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（在一些研究中估计为70%）经历临床显著的抑郁症 和/或焦虑（一起心理困扰，以下为痛苦）在完成癌症后的几个月和几年 治疗。为了满足这一重要需求，人们开发了冥想干预来减少痛苦 对于乳腺癌幸存者，同时也改善（或稳定）应激生理学的客观指标（即， 皮质醇昼夜节律。在过去的几年里，在提供这些冥想方面取得了进展， 通过数字技术进行干预，以提高可扩展性和可访问性（即，在线和/或通过应用程序） 以减轻幸存者的痛苦。在线冥想干预尤其重要，因为 他们确保了一种受欢迎的融合模式的持续可行性，因为许多幸存者无法参与 家庭外面对面的支持性护理活动。尽管取得了进展，现有的在线冥想 干预措施有若干局限性，削弱了其减轻幸存者痛苦的效力。在线 冥想干预有：1）主要集中在正念上，它不会积极地培养 亲社会和人际关系能力，并为可能 遭受社会孤立感，导致痛苦; 2）通常是异步的，没有直接的 在冥想训练过程中的干预接触;和3）往往不包括幸存者的非正式 护理人员（即，与幸存者生活在一起并通常为幸存者提供一半照顾的成年家庭成员）。这 研究将解决这些局限性。我们将建立在先前研究的严谨性基础上， 通过一种名为CBCT的同情冥想干预（基于认知的同情训练）， 由受过训练的干预人员同步提供，其中也包括护理人员。CBCT是一个为期8周的 干预始于注意力和正念，然后建立在对同情的沉思上， 自我和他人，并不同于其他冥想干预（即，冥想（Meditation）的目标 CBCT是直接增强社会联系，平静和自我同情的感觉，并减少负面影响。 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， 与主动注意力控制（健康教育，HE）相比，提高了幸存者的DCR 通过Zoom远程地将幸存者和护理者作为二分体（即，二联体的CBCT; CBCT-D）。我们还将测试 CBCT-D中是否包括照顾者可以比幸存者更好地减少痛苦并优化DCR 单独接受CBCT（即，幸存者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 通过与照顾者的社会联系这一中介途径来实现。这项研究将填补一个重要 减少痛苦的干预措施证据不足，这是NCI对越来越多的幸存者的优先事项 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.