اثربخشی شناخت درمانی مبتنی بر ذهن آگاهی بر افسردگی، کیفیت زندگی و میزان کورتیزول سرم در زنان مبتلا به سرطان پستان

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری، گروه روان شناسی بالینی، واحد شیراز، دانشگاه آزاد اسلامی، شیراز، ایران.

2 استادیار گروه روان شناسی بالینی، واحد شیراز، دانشگاه آزاد اسلامی، شیراز، ایران.

3 مرکز تحقیقات سرطان، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

4 دانشیار گروه آموزشی فیزیولوژی، واحد شیراز، دانشکده علوم، موسسه آموزش عالی زند شیراز، شیراز، ایران.

چکیده

مقدمه:
سرطان پستان شایع‌ترین نوع سرطان در بین زنان است. تشخیص و درمان می‌توانند شدیدا استرس‌زا باشند. هدف مطالعه حاضر بررسی شناخت درمانی مبتنی بر ذهن‌آگاهی بر کیفیت زندگی، افسردگی و میزان کورتیزول سرم در زنان مبتلا به سرطان پستان است
روش کار: طرح پژوهشی نیمه‌آزمایشی، ازنوع پیش‌آزمون – پس‌آزمون با گروه کنترل بود. جامعه آماری شامل30 زن مبتلا به سرطان پستان مراجعه کننده به بیمارستان امید شهر مشهد بود، افراد به روش نمونه‌گیری در دسترس انتخاب و به صورت کاملا تصادفی در دو گروه 15 نفره آزمایش و کنترل قرار گرفتند. برای آزمودنی‌های گروه آزمایش جلسات درمانی به مدت هشت جلسه 90 دقیقه‌ای در هفته توسط روانشناس بالینی آموزش دیده برگزار گردید و گروه گواه هیچ درمانی دریافت نکردند.
برای اندازه‌گیری متغیرها از پرسش‌نامه های افسردگی بک (BDI-II)، کیفیت زندگی SF36 و به منظور بررسی اندازه‌گیری سطح کورتیزول، نمونه گیری خون بین ساعت 8 الی 10 صبح قبل از شروع اولین و بعد از آخرین جلسه درمان به عمل آمد. در بخش آمار ضمن گزارش توصیفی داده‌ها و بررسی مفروضه‌های تحلیل کواریانس (آزمون شاپیرو ویلک، آزمون لوین، آزمون همگنی شیب خط رگرسیون و ..) از آزمون آماری تحلیل کواریانس استفاده شده است.
نتایج: نتایج نشان داد شناخت درمانی مبتنی بر ذهن‌آگاهی در کاهش افسردگی، افزایش کیفیت زندگی و افزایش میزان کورتیزول سرم از سطح پایین به سطح متوسط محدوده طبیعی آزمایشگاهی موثر می‌باشد(P <0.001).
نتیجه‌گیری: نتایج نشان داد که شناخت درمانی مبتنی بر ذهن‌آگاهی می‌تواند بعنوان مداخله‌ای موثر در جهت ارتقا سلامت روان در بیماران مورد استفاده قرار گیرد.

کلیدواژه‌ها

عنوان مقاله [English]

The Effectiveness of Mindfulness-Based Cognitive Therapy on Depression,Quality of Life and Serum Cortisol Levels in Women with Breast Cancer

نویسندگان [English]

  • Zahra Olyaee 1
  • Massoud Mohammadi 2
  • Kazem Anvari 3
  • Seyed Ebrahim Hosseini 4
1 PhD Student, Department of Clinical Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran.
2 Assistant Professor Department of Clinical of Psycholog , Shiraz Branch, Islamic Azad University, Shiraz, Iran
3 Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Associate Professor Department of physiology, Shiraz Branch, Faculty of Science, Zand Institute of Higher Education, Shiraz, Iran.
چکیده [English]

Abstract
Introduction:
Breast cancer is the most common type of cancer among women. Diagnosis and treatment can all be extremely stressful. This study aimed to review mindfulness-based cognitive therapy on quality of life, depression, and serum cortisol levels in women with breast cancer.

Materials and methods:
This study is a quasi-experimental research project of pre test-posttest with the control group. The statistical society contains 30 women with breast cancer referred to Omid Hospital in Mashhad that they were selected by sampling method and they were randomly divided into two groups of 15 people of the experimental and control group.
To do the therapy, a trained clinical psychologist held 8 sessions of 90 minutes per week for the experimental group, while the control group received no treatment session.
To measure variables from Beck depression questionnaires (BDI-II), quality of life SF36, and to evaluate cortisol levels, the blood samples were taken between 8 and 10 am before the first and last treatment sessions were started. In the statistics section, while describing the data descriptively and examining the assumptions of analysis of covariance (Shapiro-Wilk test,,Levin test, regression line homogeneity test and ..)statistical test of analysis of covariance was used.
Results: The results showed that mindfulness-based cognitive therapy is effective in reduced depression and enhanced quality of life and increased serum cortisol from low to moderate levels within the normal laboratory range (P <0.001).
Conclusion:The results showed that mindfulness-based cognitive therapy can be used as an effective intervention to promote mental health in patients.

کلیدواژه‌ها [English]

  • Keywords: Mindfulness-based cognitive therapy
  • Quality of life
  • Cortisol
  • Depression
  • Breast Cancer

مراجع

1-Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018 Nov;68(6):394-424.
2- Coughlin SS, Paxton RJ, Moore N, Stewart JL, Anglin J. Survivorship issues in older breast cancer survivors. Breast cancer research and treatment. 2019 Feb;174(1):47-53.
3- Moore HC. Breast cancer survivorship. InSeminars in Oncology 2020 Aug 1 (Vol. 47, No. 4, pp. 222-228). WB Saunders.
4- Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It's not over when it's over: long-term symptoms in cancer survivors—a systematic review. The International Journal of Psychiatry in Medicine. 2010 Jun;40(2):163-81.
5-Pinquart M, Duberstein P. Depression and cancer mortality: a meta-analysis. Psychological medicine. 2010 Nov;40(11):1797-810
6- Vykoukalová Z, Pavlíčková H, Čeněk J, Smolík J. Satisfaction with the quality of life in Brno: A perception survey. Kontakt. 2016 Sep 1;18(3):e203-9.
7- American Psychiatric Association, American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA. 2013.
8-Mobaraki Asl N, Mirmazhari R, Dargahi R, Hadadi Z, Montazer M. Relationships among personality traits, anxiety, depression, hopelessness, and quality of life in patients with breast cancer. Iranian Quarterly Journal of Breast Disease. 2019 Nov 10;12(3):60-71.
9-Antoni MH, Dhabhar FS. The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer. 2019 May 1;125(9):1417-31.
10-Mauvais-Jarvis F, Merz NB, Barnes PJ, Brinton RD, Carrero JJ, DeMeo DL, De Vries GJ, Epperson CN, Govindan R, Klein SL, Lonardo A. Sex and gender: modifiers of health, disease, and medicine. The Lancet. 2020 Aug 22;396(10250):565-82.
11- McEwen BS. Redefining neuroendocrinology: epigenetics of brain-body communication over the life course. Frontiers in Neuroendocrinology. 2018 Apr 1;49:8-30.
12-Lee J, Jo DG, Park D, Chung HY, Mattson MP. Adaptive cellular stress pathways as therapeutic targets of dietary phytochemicals: focus on the nervous system. Pharmacological reviews. 2014 Jul 1;66(3):815-68.
13-Buttenschøn HN, Demontis D, Kaas M, Elfving B, Mølgaard S, Gustafsen C, Kaerlev L, Petersen CM, Børglum AD, Mors O, Glerup S. Increased serum levels of sortilin are associated with depression and correlated with BDNF and VEGF. Translational psychiatry. 2015 Nov;5(11):e677-.
14- Cernackova A, Durackova Z, Trebaticka J, Mravec B. Neuroinflammation and depressive disorder: The role of the hypothalamus. Journal of Clinical Neuroscience. 2020 May 1;75:5-10.
15-Pariante CM. Why are depressed patients inflamed? A reflection on 20 years of research on depression, glucocorticoid resistance and inflammation. European neuropsychopharmacology. 2017 Jun 1;27(6):554-9.
16- Crane B. Full catastrophe living; using the wisdom of your body and mind to face stress, pain and illness. Jon Kabat‐Zinn, 1996 Publisher: Piatkus, London ISBN: 0‐749‐915‐854.
17- Kuyken W, Warren FC, Taylor RS, Whalley B, Crane C, Bondolfi G, Hayes R, Huijbers M, Ma H, Schweizer S, Segal Z. Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials. JAMA psychiatry. 2016 Jun 1;73(6):565-74.
18- Park S, Sato Y, Takita Y, Tamura N, Ninomiya A, Kosugi T, Sado M, Nakagawa A, Takahashi M, Hayashida T, Fujisawa D. Mindfulness-Based Cognitive Therapy for Psychological Distress, Fear of Cancer Recurrence, Fatigue, Spiritual Well-Being, and Quality of Life in Patients With Breast Cancer—A Randomized Controlled Trial. Journal of pain and symptom management. 2020 Aug 1;60(2):381-9.
19- Huang HP, He M, Wang HY, Zhou M. A meta-analysis of the benefits of mindfulness-based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast Cancer. 2016 Jul;23(4):568-76.
20- Zhang J, Xu R, Wang B, Wang J. Effects of mindfulness-based therapy for patients with breast cancer: a systematic review and meta-analysis. Complementary therapies in medicine. 2016 Jun 1;26:1-0.
21- McEwen BS, Akil H. Revisiting the stress concept: implications for affective disorders. Journal of Neuroscience. 2020 Jan 2;40(1):12-21.
22- Dhabhar FS. The short-term stress response–Mother nature’s mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Frontiers in neuroendocrinology. 2018 Apr 1;49:175-92.
23-Cernackova A, Durackova Z, Trebaticka J, Mravec B. Neuroinflammation and depressive disorder: The role of the hypothalamus. Journal of Clinical Neuroscience. 2020 May 1;75:5-10.
24-McEwen BS. Neurobiological and systemic effects of chronic stress. Chronic stress. 2017 Mar;1:2470547017692328.
25- Dhabhar FS. The short-term stress response–Mother nature’s mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Frontiers in neuroendocrinology. 2018 Apr 1;49:175-92.
26-Campbell TS, Labelle LE, Bacon SL, Faris P, Carlson LE. Impact of mindfulness-based stress reduction (MBSR) on attention, rumination and resting blood pressure in women with cancer: a waitlist-controlled study. Journal of behavioral medicine. 2012 Jun;35(3):262-71.
27-Carlson LE. Mindfulness Meditation for Younger Breast Cancer Survivors: A Randomized Controlled Trial. Breast Diseases: A Year Book Quarterly. 2015;4(26):294-6.
28-Bower JE, Crosswell AD, Stanton AL, Crespi CM, Winston D, Arevalo J, Ma J, Cole SW, Ganz PA. Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015 Apr 15;121(8):1231-40.
29-Rouleau CR, Garland SN, Carlson LE. The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients. Cancer management and research. 2015;7:121.
30-Tang YY, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nature Reviews Neuroscience. 2015 Apr;16(4):213-25.
31-Rahimian Booger A, Younesi J. John Teesdale: A Window on Metacognition, Published by Danje. 2014. [Persian].
32-Steer RA, Beck AT, Garrison B. Applications of the beck depression inventory. InAssessment of depression 1986 (pp. 123-142). Springer, Berlin, Heidelberg.
33-Roelofs J, van Breukelen G, de Graaf LE, Beck AT, Arntz A, Huibers MJ. Norms for the Beck Depression Inventory (BDI-II) in a large Dutch community sample. Journal of Psychopathology and Behavioral Assessment. 2013 Mar;35(1):93-8.
34- Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2005. 14(3), 875–882.
35- Akbari M, Mirzaei H, editors. Opening speech. Abstract book of 9th International Breast Cancer Congress 1st ed Tehran: Resaneh Takhasosi Pub; 2014.
36-Haller H, Winkler MM, Klose P, Dobos G, Kuemmel S, Cramer H. Mindfulness-based interventions for women with breast cancer: an updated systematic review and meta-analysis. Acta oncologica. 2017 Dec 2;56(12):1665-76.
37-Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M. Randomized controlled trial of mindfulness based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): Long term follow up results. Psycho‐Oncology. 2016 Jul;25(7):750-9.
38-Johannsen M, O’Connor M, O’Toole MS, Jensen AB, Højris I, Zachariae R. Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: a randomized controlled trial. J Clin Oncol. 2016 Oct 1;34(28):3390-9.
39-Kingston T, Collier S, Hevey D, McCormick MM, Besani C, Cooney J, O’Dwyer AM. Mindfulness-based cognitive therapy for psycho-oncology patients: an exploratory study. Irish Journal of Psychological Medicine. 2015 Sep;32(3):265-74.
40-Zhang MF, Wen YS, Liu WY, Peng LF, Wu XD, Liu QW. Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer: a meta-analysis. Medicine. 2015 Nov;94(45).
41-Huang HP, He M, Wang HY, Zhou M. A meta-analysis of the benefits of mindfulness-based stress reduction (MBSR) on psychological function among breast cancer (BC) survivors. Breast Cancer. 2016 Jul;23(4):568-76.
42-Chang YC, Yeh TL, Chang YM, Hu WY. Short-term Effects of Randomized Mindfulness-Based Intervention in Female Breast Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Nursing. 2021 Nov 1;44(6):E703-14.
43-Cillessen L, Johannsen M, Speckens AE, Zachariae R. Mindfulness based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta analysis of randomized controlled trials. Psycho‐oncology. 2019 Dec;28(12):2257-69.
44-Oberoi S, Yang J, Woodgate RL, Niraula S, Banerji S, Israels SJ, et al. Association of mindfulness-based interventions with anxiety severity in adults with cancer: a systematic review and meta-analysis. JAMA network open. 2020 Aug 3;3(8):e2012598-.
45-Xunlin NG, Lau Y, Klainin-Yobas P. The effectiveness of mindfulness-based interventions among cancer patients and survivors: a systematic review and meta-analysis. Supportive Care in Cancer. 2020 Apr;28(4):1563-78.
46-Lesiuk T. The effect of mindfulness-based music therapy on attention and mood in women receiving adjuvant chemotherapy for breast cancer: a pilot study. InOncology nursing forum 2015 May 1 (Vol. 42, No. 3).
47-Maass SW, Roorda C, Berendsen AJ, Verhaak PF, de Bock GH. The prevalence of long-term symptoms of depression and anxiety after breast cancer treatment: a systematic review. Maturitas. 2015 Sep 1;82(1):100-8.
48-Compen FR, Bisseling EM, Schellekens MP, Donders AR, Carlson LE. Face-to-face and individual internet-based Mindfulness-Based Cognitive Therapy compared to Treatment As Usual in reducing psychological distress in cancer patients: a multicentre randomized controlled trial. Mindfulness-Based Cognitive Therapy for distressed cancer patients Clinical relevance and therapeutic alliance. . J Clin Oncol. 2018;36(23):2413-2421.
49-Johannsen M, O’Connor M, O’Toole MS, Jensen AB, Zachariae R. Mindfulness-based cognitive therapy and persistent pain in women treated for primary breast cancer. The Clinical journal of pain. 2018 Jan 1;34(1):59-67.
50- Nabipour S, Rafiepour A, Haji Alizadeh K. The effectiveness of mindfulness based cognitive therapy training on anxiety of death and thoughts of suicide of patients with cancer. Zahedan Journal of Research in Medical Sciences. 2018 Jan 31;20(1).
51- Stafford L, Foley E, Judd F, Gibson P, Kiropoulos L, Couper J. Mindfulness-based cognitive group therapy for women with breast and gynecologic cancer: a pilot study to determine effectiveness and feasibility. Supportive Care in Cancer. 2013 Nov;21(11):3009-19.
52- Chu X, Lou Y, Wang Z, Xu Q. Effect of Mindfulness Based Cognitive Therapy on the Mental Health and Quality of Life in Patients with Breast Cancer. Indian Journal of Pharmaceutical Sciences. 2020 Nov 30:48-52.
53-Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It's not over when it's over: long-term symptoms in cancer survivors—a systematic review. The International Journal of Psychiatry in Medicine. 2010 Jun;40(2):163-81.
54- Almeida SN, Elliott R, Silva ER, Sales CM. Fear of cancer recurrence: a qualitative systematic review and meta-synthesis of patients' experiences. Clinical psychology review. 2019 Mar 1;68:13-24.
55- Tang YY, Hölzel BK, Posner MI. The neuroscience of mindfulness training. Nat. Rev. Neurosci. 2015;16(4):213-25.
56- Cordova MJ, Riba MB, Spiegel D. Post-traumatic stress disorder and cancer. The Lancet Psychiatry. 2017 Apr 1;4(4):330-8.
57- Abbey G, Thompson SB, Hickish T, Heathcote D. A meta analysis of prevalence rates and moderating factors for cancer related post‐traumatic stress disorder. Psycho‐Oncology. 2015 Apr;24(4):371-81.
58-Wiley JF, Bower JE, Petersen L, Ganz PA. Trajectories of C-reactive protein in the year after breast cancer treatment. Brain, Behavior, and Immunity. 2017 Nov 1;66:e28-9.
59- Herriot H, Wrosch C, Hamm JM, Pruessner JC. Stress-related trajectories of diurnal cortisol in older adulthood over 12 years. Psychoneuroendocrinology. 2020 Nov 1;121:104826.
60- McEwen BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. European journal of pharmacology. 2008 Apr 7;583(2-3):174-85.
61-Miller GE, Chen E, Zhou ES. If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological bulletin. 2007 Jan;133(1):25.
62-Sharpley CF, Bitsika V, McMillan ME, Jesulola E, Agnew LL. The association between cortisol: C-reactive protein ratio and depressive fatigue is a function of CRP rather than cortisol. Neuropsychiatric disease and treatment. 2019;15:2467.
63- Luecken LJ, Dausch B, Gulla V, Hong R, Compas BE. Alterations in morning cortisol associated with PTSD in women with breast cancer. Journal of Psychosomatic Research. 2004 Jan 1;56(1):13-5.
64-Andrykowski MA, Cordova MJ, Studts JL, Miller TW. Posttraumatic stress disorder after treatment for breast cancer: Prevalence of diagnosis and use of the PTSD Checklist—Civilian Version (PCL—C) as a screening instrument. Journal of consulting and clinical psychology. 1998 Jun;66(3):586.
65-Burke HM, Davis MC, Otte C, Mohr DC. Depression and cortisol responses to psychological stress: a meta-analysis. Psychoneuroendocrinology. 2005 Oct 1;30(9):846-56.
66- Anderson KO, Getto CJ, Mendoza TR, Palmer SN, Wang XS, Reyes-Gibby CC, Cleeland CS. Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. Journal of Pain and Symptom Management. 2003 Apr 1;25(4):307-18
67-Bower JE, Ganz PA, Aziz N. Altered cortisol response to psychologic stress in breast cancer survivors with persistent fatigue. Psychosomatic medicine. 2005 Mar 1;67(2):277-80.
 68-Lengacher CA, Kip KE, Barta M, Post-White J, Jacobsen PB, Groer M, Lehman B, Moscoso MS, Kadel R, Le N, Loftus L. A pilot study evaluating the effect of mindfulness-based stress reduction on psychological status, physical status, salivary cortisol, and interleukin-6 among advanced-stage cancer patients and their caregivers. Journal of Holistic Nursing. 2012 Sep;30(3):170-85.
69-Lengacher CA, Kip KE, Post-White J, Fitzgerald S, Newton C, Barta M, Jacobsen PB, Shelton MM, Moscoso M, Johnson-Mallard V, Harris E. Lymphocyte recovery after breast cancer treatment and mindfulness-based stress reduction (MBSR) therapy. Biological research for nursing. 2013 Jan;15(1):37-47.
70-Witek-Janusek L, Albuquerque K, Chroniak KR, Chroniak C, Durazo-Arvizu R, Mathews HL. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, behavior, and immunity. 2008 Aug 1;22(6):969-81.
71-Carlson LE, Speca M, Faris P, Patel KD. One year pre–post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, behavior, and immunity. 2007 Nov 1;21(8):1038-49.
72-Wayne PM, Lee MS, Novakowski J, Osypiuk K, Ligibel J, Carlson LE, Song R. Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2018 Apr;12(2):256-67.
73- Luo XC, Liu J, Fu J, Yin HY, Shen L, Liu ML, Lan L, Ying J, Qiao XL, Tang CZ, Tang Y. Effect of tai chi chuan in breast cancer patients: a systematic review and meta-analysis. Frontiers in oncology. 2020 Apr 23;10:607.
74-You T, Ogawa EF. Effects of meditation and mind-body exercise on brain-derived neurotrophic factor: a literature review of human experimental studies. Sports Medicine and Health Science. 2020 Mar 1;2(1):7-9.
75-Antoni MH, Lechner S, Diaz A, Vargas S, Holley H, Phillips K, McGregor B, Carver CS, Blomberg B. Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer. Brain, behavior, and immunity. 2009 Jul 1;23(5):580-91.
76-Shields GS, Spahr CM, Slavich GM. Psychosocial interventions and immune system function: A systematic review and meta-analysis of randomized clinical trials. JAMA psychiatry. 2020 Oct 1;77(10):1031-43.
مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
دوره 65، شماره 2
خرداد و تیر 1401
صفحه 825-841

فایل ها

هم رسانی

ارجاع به این مقاله

آمار