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Psychological Processes and Symptom Outcomes in Mindfulness-Based Stress Reduction for Cancer Survivors: A Pilot Study

  • Kelly ChinhEmail author
  • Catherine E. Mosher
  • Linda F. Brown
  • Kathleen A. Beck-Coon
  • Kurt Kroenke
  • Shelley A. Johns



Growing evidence supports the efficacy of mindfulness-based interventions for symptoms in cancer survivors. Identifying theory-based psychological processes underlying their effects on symptoms would inform research to enhance their efficacy and cost-effectiveness. We conducted secondary analyses examining the effect of mindfulness-based stress reduction (MBSR) for cancer-related fatigue on mindfulness facets, self-compassion, and psychological inflexibility. We also examined whether changes in these processes were associated with the symptom outcomes of fatigue interference, sleep disturbance, and emotional distress.


Thirty-five persistently fatigued cancer survivors (94% female, 77% breast cancer survivors) were randomized to either MBSR for cancer-related fatigue or a waitlist control (WC) condition. Self-report measures were administered at pre-intervention, post-intervention, and 1-month follow-up. Then the WC group received MBSR and completed a post-intervention follow-up.


Linear mixed modeling analyses of the first three time points showed steady increases over time for certain mindfulness facets (observing, acting with awareness, and nonjudging) and self-compassion in favor of the MBSR group. When analyzing pre- and post-intervention data across study conditions, none of the psychological processes predicted change in fatigue interference. However, increased nonjudging was associated with decreased sleep disturbance (β = −.39, p = 0.003), and increased acting with awareness was associated with decreased emotional distress (β = − 0.36, p = 0.003). Self-compassion did not predict change in symptom outcomes.


Results point to specific psychological processes that may be targeted to maximize the efficacy of future MBSR interventions for cancer survivors.


Cancer Fatigue Psychological flexibility Mindfulness-based stress reduction Self-compassion 


Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors’ Contributions

KC designed and executed the study, completed data analyses, and wrote the paper. CEM assisted with the study design, study execution, and the writing of this paper. LFB and KAB delivered the intervention and assisted in the writing of this paper. KK assisted in the writing of this paper. SAJ designed the original trial that generated data analyzed in this paper and assisted in the writing of this paper. All authors approved the final version of the manuscript for submission.

Funding Information

Research reported in this publication was supported by grants from the Walther Cancer Foundation, Inc. and the National Cancer Institute (R25CA117865-01A11). This work was also supported by National Cancer Institute grant K05CA175048 (CEM and SAJ).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Indiana University Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

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


The content is solely the responsibility of the authors and does not necessarily represent the official views of the Walther Cancer Foundation or the National Institutes of Health. Research reported in this paper is based on a master’s thesis completed by KC.


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© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of PsychologyIndiana University-Purdue University IndianapolisIndianapolisUSA
  2. 2.Department of MedicineIndiana University School of MedicineIndianapolisUSA
  3. 3.Center for Health Services ResearchRegenstrief Institute, Inc.IndianapolisUSA

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