Monti, D.A., Kash, K.M., Kunkel, E.J., Brainard, G., Wintering, N., Moss, A.S., . . . Newberg, A.B. (2012). Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer. Stress and Health, 28, 397–407.

To evaluate changes in cerebral blood associated with a mindfulness-based art therapy program (employing functional magnetic resonance imaging) and correlate such changes to stress and anxiety in women with breast cancer

The Mindfulness-based Art Therapy (MBAT) intervention arm consisted of the basic mindfulness-based stress reduction (MBSR) curriculum paired with expressive art tasks. The design of MBAT was intended to provide opportunities for self-expression, facilitate coping strategies, and improve self-regulation. The MBSR aspect of the MBAT intervention provided standardized tools to help participants observe, assess, and negotiate their objective and subjective experiences of the illness process. A variety of mindfulness meditation techniques were taught during the eight-week program, including body scan, awareness of breathing, awareness of emotions, and mindful yoga, walking, eating, and listening.

• The study reported on 18 female patients with breast cancer.
• Mean patient age was 55 years (range = 45–67).
• Patients received their breast cancer diagnosis between 6 months and three years prior to enrollment and were not in active treatment.

• Urban setting
• Thomas Jefferson University, Philadelphia, PA

• Patients were not receiving active treatment.
• The study has clinical applicability for elder care and palliative care.

A randomized, qualitative study design was used.

Response to the program was evaluated using the Symptom Checklist-90 Revised (SCL-90-R) as a way to rate behavior. The SCL-90-R was obtained pre- and post-MBAT and within one week of the pre- and post-functional MRI scans. The SCL-90-R is a 90-item inventory that assesses nine symptom dimensions and a summary score, the Global Severity Index. Functional MRI scans were also obtained as a way to correlate scores on the SCL-90-R with results of the functional MRI.

Overall, the study showed significant differences in cerebral blood flow in the insula, caudate, and amygdala in patients who underwent an eight-week MBAT program. Given the improvements in anxiety levels (lower scores on the SCL-90-R), these findings suggest that at the level of these brain structures, the MBAT intervention may help to mediate emotional responses in women with breast cancer.

Women who used MBAT techniques had lower scores on the anxiety scale, and also a difference in cerebral blood flow in the insula, caudate, and amygdala regions shown through functional MRI studies. These areas have known correlations with stress and anxiety.

• The study had a small sample, with less than 30 participants.
• The study had risk of bias due to lack of blinding.
• Findings are not generalizable.
• The intervention was expensive, impractical, or required training needs.
• Functional MRI is prohibitively expensive and only available in university settings.

Brief guided imagery or simple meditation techniques could be employed by nurses to relieve patients’ stress and anxiety. Guiding patients toward reading about meditation and guided imagery and encouraging them to try these techniques on their own may also be useful.