Leveraging social connection by including informal caregivers in an internet video conference-based compassion meditation intervention to reduce psychological distress in breast cancer survivors

摘要 许多乳腺癌幸存者(在一些研究中估计有70%)经历了明显的临床抑郁症。 和/或在癌症结束后的几个月和几年中的焦虑(心理痛苦，以下称为痛苦) 治疗。为了满足这一重要需求，冥想干预已被开发出来以减少痛苦。 对于乳腺癌幸存者，同时还改善(或稳定)应激生理的客观指标(即， 昼夜皮质醇节律；DCR)。在过去的几年里，在提供这些冥想方面已经取得了进展。 通过数字技术进行干预，以提高可扩展性和可及性(即，在线和/或通过应用程序) 以减少幸存者经历的痛苦。在线冥想干预特别重要，因为 它们为许多无法参与的幸存者确保了一种受欢迎的综合模式的持续生存能力 在家外开展面对面的支持性关怀活动。尽管取得了进展，但现有的在线冥想 干预措施有几个局限性，削弱了其减少幸存者痛苦的有效性。线上 冥想干预有：1)主要集中在正念上，而不是积极地培养 亲社会和人际关系能力，并为幸存者提供有限的沉思技能 遭受社会孤立的感觉，这会导致痛苦；2)通常是不同步的，没有直接的 在冥想训练过程中的干预者接触；3)通常不包括幸存者的非正式 照顾者(即与幸存者共同生活并通常为其提供一半照料的成年家庭成员)。这 研究将解决这些限制。我们将在先前研究的严谨基础上，减少幸存者的痛苦 通过名为CBCT(基于认知的慈悲训练)的在线慈悲冥想干预 由训练有素的干预者同步分娩，其中也包括护理人员。CBCT为期8周 从注意力和正念开始的干预，但随后逐渐形成对 而不同于其他冥想干预(即正念冥想)。的目标是 CBCT是直接增强社交、沉稳、自怜的感觉，减少负面情绪 影响，并通过这些途径减轻痛苦。我们试图确定CBCT是否能减少痛苦和 与主动注意控制(健康教育，HE)相比，在提供时提高了幸存者的DCR 通过将幸存者和照顾者作为二联体(即，CBCT用于二联体；CBCT-D)进行远程缩放。我们还将测试 是否将照顾者纳入CBCT-D比幸存者更能减少痛苦和优化DCR 单独接受CBCT(即幸存者接受CBCT；CBCT-S)。如果成功，这项研究将提供 关于在线、同步二元CBCT干预的有效性及其程度的证据 这是通过与照顾者建立社会联系的中介途径来实现的。这项研究将填补一个重要的 可以减少痛苦的干预措施证据不足，对于越来越多的幸存者来说，这是NCI的优先事项 和照顾者。

ABSTRACT Many breast cancer survivors (estimated 70% in some studies) experience clinically significant depression and/or anxiety (together psychological distress, hereafter distress) in the months and years after finishing cancer treatments. To address this important need, meditation interventions have been developed to reduce distress for breast cancer survivors, while also improving (or stabilizing) objective indicators of stress physiology (i.e., diurnal cortisol rhythm; DCR). In the last several years, progress has been made to deliver these meditation interventions through digital technology to improve scalability and accessibility (i.e., online and/or through apps) to reduce distress experienced by survivors. Online meditation interventions are especially important because they ensure ongoing viability of a popular integrative modality for many survivors who are unable to engage in face-to-face supportive care activities outside the home. Despite progress, existing online meditation interventions have several limitations that undercut their effectiveness to reduce survivor distress. Online meditation interventions have: 1) centered mostly on mindfulness, which does not actively work to cultivate prosocial and interpersonal relationship capacity and provides limited contemplative skills for survivors who may suffer from feelings of social isolation that contribute to distress; 2) often been asynchronous, with no direct interventionist contact over the course of meditation training; and 3) have often not included survivors' informal caregivers (i.e., adult family members who live with and typically provide half the care for survivors). This research will address these limitations. We will build on the rigor of prior research to reduce survivor distress with a compassion meditation intervention called CBCT (Cognitively-Based Compassion Training) for online synchronous delivery by trained interventionists that is also inclusive of caregivers. CBCT is an 8-week intervention that starts with attention and mindfulness but then builds to contemplation about compassion for the self and others, and is different from other meditation interventions (i.e., mindfulness meditation). The goal of CBCT is to directly enhance feelings of social connection, equanimity, and self-compassion, and reduce negative affect, and through these pathways lessen distress. We seek to determine if CBCT reduces distress and improves DCR for survivors compared to an active attention control (Health Education, HE) when delivered remotely by Zoom to both survivors and caregivers as a dyad (i.e., CBCT for dyads; CBCT-D). We will also test whether or not including caregivers in CBCT-D reduces distress and optimizes DCR more than when survivors receive CBCT by themselves alone (i.e., CBCT for survivors; CBCT-S). If successful, this research will provide evidence regarding efficacy of an online, synchronous dyadic CBCT intervention and the extent to which it does so through the mediational pathway of social connection with caregivers. This research will fill an important gap in evidence for interventions that can reduce distress, an NCI priority for the growing numbers of survivors and caregivers.