Mindfulness based stress reduction (MBSR(BC)) in breast cancer: evaluating fear of recurrence (FOR) as a mediator of psychological and physical symptoms in a randomized control trial (RCT)

“These analyses were followed by use of the Sobel test (Baron & Kenny, 1986) to examine the indirect effect of potential mediating variables (X2) taking into account the direct effect of MBSR(BC) on the outcomes of interest (i.e. ‘‘a ? b’’ path).”

“Scores range from 0 to 60 (Radloff, 1977) Alpha coefficient reliability is 0.92 for breast cancer survivors.”

“Internal consistency reliability is 0.84–0.86 (Cohen et al., 1983).”

“Through the MBSR program patients learn to self-regulate awareness and attention (Bishop, 2002) and cultivate non-judging acceptance to implement change (Bishop et al., 2004; Brown et al., 2007; Kabat-Zinn, 1990, 2003).”

“This training emphasizes a moment-to-moment, nonjudgmental and non-reactive awareness to internal and external experiences, thus reducing rumination and elaboration of distressful experiences (Baer, 2003; Bishop et al., 2004).”

“This training emphasizes a moment-to-moment, nonjudgmental and non-reactive awareness to internal and external experiences, thus reducing rumination and elaboration of distressful experiences (Baer, 2003; Bishop et al., 2004).”

“Participants learn the use of four meditative practices including sitting meditation, walking meditation, body scan, and yoga while integrating mindful attention to self-regulate and manage stressful symptoms (Kabat-Zinn et al., 1985; Teasdale et al., 1995).”

“…meditative practices has demonstrated effectiveness in reducing psychological and physical symptoms in a wide variety of clinical and non-clinical populations (Bohlmeijer et al., 2010; Brown et al., 2007; Chiesa & Serretti, 2009; Grossman et al., 2004; Matchim & Armer, 2007; Musial et al., 2011).”

“…meditative practices has demonstrated effectiveness in reducing psychological and physical symptoms in a wide variety of clinical and non-clinical populations (Bohlmeijer et al., 2010; Brown et al., 2007; Chiesa & Serretti, 2009; Grossman et al., 2004; Matchim & Armer, 2007; Musial et al., 2011).”

“Participants learn the use of four meditative practices including sitting meditation, walking meditation, body scan, and yoga while integrating mindful attention to self-regulate and manage stressful symptoms (Kabat-Zinn et al., 1985; Teasdale et al., 1995).”

“96 indicates reliable or clinically significant change (Jacobson et al., 1984).”

“…meditative practices has demonstrated effectiveness in reducing psychological and physical symptoms in a wide variety of clinical and non-clinical populations (Bohlmeijer et al., 2010; Brown et al., 2007; Chiesa & Serretti, 2009; Grossman et al., 2004; Matchim & Armer, 2007; Musial et al., 2011).”

“Through the MBSR program patients learn to self-regulate awareness and attention (Bishop, 2002) and cultivate non-judging acceptance to implement change (Bishop et al., 2004; Brown et al., 2007; Kabat-Zinn, 1990, 2003).”

“…fear of recurrence as a distressing psychological and physical problem occurs regardless of risk, cancer site and can persist years after treatment (Armes et al., 2009; Baker et al., 2005; Deimling et al., 2006; Hodges & Humphris, 2009; Humphris et al., 2003; Llewellyn et al., 2008; Matthews,…”

“…is an established source of significant emotional distress among breast cancer survivors, it represents a logical, clinically-relevant target for intervention (Connell et al., 2006; Costanzo et al., 2007; Fredette, 1995; Johnson Vickberg, 2001; Oxlad et al., 2008; SchmidBuchi et al., 2008).”

“…and physical problem occurs regardless of risk, cancer site and can persist years after treatment (Armes et al., 2009; Baker et al., 2005; Deimling et al., 2006; Hodges & Humphris, 2009; Humphris et al., 2003; Llewellyn et al., 2008; Matthews, 2003; Mehta et al., 2003; Simard et al.,…”

“Additionally, in terms of appropriate intervention targeting, fear of recurrence may vary by age, with younger women having higher levels (Costanzo et al., 2007; Curran et al., 1998; Kornblith et al., 2007; Mast, 1998; Mehnert et al., 2009; van den Beuken-van Everdingen et al., 2008).”

“The need for post-treatment intervention is not time dependent, per se, (Mehnert et al., 2009) in that fear of cancer recurrence has been found to persist up to 32 years after surgery (Polinsky, 1994).”

“…is an established source of significant emotional distress among breast cancer survivors, it represents a logical, clinically-relevant target for intervention (Connell et al., 2006; Costanzo et al., 2007; Fredette, 1995; Johnson Vickberg, 2001; Oxlad et al., 2008; SchmidBuchi et al., 2008).”

“…disease-related emotional distress, fear of recurrence has been shown to chronically plague 24–89 % of women with breast cancer (Girgis et al., 2000; Hartl et al., 2003; Mehnert et al., 2009; Polinsky, 1994; Stanton et al., 2005; Stephens et al., 2008; van den Beuken-van Everdingen et al., 2008).”

“…over time to their disease-related emotional distress, fear of recurrence has been shown to chronically plague 24–89 % of women with breast cancer (Girgis et al., 2000; Hartl et al., 2003; Mehnert et al., 2009; Polinsky, 1994; Stanton et al., 2005; Stephens et al., 2008; van den Beuken-van…”

“…of Clinical Medicine, University of Virginia, Charlottesville, VA, USA psychological distress, decreased quality of life, and functional impairment (Simard et al., 2010; van den Beuken-van Everdingen et al., 2008) while contributing indirectly to fatigue (Minton & Stone, 2008; Young & White, 2006).”

“…and physical problem occurs regardless of risk, cancer site and can persist years after treatment (Armes et al., 2009; Baker et al., 2005; Deimling et al., 2006; Hodges & Humphris, 2009; Humphris et al., 2003; Llewellyn et al., 2008; Matthews, 2003; Mehta et al., 2003; Simard et al., 2010).”

“…is an established source of significant emotional distress among breast cancer survivors, it represents a logical, clinically-relevant target for intervention (Connell et al., 2006; Costanzo et al., 2007; Fredette, 1995; Johnson Vickberg, 2001; Oxlad et al., 2008; SchmidBuchi et al., 2008).”

“…and physical problem occurs regardless of risk, cancer site and can persist years after treatment (Armes et al., 2009; Baker et al., 2005; Deimling et al., 2006; Hodges & Humphris, 2009; Humphris et al., 2003; Llewellyn et al., 2008; Matthews, 2003; Mehta et al., 2003; Simard et al., 2010).”

“…and physical problem occurs regardless of risk, cancer site and can persist years after treatment (Armes et al., 2009; Baker et al., 2005; Deimling et al., 2006; Hodges & Humphris, 2009; Humphris et al., 2003; Llewellyn et al., 2008; Matthews, 2003; Mehta et al., 2003; Simard et al., 2010).”

“…and physical problem occurs regardless of risk, cancer site and can persist years after treatment (Armes et al., 2009; Baker et al., 2005; Deimling et al., 2006; Hodges & Humphris, 2009; Humphris et al., 2003; Llewellyn et al., 2008; Matthews, 2003; Mehta et al., 2003; Simard et al., 2010).”

“Few interventions have been tested to reduce fear of recurrence, however, fear of progression was reduced among cancer survivors by short psychotherapeutic interventions of a cognitive-behavioral group therapy and supportive-experiential group therapy (Herschbach et al., 2010).”

“For some patients this leads to behavioral consequences including increased health care visits, and double checking for recurrence (Cannon et al., 2011; Hawkins et al., 2010).”

“…which involves motivation and knowing why one is paying attention; (2) attention, which is knowing what is happening directly; and (3) attitude, which is paying attention through acceptance, caring qualities of mindfulness, or ‘‘affectionate attention’’ (Cullen, 2006; Shapiro et al., 2008).”

“The foundations of the MBSR program are built on the healing power of ‘‘mindfulness’’ that is operationalized through two cognitive processes, awareness and attention (Brown & Cordon, 2009).”

“…meditative practices has demonstrated effectiveness in reducing psychological and physical symptoms in a wide variety of clinical and non-clinical populations (Bohlmeijer et al., 2010; Brown et al., 2007; Chiesa & Serretti, 2009; Grossman et al., 2004; Matchim & Armer, 2007; Musial et al., 2011).”

“…of Clinical Medicine, University of Virginia, Charlottesville, VA, USA psychological distress, decreased quality of life, and functional impairment (Simard et al., 2010; van den Beuken-van Everdingen et al., 2008) while contributing indirectly to fatigue (Minton & Stone, 2008; Young & White, 2006).”

“…and physical problem occurs regardless of risk, cancer site and can persist years after treatment (Armes et al., 2009; Baker et al., 2005; Deimling et al., 2006; Hodges & Humphris, 2009; Humphris et al., 2003; Llewellyn et al., 2008; Matthews, 2003; Mehta et al., 2003; Simard et al., 2010).”

“Since fear of recurrence is an established source of significant emotional distress among breast cancer survivors, it represents a logical, clinically-relevant target for intervention (Connell et al., 2006; Costanzo et al., 2007; Fredette, 1995; Johnson Vickberg, 2001; Oxlad et al., 2008; SchmidBuchi et al., 2008).”

“…meditative practices has demonstrated effectiveness in reducing psychological and physical symptoms in a wide variety of clinical and non-clinical populations (Bohlmeijer et al., 2010; Brown et al., 2007; Chiesa & Serretti, 2009; Grossman et al., 2004; Matchim & Armer, 2007; Musial et al., 2011).”

“…is an established source of significant emotional distress among breast cancer survivors, it represents a logical, clinically-relevant target for intervention (Connell et al., 2006; Costanzo et al., 2007; Fredette, 1995; Johnson Vickberg, 2001; Oxlad et al., 2008; SchmidBuchi et al., 2008).”

“…randomized trial by our team, was found to significantly reduce fear of recurrence among 84 breast cancer survivors (Lengacher et al., 2009) however in another pre-post study, only a trend towards reduction of fear of recurrence was found among 19 prostate cancer survivors (Chambers et al., 2012).”

“A previous article details the CONSORT diagram regarding the number of participants recruited, enrolled and lost to follow-up for this study (Lengacher et al., 2011).”

“…disease-related emotional distress, fear of recurrence has been shown to chronically plague 24–89 % of women with breast cancer (Girgis et al., 2000; Hartl et al., 2003; Mehnert et al., 2009; Polinsky, 1994; Stanton et al., 2005; Stephens et al., 2008; van den Beuken-van Everdingen et al., 2008).”

“…have tested RNT constructs as mediators of MBIs, the most frequently assessed outcome was levels of depression (n = 5), followed by stress (n = 2), anxiety (n = 1) and global psychopathological symptoms (n = 1), with one study including measures of both stress and anxiety (Lengacher et al., 2014).”

“Fear of recurrence is often viewed as a multidimensional phenomenon, including emotional components of anxiety and fear, and a cognitive dimension, including worry, preoccupation and intrusive thought [39] E,C”