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

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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.