Mindfulness-Based Stress Reduction

Mindfulness-Based Stress Reduction

PEP Topic 
Cognitive Impairment

Mindfulness-based stress reduction (MBSR) is a consciousness discipline that is grounded in eastern philosophy and traditions such as yoga and Buddhism, focusing on awareness of the present moment. It aims to teach people to deal more effectively with experience through awareness of feelings, thoughts, and bodily sensations. Participants learn to engage in mindfulness practices such as body scan, simple yoga exercises, and meditation. MBSR has been studied in patients with cancer for its effect on anxiety, cognitive impairment, fatigue, sleep-wake disturbance, and depression. It has also been studied in caregivers of patients with cancer for its effect on caregiver strain and burden (Piet, Würtzen, & Zachariea, 2012).

Effectiveness Not Established

Research Evidence Summaries

Hoffman, C. J., Ersser, S. J., Hopkinson, J. B., Nicholls, P. G., Harrington, J. E., & Thomas, P. W. (2012). Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. Journal of Clinical Oncology, 30, 1335–1342.

doi: 10.1200/JCO.2010.34.0331

Study Purpose:

  • To assess the effectiveness of a mindfulness-based stress reduction (MBSR) intervention for mood, breast- and endocrine-specific quality of life, and well-being after hospital treatment in women with stage 0 to III breast cancer.
  • To compare MBSR to usual care and its effect on mood and disease-related quality of life.
  • To measure if a dose-related effect was evident with formal, eight-week MBSR practice.

Intervention Characteristics/Basic Study Process:

The intervention consisted of an eight-week MBSR program closely following the Kabat-Zinn method. The intervention involved 2- to 2.25-hour classes and a 6-hour retreat. Home practice was recommended for 45 minutes, six to seven days per week. Outcomes were measured at baseline, weeks 8 to 12, and weeks 12 to 14. A wait-list control group received usual care.

Sample Characteristics:

  • A total of 229 patients (100% female) participated.
  • Mean age was 49 years (SD = 9.26 years) in the treatment group and 50.1 years (SD = 9.14 years) in the control group.
  • Patients had been diagnosed with stage 0 to III breast cancer; 47% had stage II cancer.
  • Participants were recruited from The Haven, a charitable day center that provides free psychosocial services for patients with breast cancer. All patients had received an average of 30 hours of support prior to entering the study.


  • Single site
  • Outpatient
  • The Haven, London, England

Phase of Care and Clinical Applications:

  • Patients were undergoing long-term follow-up.
  • The study has clinical applicability for late effects and survivorship.

Study Design:

The study used a randomized, controlled trial design.

Measurement Instruments/Methods:

  • Profile of Mood States (POMS) questionnaire
  • Functional Assessment of Cancer Therapy (FACT)–Breast and Endocrine Symptoms 
  • World Health Organization (WHO) (Five) Well-being Index


  • The study revealed significant differences between the groups in regard to POMS subscale scores (p < 0.001): depression (p = 0.017), anxiety (p < 0.001), anger (p = 0.005), vigor (p < 0.001), fatigue (p = 0.002), and confusion (p = 0.002).
  • Participants completed a mean of 19.58 hours (standard deviation = 11.49 hours) of home MBSR practice over eight weeks, or 21 minutes per day. Increased hours of MBSR practice improved POMS scores at T3 for overall mood (p = 0.004), vigor (p = 0.02), fatigue (p = 0.03), and anxiety (p = 0.01). POMS scores improved at T2 and T3 for anger (p = 0.005 and 0.02, respectively), confusion (p = 0.04 and 0.001, respectively), and well-being.


MBSR significantly improved mood and reduced confusion.


  • The study lacked an appropriate control group.
  • The control group was not attention controlled, which limited the interpretation of between-group differences.
  • The setting was unique, and the intervention used many resources, which made implementing and generalizing findings difficult.
  • The study had a risk of bias due to lack of blinding.

Nursing Implications:

Although further study is needed to measure MBSR and its impact on depression and anxiety, in this sample, home-based practice was feasible and improved mood. In practice and education, nurses can promote components of MBSR, such as breathing, yoga, relaxation, meditation, seeking support resources, and gentle stretching.