title: Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators.
abstract: Despite growing evidence in support of mindfulness as an underlying mechanism of mindfulness-based interventions (MBIs), it has been suggested that nonspecific therapeutic factors, such as the experience of social support, may contribute to the positive effects of MBIs. In the present study, we examined whether change in mindfulness and/or social support mediated the effect of Mindfulness-Based Cancer Recovery (MBCR) compared to another active intervention (i.e. Supportive Expressive Group Therapy (SET)), on change in mood disturbance, stress symptoms and quality of life. A secondary analysis was conducted of a multi-site randomized clinical trial investigating the impacts of MBCR and SET on distressed breast cancer survivors (MINDSET). We applied the causal steps approach with bootstrapping to test mediation, using pre- and post-intervention questionnaire data of the participants who were randomised to MBCR (n = 69) or SET (n = 70). MBCR participants improved significantly more on mood disturbance, stress symptoms and social support, but not on quality of life or mindfulness, compared to SET participants. Increased social support partially mediated the impact of MBCR versus SET on mood disturbance and stress symptoms. Because no group differences on mindfulness and quality of life were observed, no mediation analyses were performed on these variables. Findings showed that increased social support was related to more improvement in mood and stress after MBCR compared to support groups, whereas changes in mindfulness were not. This suggests a more important role for social support in enhancing outcomes in MBCR than previously thought.
authors.affiliation: Radboud Centre for Mindfulness, Department of Psychiatry, Radboud University Medical Centre, Reinier Postlaan 4, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. melanie.schellekens@radboudumc.nl.
authors.forename: Melanie P J
authors.identifier: http://orcid.org/0000-0001-8397-7674
authors.initials: MPJ
authors.lastname: Schellekens
authors.affiliation: Department of Oncology, University of Calgary, Calgary, AB, Canada.|Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Rie
authors.initials: R
authors.lastname: Tamagawa
authors.affiliation: Department of Oncology, University of Calgary, Calgary, AB, Canada.|Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Labelle
authors.affiliation: Department of Oncology, University of Calgary, Calgary, AB, Canada.|Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Speca
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Joanne
authors.initials: J
authors.lastname: Stephen
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Elaine
authors.initials: E
authors.lastname: Drysdale
authors.affiliation: Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sample
authors.affiliation: Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pickering
authors.affiliation: Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Dale
authors.initials: D
authors.lastname: Dirkse
authors.affiliation: Department of Oncology, University of Calgary, Calgary, AB, Canada.
authors.forename: Linette Lawlor
authors.initials: LL
authors.lastname: Savage
authors.affiliation: Department of Oncology, University of Calgary, Calgary, AB, Canada.|Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Carlson
mesh_terms: D000073116:Cancer Survivors / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D064866:Mindfulness; D011615:Psychotherapy, Group; D011788:Quality of Life; D012944:Social Support; D013315:Stress, Psychological / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: Breast cancer; Mediation; Mindfulness; Mindfulness-Based Cancer Recovery; Social support; Supportive Expressive Group Therapy