Garland, S. N., Tamagawa, R., Todd, S. C., Speca, M., & Carlson, L. E. (2013). Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program in individuals with cancer. Integrative Cancer Therapies, 12, 31–40.

To examine the effects of a mindfulness-based stress-reduction therapy (MBSRT) on stress and mood disturbances and to examine the relationship of improved mindfulness and mood changes.

Hospital staff referred patients to the study or patients self-referred to the study. MBSRT consisted of eight weekly sessions and a six-hour silent retreat held after the sixth session. Classes taught participants about the mind-body connection, principles of mindfulness, and yoga practice. Patients were encouraged to share experiences to generate support from group members. All were given CDs with guided meditation exercises, and all received a program manual. Patients were encouraged to practice meditation and mindful movement at least 45 minutes per day. Patients who did not attend at least five sessions were excluded from the analysis.

• The sample was comprised of 268 patients.
• Mean age was 53.8 years.
• The sample was 15.7% male and 84% female; 71% were married or partnered.
• Patients were diagnosed with breast, hematologic, and colon cancer.
• Average time from diagnosis was zero years, indicating participation close in time to diagnosis.

• Single site
• Outpatient
• Canada

Patients were undergoing the transition phase after active treatment.

The study used a pre-/posttest design.

• Mindfulness Attention Awareness Scale (MAAS)
• Five Facet Mindfulness Questionnaire (FFMQ)
• Calgary Symptoms of Stress Inventory (C-SOSI)
• Profile of Mood States (POMS) Questionnaire

• The level of mindfulness increased significantly over the course of the program (p < 0.001). 
• Improvements in stress and mood outcomes were noted, with effects of at least small to moderate size.
• Change was observed in tension-anxiety (d = 0.52), depression (d = 0.44), and fatigue (d = 0.37) (p < 0.001). 
• The study revealed no significant or strong correlation between mindfulness change and mood change.

The findings supported the use of MBSRT approaches for managing the symptoms of anxiety, depression, and fatigue.

• The study had risks of bias:  the sample consisted mostly of self-referred participants, suggesting that participants may have been predisposed to find therapy effective; and the study lacked a control group, blinding, random assignment, and appropriate attentional control condition. The lack of a control condition is particularly important because anxiety, depression, and fatigue can improve over time with no intervention.
• The findings were not generalizable.
• Baseline anxiety and depression scores were not reported, so it is not known if patients had any initial significant mood problems.
• The authors stated that patients who did not attend at least five sessions were excluded from the analysis, but the authors did not report how many patients, if any, were excluded; therefore, the drop-out rate and final sample size were unclear.
• The fact that the study revealed no significant correlations between change in mindfulness scores and mood changes may suggest that the mindfulness aspect of the intervention may not be the main effective component—the component may have been yoga or the support group sessions.

The findings suggested that a stress-reduction intervention involving group support, yoga, and mindfulness may help patients manage the symptoms of anxiety, depression, and fatigue. The various study limitations prevented firm conclusions from being drawn.