Increased Mindfulness Is Related to Improved Stress and Mood Following Participation in a Mindfulness-Based Stress Reduction Program in Individuals With Cancer
Open accessAbstract
Background. Mindfulness-based stress reduction (MBSR) has demonstrated efficacy for alleviating cancer-related distress. Although theorized to be the means by which people improve, it is yet to be determined whether outcomes are related to the development or enhancement of mindfulness among participants. This study examined the effect of participation in an MBSR program on levels of mindfulness in a heterogeneous sample of individuals with cancer, and if these changes were related to improvements in stress and mood outcomes. Methods. In all, 268 individuals with cancer completed self-report assessments of stress and mood disturbances before and after participation in an 8-week MBSR program. Of these, 177 participants completed the Mindful Attention Awareness Scale and 91 participants completed the Five Facet Mindfulness Questionnaire, at both time points. Results. Levels of mindfulness on both measures increased significantly over the course of the program. These were accompanied by significant reductions in mood disturbance (55%) and symptoms of stress (29%). Increases in mindfulness accounted for a significant percentage of the reductions in mood disturbance (21%) and symptoms of stress (14%). Being aware of the present moment and refraining from judging inner experience were the 2 most important mindfulness skills for improvements of psychological functioning among cancer patients. Conclusions. These results add to a growing literature measuring the impact of mindfulness and its relationship to improved psychological health. Moreover, specific mindfulness skills may be important in supporting these improvements.
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Prior research suggests that mindfulness facets may vary in their strength and direction of association with patient-reported symptoms.
“given prior research suggesting that the mindfulness facets may vary in their strength and direction of association with patient-reported symptoms,8, 9, 11–14”
From Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer. (2020) · cites this paper as [12]
The Discussion (page unavailable) reports differential associations: nonjudging was linked to improved mood, acting with awareness to improved stress symptoms, and nonreacting to neither outcome. This supports variation in the strength of associations with patient-reported outcomes, but the cited passages do not show mindfulness facets having associations in opposite directions with symptoms. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAmong cancer samples, nonreactivity, acting with awareness, and nonjudging have been found to relate to positive psychological outcomes, including decreased anxiety and depression and improved mood and stress levels.
“nonjudging, acting with awareness, and nonreactivity have been found to relate to positive psychological outcomes among cancer samples, including improved mood and stress levels, as well as decreased anxiety and depression.11, 12, 15”
From Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer. (2020) · cites this paper as [12]
The Relation Between Mindfulness, Stress, and Mood Outcomes section links nonjudging and acting with awareness to improvements in mood or stress, including anxiety and depression subscales. The Discussion says the nonreacting scale showed no relation to any outcome measure in this study, although it notes an association with psychological improvement at three-month follow-up in another study. No page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMindfulness has been associated with lower levels of psychological symptoms in non-metastatic breast cancer patients and other oncology populations.
“While mindfulness has been associated with lower levels of psychological symptoms in non-metastatic breast cancer patients10 and other oncology populations,11, 12”
From Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer. (2020) · cites this paper as [12]
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Wahbeh, H., Lane, J. B., Goodrich, E., Miller, M., & Oken, B. (2012) · Mindfulness · doi:10.1007/s12671-012-0155-9 · Cited by 46 · see citing works
“50) in 177 participants with cancer (Garland et al. 2012).”
Zernicke, K. A., Campbell, T. S., Speca, M., Ruff, K. M., Flowers, S., Tamagawa, R., & Carlson, L. E. (2016) · Mindfulness · doi:10.1007/s12671-016-0545-5 · Cited by 46 · see citing works
“…awareness in daily life (Act), observing present moment experience (Observe), and allowing experience without judgment (Nonjudge) increased following the online intervention, which parallel previous research findings in F2F MBCR in oncology populations (Labelle et al. 2015a; Garland et al. 2013).”
BackgroundResultInfluentialSelf-citationGarland, S. N., Campbell, T., Samuels, C., & Carlson, L. E. (2013) · Personality and Individual Differences · doi:10.1016/j.paid.2013.03.003 · Cited by 45 · see citing works
Self-citationMcDonald, H. M., Sherman, K. A., Petocz, P., Kangas, M., Grant, K.-A., & Kasparian, N. A. (2016) · Mindfulness · doi:10.1007/s12671-016-0517-9 · Cited by 45 · see citing works
Mindful Caring: Using Mindfulness-Based Cognitive Therapy With Caregivers of Cancer Survivors
Wood, A. W., Gonzalez, J., & Barden, S. M. (2014) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2014.977418 · Cited by 38 · see citing works
Associations of Five Facets of Mindfulness With Self-Regulation in College Students
MacDonald, H. Z. (2021) · Psychological Reports · doi:10.1177/0033294120937438 · Cited by 40 · see citing works
Platt, L. M., Whitburn, A. I., Platt-Koch, A. G., & Koch, R. L. (2016) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20160725-07 · Cited by 33 · see citing works
Association Between Pain and Mindfulness in Multiple Sclerosis
Senders, A., Borgatti, A., Hanes, D., & Shinto, L. (2018) · International Journal of MS Care · doi:10.7224/1537-2073.2016-076 · Cited by 28 · see citing works
Effects of Making Art and Listening to Music on Symptoms Related to Blood and Marrow Transplantation
Lawson, L. M., Glennon, C., Fiscus, V., Harrell, V., Krause, K., Moore, A. B., & Smith, K. (2016) · Oncology nursing forum · doi:10.1188/16.onf.e56-e63 · Cited by 29 · see citing works
van der Donk, L. J., Fleer, J., Tovote, A., Ranchor, A. V., Smink, A., Mul, V. E. M., Sanderman, R., & Schroevers, M. J. (2020) · Mindfulness · doi:10.1007/s12671-019-01298-1 · Cited by 25 · see citing works
“Studies in people with cancer found somewhat stronger associations of mindfulness with lower depressive symptoms (Chambers et al. 2016; Schellekens et al. 2017), whereas others found associations of comparable strength as in the general population (Garland et al. 2013a).”
BackgroundInfluentialA Model of an Integrative Approach to Breast Cancer Patients
Rossi, C., Maggiore, C., Rossi, M. M., Filippone, A., Guarino, D., Micco, A. D., Forcina, L., & Magno, S. (2021) · Integrative Cancer Therapies · doi:10.1177/15347354211040826 · Cited by 24 · see citing works
Li, J., Yuan, E., Zhu, D., Chen, M., & Luo, Q. (2022) · Medicine · doi:10.1097/md.0000000000028421 · Cited by 17 · see citing works
Terapias cognitivo-conductuales de tercera generación (TTG): la atención plena / mindfulness
Moreno-Coutiño, A. B. (2012) · Revista Internacional de Psicología · doi:10.33670/18181023.v12i01.66 · Cited by 17 · see citing works
Self-reported measures of mindfulness in meditators and non-meditators: A cross-sectional study
Visweswaraiah, N. K., Vinchurkar, S. A., & Singh, D. (2014) · International Journal of Yoga · doi:10.4103/0973-6131.133898 · Cited by 16 · see citing works
“[26] Another study with cancer patients undergoing 8‐weeks of MBSR, showed improved levels of mindfulness and lowered mood disturbances and symptoms of stress.[27] A similar study like ours, comparing two different meditation techniques concluded that meditation improves the levels of mindfulness regardless of the med…”
ResultThe Effectiveness of Mindfulness-Based-Stress-Reduction for Military Cadets on Perceived Stress
Chen, Y.-H., Chiu, F.-C., Lin, Y.-N., & Chang, Y.-L. (2021) · Psychological Reports · doi:10.1177/00332941211010237 · Cited by 16 · see citing works
Case, L. K., Adler-Neal, A. L., Wells, R. E., & Zeidan, F. Z. (2021) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000908 · Cited by 14 · see citing works
Zarei, S., Lakhanpal, G., & Sadavoy, J. (2022) · Current Alzheimer Research · doi:10.2174/1567205019666220514131015 · Cited by 14 · see citing works
Lopez, G., Chaoul, A., Powers-James, C. R., Spelman, A. R., Wei, Q., Engle, R., Hashmi, Y., Bruera, E. D., & Cohen, L. G. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.01.018 · Cited by 13 · see citing works
Update on Research-Based Interventions for Anxiety in Patients With Cancer
Smith, P. R., Cope, D., Sherner, T. L., & Walker, D. (2014) · Clinical journal of oncology nursing · doi:10.1188/14.cjon.s3.5-16 · Cited by 13 · see citing works
Carsley, D., Heath, N. L., Gomez-Garibello, C. A., & Mills, D. J. (2016) · School Mental Health · doi:10.1007/s12310-016-9196-x · Cited by 14 · see citing works
Facets of mindfulness related to a change in anxiety following a mindfulness-based intervention.
Mizera, C. M., Bolin, R. M., Nugent, W. R., & Strand, E. B. (2016) · Journal of Human Behavior in the Social Environment · doi:10.1080/10911359.2015.1062674 · Cited by 10 · see citing works
“Another issue was that samples were disparate except for two studies examining cancer patients (Bränström et al., 2010; Garland et al., 2013).”
BackgroundMethodResultInfluentialLopez, G., Chaoul, A., Warneke, C. L., Christie, A. J., Powers-James, C. R., Liu, W., Narayanan, S., Delgado-Guay, M. O., Li, Y., Bruera, E. D., et al. (2023) · Integrative Cancer Therapies · doi:10.1177/15347354221148710 · Cited by 10 · see citing works
“14 The expectancy questionnaire, completed at baseline by all participants, asked 5 questions on a 5-point scale from strongly disagree (0) to strongly agree (5) about the degree to which they thought meditation would help with: well-being, focus mood, energy, and sleep.”
BackgroundChristopher, M., Rogers, B., Hunsinger, M., Colgan, D. D., Reiss, A. L., & Farwood, H. B. (2014) · Mindfulness · doi:10.1007/s12671-014-0305-3 · Cited by 9 · see citing works
Janusek, L. W., Tell, D., & Mathews, H. L. (2021) · Western Journal of Nursing Research · doi:10.1177/0193945920932290 · Cited by 7 · see citing works
“In the cancer population, only a few studies have sought to identify the “active” component or facet of mindfulness, and its relationship to psycho-behavioral outcomes in response to a mindfulness-based intervention (Bränström et al., 2010; Garland et al., 2013).”
BackgroundTseng, A. A. (2024) · OBM Integrative and Complementary Medicine · doi:10.21926/obm.icm.2401019 · Cited by 8 · see citing works
MacDonald, H. Z. (2023) · Journal of American College Health · doi:10.1080/07448481.2022.2155053 · Cited by 8 · see citing works
“28 There is robust evidence that mindfulness can be practiced and learned and that mindfulness-based interventions are effective in increasing mindfulness, promoting mental health, and reducing psychological distress across a range of populations, 30 including among college students.”
Putting Evidence Into Practice: Evidence-Based Interventions for Depression
Fulcher, C. D., Kim, H., Smith, P. R., & Sherner, T. L. (2014) · Clinical journal of oncology nursing · doi:10.1188/14.cjon.s3.26-37 · Cited by 8 · see citing works
“Six to eight weeks of MBSR interventions are recommended to reduce depression, with sessions typically lasting two hours (Ando et al., 2009; Garland, Tamagawa, Todd, Speca, & Carlson, 2013; Hofmann, Sawyer, Witt, & Oh, 2012; Len-gacher et al., 2012; Sharplin et al., 2010; Würtzen et al., 2013).”
Mindful Scroll: An Infinite Scroll Abstract Colouring App for Mindfulness
Zassman, S., Kaplan, C. S., & Vogel, D. (2024) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3613904.3642729 · Cited by 8 · see citing works
“POMS has been used in existing work that found a positive impact of mindfulness training on mood [25, 53], including one study [61] on the effects of a short-term (20 minute) meditation technique applied over a span of five days.”
MethodFlynn, M. J., Abolhosseini, S., Gamboa, J., Campbell, T. S., & Carlson, L. E. (2023) · Journal of Psychosocial Oncology Research and Practice · doi:10.1097/or9.0000000000000094 · Cited by 8 · see citing works
Self-citationChinh, K., Mosher, C. E., Brown, L. F., Beck‐Coon, K., Kroenke, K., & Johns, S. A. (2020) · Mindfulness · doi:10.1007/s12671-019-01299-0 · Cited by 6 · see citing works
Yousefi, A., Arani, A. M., Ghadiany, M., Jafari, M., Lighvan, M. A., Asanjarani, B., & Isfeedvajani, M. S. (2022) · Medical Science · doi:10.54905/disssi/v26i120/ms55e2021 · Cited by 6 · see citing works
“These results are in line with previous research indicating that participation in mindfulness-based interventions is correlated with improved psychological outcomes in cancer populations (Bränström et al., 2010; Garland et al., 2013; Dobkin & Zhao, 2011).”
ResultBaralo, B., Paravathaneni, M., Jain, A., Buragamadagu, B., Khanam, A., Iqbal, S. F., Hossain, S., Mulla, S., Choi, E., & Thirumaran, R. (2022) · BMC Psychology · doi:10.1186/s40359-022-00994-3 · Cited by 5 · see citing works
Blouin, R., & Proeschold‐Bell, R. J. (2015) · BRILL eBooks · doi:10.1163/9789004299436_010 · Cited by 5 · see citing works
“It has been successfully used to measure changes in stress symptoms following stress reduction interventions [32, 33, 34, 35, 36].”
MethodHealth Psychology in Australia
Dorrian, J., Thorsteinsson, E., Benedetto, M. D., Lane‐Krebs, K., Day, M. A., Hutchinson, A. D., & Sherman, K. A. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316779156 · Cited by 4 · see citing works
Coping in Conflict Zones: A Model Integrating Mindfulness, Yoga, and Support Groups
Litvak‐Hirsch, T., & Ben-Arie, D. K. (2025) · Journal of Loss and Trauma · doi:10.1080/15325024.2025.2499871 · Cited by 3 · see citing works
“For instance, a study by Garland et al. (2013) found that participants in an eight-week Mindfulness-Based Stress Reduction (MBSR) program exhibited significant reductions in mood disturbance and stress symptoms.”
Franchi, G., Bulli, F., Muraca, M. G., Maruelli, A., Grechi, E., & Miccinesi, G. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1803-x · Cited by 3 · see citing works
Sweeney, T. (2016) · Nottingham ePrints (University of Nottingham) · Cited by 3 · see citing works
Effects of a Conscious Breathing Intervention on Emotion and Energy Flow
Heath, A. K., Mashuga, H., & Arens, A. M. (2015) · SOPHIA (St. Catherine University) · Cited by 2 · see citing works
The Cancer Survivor and Complementary Health Approaches
Lee, J., Mucci, G. A., Zeltzer, L. K., & Vincent, N. (2015) · Springer eBooks · doi:10.1007/978-1-4899-7584-3_28 · Cited by 1 · see citing works
Estrategias no farmacológicas en el paciente clínicamente enfermo, ¿qué nos dice la literatura?
Sucerquia-Quintero, J. A. (2017) · Universitas Médica · doi:10.11144/javeriana.umed58-3.farm · Cited by 1 · see citing works
“En los artículos seleccionados se halló el mindfulness con aplicación a la patología oncológica [7, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63], así como su uso en otras patologías crónicas [4, 18, 64, 65].”
Costalupes, B., Gilbert, J. N., Gilbert, W., & COLES, M. G. H. (2021) · Journal of Kinesiology & Wellness · doi:10.56980/jkw.v9i.76 · Cited by 1 · see citing works
Butt, M. K. (2022) · Open Journal of Social Sciences · doi:10.4236/jss.2022.105027 · Cited by 1 · see citing works
Intervenciones grupales breves basadas en mindfulness: una revisión sistemática
González, B. B., Calventus-Salvador, J., & Pavez, P. (2023) · Límite · doi:10.4067/s0718-50652023000100215 · Cited by 1 · see citing works
Yang, R., Rush, T., & Huang, C. (2023) · Springer eBooks · doi:10.1007/978-3-031-50977-3_8 · Cited by 1 · see citing works
Sexual Functioning and Body Image in Younger Breast Cancer Survivors
Paterson, C. L. (2015) · Digital Commons - University of South Florida (University of South Florida) · Cited by 1 · see citing works
Stewart, A., Zimmerman, A., Tutterow, C., Manna, J., Meletis, S., & Conner, R. S. (2019) · Nursing Made Incredibly Easy! · doi:10.1097/01.nme.0000613620.52208.74 · Cited by 1 · see citing works
Garland, S. N. (2012) · Libraries and Cultural Resources (University of Calgary) · doi:10.5072/prism/27123 · Cited by 1 · see citing works
Self-citationArasil, P. F. (2022) · doi:10.6035/14109.2022.428585 · Cited by 1 · see citing works
MacKenzie, M. J. (2012) · Libraries and Cultural Resources (University of Calgary) · doi:10.11575/prism/26121
Zernicke, K. A. (2015) · Libraries and Cultural Resources (University of Calgary) · doi:10.11575/prism/27180
Chinh, K. (2017) · Purdue e-Pubs (Purdue University System) · doi:10.7912/c20942
Cohen, J. D., & Mullen, S. P. (2019) · Illinois Digital Environment for Access to Learning and Scholarship (University of Illinois at Urbana-Champaign) · doi:10.17605/osf.io/xkv6t
Meditation for Major Depressive Disorder: A Systematic Review
Sorbero, M. E. S., Ahluwalia, S. C., Reynolds, K. A., Lovejoy, S. L., Farris, C. A., Sloan, J., Miles, J. N. V., Vaughan, C., Kandrack, R., Apaydin, E. A., et al. (2015) · RAND Corporation eBooks · doi:10.7249/rr1138
Meditators and Non-Meditators: Level of Mindfulness and Psychological Well-Being
Khandelwal, S., & Koradia, K. (2017) · International Journal of Indian Psychology · doi:10.25215/0404.059
Non-drug Stress Management for Patients with Cancer: A Systematic Review
Sumneangsanor, T., Ruchiwit, M., & Weglicki, L. (2021) · The Open Nursing Journal · doi:10.2174/1874434602115010211
Complementary Mind-Body Therapies in Cancer
Hriso, C., Newberg, A. B., & Monti, D. (2022) · Springer eBooks · doi:10.1007/978-3-030-85702-8_13
A Theoretical Understanding of the Role of Mindfulness in Stress Among Cancer Patients
Maryam, R. (2023) · Indian Journal of Health Studies · doi:10.56490/ijhs.2023.5107
Mindfulness Meditation: A Hellenic Perspective Through Quantitative and Qualitative Study
Callifronas, M. D., & Kaltsouni, A. (2025) · Journal of Advances in Medicine and Medical Research · doi:10.9734/jammr/2025/v37i15706
Research Progress on Premonitive Grief in Patients with Advanced Colorectal Cancer
陈, 晨. (2025) · Nursing Science · doi:10.12677/ns.2025.144073
Integrative Medicine to Treat Tracheae, Bronchus, and Lung Cancer
Zahoor, I., Bala, R., Singh, S., Sharma, N., Chauhan, S., Wani, S. N., Ali, A. Z. E., & Dhiman, P. (2025) · Advances in Integrative Medicine · doi:10.1002/9781394336807.ch7
Management and Treatment of Pain in Cancer Patients
Ganguly, K. (2025) · BENTHAM SCIENCE PUBLISHERS eBooks · doi:10.2174/9798898813727125010019
Bridging the Gap: Engagement With Behavioral Health for Pain Management Among Oncology Patients
Kao, G., Javed, S., Asis, O. D., Wang, J., & Sun, X. (2026) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2026.04.625
Taşkaya, C., SEZGİN, L., & Çiftçi, N. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122131
Chu, X. (2026) · Journal of medicine and physical education. · doi:10.62517/jmpe.202618204
- Authors
- Garland, S. N., Tamagawa, R., Todd, S. C., Speca, M., & Carlson, L. E.
- Affiliations
- University of Calgary (CA)
- Venue
- Integrative Cancer Therapies
- Publisher
- SAGE Publications
- Published
- 2012-04-13
- Volume
- 12
- Issue
- 1
- Pages
- 31-40
- ISSN
- 1534-7354 (ISSN-L)
- 1552-695X
- OpenAlex
- W1966382343
- Cited by
- 91
- References
- 51
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 6 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 6 · 2018: 3 · 2017: 8 · 2016: 11 · 2015: 10 · 2014: 8 · 2013: 6 · 2012: 4
- FWCI
- 10.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Integrative Cancer Therapies (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Alberta Cancer Foundation
- Alberta Innovates - Health Solutions
- Alberta Innovates
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Keywords
- mindfulness-based stress reduction, mindfulness, cancer patients, stress, mood disturbance, psychological distress, mindfulness skills, present-moment awareness, non-judgment, Mindful Attention Awareness Scale, Five Facet Mindfulness Questionnaire
- MeSH terms
- Adult, Affect, Aged, Female, Humans, Male, Middle Aged, Neoplasms, Surveys and Questionnaires, Stress, Psychological, Time Factors, Treatment Outcome, Meditation
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