Randomized Controlled Trial of Mindfulness-Based Cancer Recovery Versus Supportive Expressive Group Therapy for Distressed Survivors of Breast Cancer (MINDSET)
Randomized Controlled Trial of Mindfulness-Based Cancer Recovery Versus Supportive Expressive Group Therapy for Distressed Survivors of Breast Cancer (MINDSET)
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DOI：
10.1200/jco.2012.47.5210
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发表时间：
2013-09-01
影响因子：
45.3
通讯作者：
Speca, Michael
中科院分区：
文献类型：
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作者：
Carlson, Linda E.;Doll, Richard;Speca, Michael
目的比较基于正念的癌症康复(MBCR)和支持性表达的团体治疗(SET)这两种有经验支持的团体干预措施帮助乳腺癌痛苦幸存者应对的效果。患者和方法这项多点随机对照试验将271名I-III期乳腺癌痛苦幸存者分配到MBCR、SET或为期1天的压力管理控制条件下。MBCR专注于正念冥想和温和瑜伽的训练，而SET专注于情感表达和团队支持。两个干预组都包括18小时的专业接触。评价者在基线和干预后收集测量数据，对研究条件视而不见。主要观察指标为情绪和昼夜唾液皮质醇斜率。结果使用线性混合效应模型，在意向处理分析中，与对照组相比，SET组(P=.002)和MBCR组(P=.011)的皮质醇斜率随着时间的推移保持不变，后者的皮质醇斜率变得更平坦。与SET组(P=.009)和对照组(P=.024)组的女性相比，MBCR组的女性在压力症状上随着时间的推移得到了更多的改善。按方案分析显示，与对照组相比，MBCR组在生活质量(P=.005)和社会支持(P=.012)方面有更大的改善。结论在迄今规模最大的试验中，MBCR在改善乳腺癌痛苦幸存者的一系列心理结果方面优于SET组。与对照条件相比，SET和MBCR也导致了更标准的皮质醇昼夜变化。这一发现的临床意义需要进一步研究。(C)美国临床肿瘤学会2013年
PurposeTo compare the efficacy of the following two empirically supported group interventions to help distressed survivors of breast cancer cope: mindfulness-based cancer recovery (MBCR) and supportive-expressive group therapy (SET).Patients and MethodsThis multisite, randomized controlled trial assigned 271 distressed survivors of stage I to III breast cancer to MBCR, SET, or a 1-day stress management control condition. MBCR focused on training in mindfulness meditation and gentle yoga, whereas SET focused on emotional expression and group support. Both intervention groups included 18 hours of professional contact. Measures were collected at baseline and after intervention by assessors blind to study condition. Primary outcome measures were mood and diurnal salivary cortisol slopes. Secondary outcomes were stress symptoms, quality of life, and social support.ResultsUsing linear mixed-effects models, in intent-to-treat analyses, cortisol slopes were maintained over time in both SET (P = .002) and MBCR (P = .011) groups relative to the control group, whose cortisol slopes became flatter. Women in MBCR improved more over time on stress symptoms compared with women in both the SET (P = .009) and control (P = .024) groups. Per-protocol analyses showed greater improvements in the MBCR group in quality of life compared with the control group (P = .005) and in social support compared with the SET group (P = .012).ConclusionIn the largest trial to date, MBCR was superior for improving a range of psychological outcomes for distressed survivors of breast cancer. Both SET and MBCR also resulted in more normative diurnal cortisol profiles than the control condition. The clinical implications of this finding require further investigation. (C) 2013 by American Society of Clinical Oncology