, Volume 8, Issue 5, pp 1291–1303 | Cite as

A Brief Mindfulness Intervention Is Associated with Negative Outcomes in a Randomised Controlled Trial Among Chemotherapy Patients

  • Lisa M. ReynoldsEmail author
  • Ian P. Bissett
  • David Porter
  • Nathan S. Consedine


Emotional distress is common during chemotherapy, and supportive interventions during this time are often required. Mindfulness-based interventions appear promising amongst cancer survivors, but scant research has been conducted amongst patients undergoing acute treatment. This trial compared the efficacy of a brief mindfulness-based intervention (bMBT) with relaxation therapy on reducing distress amongst chemotherapy patients. Sixty-eight people receiving first-line chemotherapy at Auckland City Hospital were randomised to bMBT (n = 32) or relaxation training groups (n = 36). In both conditions, participants attended three 90-min weekly sessions. Overall distress (distress thermometer (DT); impact thermometer (IT)), cancer-related stress (Impact Events Scale–Cancer (IES-C)), cancer symptom distress (Memorial Symptom Assessment Scale–Short Form (MSAS-SF)) and social avoidance (SA) were assessed at enrolment, post-intervention and at 3-month follow-up. Both groups reported reductions in overall and cancer-related stress over time. Immediately post-intervention, however, bMBT (but not relaxation training) participants reported increased symptom distress, marginally increased social avoidance and decreased quality of life. So whilst overall distress and cancer distress declined in both groups, the mindfulness intervention was associated with increased symptom distress and social avoidance and reduced quality of life. This report presents a randomised controlled trial of a mindfulness-based intervention during chemotherapy and suggests that care is needed in employing mindfulness-based interventions in acute health treatment contexts.


Mindfulness Relaxation Emotion Chemotherapy Cancer 



This research could not have been conducted without funding from the Oakley Mental Health Foundation, the generosity of our participants and support of the Medical Oncology Department, Auckland City Hospital, the Regional Cancer and Blood Service, and the Auckland Division of the Cancer Society. We also thank Clinical Psychologist, Sue Dykes, for her mindfulness expertise and Natalie Tuck, Kate Loveys and Katie Simpson for their research assistance.

Author’s Contributions

LR designed and executed the study, delivered interventions, analysed the data and wrote the paper. IB collaborated with the study design, analyses and editing of manuscript. DB collaborated with the study design, recruitment of participants and editing of the manuscript. NC supervised the design and execution of the study, analyses of data and collaborated in writing paper.


  1. Andrykowski, M. A., & Manne, S. L. (2006). Are psychological interventions effective and accepted by cancer patients? I. Standards and levels of evidence. Annals of Behavioral Medicine, 32(2), 93–97.CrossRefPubMedGoogle Scholar
  2. 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(1), 27–45. doi: 10.1177/1073191105283504.CrossRefPubMedGoogle Scholar
  3. 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(3), 329–342. doi: 10.1177/1073191107313003.CrossRefPubMedGoogle Scholar
  4. Baken, D. M. L., & Woolley, C. (2011). Validation of the distress thermometer, impact thermometer and combinations of these in screening for distress. Psycho-Oncology, 20(6), 609–614. doi: 10.1002/pon.1934.CrossRefPubMedGoogle Scholar
  5. Bartley, T. (2012). Mindfulness-based cognitive therapy for cancer. Oxford: Wiley-Blackwell.Google Scholar
  6. Berghmans, C., Godard, R., Joly, J., Tarquinio, C., & Cuny, P. (2012). Effects of the mindfulness based stress reduction (MBSR) approach on psychic health (stress, anxiety, depression) and coping mode of diabetic patients: a controlled and randomized pilot study. Annales Medico-Psychologiques, 170(5), 312–317. doi: 10.1016/j.amp.2010.08.010.CrossRefGoogle Scholar
  7. Bränström, R., Kvillemo, P., Brandberg, Y., & Moskowitz, J. T. (2010). Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients—a randomized study. Annals of Behavioral Medicine, 39(2), 151–161. doi: 10.1007/s12160-010-9168-6.CrossRefPubMedGoogle Scholar
  8. Brotto, L. A., Erskine, Y., Carey, M., Ehlen, T., Finalyson, S., Heywood, M., et al. (2012). A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecologic Oncology, 125(2), 320–325. doi: 10.1016/j.ygyno.2012.01.035.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Brucker, P. S., Yost, K., Cashy, J., Webster, K., & Cella, D. (2005). General population and cancer patient norms for the Functional Assessment of Cancer Therapy–General (FACT-G). Evaluation and the Health Professions, 28(2), 192–211. doi: 10.1177/0163278705275341.CrossRefPubMedGoogle Scholar
  10. 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(4), 278–285. doi: 10.1207/s15327558ijbm1204_9.CrossRefPubMedGoogle Scholar
  11. 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. Oakland: New Harbinger Publications.Google Scholar
  12. Carlson, L. E., Angen, M., Cullum, J., Goodey, E., Koopmans, J., Lamont, L., et al. (2004). High levels of untreated distress and fatigue in cancer patients. British Journal of Cancer, 90(12), 2297–2304.PubMedPubMedCentralGoogle Scholar
  13. Carlson, L. E., Doll, R., Stephen, J., Faris, P., Tamagawa, R., Drysdale, E., & Speca, M. (2013). Randomized controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). Journal of Clinical Oncology, 31(25), 3119–3126.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., et al. (1993). The functional assessment of cancer therapy scale: development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570–579.CrossRefPubMedGoogle Scholar
  16. Chang, V. T., Hwang, S. S., Feuerman, M., Kasimis, B. S., & Thaler, H. T. (2000). The Memorial Symptom Assessment Scale–Short Form (MSAS-SF). Cancer, 89(5), 1162–1171.CrossRefPubMedGoogle Scholar
  17. Chiesa, A., & Serretti, A. (2011). Mindfulness-based interventions for chronic pain: a systematic review of the evidence. The Journal of Alternative and Complementary Medicine, 17(1), 83–93.CrossRefPubMedGoogle Scholar
  18. Davis, M., Eshelman, E. R., & McKay, M. (2008). The relaxation and stress reduction workbook. Oakland: New Harbinger Publications.Google Scholar
  19. Dobkin, P. L., Irving, J. A., & Amar, S. (2012). For whom may participation in a mindfulness-based stress reduction program be contraindicated? Mindfulness, 3(1), 44–50.CrossRefGoogle Scholar
  20. Donovan, K. A., Grassi, L., McGinty, H. L., & Jacobsen, P. B. (2014). Validation of the distress thermometer worldwide: state of the science. Psycho-Oncology, 23(3), 241–250. doi: 10.1002/pon.3430.CrossRefPubMedGoogle Scholar
  21. Eakin, E. G., & Strycker, L. A. (2001). Awareness and barriers to use of cancer support and information resources by HMO patients with breast, prostate, or colon cancer: patient and provider perspectives. Psycho-Oncology, 10(2), 103–113. doi: 10.1002/pon.500.CrossRefPubMedGoogle Scholar
  22. Epstein, M. D., & Lieff, J. D. (1981). Psychiatric complications of meditation practice. Journal of Transpersonal Psychology, 13(2), 137–147.Google Scholar
  23. Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 78(1), 72–79.CrossRefPubMedGoogle Scholar
  24. Germer, C. K., & Neff, K. D. (2013). Self-compassion in clinical practice. Journal of Clinical Psychology, 69(8), 856–867.CrossRefPubMedGoogle Scholar
  25. Hayes, A. M., & Feldman, G. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science and Practice, 11(3), 255–262. doi: 10.1093/clipsy.bph080.Google Scholar
  26. Henry, D. H., Viswanathan, H. N., Elkin, E. P., Traina, S., Wade, S., & Cella, D. (2008). Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Supportive Care in Cancer, 16(7), 791–801. doi: 10.1007/s00520-007-0380-2.CrossRefPubMedGoogle Scholar
  27. Higgins, S. C., Montgomery, G. H., & Bovbjerg, D. H. (2007). Distress before chemotherapy predicts delayed but not acute nausea. Supportive Care in Cancer, 15(2), 171–177. doi: 10.1007/s00520-006-0113-y.CrossRefPubMedGoogle Scholar
  28. Higgins, S. C., Montgomery, G. H., Raptis, G., & Bovbjerg, D. H. (2008). Effect of pretreatment distress on daily fatigue after chemotherapy for breast cancer. Journal of Oncology Practice, 4(2), 59–63.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Hohneker, J., Shah-Mehta, S., & Brandt, P. S. (2011). Perspectives on adherence and persistence with oral medications for cancer treatment. Journal of Oncology Practice, 7(1), 65–67.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Huijbers, M. J., Spinhoven, P., Spijker, J., Ruhé, H. G., van Schaik, D. J. F., van Oppen, P., et al. (2016). Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial. The British Journal of Psychiatry, 208(4), 366–373. doi: 10.1192/bjp.bp.115.168971.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Iconomou, G., Mega, V., Koutras, A., Iconomou, A. V., & Kalofonos, H. P. (2004). Prospective assessment of emotional distress, cognitive function, and quality of life in patients with cancer treated with chemotherapy. Cancer, 101(2), 404–411. doi: 10.1002/cncr.20385.CrossRefPubMedGoogle Scholar
  32. Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. R. (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. doi: 10.1207/s15324796abm3301_2.CrossRefPubMedGoogle Scholar
  33. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Delta.Google Scholar
  34. Klatt, M. D., Buckworth, J., & Malarkey, W. B. (2008). Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults. Health Education and Behavior, published online May 9.Google Scholar
  35. Kuijpers, H. J. H., van der Heijden, F. M. M. A., Tuinier, S., & Verhoeven, W. M. A. (2007). Meditation-induced psychosis. Psychopathology, 40(6), 461–464.CrossRefPubMedGoogle Scholar
  36. Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., et al. (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. The Lancet, 386(9988), 63–73. doi: 10.1016/S0140-6736(14)62222-4.CrossRefGoogle Scholar
  37. 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. doi: 10.1002/jclp.22117.CrossRefPubMedGoogle Scholar
  38. Larouche, S., & Edgar, L. (2004). The measure of distress: a practical thermometer for outpatient screening. Oncology Exchange, 3(3), 34–39.Google Scholar
  39. Lehrer, P., & Carrington, P. (2003). Progressive relaxation, autogenic training and meditation. In D. Moss (Ed.), Handbook of mind-body medicine for primary care (pp. 137–149). Thousand Oaks: Sage Publications.CrossRefGoogle Scholar
  40. Lotfi-Jam, K., Carey, M., Jefford, M., Schofield, P., Charleson, C., & Aranda, S. (2008). Nonpharmacologic strategies for managing common chemotherapy adverse effects: a systematic review. Journal of Clinical Oncology, 26(34), 5618–5629.CrossRefPubMedGoogle Scholar
  41. Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies: is it true that “everyone has won and all must have prizes”? Archives of General Psychiatry, 32(8), 995–1008. doi: 10.1001/archpsyc.1975.01760260059004.CrossRefPubMedGoogle Scholar
  42. Luckett, T., King, M. T., Butow, P. N., Oguchi, M., Rankin, N., Price, M. A., et al. (2011). Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: issues, evidence and recommendations. Annals of Oncology, 22(10), 2179–2190.CrossRefPubMedGoogle Scholar
  43. Luebbert, K., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psycho-Oncology, 10(6), 490–502. doi: 10.1002/pon.537.CrossRefPubMedGoogle Scholar
  44. Lustyk, M. K., Chawla, N., Nolan, R. S., & Marlatt, G. A. (2009). Mindfulness meditation research: issues of participant screening, safety procedures, and researcher training. Advances in Mind-Body Medicine, 24(1), 20–30.PubMedGoogle Scholar
  45. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72(1), 31–40.CrossRefPubMedGoogle Scholar
  46. Manne, S., Badr, H., Zaider, T., Nelson, C., & Kissane, D. (2010). Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer. Journal of Cancer Survivorship, 4(1), 74–85. doi: 10.1007/s11764-009-0109-y.CrossRefPubMedGoogle Scholar
  47. Moyers, B. (1993). Meditate!... for stress reduction, inner peace... or whatever! Psychology Today, 26, 36–43.Google Scholar
  48. National Comprehensive Cancer Network. (2003). Distress management. Clinical practice guidelines. Journal of the National Comprehensive Cancer Network: JNCCN, 1(3), 344.CrossRefGoogle Scholar
  49. Rawl, S. M., Given, B. A., Given, C. W., Champion, V. L., Kozachik, S. L., Barton, D., … Williams, S. D. (2002). Intervention to improve psychological functioning for newly diagnosed patients with cancer. Paper presented at the Oncology Nursing Forum.Google Scholar
  50. Rosenbaum, E., & Kabat-Zinn, J. (2007). Here for now: living well with cancer through mindfulness: Satya House Pub.Google Scholar
  51. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford Press.Google Scholar
  52. Shennan, C., Payne, S., & Fenlon, D. (2011). What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psycho-Oncology, 20(7), 681–697. doi: 10.1002/pon.1819.CrossRefPubMedGoogle Scholar
  53. 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.CrossRefPubMedGoogle Scholar
  54. Stanton, A. L. (2006). Psychosocial concerns and interventions for cancer survivors. Journal of Clinical Oncology, 24(32), 5132–5137. doi: 10.1200/jco.2006.06.8775.CrossRefPubMedGoogle Scholar
  55. Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials. PloS One, 9(4), e96110.CrossRefPubMedPubMedCentralGoogle Scholar
  56. Tacon, A. M., McComb, J., Caldera, Y., & Randolph, P. (2003). Mindfulness meditation, anxiety reduction, and heart disease: a pilot study. Family and Community Health, 26(1), 25–33.CrossRefPubMedGoogle Scholar
  57. Thewes, B., Meiser, B., & Hickie, I. B. (2001). Psychometric properties of the impact of event scale amongst women at increased risk for hereditary breast cancer. Psycho-Oncology, 10(6), 459–468. doi: 10.1002/pon.533.CrossRefPubMedGoogle Scholar
  58. Veehof, M., ten Klooster, P., Taal, E., Westerhof, G., & Bohlmeijer, E. (2011). Psychometric properties of the Dutch Five Facet Mindfulness Questionnaire (FFMQ) in patients with fibromyalgia. Clinical Rheumatology, 30(8), 1045–1054. doi: 10.1007/s10067-011-1690-9.CrossRefPubMedPubMedCentralGoogle Scholar
  59. Weiss, D. (2007). The impact of event scale: revised. In J. P. Wilson & C. S. Tang (Eds.), Cross-cultural assessment of psychological trauma and PTSD (pp. 219–238). New York: Springer.CrossRefGoogle Scholar
  60. Wells, A. (2005). Detached mindfulness in cognitive therapy: a metacognitive analysis and ten techniques. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 23(4), 337–355. doi: 10.1007/s10942-005-0018-6.CrossRefGoogle Scholar
  61. Wilson, B. M., Mickes, L., Stolarz-Fantino, S., Evrard, M., & Fantino, E. (2015). Increased false-memory susceptibility after mindfulness meditation. Psychological Science, 26(10), 1567–1573. doi: 10.1177/0956797615593705.CrossRefPubMedGoogle Scholar
  62. Yoo, H. J., Ahn, S. H., Kim, S. B., Kim, W. K., & Han, O. S. (2005). Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in improving their quality of life. Supportive Care in Cancer, 13(10), 826–833. doi: 10.1007/s00520-005-0806-7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Lisa M. Reynolds
    • 1
    Email author
  • Ian P. Bissett
    • 2
  • David Porter
    • 3
  • Nathan S. Consedine
    • 1
  1. 1.Department of Psychological MedicineThe University of AucklandAucklandNew Zealand
  2. 2.Department of SurgeryThe University of AucklandAucklandNew Zealand
  3. 3.Regional Cancer and Blood ServiceAucklandNew Zealand

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