Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial

Abstract

Purpose Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate psychological distress in patients with cancer. However, patients experience barriers to participating in face-to-face MBCT. Individual Internet-based MBCT (eMBCT) could be an alternative. The study aim was to compare MBCT and eMBCT with treatment as usual (TAU) for psychological distress in patients with cancer. Patients and Methods We obtained ethical and safety approval to include 245 patients with cancer with psychological distress (≥ 11 on the Hospital Anxiety and Depression Scale) in the study. They were randomly allocated to MBCT (n = 77), eMBCT (n = 90), or TAU (n = 78). Patients completed baseline (T0) and postintervention (T1) assessments. The primary outcome was psychological distress on the Hospital Anxiety and Depression Scale. Secondary outcomes were psychiatric diagnosis, fear of cancer recurrence, rumination, health-related quality of life, mindfulness skills, and positive mental health. Continuous outcomes were analyzed using linear mixed modeling on the intention-to-treat sample. Because both interventions were compared with TAU, the type I error rate was set at P < .025. Results Compared with TAU, patients reported significantly less psychological distress after both MBCT (Cohen's d, .45; P < .001) and eMBCT (Cohen's d, .71; P < .001) . In addition, post-treatment prevalence of psychiatric diagnosis was lower with both MBCT (33% improvement; P = .030) and eMBCT (29% improvement; P = .076) in comparison with TAU (16%), but these changes were not statistically significant. Both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU (all Ps < .025). Physical health-related quality of life did not improve ( P = .343). Conclusion Compared with TAU, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.

Effect of lymphedema self-management group-based education compared with social network-based education on quality of life and fear of cancer recurrence in women with breast cancer: a randomized controlled clinical trial

“…Internet-based and face-to-face methods combined with group meetings on mental tension in cancer patients. They reported both Internet-based and face-to-face approaches, combined with group sessions, were effective in the improvement of FCR, mind rumination, mental function, mental health and QoL, compared to the routine treatment [19]. This difference can be attributed to our research populations, which were women with lymphedema.…”

“…Self-management is often taught in a group and is associated with increased empowerment and self-confidence, facilitating positive relationships and social support [18]. The use of information and communication technology and the Internet, such as online social networks, provides cheaper and more costeffective than in-person interventions due to lower costs of transportation, travel, equipment, and other overhead costs [19] and can reduce patient stress, improve treatment progress, empower individuals in self-management, increase individual's participation in the treatment process, increase access to information, and improve QoL and self-efficacy skills [20][21][22]. Telegram, a messaging app, is one of the largest social networks with more than 200 million users worldwide, and with features such as channel allows broadcasting messages, photos, videos, and audio to an unlimited number of subscribers, and can be installed on a smartphone or laptop.…”

Therapeutic alliance—not therapist competence or group cohesion—contributes to reduction of psychological distress in group‐based mindfulness‐based cognitive therapy for cancer patients

“…Consequently, as therapeutic alliance may also serve to reduce risk of dropout (Swift & Greenberg, ), better therapeutic alliance might contribute to better adherence. This is of clinical importance, particularly in internet‐based MBCT, where dropout was shown to be higher than in face‐to‐face group MBCT (Compen et al, ).…”

“…Patients filled out the HADS prior to randomization (baseline, T0), directly after the intervention (T1), or directly after TAU (T0b). After TAU, the scores on the HADS in the TAU condition had not significantly changed (Compen et al, ). For patients participating in the group‐based MBCT after TAU, baseline scores on the HADS were replaced with end‐of‐waiting list scores as those were closer in time to the start of the treatment, in accordance with a previous study on the long‐term effect of (e)MBCT in cancer patient (Cillessen et al, ).…”

“…A 2012 meta‐analysis of nine randomized controlled trials (RCTs; n = 955) in cancer patients demonstrated that MBIs result in significant improvements in depressive and anxiety symptoms (Piet, Wurtzen, & Zachariae, ). Since then, several RCTs have confirmed these effects (Carlson et al, ; Compen et al, ; Garland et al, ; Johannsen et al, ; Lengacher et al, ). Mindfulness is defined as “paying attention; on purpose, in the present moment and non‐judgmentally” (Kabat‐Zinn, ).…”