMedCrossRefGoogle Scholar
  10. Bonadona, V., Saltel, P., Desseigne, F., Mignotte, H., Saurin, J. C., Wang, Q., et al. (2002). Cancer patients who experienced diagnostic genetic testing for cancer susceptibility: Reactions and behavior after the disclosure of a positive test result. Cancer Epidemiology, Biomarkers and Prevention, 11(1), 97–104.PubMedGoogle Scholar
  11. Bower, J. E. (2008). Behavioral symptoms in patients with breast cancer and survivors. Journal of Clinical Oncology, 26(5), 768–777.PubMedCrossRefGoogle Scholar
  12. Bredart, A., Autier, P., Audisio, R. A., & Geragthy, J. (1998). Psycho-social aspects of breast cancer susceptibility testing: A literature review. European Journal of Cancer Care (Engl.), 7(3), 174–180.CrossRefGoogle Scholar
  13. Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.PubMedCrossRefGoogle Scholar
  14. Cameron, L. D., & Diefenbach, M. A. (2001). Responses to information about psychosocial consequences of genetic testing for breast cancer susceptibility: Influences of cancer worry and risk perceptions. Journal of Health Psychology, 6(1), 47–59.CrossRefGoogle Scholar
  15. Carlson, L. E., & Brown, K. W. (2005). Validation of the mindful attention awareness scale in a cancer population. Journal of Psychosomatic Research, 58, 29–33.PubMedCrossRefGoogle Scholar
  16. Carlson, L. E., & Garland, S. N. (2005). Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine, 12, 278–285.PubMedCrossRefGoogle Scholar
  17. Carlson, L. E., Labelle, L. E., Garland, S. N., Hutchins, M. L., & Birnie, K. (2009). Mindfulness-based interventions in oncology. In F. Didonna (Ed.), Clinical handbook of mindfulness (pp. 383–404). New York: Springer.CrossRefGoogle Scholar
  18. Carlson, L. E., & Speca, M. (2010). Mindfulness-based cancer recovery: A step-by-step MBSR approach to help you cope with treatment and reclaim your life. Oakville: New Harbinger. In Press.Google Scholar
  19. Carlson, L. E., Speca, M., Patel, K. D., & Faris, P. (2007). One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior, and Immunity, 21, 1038–1049.PubMedCrossRefGoogle Scholar
  20. Carlson, L. E., Speca, M., Patel, K. D., & 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. Psychosomatic Medicine, 65(4), 571–581.PubMedCrossRefGoogle Scholar
  21. Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2004). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology, 29(4), 448–474.PubMedCrossRefGoogle Scholar
  22. Carlson, L. E., 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. Supportive Care in Cancer, 9, 112–123.PubMedCrossRefGoogle Scholar
  23. Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31, 23–33.PubMedCrossRefGoogle Scholar
  24. Carmody, J., Baer, R. A., Lykins, E. L. B., & Olendzki, N. (2009). An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 65(6), 613–626.PubMedCrossRefGoogle Scholar
  25. Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29(6), 560–572.PubMedCrossRefGoogle Scholar
  26. Cheng, S. T., & Chan, A. C. (2005). The center for epidemiologic studies depression scale in older Chinese: Thresholds for long and short forms. International Journal of Geriatric Psychiatry, 20(5), 465–470.PubMedCrossRefGoogle Scholar
  27. Cohen, J. (1977). Statistical power analysis for the behavioral sciences (revisedth ed.). New York: Academic.Google Scholar
  28. Cohen, J. (1988). Statistical power analysis for the behavioral sciences, 2nd ed. Hillsdale, NJ: Erlbaum.Google Scholar
  29. Dimeo, F., Bertz, H., Finke, J., Fetscher, S., Mertelsmann, R., & Keul, J. (1996). An aerobic exercise program for patients with haematological malignancies after bone marrow transplantation. Bone Marrow Transplantation, 18(6), 1157–1160.PubMedGoogle Scholar
  30. Dobkin, P. L. (2008). Mindfulness-based stress reduction: What processes are at work? Complementary Therapies in Clinical Practice, 14(1), 8–16.PubMedCrossRefGoogle Scholar
  31. Epstein, M. (1995). Thoughts without a thinker: Psychotherapy from a Buddhist perspective. New York: Basic Books.Google Scholar
  32. Fritz, M. S., & Mackinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233–239.PubMedCrossRefGoogle Scholar
  33. Garland, S. N., Carlson, L. E., Cook, S., Lansdell, L., & Speca, M. (2007). A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients. Supportive Care in Cancer, 15(8), 949–961.PubMedCrossRefGoogle Scholar
  34. Germer, C. K. (2005). Mindfulness: What is it? what does it matter? In C. K. Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp. 3–27). New York: Guilford.Google Scholar
  35. Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299.CrossRefGoogle Scholar
  36. Hopwood, P. (1997). Psychological issues in cancer genetics: Current research and future priorities. Patient Education and Counselling, 32(1–2), 19–31.CrossRefGoogle Scholar
  37. Hopwood, P., Keeling, F., Long, A., Pool, C., Evans, G., & Howell, A. (1998). Psychological support needs for women at high genetic risk of breast cancer: Some preliminary indicators. Psycho-Oncology, 7(5), 402–412.PubMedCrossRefGoogle Scholar
  38. Horner, M. J., Ries, L. A. G., Krapcho, M., Neyman, N., Aminou, R., Howlader, N., et al. (2009). SEER cancer statistics review, 1975–2006. Bethesda: National Cancer Institute.Google Scholar
  39. Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., et al. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33(1), 11–21.PubMedCrossRefGoogle Scholar
  40. Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4, 33–47.PubMedCrossRefGoogle Scholar
  41. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York: Delacourt.Google Scholar
  42. Kash, K. M., Holland, J. C., Halper, M. S., & Miller, D. G. (1992). Psychological distress and surveillance behaviors of women with a family history of breast cancer. Journal of the National Cancer Institute, 84(1), 24–30.PubMedCrossRefGoogle Scholar
  43. Keller, M. (2000). Psychosocial issues in cancer genetics: State of the art. Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 46(1), 80–97.Google Scholar
  44. Kim, Y. S., Jun, H., Chae, Y., Park, H. J., Kim, B. H., Chang, I. M., et al. (2005). The practice of Korean medicine: An overview of clinical trials in acupuncture. Evidence-Based Complementary and Alternative Medicine, 2(3), 325–352.PubMedCrossRefGoogle Scholar
  45. Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59(10), 877–883.PubMedCrossRefGoogle Scholar
  46. Kramer, J. H., Crittenden, M. R., DeSantes, K., & Cowan, M. J. (1997). Cognitive and adaptive behavior 1 and 3 years following bone marrow transplantation. Bone Marrow Transplantation, 19(6), 607–613.PubMedCrossRefGoogle Scholar
  47. Lamanque, P., & Daneault, S. (2006). Does meditation improve the quality of life for patients living with cancer? Canadian Family Physician Medecin De Famille Canadien, 52, 474–475.PubMedGoogle Scholar
  48. Lasry, J. C., Margolese, R. G., Poisson, R., Shibata, H., Fleischer, D., Lafleur, D., et al. (1987). Depression and body image following mastectomy and lumpectomy. Journal of Chronic Diseases, 40(6), 529–534.PubMedCrossRefGoogle Scholar
  49. Lau, M. A., Bishop, S. R., Segal, Z. V., Buis, T., Anderson, N. D., Carlson, L., et al. (2006). The Toronto mindfulness scale: Development and validation. Journal of Clinical Psychology, 62(12), 1445–1467.PubMedCrossRefGoogle Scholar
  50. Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: A meta-analysis. Psycho-Oncology, 18(571), 579.Google Scholar
  51. Lengacher, C. A., Johnson-Mallard, V., Post-White, J., Moscoso, M. S., Jacobson, P. B., Klein, T. W., et al. (2009). Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology, 18(12), 1261–1272.PubMedCrossRefGoogle Scholar
  52. Lerman, C., Daly, M., Sands, C., Balshem, A., Lustbader, E., Heggan, T., et al. (1993). Mammography adherence and psychological distress among women at risk for breast cancer. Journal of the National Cancer Institute, 85(13), 1074–1080.PubMedCrossRefGoogle Scholar
  53. Lerman, C., Lustbader, E., Rimer, B., Daly, M., Miller, S., Sands, C., et al. (1995). Effects of individualized breast cancer risk counseling: A randomized trial. Journal of the National Cancer Institute, 87(4), 286–292.PubMedCrossRefGoogle Scholar
  54. Lerman, C., & Schwartz, M. (1993). Adherence and psychological adjustment among women at high risk for breast cancer. Breast Cancer Research and Treatment, 28(2), 145–155.PubMedCrossRefGoogle Scholar
  55. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting & Clinical Psychology, 72(1), 31–40.CrossRefGoogle Scholar
  56. 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: Journal of the International Society for the Investigation of Stress, 23(1), 59–69.Google Scholar
  57. Mackenzie, M. J., Carlson, L. E., & Speca, M. (2005). Mindfulness-based stress reduction (MBSR) in oncology: Rationale and review. Evidence Based Integrative Medicine, 2, 139–145.CrossRefGoogle Scholar
  58. MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York: Erlbaum.Google Scholar
  59. MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83–104.PubMedCrossRefGoogle Scholar
  60. MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39(1), 99–128.PubMedCrossRefGoogle Scholar
  61. Matchim, Y., & Armer, J. M. (2007). Measuring the psychological impact of mindfulness meditation on health among patients with cancer: A literature review. Oncology Nursing Forum, 34(5), 1059–1066.PubMedCrossRefGoogle Scholar
  62. Morris, S. B., & DeShon, R. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7(1), 105–125.PubMedCrossRefGoogle Scholar
  63. Mullens, A. B., McCaul, K. D., Erickson, S. C., & Sandgren, A. K. (2004). Coping after cancer: Risk perceptions, worry, and health behaviors among colorectal cancer survivors. Psycho-Oncology, 13(6), 367–376.PubMedCrossRefGoogle Scholar
  64. National Institute of Mental Health. (2002). Psychotherapeutic interventions: How and why they work. Bethesda: National Institute of Mental Health.Google Scholar
  65. Norman, G. R., Sloan, J. A., Wyrwich, K. W., & Norman, G. R. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41, 582–592.PubMedCrossRefGoogle Scholar
  66. Nyklicek, I., & Kuijpers, K. F. (2008). Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: Is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine, 35(3), 331–340.PubMedCrossRefGoogle Scholar
  67. Onitilo, A. A., Nietert, P. J., & Egede, L. E. (2006). Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. General Hospital Psychiatry, 28(5), 396–402.PubMedCrossRefGoogle Scholar
  68. Ott, M. J., Norris, R. L., & Bauer-Wu, S. M. (2006). Mindfulness meditation for oncology patients. Integrative Cancer Therapies, 5, 98–108.PubMedCrossRefGoogle Scholar
  69. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36(4), 717–731.Google Scholar
  70. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891.PubMedCrossRefGoogle Scholar
  71. Prieto, J. M., Atala, J., Blanch, J., Carreras, E., Rovira, M., Cirera, E., et al. (2005). Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation. Journal of Clinical Oncology, 23(25), 6063–6071.PubMedCrossRefGoogle Scholar
  72. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  73. Ramel, W., Goldin, P. R., Carmona, P. E., & McQuaid, J. R. (2004). The effects of mindfulness meditation on cognitive processes and affect in patients with past depression. Cognitive Therapy and Research, 28, 433–455.CrossRefGoogle Scholar
  74. Rosnow, R. L., & Rosenthal, R. (1996). Computing contrasts, effect sizes, and counternulls on other people's published data: General procedures for research consumers. Psychological Methods, 1(4), 331–340.CrossRefGoogle Scholar
  75. Satin, J. R., Linden, W., & Phillips, M. J. (2009). Depression as a predictor of disease progression and mortality in cancer patients: A meta-analysis. Cancer, 115(22), 5349–5361.PubMedCrossRefGoogle Scholar
  76. Segal, Z. V., Bizzini, L., & Bondolfi, G. (2005). Cognitive behaviour therapy reduces long term risk of relapse in recurrent major depressive disorder. Evidence Based Mental Health, 8, 38.PubMedCrossRefGoogle Scholar
  77. Segal, Z. V., Williams, M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.Google Scholar
  78. 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.CrossRefGoogle Scholar
  79. Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62, 373–386.PubMedCrossRefGoogle Scholar
  80. Shapiro, S. L., Oman, D., Thoresen, C. E., Plante, T. G., & Flinders, T. (2008). Cultivating mindfulness: Effects on well-being. Journal of Clinical Psychology, 64(7), 840–862.PubMedCrossRefGoogle Scholar
  81. Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21, 581–599.PubMedCrossRefGoogle Scholar
  82. Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422–445.PubMedCrossRefGoogle Scholar
  83. Smith, J. E., Richardson, J., Hoffman, C., & Pilkington, K. (2005). Mindfulness-based stress reduction as supportive therapy in cancer care: Systematic review. Journal of Advanced Nursing, 52, 315–327.PubMedCrossRefGoogle Scholar
  84. Spahn, G., Lehmann, N., Franken, U., Paul, A., Longhorst, J., Michalsen, A., et al. (2003). Improvement of fatigue and role function of cancer patients after an outpatient integrative mind-body intervention. Focus on Alternative and Complementary Therapies, 8(4), 540.Google Scholar
  85. Speca, M., Carlson, L. E., 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. Psychosomatic Medicine, 62(5), 613–622.PubMedGoogle Scholar
  86. Speca, M., Carlson, L. E., Mackenzie, M. J., & Angen, M. (2006). Mindfulness-based stress reduction (MBSR) as an intervention for cancer patients. In R. A. Baer (Ed.), Mindfulness-based treatment approaches: A clinician's guide to evidence base and approaches (pp. 239–261). Burlington: Elsevier.Google Scholar
  87. Spiegel, D., & Giese-Davis, J. (2003). Depression and cancer: Mechanisms and disease progression. Biological Psychiatry, 54, 269–282.PubMedCrossRefGoogle Scholar
  88. Teasdale, J. D., & Green, H. A. (2004). Ruminative self-focus and autobiographical memory. Personality & Individual Differences, 36, 1933–1943.CrossRefGoogle Scholar
  89. Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.PubMedCrossRefGoogle Scholar
  90. Temoshok, L. R. (2000). Psychological response and survival in breast cancer. Lancet, 355(920), 404–405.PubMedCrossRefGoogle Scholar
  91. Temoshok, L. R., & Wald, R. L. (2002). Change is complex: Rethinking research on psychosocial interventions and cancer. Integrative Cancer Therapies, 1(2), 135–145.PubMedCrossRefGoogle Scholar
  92. Trapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-factor model of personality: Distinguishing rumination from reflection. Journal of Personality & Social Psychology, 76, 284–304.CrossRefGoogle Scholar
  93. Van Wielingen, L. E., Carlson, L. E., & Campbell, T. S. (2007). Mindfulness-based stress reduction (MBSR), blood pressure, and psychological functioning in women with cancer. Psychosomatic Medicine, 69, A43.Google Scholar
  94. Verhoef, M. J., Casebeer, A. L., & Hilsden, R. J. (2002). Assessing efficacy of complementary medicine: Adding qualitative research methods to the "gold standard". Journal of Alternative and Complementary Medicine, 8(3), 275–281.CrossRefGoogle Scholar
  95. Vickers, A. J. (1996). Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. Journal of the Royal Society of Medicine, 89(6), 303–311.PubMedGoogle Scholar
  96. Vickers, A. J. (2004). Statistical reanalysis of four recent randomized trials of acupuncture for pain using analysis of covariance. Clinical Journal of Pain, 20(5), 319–323.PubMedCrossRefGoogle Scholar
  97. Vickers, A. J., Rees, R. W., Zollman, C. E., McCarney, R., Smith, C. M., Ellis, N., et al. (2004). Acupuncture of chronic headache disorders in primary care: Randomised controlled trial and economic analysis. Health Technology Assessment, 8(48), 1–35.Google Scholar
  98. Watanabe, S., & Bruera, E. (1996). Anorexia and cachexia, asthenia, and lethargy. Hematology/oncology Clinics of North America, 10(1), 189–206.PubMedCrossRefGoogle Scholar
  99. Watson, M., Haviland, J. S., Greer, S., Davidson, J., & Bliss, J. M. (1999). Influence of psychological response on survival in breast cancer: A population-based cohort study. Lancet, 354(9187), 1331–1336.PubMedCrossRefGoogle Scholar
  100. Watson, M., Homewood, J., Haviland, J., & Bliss, J. M. (2005). Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort. European Journal of Cancer, 41(12), 1710–1714.PubMedCrossRefGoogle Scholar
  101. Wetzel, W. (1989). Reiki healing: A physiologic perspective. Journal of Holistic Nursing, 7(1), 47–54.CrossRefGoogle Scholar
  102. White, A., & Ernst, E. (2003). Pitfalls in conducting systematic reviews of acupuncture. Rheumatology (Oxford, England), 42(10), 1271–1272.CrossRefGoogle Scholar
  103. White, A., & Ernst, E. (2004). A brief history of acupuncture. Rheumatology (Oxford, England), 43(5), 662–663.CrossRefGoogle Scholar
  104. Williams, K. A., Kolar, M. M., Reger, B. E., & Pearson, J. C. (2001). Evaluation of a wellness-based mindfulness stress reduction intervention: A controlled trial. American Journal of Health Promotion, 15, 422–432.PubMedGoogle Scholar
  105. Witek-Janusek, L., Albuquerque, K., Chroniak, K. R., Chroniak, C., Durazo-Arvizu, R., & Mathews, H. L. (2008). Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior, & Immunity, 22(6), 969–981.CrossRefGoogle Scholar
  106. Wonderling, D., Vickers, A. J., Grieve, R., & McCarney, R. (2004). Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care. BMJ, 328(7442), 747.PubMedCrossRefGoogle Scholar
  107. Yano, K., Kanie, T., Okamoto, S., Kojima, H., Yoshida, T., Maruta, I., et al. (2000). Quality of life in adult patients after stem cell transplantation. International Journal of Hematology, 71(3), 283–289.PubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Laura E. Labelle
    • 1
  • Tavis S. Campbell
    • 1
  • Linda E. Carlson
    • 1
    • 2
    • 3
  1. 1.Department of PsychologyUniversity of CalgaryCalgaryCanada
  2. 2.Division of Psychosocial Oncology, Department of Oncology, Faculty of MedicineUniversity of CalgaryCalgaryCanada
  3. 3.Department of Psychosocial ResourcesTom Baker Cancer CentreCalgaryCanada

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