Bagherzadeh, R., Sohrabineghad, R., Gharibi, T.,…Vahedparast, H. (2022). Effects of mindfulness-based stress reduction training on rumination in patients with breast cancer. BMC Women’s Health. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-02124-y#Tab3
I find this study interesting because: 1) It supports the use of Mindfulness Based Stress Reduction (MBSR) in the treatment of women with breast cancer for the reduction of distressing rumination and improved quality of life 2) The paper provides an easy-to-understand description of the “response styles theory” of Metacognitive beliefs and the phenomenon of rumination 3) The description of MBSR is succinct and accurate 4) The study design uses an abbreviated MBSR format consisting of shorter weekly sessions (90 minutes versus 2 ½ hours) with no day-long retreat yet shows results which support the efficacy of this intervention for the target population.
This summary of the study prepared with scisummary.com AI and reiterated by me.
Breast cancer is a major public health challenges for women worldwide. Complicating factors include physical, social, and psychological stress responses such as rumination. Rumination is characterized by persistent preoccupation with thoughts about treatment, complications and outcomes. This study sought to evaluate the effectiveness of mindfulness-based stress reduction (MBSR) in reducing rumination among women diagnosed with breast cancer.
Rumination:
According to the American Psychological Association “Rumination involves repetitive thinking or dwelling on negative feelings and distress and their causes and consequences. The repetitive, negative aspect of rumination can contribute to the development of depression or anxiety and can worsen existing conditions.” Metacognitive beliefs are defined as one’s beliefs about thinking and its processes. Negative metacognitive beliefs increase in women with BC . The authors state: “Regarding rumination there are two main metacognitive beliefs: positive and negative. Positive beliefs refer to the benefit of rumination (e.g., If I am worried, I will be more prepared), while negative beliefs refer to the uncontrollability and danger of rumination and its negative interpersonal and social consequences (e.g., I have no control over my worry and rumination; feeling like this means I am losing my mind).”
The authors continue: “The response styles theory is the most robust and solid theory of rumination. Based on this theory, when people are faced with unpleasant events, there are two main responses: distraction and rumination. A major characteristic of individuals who mostly use the rumination response style is assumed to be the fact that they ask a lot of questions in their minds about the possible causes of unpleasant events. They try hard to figure out the root(s) of that upsetting event, which means trying to solve the problem. But in doing so, not only do they fail to solve the problems, but also experience an increased level of anxiety and unusual worries.”
Patients with cancer exhibit more negative metacognitive beliefs than healthy individuals. The World Health Organization (WHO), psychological problems in patients with cancer is estimated to be 8 times higher than that in healthy people. Persistent rumination can harm health and well-being, and increase psychological distress.
“According to the American Cancer Society, one of the most important factors in the survival of patients with BC is the assessment and management of long-term physical and mental health conditions related to the disease and its complications.” Compared to other complications of cancer treatments such as nausea, vomiting, hair loss, etc., the concept of rumination has received less attention. Identifying treatment which reduces stress and rumination can improve quality of life and decrease “death anxiety”. Studies reveal that 32% of cancer patients report using mind–body interventions such as meditation to maintain physical and emotional well-being. Mindfulness-based stress reduction (MBSR) issuch a intervention.
Method, including description of MBSR: This randomized controlled trial, using a pretest, posttest, control group, and one-month follow-up design, involved 46 female breast cancer survivors for whom at least three months had elapsed since the last chemotherapy or radiotherapy session. Participants were randomly assigned to either an experimental or control group. The experimental group underwent eight sessions of MBSR lasting ninety minutes each. Data was collected at the pretest, posttest, and follow-up stages.
Training followed established protocols for Mindfulness Based Stress Reduction courses except for sessions shortened from 2 1/2 hours to 90 minutes and the omission of the full-day retreat.
MBSR focuses on present-moment attention to physical and environmental situations, somatic sensations, and thoughts. The primary mechanism of this treatment is attention control and non-elaborative experiencing.
During the 8 sessions, the participants in the experimental group were requested to meditate for 10–15 min a day, 5–7 days a week. This time increased as the participants’ experience increased every week.
A WhatsApp group was created for the experimental group, to monitor the completion of the assignment. The tutor was a facilitator who responded to questions and gave feedback if needed.
Results: No significant differences were found in the rumination scores of the experimental group across the three measurement stages. The control group exhibited significantly higher mean rumination scores on both the posttest and follow-up compared to the pre-test (P < 0.001). Additionally, the control group’s mean follow-up rumination score was significantly higher than that of the post-test (P=0.02). Adjusted comparisons between the two groups revealed a significant difference in mean rumination scores for both the post-test (P=0.01) and follow-up (P < 0.001).
Conclusion: The experimental group demonstrated greater success in preventing increased rumination compared to the control group, suggesting mindfulness training’s potential impact. This method is recommended due to its non-invasive, non-pharmacological nature and ease of implementation. Future research should include larger sample sizes and extended follow-ups.
