Body-Mind-Spirit Therapy/Qigong

Body-Mind-Spirit Therapy/Qigong

PEP Topic 
Depression
Description 

Body-mind-spirit therapy incorporates ideas and approaches from Western and Chinese medicine, the philosophies of Taoism and Confucianism, and the practice of Buddhism. Qigong is a traditional Chinese discipline involving the alignment of breathing, movement, and awareness to cultivate and balance qi (chi), or life energy. Medical qigong is a form of qigong designed to improve health. It incorporates the gentle exercise and relaxation through meditation and breathing. The efficacy of these approaches was evaluated in terms of fatigue, mood status, sleep-wake disturbances, lymphedema, and cognitive impairment.

Effectiveness Not Established

Research Evidence Summaries

Chen, Z., Meng, Z., Milbury, K., Bei, W., Zhang, Y., Thornton, B., . . . Cohen, L. (2013). Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer, 119, 1690–1698.

doi: 10.1002/cncr.27904
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Study Purpose:

To evaluate whether patients with breast cancer undergoing radiotherapy (RT) who practiced qigong would report better quality of life, less fatigue, and less sleep disturbance than did patients in a control group.

Intervention Characteristics/Basic Study Process:

Patients were randomly assigned to a group that received a qigong intervention or to a wait-list control group. Patients were assigned to cohorts to prevent group contamination during the study. Each week, the qigong group participated in five classes lasting 40 minutes each during RT. These patients received printed materials and a DVD of the qigong program. Patients were encouraged to practice qigong techniques on their own. The intervention included relaxation breathing, meditation, walking in a circle while breathing in sync with arm movement, and self-massage. The control group received standard care. Assessments were performed at baseline, in the middle of the RT schedule, during the last week of RT, and at one and three months after treatment.

Sample Characteristics:

  • The sample was comprised of 95 participants (100% female).
  • Mean age was 45 years (range 25–62).
  • All participants had breast cancer.
  • Most participants had stage II or stage III disease.
  • All participants had undergone mastectomy or lumpectomy.
  • Of the participants in both groups, 78% were receiving 25 RT fractions.
  • Most participants were married, and 52.5% had some college or higher education.

Setting:

  • Single site
  • Multiple settings
  • China and the United States

Phase of Care and Clinical Applications:

Participants were undergoing the active antitumor treatment phase of care.

Study Design:

The study was a randomized, controlled trial.

Measurement Instruments/Methods:

  • Brief Fatigue Inventory (BFI)
  • Center for Epidemiologic Studies Depression (CESD) Scale 
  • Pittsburgh Sleep Quality Index (PSQI)
  • Functional Assessment of Cancer Therapy-General (FACT-G)
  • Salivary cortisol samples taken for two consecutive days at waking, 45 minutes after waking, 45 minutes later, eight hours later, and at bedtime

Results:

  • Time had a significant effect in reducing depression, with a significantly greater effect in the qigong group (p = 0.05); however, no significant differences were observed between groups at any time point.
  • Participants with low measures of depression symptoms at baseline showed no significant differences in fatigue, regardless of group. At the end of the study, of participants who had had high measures of depression symptoms at baseline, those in the qigong group had measures of fatigue that were significantly lower (p < 0.05; 2.93 versus 4.19) than those in the control group.
  • No differences were observed between groups in sleep quality, and there was no interaction of depression symptoms with sleep measures.
  • One-third of participants attended 100% of the sessions and 78.3% attended more than 50% of the sessions. Attendance ranged from five to 30 sessions.
  • Sessions involved one to 10 people at a time.
  • No differences were observed between groups in regard to cortisol measures.

Conclusions:

Practicing qigong appears to be beneficial in reducing fatigue and depression during RT and appears to be of most benefit to women with high measures of depression symptoms.

Limitations:

  • The study had a small sample size, with less than 100 participants.
  • The study had risks of bias due to no blinding and no appropriate attentional control condition.
  • Adherence varied. No information was provided regarding participants' qigong practice outside the treatment group.
  • The study was inconclusive in regard to the effectiveness of qigong itself versus the potential effect of the group activity involved in the qigong intervention.
  • Follow-up time was limited.

Nursing Implications:

Qigong, a type of mind-body discipline, appears to have benefit in reducing fatigue and depression over time, particularly among women who have high measures of depression symptoms. Effects were not seen until after RT completion.

Larkey, L.K., Roe, D.J., Weihs, K.L., Jahnke, R., Lopez, A.M., Rogers, C.E., . . . Guillen-Rodriguez, J. (2014). Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Annals of Behavioral Medicine. Advance online publication. 

doi: 10.1007/s12160-014-9645-4
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Study Purpose:

To compare a meditative movement practice, Qigong/Tai Chi Easy (QG/TCE), with sham Qigong (SQG), testing the effects of the meditation/breath aspects of QG/TCE on breast cancer survivors’ persistent fatigue and other symptoms

Intervention Characteristics/Basic Study Process:

Hour-long sessions held twice weekly taught breast cancer survivors QE/TCE or SQG for 12 weeks measuring the effect on fatigue, depression, and sleep. Participants were asked to practice at home at least 30 minutes per day.

Sample Characteristics:

  • N = 87  
  • AGE RANGE = 40–75 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: Stages 0–III; the majority of participants were educated at the level of at least some college and were at higher income levels. 90% were white and non-Latino.

Setting:

  • SITE: Single-site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Mayo Clinic Cancer Center, Scottsdale, AZ

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Late effects and survivorship

Study Design:

This was a double-blinded, randomized, controlled trial. Fatigue was the primary outcome and sleep quality and depression were secondary outcomes.

Measurement Instruments/Methods:

  • Fatigue Symptom Inventory (FSI)
  • The Pittsburgh Sleep Quality Index (PSQI)
  • Beck Depression Inventory (BDI)

Results:

Fatigue decreased in the QG/TCE group compared to the SQG group at postintervention and at the three-month follow-up (p = .024). However, fatigue declined significantly in both groups. Depression and sleep quality did not demonstrate improvement in the QG/TCE group compared to the SQG group at the post-intervention and at the three-month follow-up.

Conclusions:

QG/TCE showed significant improvement over time compared to SQG for fatigue. Both groups showed improvement for fatigue, depression, and sleep dysfunction

Limitations:

  • Small sample (< 100)
  • Findings not generalizable
  • Subject withdrawals ≥ 10%
  • Other limitations/explanation: Blinding of the session instructors is identified as a limitation. The instructors could have unintentionally made a difference in the delivery of the interventions and outcomes. There is a concern that the contrast between the two interventions may have not been enough. The sham intervention is not described fully. There was a greater than 15% drop-out rate with no intent to treat analysis.

Nursing Implications:

Low-intensity exercise may be beneficial in reducing a number of symptoms and improving the well-being of cancer survivors. This study demonstrates that QG/TCE’s focus on meditative movement with a focus on breath appears to have an advantage for improving breast cancer survivors' persistent fatigue. A larger sample and longer intervention time is needed.

Liu, C., Hsiung, P., Chang, K., Liu, Y., Wang, K., Hsiao, F., . . . Chan, C. (2008). A study on the efficacy of body-mind-spirit group therapy for patients with breast cancer. Journal of Clinical Nursing, 17, 2539–2549.

doi: 10.1111/j.1365-2702.2008.02296.x
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Study Purpose:

To examine the effects of body-mind-spirit group therapy on anxiety, depression, and holistic well-being among women with breast cancer

Intervention Characteristics/Basic Study Process:

Patients in the control group received standard care. Patients in the experimental group received standard care plus 10 sessions of weekly group therapy, 180 minutes per session. Therapy integrated concepts and practices, such as qigong exercises of vital energy, massage, meditation, positive thinking, group mutual support, long-term survivors’ sharing, songs, home assignments, and exercises. These activities were based on traditional Chinese medicine, the Eastern philosophies of Taoism and Confucianism, and the practice of Buddhism. The goal of the activities were to manage physical, psychosocial, and spiritual distress. Sessions included qigong exercises provided for 20 minutes each week by a qigong master and body-mind-spirit group assignments that included sharing and singing. The qigong master facilitated the first 20 minutes of each session. Then the primary investigator and co-investigators, working as mental health nurses, managed the rest of each session. Co-investigators held a 90-minute focus group interview after the last group therapy session. They conducted the interview in Mandarin and transcribed it. A bilingual researcher translated the transcription.

A coinvestigator implemented the randomization so that the patients, physician, and primary investigator were blinded to the randomization process. The primary investigator conducted groups after randomization and completion of initial surveys. Participants completed a baseline questionnaire after informed consent. After two months of intervention, participants completed a postintervention questionnaire.

Sample Characteristics:

  • The sample was composed of 28 participants: 12 in the experimental group and 16 in the control group. 
  • Mean patient age in the study was 40–60 years. In the experimental group, mean patient age was 52 years (SD = 8.3 years). In the control group, mean patient age was 46.1 years (SD = 7.8 years).
  • The sample was composed of female patients with breast cancer only. Those suffering ailments in addition to breast cancer or receiving other psychotherapy were excluded.
  • Patients had cancer in stages I–III. The distribution of stages in groups follows: stage I, three patients in the experimental group and three in the control group; stage II, six patients in the experimental group and eight in the control group; stage III, two patients in the experimental group and three in the control group.
  • The types of surgery that patients had undergone included modified radical mastectomy, conservative surgery, and radical mastectomy, with the distribution of types in groups as follows: modified radical mastectomy, seven patients in the experimental group and nine in the control group; conservative surgery, three patients in the experimental group and five in the control group; radical mastectomy, two patients in the experimental group and two in the control group.
  • One patient in the experimental group and two patients in the control group experienced relapse.

Setting:

  • Single site
  • Outpatient setting 
  • Consultation room of a cancer foundation center

Phase of Care and Clinical Applications:

  • Phase of care: active treatment
  • Clinical applications: late effects and survivorship

Study Design:

Mixed-methods design incorporating a randomized controlled trial and focus-group interviews

Measurement Instruments/Methods:

  • Beck Depression Inventory II (BDI-II)      
  • State-Trait Anxiety Inventory (STAI)
  • Body-Mind-Spirit Well-being Inventory (BMSWBI)

Results:

  • Pre/post-test comparison of symptoms of depression in the intervention, or experimental, group and control group showed a difference in depression improvement and body-mind-spirit well-being; the difference was not significant.
  • Pre/post-test comparison of symptoms of anxiety in the intervention, or experimental, group and control group showed a significant difference (p < 0.03) in state anxiety.
  • Qualitative focus group interviews revealed eight domains with subthemes. The imparting information domain had seven themes: learning about appropriate diet, learning about treatment and care of breast cancer, learning how to monitor physical condition, learning to exercise, learning to practice relaxation, learning to reframe cognitive distress, and learning to practice forgiveness.
  • The interpersonal learning domain had two themes: having more interpersonal interactions and obtaining support from group members.
  • The catharsis domain had three themes: understanding the impact of suppressing emotions on holistic well-being, sharing suffering with group members, and learning to use projective methods to express emotions.
  • The universality domain had two themes: learning that I am not the only one who suffers from cancer and learning that personal characteristics are the common cause of cancer.
  • The domains of group cohesiveness and altruism each had one theme: having a sense of belonging and using one’s own successful experience to help others, respectively.
  • The existential factors domain had two themes: practicing self-love and learning to view misfortune positively.

Conclusions:

Culturally sensitive body-mind-spirit group therapy reduced anxiety among outpatients with breast cancer.

Limitations:

  • The study had a small sample, with fewer than 30 participants.
  • The researchers were not completely blinded to the randomization process because the coinvestigator implemented it.
  • Forty-nine participants were enrolled in the study, but only 28 completed the study. The drop-out rate reduces the power of the study.
  • Findings may have limited generalizability beyond women ages 40–60 with stage II breast cancer.
  • Longer-term follow-up to study maintenance of depression improvement are needed.

Nursing Implications:

Mental health nurses who provide group therapy for patients with cancer could help to enhance quality of care in psycho-ontological nursing. Further research with older and younger women — as well as with patients in stages I, III, and relapse — are suggested.


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