Meditation

Meditation

PEP Topic 
Anxiety
Description 

Meditation refers to a variety of practices to focus the mind and increase awareness. A person who is meditating may use certain techniques, such as specific postures and attention to breathing. Meditation has been examined as a way to address anxiety, cognitive impairment, depression, sleep-wake disturbances, and fatigue in patients with cancer.

Effectiveness Not Established

Research Evidence Summaries

Ando, M., Morita, T., Akechi, T., Ito, S., Tanaka, M., Ifuku, Y., & Nakayama, T. (2009). The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. Journal of Palliative Medicine, 12,1091–1094.

doi: 10.1089/jpm.2009.0143
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Study Purpose:

To determine the effects of a mindfulness intervention on anxiety, depression, and spirituality

Intervention Characteristics/Basic Study Process:

The intervention involved 30–60-minute cyclic meditation and yoga training with practice at home. In pretherapy sessions, patients learned the cyclic meditation program and were recommended to perform the therapy at home once daily. After two weeks, patients met therapists in a second session to talk about their impressions.

Sample Characteristics:

  • The study reported on a sample of 28 patients.
  • Mean patient age was 60 years (SD = 9.2).
  • The sample was 85.7% female and 14.3% male.
  • Most patients were diagnosed with breast cancer, with other sites including colon, stomach, and bladder.
  • All patients were actively receiving either chemotherapy, radiation, or medication at a general hospital.

Setting:

  • Single site
  • Outpatient clinic
  • Western Japan

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

A pre/post-intervention study design was used.

Measurement Instruments/Methods:

  • Functional Assessment of Chronic Illness Therapy–Spirituality (FACIT-Sp)
  • Hospital Anxiety and Depression Scale (HADS)
  • Caregiving Consequence Inventory: Selected two items to measure appreciation
  • Benefit Finding Scale: Three items to measure growth
  • Pain and physical symptoms measured on a 10-point numeric scale

Results:

Anxiety (p = 0.01) and depression (p = 0.009) decreased significantly. There was no significant change related to spirituality. Spirituality is correlated with anxiety and depression.

Conclusions:

Mindfulness-based cyclic meditation affects anxiety and depression for Japanese patients with cancer and may be effective as an individual short-term therapy.

Limitations:

  • The study had a small sample.
  • The study did not have a control or comparison group.
  • No information was given regarding patients’ adherence to home practice.

Nursing Implications:

This type of intervention may be helpful to some patients to affect anxiety and depression during cancer treatment. The amount of training required for administration of the therapy, as well as therapist time with the patient, suggests that this approach may be feasible.

Hidderley, M., & Holt, M. (2004). A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. European Journal of Oncology Nursing, 8(1), 61–65.

doi: 10.1016/j.ejon.2003.09.003
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Intervention Characteristics/Basic Study Process:

The intervention was autogenic training (AT), a type of meditation, with mental exercises:

  • Heaviness of limbs
  • Warmth of limbs
  • Calm regular heartbeat
  • Easy breathing
  • Abdominal warmth
  • Cooling of forehead

Measurements were taken at baseline and at the end of two monthly periods. Patients were observed for evidence of meditative state. Group 1 (control) received one home visit, and group II (intervention) received one home visit plus two months of AT intervention.

Sample Characteristics:

The study reported on a sample of 31 women with early-stage breast cancer.

Study Design:

A randomized controlled trial design was used.

Measurement Instruments/Methods:

  • Hospital Anxiety and Depression Scale (HADS)
  • T and B cell markers
  • Unpaired t tests
  • Calculations of blood results and HADS scores were made of mean and standard deviation.

Results:

Results showed a p value of 0.0027 between groups for anxiety. T and B cell markers remained similar in both groups. The AT group reported improved HADS anxiety levels (t = 2.00, p = 0.092). There was no statistical difference in HADS scores for patients within the group.

Limitations:

  • The study had a small sample of women with early-stage breast cancer.
  • Specialized education was needed to provide the AT.
  • The authors state a limitation may be that only 7 of 16 patients in the experimental group achieved a meditative state.

Kim, Y.H., Kim, H.J., Ahn, S.D., Seo, Y.J., & Kim, S.H. (2013). Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer. Complementary Therapies in Medicine, 21(4), 379–387. 

doi: 10.1016/j.ctim.2013.06.005
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Study Purpose:

Investigate the effects of meditation on the symptoms of anxiety, depression, and fatigue in women who were receiving radiation therapy for breast cancer

Intervention Characteristics/Basic Study Process:

The intervention group received a total of 12 meditation therapy sessions during its six-week radiation therapy period. The control group received only conventional radiation therapy. The meditation intervention was Brain Wave Vibration meditation, which is based on a Korean traditional exercise, simple movements, music, and positive messages (changing weekly). This focuses on the senses of the body, relaxing the body and mind and relieving negative thoughts through natural rhythmic movements.

Sample Characteristics:

  • N = 83    
  • MEAN AGE = 47 years
  • MALES: 0%, FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Female patients with breast cancer undergoing breast conservation and radiation therapy with curative intent
  • OTHER KEY SAMPLE CHARACTERISTICS: Primarily married, primarily financially stable, primarily HER-2/neu negative

Setting:

  • SITE: Single site  
  • SETTING TYPE: Outpatient  
  • LOCATION: Asan Cancer Center, Seoul, Korea

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active anti-tumor treatment
  • APPLICATIONS: Elder care

Study Design:

Randomized, controlled trial

Measurement Instruments/Methods:

  • Hospital Anxiety and Depression Scale (HADS)
  • Revised Piper Fatigue Scale
  • The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30

Results:

Patients who received meditation therapy saw mild improvements, with a reduction in anxiety and fatigue. Patients in the control group also showed significant reduction in fatigue and anxiety, and post-intervention scores actually were lower for both of these in the control group. No effect was seen for depression.

Conclusions:

The study states that an “affirmation” can be made that meditation can be used as a non-invasive intervention for improving fatigue and anxiety. However, results showed significant reductions in these symptoms for patients in the control group as well. This provides minimal support for effectiveness of the approach used here.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (no appropriate attentional control condition)
  • Unintended interventions or applicable interventions not described that would influence results
  • Findings not generalizable
  • Intervention expensive, impractical, or training needs
  • Subject withdrawals ≥ 10%
  • Korean study, using a Korean meditation technique; likely not generalizable to the United States
  • Big impact on time
  • Not a billable service; great staff time and training involved
  • Unclear whether the meditation was in a group setting or individual; what relation did group dynamics play in a group of patients who may have met together 12 times and formed an effective peer-to-peer support group?
  • The study was underpowered by the author's calculations.
  • An intent to treat analysis was used, but how this was applied was not stated.

Nursing Implications:

Nurses likely would not have any options of referral to meditation resources. Something more generalizable, like relaxation or mindfulness, would have been a better option for a study. The study is Korean; typically educated Korean women may have had previous exposure to meditation, and the intervention would be more acceptable to them than to American women.

Lengacher, C.A., Johnson-Mallard, V., Post-White, J., Moscoso, M.S., Jacobsen, P. B., Klein, T. W., . . . Kip, K.E. (2009). Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology, 18, 1261–1272.

doi: 10.1002/pon.1529
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Study Purpose:

To determine if a mindfulness-based stress reduction (MBSR) intervention is effective in improving psychological and physical status in breast cancer survivors

Intervention Characteristics/Basic Study Process:

The intervention was six group sessions of an MBSR program using meditation and body scan techniques. Participants received a training manual and audiotapes to support home practice of various forms of meditation and gentle yoga. The training manual included weekly objectives, exercises, program content, and a daily diary for recording practice activities.

Sample Characteristics:

  • The study reported on a sample of 82 female patients with breast cancer.
  • In terms of age, 40% were younger than 55 years, and 27.4% were older than 65 years; the MBSR group had a significantly larger percentage of younger patients.
  • All patients had undergone surgery and received either adjuvant radiation or chemotherapy. Therapy was completed within the prior 18 months.
  • Of the sample, 56% were employed; 72.6% were white, non-Hispanic; 78.5% had at least some college level education; and 25% were on medications for depression.

Setting:

  • Single site
  • Outpatient setting
  • Florida

Phase of Care and Clinical Applications:

  • Patients were undergoing the transition phase of care after initial treatment.
  • The study has clinical applicability for late effects and survivorship.

Study Design:

A randomized controlled trial design was used.

Measurement Instruments/Methods:

  • Concerns About Recurrence Scale – 30 items
  • State-Trait Anxiety Inventory – 20 items
  • Center for Epidemiologic Studies Depression Scale (CESDS) – 20 items
  • Perceived Stress Scale – 10 items assessing how often in the past month life situations were stressful
  • Life Orientation Test – 6 items to assess expectancy for positive and negative life outcomes
  • Medical Outcomes Study Short Form General Health Survey
  • Medical Outcomes Social Support Survey – 19 items

Results:

Seventy percent of participants were determined to be compliant with the program. Intervention participants had better mean scores for state anxiety and depression compared to the control group at six weeks (p = 0.004; p = 0.03).

Conclusions:

The MBSR program improved psychological distress, fear of recurrence, and quality of life among patients with breast cancer who recently transitioned from active treatment. The extent of practice of MBSR activities appears to influence the overall degree of benefit derived. A large percentage of patients were able to comply with a complex MBSR intervention.

Limitations:

  • The study had a limited follow-up period.
  • The study design lacked an attentional control.

Nursing Implications:

Whether benefits seen were due to the actual intervention or the supportive aspects of the group was unable to be determined. More than half of eligible patients approached for enrollment declined due to scheduling issues, travel distance, lack of interest, and other issues. This suggests that such a program is limited in application related to these types of issues.

Ramachandra, P., Booth, S., Pieters, T., Vrotsou, K., & Huppert, F.A. (2009). A brief self-administered psychological intervention to improve well-being in patients with cancer: Results from a feasibility study. Psycho-Oncology, 18, 1323–1326.

doi: 10.1002/pon.1516
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Study Purpose:

To test the feasibility of a brief self-administered psychological intervention to improve well-being in patients with cancer

Intervention Characteristics/Basic Study Process:

The intervention consisted of patient diary and CD meditation for home use with brief telephone support. Patients were requested to record three positive experiences each day in the diary and to plan one enjoyable activity each week and record in the diary. A recorded mindfulness “body scan” (meditation approach) 10 minutes in length was provided to each patient, and he or she was instructed to use this twice a day. Brief telephone contact was made in weeks 1, 2, and 4 to answer questions and encourage continued home practice.

Sample Characteristics:

  • The study reported on a sample of 46 patients.
  • Mean patient age was 60.8 years for women and 72.4 years for men.
  • The sample was 47.8% female and 52.2% male.
  • Female patients were diagnosed with breast cancer, and male patients were diagnosed with prostate cancer.

Setting:

  • Outpatient setting
  • United Kingdom

Phase of Care and Clinical Applications:

Patients were undergoing the transition phase of care after initial treatment.

Study Design:

A randomized controlled trial design was used.

Measurement Instruments/Methods:

  • World Health Organization Quality of Life Scale (WHO-QOL-BREF)
  • Hospital Anxiety and Depression Scale (HADS)
  • Social and Occupational Functional Assessment Scale (SOFAS): Interviewer-rated measure of overall level of functioning
  • Life Orientation Test–revised (LOTR): 10-item scale to measure optimism/pessimism
  • Ten-Item Personality Inventory (TIPI)

Results:

The drop-out rate was almost 50% at the six-week point. Quality of life showed significant improvement at the six-week point (p = 0.046). No other significant differences were identified.

Conclusions:

Compliance rates of patients remaining in the study suggest that the approaches used here were easy enough to use and acceptable to them; however, the extremely high drop-out rate suggests that the actual feasibility of this approach for any length of time is questionable.

Limitations:

  • The study had a small sample size.
  • The study has questionable feasibility due to the high drop-out rate.
  • The final sample was too small to detect any significant differences.

Nursing Implications:

This study involved multiple follow-up periods and several self-report questionnaires. The burden of this activity may have contributed to the high drop-out rate.

Systematic Review/Meta-Analysis

Chen, K.W., Berger, C.C., Manheimer, E., Forde, D., Magidson, J., Dachman, L., & Lejuez, C.W. (2012). Meditative therapies for reducing anxiety: A systematic review and meta‐analysis of randomized controlled trials. Depression and Anxiety, 29, 545–562.

doi: 10.1002/da.21964
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Purpose:

STUDY PURPOSE: To investigate all types of meditative therapies for overall efficacy and effect size for reducing anxiety in various types of patients
TYPE OF STUDY: Meta-analysis and systematic review
 

Search Strategy:

DATABASES USED: PubMed, EMBASE, PsycInfo, Cochrane collaboration Qigong database
KEYWORDS: Keywords incorporated various types of practices including yoga, reiki, guided imagery, and mindfulness.
INCLUSION CRITERIA: RCT, anxiety was an outcome with a psychometric measure, sample size of more than 20, anxiety level data provided for baseline and postintervention
EXCLUSION CRITERIA: Qualitative report, literature review, combined measure of anxiety and stress, no psychometric measure of anxiety alone

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: 1,030 references were retrieved.

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Use the CLEAR = NPT quality checklist. Most studies did not provide the information needed for quality assessment. Sixteen studies had good quality, and 17 had moderate or acceptable quality.

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED = 40; 36 in meta analysis
  • SAMPLE RANGE ACROSS STUDIES: 18–207
  • KEY SAMPLE CHARACTERISTICS: Only 3 studies included were done with patients with cancer. Several studies were done with healthy subjects and college students.

Phase of Care and Clinical Applications:

PHASE OF CARE: Not provided

Results:

In meta-analysis, overall results in comparison to wait list controls to interventions had standard mean difference (SMD) of –0.52 (95% confidence interval [CI] [–0.79, –0.41]). Results in comparison to attention control condition had SMD of –0.59 (95% CI -[–0.79, –0.39]). Results in comparison to an alternative intervention had SMD of –0.27 (95% CI [–0.46, –0.09]). Studies conducted in China and Japan had larger effect sizes, and lower quality studies had larger effect sizes.

Conclusions:

Interventions incorporating meditative practices have overall positive effects on mood.

Limitations:

Very few studies included patients with cancer, and the review incorporated findings from normal health controls as well as individuals with various acute and chronic diseases. All types of practices including imagery and those involving movement were considered together. Although there are certainly some similarities in the mental components of many of these practices, it is unclear that they would be routinely viewed as the same. Many studies also included counseling, education, and psychoeducational types of components, which can be expected to confound results.

Nursing Implications:

Findings suggest that in the general population and patients with various types of chronic disease, interventions that involve incorporation of mindfulness and meditative types of practice may be beneficial in reducing anxiety. The application specifically forcancer care is difficult to determine because there were so few studies involving patients with cancer. Nurses can expect that some patients may benefit from meditative practices, and these approaches may be more acceptable to some ethnic groups.


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