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Effects of Internet Training in Mindfulness Meditation on Variables Related to Cancer Recovery

  • David MesserEmail author
  • John J. Horan
  • Linda K. Larkey
  • Caroline E. Shanholtz



Once cancer patients complete treatment, experiences with stress-related sequelae that impede recovery often persist. This study examined whether Internet-delivered mindfulness treatment alleviated symptoms associated with this stress.


Cancer survivors were randomly assigned to either 6-week Internet-delivered mindfulness training or a usual care control and were compared on the following outcome battery: The Hospital Anxiety and Depression Scale, the Profile of Mood States, the Pittsburgh Sleep Quality Index, and the Fatigue Symptom Inventory. Assessments were conducted before and after treatment and intervention compliance was monitored. Mindfulness treatments were delivered at a time and on a computer of the participants’ choosing.


Multivariate and univariate follow-up analyses indicated that mindfulness training produced significant benefits on all measures. Effect sizes were all medium to large as well.


Online mindfulness instruction represents a widely accessible intervention for reducing psychological distress and its behavioral manifestations in cancer survivors, especially those who are unable to participate in in-person training.


Mindfulness Cancer Online RCT Stress 


Authors’ Contributions

DM designed and executed the study, assisted with the data analysis, and wrote the manuscript. JH collaborated with designing the study, analyzing data, and editing the final manuscript. LL collaborated with designing the study and editing an initial version of the manuscript. CS collaborated with designing the study and analyzing data. All authors approved the final version of the manuscript for submission.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Arizona State University Institutional Review Board.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. Adler, N. E., & Page, A. E. K. (2008). Cancer care for the whole patient: Meeting psychosocial health needs. Institute of Medicine: Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting Board on Health Care Services.Google Scholar
  2. Ainsworth, B., Eddershaw, R., Meron, D., Baldwin, D. S., & Garner, M. (2013). The effect of focused attention and open monitoring meditation on attention network function in healthy volunteers. Psychiatry Research, 210(3), 1226–1231. Scholar
  3. Allen, J. D., Savadatti, S., & Levy, A. G. (2009). The transition from breast cancer ‘patient’ to ‘survivor’. Psycho-oncology, 18(1), 71–78. Scholar
  4. Altschuler, A., Rosenbaum, E., Gordon, P., Canales, S., & Avins, A. L. (2012). Audio recordings of mindfulness-based stress reduction training to improve cancer patients’ mood and quality of life—A pilot feasibility study. Support Cancer Care, 20, 1291–1297. Scholar
  5. Andreu, Y., Galdón, M. J., Durá, E., Martínez, P., Pérez, S., & Murgui, S. (2012). A longitudinal study of psychosocial distress in breast cancer: Prevalence and risk factors. Psychology & Health, 27(1), 72–87. Scholar
  6. Arnold, E. M. (1999). The cessation of cancer treatment as a crisis. Social Work in Health Care, 29(2), 21–38.Google Scholar
  7. Astin, J. A., Shapiro, S. L., Eisenberg, D. M., & Forys, K. L. (2003). Mind–body medicine: State of the science, implications for practice. Journal of the American Board of Family Practice, 16(2), 131–147.Google Scholar
  8. Baker, F., Denniston, M., Zabora, J., Polland, A., & Dudley, W. N. (2002). A POMS short form for cancer patients: Psychometric and structural evaluation. Psycho-Oncology, 11(4), 273–281.Google Scholar
  9. Baltrusch, H. J., Stangel, W., & Titze, I. (1991). Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research. Acta Neurologica, 13(4), 315–327.Google Scholar
  10. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., ..., Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. doi:
  11. Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the hospital anxiety and depression scale: An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.
  12. Bower, J. E. (2007). Cancer-related fatigue: Links with inflammation in cancer patients and survivors. Brain, Behavior, and Immunity, 21, 863–871.Google Scholar
  13. Bower, J. E. (2008). Perceptions of vulnerability and growth among cancer survivors: Positive and negative effects of cancer diagnosis. Journal of Clinical Oncology, 26(5), 768–777. Scholar
  14. Bower, J. E., Crosswell, A. D., Stanton, A. L., Crespi, C. M., Winston, D., Arevalo, J., ..., Ganz, P. A. (2015). Mindfulness meditation for younger breast cancer survivors: A randomized controlled trial. Cancer, 121(8), 1231–1240.Google Scholar
  15. Boyle, C. C., Stanton, A. L., Ganz, P. A., Crespi, C. M., & Bower, J. E. (2017). Improvements in emotion regulation following mindfulness meditation: Effects on depressive symptoms and perceived stress in younger breast cancer survivors. Journal of Consulting and Clinical Psychology, 85(4), 397–402.Google Scholar
  16. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research, 28(2), 193–213.Google Scholar
  17. Carlson, L., & Garland, S. (2005). Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine., 12(4), 278–285.Google Scholar
  18. Carlson, L. E., Beattie, T. L., Giese-Davis, J., Faris, P., Tamagawa, R., Fick, L. J., ..., Speca, M. (2015). Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer, 121(3), 476–484.Google Scholar
  19. Carlson, L. E., Tamagawa, R., Stephen, J., Drysdale, E., Zhong, L., & Speca, M. (2016). Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): Long-term follow-up results. Psycho-Oncology, 25(7), 750–759.Google Scholar
  20. 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(1), 23–33. Scholar
  21. Carmody, J., & Baer, R. A. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65(6), 627–638.Google Scholar
  22. Cordova, M., Andrykowski, M., Kenady, D., McGrath, P., Sloan, D., & Redd, W. (1995). Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer. Journal of Consulting and Clinical Psychology, 63, 981–986.Google Scholar
  23. Crist, J. V., & Grunfeld, E. A. (2013). Factors reported to influence fear of recurrence in cancer patients: A systematic review. Psycho-oncology, 22(5), 978–986. Scholar
  24. Curran, S. L., Andrykowski, M. A., & Studts, J. L. (1995). Short form of the profile of mood states (POMS-SF): Psychometric information. Psychological Assessment, 7(1), 80–83.Google Scholar
  25. Davidson, A., & Diamond, B. (2001). Autoimmune diseases. The New England Journal of Medicine, 345(5), 340–350. Scholar
  26. Dhabhar, F. S. (2009). Enhancing versus suppressive effects of stress on immune function: Implications for immunoprotection and immunopathology. Neuroimmunomodulation, 16, 300–317.Google Scholar
  27. Dowd, H., Hogan, M. J., McGuire, B. E., Davis, M. C., Sarma, K. M., Fish, R. A., & Zautra, A. J. (2015). Comparison of an online mindfulness-based cognitive therapy intervention with online pain management psychoeducation: A randomized controlled study.Google Scholar
  28. El-Jawahri, A. R., Vandusen, H. B., Traeger, L. N., Fishbein, J. N., Keenan, T., Gallagher, E. R., ... Temel, J. S. (2016). Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. Cancer, 122(5), 806–812.Google Scholar
  29. Er, E., Özden, M., & Arifoglu, A. (2009). A blended e-learning environment: A model proposition for integration of asynchronous and synchronous e-learning. International Journal of Learning, 16(2), 449–460.Google Scholar
  30. Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.Google Scholar
  31. Fish, J., Brimson, J., & Lynch, S. (2016). Mindfulness interventions delivered by technology without facilitator involvement: What research exists and what are the clinical outcomes? Mindfulness, 7(5), 1011–1023.Google Scholar
  32. Gaab, J. N., Blattler, N., Menzi, T., Pabst, B., Stoyer, S., & Elhert, U. (2003). Randomized controlled evaluation of the effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects. Psychoneuroendocrinology, 28(6), 767–779.Google Scholar
  33. Ganz, P. A. (2009). Survivorship: Adult cancer survivors. Primary Care, 36(4), 721–741. Scholar
  34. Gupta, S. K. (2011). Intention-to-treat concept: A review. Perspectives in clinical research, 2(3), 109–112.Google Scholar
  35. Hann, D. M., Jacobsen, P. B., Azzarello, L. M., Martin, S. C., Curran, S. L., Fields, K. K., et al. (1998). Measurement of fatigue in cancer patients: Development and validation of the fatigue symptom inventory. Quality of Life Research, 7(4), 301–310.Google Scholar
  36. Hann, D. M., Denniston, M. M., & Baker, F. (2000). Measurement of fatigue in cancer patients: Further validation of the fatigue symptom inventory. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 9(7), 847–854.Google Scholar
  37. Harrington, C. B., Hansen, J. A., Moskowitz, M., Todd, B. L., & Feuerstein, M. (2010). It’s not over when it’s over: Long-term symptoms in cancer survivors: A systematic review. International Journal of Psychiatry in Medicine, 40(2), 163–181.Google Scholar
  38. Harris, J., Mishra, P., & Koehler, M. (2009). Teachers’ technological pedagogical content knowledge and learning activity types: Curriculum-based technology integration reframed. Journal of Research on Technology in Education, 41(4), 393–416.Google Scholar
  39. Herzberg, K. N., Sheppard, S. C., Forsyth, J. P., Credé, M., Earleywine, M., & Eifert, G. H. (2012). The believability of anxious feelings and thoughts questionnaire (BAFT): A psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample. Psychological Assessment, 24(4), 877–891. Scholar
  40. Hinnen, C., Hagedoorn, M., Ranchor, A. V., & Sanderman, R. (2008). Relationship satisfaction in women: A longitudinal case-control study about the role of breast cancer, personal assertiveness, and partners’ relationship-focused coping. British Journal of Health Psychology, 13(4), 737–754 Scholar
  41. Irwin, M. R., Olmstead, R. E., Ganz, P. A., & Haque, R. (2013). Sleep disturbance, inflammation and depression risk in cancer survivors. Brain, Behavior, and Immunity, 30, S58–S67.Google Scholar
  42. Johns, S. A., Brown, L. F., Beck-Coon, K., Monahan, P. O., Tong, Y., & Kroenke, K. (2015). Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psycho-Oncology, 24(8), 885–893.Google Scholar
  43. Johns, S. A., Von Ah, D., Brown, L. F., Beck-Coon, K., Talib, T. L., Alyea, J. M., ..., Giesler, R. B. (2016). Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: Effects on cancer-related cognitive impairment. Journal of Cancer Survivorship, 10(3), 437–448.Google Scholar
  44. Kabat-Zinn, J. (1982). An out-patient 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.Google Scholar
  45. Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M. J., Cropley, T. G., ..., Bernhard, J. D. (1998). Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosomatic Medicine, 60(5), 625–632.Google Scholar
  46. Kamei, T., Toriumi, Y., Kimura, H., Ohno, S., Kumano, H., & Kimura, K. (2000). Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation. Perceptual and Motor Skills, 90(3), 1027–1032.Google Scholar
  47. Kjaer, T. K., Johansen, C., Ibfelt, E., Christensen, J., Rottmann, N., Hoybye, M. T., et al. (2011). Impact of symptom burden on health related quality of life of cancer survivors in a Danish cancer rehabilitation program: A longitudinal study. Acta Oncologica, 50(2), 223–232.Google Scholar
  48. Koolhaas, J. M., Bartolomucci, A., Buwalda, B., de Boer, S. F., Flügge, G., Korte, S. M., Meerlo, P., Murison, R., Olivier, B., Palanza, P., Richter-Levin, G., Sgoifo, A., Steimer, T., Stiedl, O., van Dijk, G., Wöhr, M., Fuchs, E. (2011). Stress revisited: A critical evaluation of the stress concept. Neuroscience & Biobehavioral Reviews, 35(5), 1291–1301.Google Scholar
  49. Labelle, L. E., Campbell, T. S., Faris, P., & Carlson, L. E. (2015). Mediators of mindfulness-based stress reduction (MBSR): Assessing the timing and sequence of change in cancer patients. Journal of Clinical Psychology, 71(1), 21–40.Google Scholar
  50. Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in Psychology 4, 863.Google Scholar
  51. Larkey, L. K., Greenlee, H., & Mehl-Madrona, L. E. (2013). Complementary and alternative approaches to cancer prevention. In D. S. Alberts & L. M. Hess (Eds.), Fundamentals of cancer prevention (3rd ed.). Berlin, Germany: Springer.Google Scholar
  52. Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: A meta-analysis. Psycho-oncology, 18, 571–579.Google Scholar
  53. Lengacher, C. A., Reich, R. R., Paterson, C. L., Jim, H. S., Ramesar, S., Alinat, C. B., ..., Kip, K. E. (2015). The effects of mindfulness-based stress reduction on objective and subjective sleep parameters in women with breast cancer: A randomized controlled trial. Psycho-Oncology, 24(4), 424–432.Google Scholar
  54. Linden, W., & Chambers, L. (1994). Clinical effectiveness of non-drug treatment for hypertension: A meta-analysis. Annals of Behavioral Medicine, 16, 35–45.Google Scholar
  55. Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.Google Scholar
  56. Ljótsson, B., Falk, L., Vesterlund, A. W., Hedman, E., Lindfors, P.,Rück, C., Hursti, T., Andréewitch, S., Jansson, L., Lindefors, N., Andersson, A. (2010). Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome – A randomized controlled trial. Behaviour Research and Therapy, 48(6), 531–539.Google Scholar
  57. Ljótsson, B., Hedman, E., Lindfors, P., Hursti, T., Lindefors, N., Andersson, G., & Rück, C. (2011). Long-term follow-up of internetdelivered exposure and mindfulness based treatment for irritable bowel syndrome. Behaviour Research and Therapy, 49(1), 58–61.Google Scholar
  58. Marshall, C. A., Larkey, L. K., Curran, M. A., Weihs, K. L., Badger, T. A., Armin, J., & García, F. (2011). Considerations of culture and social class for families facing cancer: The need for a new model for health promotion and psychosocial intervention. Families, Systems, & Health, 29(2), 81–94. Scholar
  59. Matchim, Y., Armer, J. M., & Stewart, B. R. (2011). Mindfulness-based stress reduction among breast cancer survivors: A literature review and discussion. Oncology Nursing Forum, 38(2), 61–71. Scholar
  60. Messer, D., Horan, J. J., Turner, W., & Weber, W. (2016). The effects of internet-delivered mindfulness training on stress, coping, and mindfulness in university students. AERA Open.
  61. Meyer, B., Berger, T., Caspar, F., Beevers, C. G., Andersson, G., & Weiss, M. (2009). Effectiveness of a novel integrative online treatment for depression (deprexis): Randomized controlled trial. Journal of Medical Internet Research., 11(2), 1–18.Google Scholar
  62. Miller, A. H., Ancoli-Israel, S., Bower, J. E., Capuron, L., & Irwin, M. R. (2008). Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. Journal of Clinical Oncology, 26(6), 971–982.Google Scholar
  63. Monti, D. A., Peterson, C., Kunkel, E. J. S., Hauck, W. W., Pequignot, E., Rhodes, L., & Brainard, G. C. (2006). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psycho-Oncology, 15(5), 363–373. Scholar
  64. Musial, F., Bussing, A., Heusser, P., Choi, K., & Ostermann, T. (2011). Mindfulness-based stress reduction for integrative cancer care—A summary of evidence. Forschende Komplementarmedizin, 18, 192–202. Scholar
  65. O’Donnell, E., Lawless, S., Sharp, M., & Wade, V. P. (2015). A review of personalised e-learning: Towards supporting learner diversity. International Journal of Distance Education Technologies, 13(1), 22–47.Google Scholar
  66. Peavey, B. S., Lawlis, G. F., & Goven, A. (1985). Biofeedback-assisted relaxation: Effects on phagocytic capacity. Biofeedback and Self Regulation, 10(1), 33–47.Google Scholar
  67. Piet, J., Würtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80(6), 1007–1020. Scholar
  68. Raison, C. L., & Miller, A. H. (2001). The neuroimmunology of stress and depression. Seminars in Clinical Neuropsychiatry, 6(4), 277–294.Google Scholar
  69. Rush, S. E., & Sharma, M. (2017). Mindfulness-based stress reduction as a stress management intervention for cancer care: A systematic review. Journal of Evidence-Based Complementary & Alternative Medicine, 22(2), 348–359.Google Scholar
  70. Sapolsky, R. M. (2004). Why zebras don’t get ulcers. New York: Henry Holt & Company.Google Scholar
  71. Sapolsky, R. M., Romero, L. M., & Munck, A. U. (2000). How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocrine Reviews, 21(1), 55–89.Google Scholar
  72. Scholl, R., Bekker, A., & Babu, R. (2012). Neuroendocrine and immune responses to surgery. The Internet Journal of Anesthesiology, 30(3), 3.Google Scholar
  73. Schultz, J. H., & Luthe, W. (1959). Autogenic training: A psychophysiologic approach in psychotherapy. New York, NY: Grune & Stratton.Google Scholar
  74. Sedlmeier, P., Loße, C., & Quasten, L. C. (2017). Psychological effects of meditation for healthy practitioners: An update. Mindfulness, 9(2), 371–387 Scholar
  75. Segal, Z., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach for preventing relapse. New York: Guilford Press.Google Scholar
  76. Sephton, S. E., & Spiegel, D. (2003). Circadian disruption in cancer: A neuroendocrine-immune pathway from stress to disease? Brain, Behavior, and Immunity, 17(5), 321–328.Google Scholar
  77. Shacham, S. (1983). A shortened version of the profile of mood states. Journal of Personality Assessment, 47, 305–306.Google Scholar
  78. Shao, D., Gao, W., & Cao, F. (2016). Brief psychological intervention in patients with cervical cancer: A randomized controlled trial. Health Psychology, 35(12), 1383–1391.Google Scholar
  79. Shapiro, S. L., Bootzin, R. R., Figueredo, A. J., Lopez, A. M., & Schwartz, G. E. (2003). The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study. Journal of Psychosomatic Research, 54(1), 85–91.
  80. Shiyko, M. P., Hallinan, S., & Naito, T. (2017). Effects of mindfulness training on posttraumatic growth: A systematic review and meta-analysis. Mindfulness, 8(4), 848–858 Scholar
  81. Simonson, M., Smaldino, S., Albright, M., & Zvacek, S. (2012). Teaching and learning at a distance: Foundations of distance education (5th ed.). Boston: Pearson.Google Scholar
  82. Smith, K. B., & Pukall, C. F. (2009). An evidence-based review of yoga as a complementary intervention for patients with cancer. Psycho-oncology, 18(5), 465–475. Scholar
  83. 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.Google Scholar
  84. Stein, K. D., Syrjala, K. L., & Andrykowski, M. A. (2008). Physical and psychological long-term and late effects of cancer. Cancer, 112(11 Supplement), 2577–2592. Scholar
  85. Tesauro, G. M., Rowland, J. H., & Lustig, C. (2002). Survivorship resources for post-treatment cancer survivors. Cancer Practice, 10(6), 277–283.Google Scholar
  86. Thompson, N. J., Walker, E. R., Obolensky, N., Winning, A., Barmon, C., Cilorio, C., & Compton, M. T. (2010). Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT. Epilepsy and Behavior, 19, 247–254.Google Scholar
  87. Toivonen, K. I., Zernicke, K., & Carlson, L. E. (2017). Web-based mindfulness interventions for people with physical health conditions: Systematic review. Journal of Medical Internet Research, 19(8), e303. Scholar
  88. Van der Kolk, B. (2000). Posttraumatic stress disorder and the nature of trauma. Dialogues in Clinical Neuroscience, 2(1), 7–22.Google Scholar
  89. van der Lee, M. L., & Garssen, B. (2012). Mindfulness‐based cognitive therapy reduces chronic cancer‐related fatigue: A treatment study. Psycho-Oncology, 21(3), 264–272.Google Scholar
  90. Vettese, L. C., Toneatto, T., Stea, J. N., Nguyen, L., & Wang, J. J. (2009). Do mindfulness meditation participants do their homework? And does it make a difference? A review of the empirical evidence. Journal of Cognitive Psychotherapy: An International Quarterly, 23(3), 198–225.Google Scholar
  91. Weinberg, R. A. (2013). The biology of cancer (2nd ed.). New York: Garland Science, Taylor and Francis Group.Google Scholar
  92. Wolever, R. Q., Bobinet, K. J., McCabe, K., Mackenzie, E. R., Fekete, E., Kusnick, C. A., & Baime, M. (2012). Effective and viable mind-body stress reduction in the workplace: A randomized controlled trial. Journal of Occupational Health Psychology, 17(2), 246–258. Scholar
  93. Younge, J. O., Wery, M. F., Gotink, R. A., Utens, E. M. W. J., Michels, M., Rizopoulos, D., et al. (2015). Web-based mindfulness intervention in heart disease: A randomized controlled trial. PLoS One, 10(12), e0143843. Scholar
  94. Zatura, A. J., Davis, M. C., Reich, J. W., Sturgeon, J. A., Arewasikporn, A., & Tennen, H. (2012). Phone-based interventions with automated mindfulness and mastery messages improve the daily functioning for depressed middle-aged community residents. Journal of Psychotherapy Integration, 22(3), 206–228. Scholar
  95. Zernicke, K. A., Campbell, T. S., Speca, M., McCabe-Ruff, K., Flowers, S., & Carlson, L. E. (2014). A randomized wait-list controlled trial of feasibility and efficacy of an online mindfulness-based cancer recovery program: The etherapy for cancer applying mindfulness trial. Psychosomatic Medicine, 76(4), 257–267.Google Scholar
  96. Zernicke, K. A., Campbell, T. S., Speca, M., Ruff, K. M., Flowers, S., Tamagawa, R., & Carlson, L. E. (2016). The eCALM trial: ETherapy for cancer applying mindfulness. Exploratory analyses of the associations between online mindfulness-based cancer recovery participation and changes in mood, stress symptoms, mindfulness, posttraumatic growth, and spirituality. Mindfulness, 7(5), 1071–1081.Google Scholar
  97. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.Google Scholar

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Authors and Affiliations

  1. 1.Arizona State UniversityTempeUSA
  2. 2.University of ArizonaTucsonUSA

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