Skip to main content

Advertisement

SpringerLink
Log in

The eCALM Trial: eTherapy for Cancer Applying Mindfulness. Exploratory Analyses of the Associations Between Online Mindfulness-Based Cancer Recovery Participation and Changes in Mood, Stress Symptoms, Mindfulness, Posttraumatic Growth, and Spirituality

  • ORIGINAL PAPER
  • Published:
Mindfulness Aims and scope Submit manuscript

Abstract

Avenues to increase accessibility of evidence-based psychosocial programs that mitigate cancer-related distress and symptoms are needed, and the internet represents one modality garnering research attention. Mindfulness-Based Cancer Recovery (MBCR) is an evidence-based group psychosocial program adapted to an online “real-time” synchronous format. The objective of this study was to assess the effects of participation in online MBCR on patient-reported outcomes in cancer patients. Participants completed questionnaires before and after the online MBCR program. The intervention consisted of eight weekly 2-hour online classes plus a 6-hour retreat. Mixed model analyses for repeated measures were conducted and subgroup analyses investigated associations of age, sex, and cancer stage on patient-reported outcomes. Standardized subscale change score analyses for mood and stress symptom measures were conducted to evaluate relative improvements over time. Sixty-two distressed participants enrolled. Analyses revealed improvements over time on measures of mood, stress, spirituality, posttraumatic growth, and four of five measured mindfulness facets. Relative to older participants, younger participants showed greater improvements in stress symptoms (p = 0.031), spirituality (p = 0.019), and non-reactivity to experience (p = 0.023). Posttraumatic growth increased more over time in men compared to women (p = 0.005). Within mood and stress symptoms subscales, Vigor, Fatigue, and Sympathetic Arousal had the greatest relative improvements, suggesting improved energy while also inducing relaxation. Results are promising in terms of offering an accessible online MBCR approach to help cope with symptoms associated with cancer and its treatment. Further research into differential effects may allow for greater tailoring to further improve access and ease of use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.

    Article  PubMed  Google Scholar 

  • Baer, R., Carmody, J., & Hunsinger, M. (2012). Weekly change in mindfulness and perceived stress in mindfulness-based stress reduction program. Journal of Clinical Psychology, 68(7), 755–765.

    Article  PubMed  Google Scholar 

  • Barak, A., Klein, B., & Proudfoot, J. G. (2009). Defining Internet-supported therapeutic interventions. Annals of Behavioral Medicine, 38(1), 4–17.

    Article  PubMed  Google Scholar 

  • Birnie, K., Garland, S. N., & Carlson, L. E. (2010). Psychological benefits for cancer patients and their partners participating in mindfulness-based stress reduction (MBSR). Psycho-Oncology, 19(9), 1004–1009.

    Article  PubMed  Google Scholar 

  • Brady, M. J., Peterman, A. H., Fitchett, G., Mo, M., & Cella, D. (1999). A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology, 8(5), 417–428.

    Article  PubMed  Google Scholar 

  • Carlson, L. (2012). Mindfulness-based interventions for physical conditions: a narrative review evaluating levels of evidence. ISRN Psychiatry. doi:10.5402/2012/651583.

    PubMed  PubMed Central  Google Scholar 

  • Carlson, L. E., & Speca, M. (2010). Mindfulness-based cancer recovery: a step-by-step MBSR approach to help you cope with treatment and reclaim your life. Oakville: New Harbinger.

    Google Scholar 

  • Carlson, L. E., & Thomas, B. C. (2007). Development of the Calgary Symptoms of Stress Inventory (C-SOSI). International Journal of Behavioral Medicine, 14(4), 249–256.

    Article  PubMed  Google Scholar 

  • Carlson, L. E., Ursuliak, Z., Goodey, E., Angen, M., & Speca, M. (2001). The effects of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients: 6-month follow-up. Supportive Care in Cancer, 9, 112–123.

    Article  PubMed  Google Scholar 

  • Carlson, L. E., Angen, M., Cullum, J., Goodey, E., Koopmans, J., Lamont, L., et al. (2004). High levels of untreated distress and fatigue in cancer patients. British Journal of Cancer, 90(12), 2297–2304.

    PubMed Central  PubMed  Google Scholar 

  • Carlson, L. E., Speca, M., Patel, K. D., & Faris, P. (2007). One year follow-up of psychological, endocrine, immune, and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior, and Immunity, 21(8), 1038–1049.

    Article  PubMed  Google Scholar 

  • Carver, C. S., & Antoni, M. H. (2004). Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychology, 23, 595–598.

    Article  PubMed  Google Scholar 

  • Cotton, S. P., Levine, E. G., Fitzpatrick, C. M., Dold, K. H., & Targ, E. (1999). Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psycho-Oncology, 8, 429–438.

    Article  PubMed  Google Scholar 

  • Deng, G., & Cassileth, B. (2013). Complementary or alternative medicine in cancer care—myths and realities. Nature Reviews. Clinical Oncology, 10(11), 656–664.

    Article  PubMed  Google Scholar 

  • Faller, H., Schuler, M., Richard, M., Heckl, U., Weis, J., & Kuffner, R. (2013). Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. Journal of Clinical Oncology, 31(6), 782–793.

    Article  PubMed  Google Scholar 

  • Gardner-Nix, J., Backman, S., Barbati, J., & Grummitt, J. (2008). Evaluating distance education of mindfulness-based meditation program for chronic pain management. Journal of Telemedicine and Telecare, 14, 88–92.

    Article  PubMed  Google Scholar 

  • Garland, S., Tamagawa, R., Todd, S., Speca, M., & Carlson, L. (2013). Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program with individuals with cancer. Integrative Cancer Therapies, 12(1), 31–40.

    Article  PubMed  Google Scholar 

  • Gonzalez-Angulo, A. M., Hennessy, B. T., & Mills, G. B. (2010). Future of personalized medicine in oncology: a systems biology approach. Journal of Clinical Oncology, 28, 2777–2783.

    Article  PubMed  PubMed Central  Google Scholar 

  • Henderson, V. P., Clemow, L., Massion, A. O., Hurley, T. G., Druker, S., & Hebert, J. R. (2012). The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial. Breast Cancer Research and Treatment, 131(1), 99–109.

    Article  PubMed  Google Scholar 

  • Henoch, I., & Danielson, E. (2009). Existential concerns among patients with cancer and interventions to meet them: an integrative literature review. Psycho-Oncology, 18(3), 225–236.

    Article  PubMed  Google Scholar 

  • Holland, J. C., Andersen, B., Breitbart, W. S., Buchmann, L. O., Compas, B., Deshields, T. L., et al. (2013). Distress management. Journal of the National Comprehensive Cancer Network, 11(2), 190–209.

    PubMed  Google Scholar 

  • Howell, D., Hack, T. F., Oliver, T. K., Chulak, T., Mayo, S., Aubin, M., et al. (2011). Survivorship services for adult cancer populations: a pan-Canadian guideline. Current Oncology, 18(6), e265–e281.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jacobsen, P. B., Donovan, K. A., Trask, P. C., Fleishman, S. B., Zabora, J., Baker, F., et al. (2005). Screening for psychologic distress in ambulatory cancer patients. Cancer, 103, 1494–1502.

    Article  PubMed  Google Scholar 

  • Krupski, T. L., Kwan, L., Fink, A., Sonn, G. A., Malinski, S., & Litwin, M. S. (2006). Spirituality influences health related quality of life in men with prostate cancer. Psycho-Oncology, 15, 132–142.

    Article  Google Scholar 

  • Labelle, L., Lawlor-Savage, L., Campbell, T., Faris, P., & Carlson, L. (2015a). Does self-report mindfulness mediate the effect of mindfulness-based stress reduction (MBSR) on spirituality and posttraumatic growth in cancer patients? The Journal of Positive Psychology, 10(2), 153–166.

    Article  Google Scholar 

  • Labelle, L., Campbell, T., Faris, P., & Carlson, L. (2015b). Mediators of mindfulness-based stress reduction (MBSR): assessing the timing and sequence of change in cancer patients. Journal of Clinical Psychology, 71(1), 21–40.

    Article  PubMed  Google Scholar 

  • Lechner, S. C., & Antoni, M. H. (2004). Posttraumatic growth and group-based interventions for persons dealing with cancer: what have we learned so far? Psychological Inquiry, 15, 35–41.

    Google Scholar 

  • Lechner, S.C., Stoelb, B. L., Antoni, M.H. (2008) Group-based therapies for benefit finding in cancer. In S. Joseph and A.P. Linley (Eds.) Trauma, recovery, and growth: positive psychological perspectives on posttraumatic stress. Hoboken, NJ. 207–231.

  • Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: a meta-analysis. Psycho-Oncology, 18(6), 571–579.

    Article  PubMed  Google Scholar 

  • Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: a review. Journal of Traumatic Stress, 17(1), 11–21.

    Article  PubMed  Google Scholar 

  • Matchim, Y., Armer, J. M., & Stewart, B. R. (2011). Mindfulness-based stress reduction among breast cancer survivors: a literature review and discussion. Oncology Nursing Forum, 38(2), E61–71.

    Article  PubMed  Google Scholar 

  • McNair, D. A., Lorr, M., & Droppelman, L. F. (1971). Profile of mood states. San Diego: Educational and Industrial Testing Service.

    Google Scholar 

  • Mitchell, A. J. (2007). Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. Journal of Clinical Oncology, 25(29), 4670–4681.

    Article  PubMed  Google Scholar 

  • Morrill, E. F., Brewer, N. T., O’Neill, S. C., Lillie, S. E., Dees, E. C., Carey, L. A., & Rimer, B. K. (2008). The interaction of post‐traumatic growth and post‐traumatic stress symptoms in predicting depressive symptoms and quality of life. Psycho-Oncology, 17(9), 948–953.

    Article  PubMed  Google Scholar 

  • Musial, F., Bussing, A., Heusser, P., Choi, K., & Ostermann, T. (2011). Mindfulness-based stress reduction for integrative cancer care—a summary of evidence. Forschende Komplementmed, 18, 192–202.

    Article  Google Scholar 

  • National Comprehensive Cancer Network. (2002). Practice guidelines in oncology: distress management. National Comprehensive Cancer Network.

  • Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). Annals of Behavioral Medicine, 24(1), 49–58.

    Article  PubMed  Google Scholar 

  • Piet, J., Wurtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer survivors: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80(6), 1007–1020.

    Article  PubMed  Google Scholar 

  • Rouleau, C. R., Garland, S. N., & Carlson, L. E. (2015). The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients. Cancer Management and Research, 7, 121.

    PubMed  PubMed Central  Google Scholar 

  • Shapiro, S. L., Brown, K. W., Thoresen, C., & Plante, T. G. (2011). The moderation of mindfulness-based stress reduction effects by trait mindfulness: results from a randomized controlled trial. Journal of Clinical Psychology, 67(3), 267–277.

    Article  PubMed  Google Scholar 

  • Shennan, C., Payne, S., & Fenlon, D. (2011). What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psycho-Oncology, 20(7), 681–697.

    Article  PubMed  Google Scholar 

  • Speca, M., Carlson, L. E., Goodey, E., & Angen, M. (2000). A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Medicine, 62(5), 613–622.

    Article  PubMed  Google Scholar 

  • Stephen, J., Rojubally, A., MacGregor, K., McLeod, D., Speca, M., Taylor-Brown, J., et al. (2013). Evaluation of CancerChatCanada: a program of online support for Canadians affected by cancer. Current Oncology, 20, 39e47. doi:10.3747/co.20.1210.

    Google Scholar 

  • Stephen, J., Collie, K., McLeod, D., Rojubally, A., Fergus, K., Speca, M., et al. (2014). Talking with text: communication in therapist-led, live chat cancer support groups. Social Science & Medicine, 104, 178–186.

    Article  Google Scholar 

  • Tallman, B. A., Altmaier, E., & Garcia, C. (2007). Finding benefit from cancer. Journal of Counseling Psychology, 54(4), 481.

    Article  Google Scholar 

  • Tamagawa, R., Garland, S., Vaska, M., & Carlson, L. (2012). Who benefits from psychosocial interventions in oncology? A systematic review of psychological moderators of treatment outcome. Journal of Behavioral Medicine, 35(6), 658–673.

    Article  PubMed  Google Scholar 

  • Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–471.

    Article  PubMed  Google Scholar 

  • Tedeschi, R. G., & Calhoun, L. G. (2004). Target article: “Posttraumatic growth: Conceptual foundations and empirical evidence”. Psychological Inquiry, 15(1), 1–18.

    Article  Google Scholar 

  • Thompson, N. J., Walker, E. R., Obolensky, N., Winning, A., Barmon, C., DiIorio, C., & Compton, M. T. (2010). Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT. Epilepsy & Behavior, 19(3), 247–254.

    Article  Google Scholar 

  • Visser, A., Garssen, B., & Vingerhoets, A. (2010). Spirituality and well‐being in cancer patients: a review. Psycho-Oncology, 19(6), 565–572.

    Article  PubMed  Google Scholar 

  • Whitford, H. S., & Olver, I. N. (2012). The multidimensionality of spiritual wellbeing: peace, meaning, and faith and their association with quality of life and coping in oncology. Psycho-Oncology, 21(6), 602–610.

    Article  PubMed  Google Scholar 

  • Witek-Janusek, L., Albuquerque, K., Chroniak, K. R., Chroniak, C., Durazo-Arvizu, R., & Mathews, H. L. (2008). Effect of mindfulness-based stress reduction on immune function, quality of life, and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior, and Immunity, 22(6), 969–981.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zabora, J., Brintzenhofeszoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19–28.

    Article  PubMed  Google Scholar 

  • Zernicke, K., Campbell, T., Speca, M., McCabe-Ruff, K., Flowers, S., Dirkse, D., & Carlson, L. (2013). The eCALM trial—etherapy for cancer applying mindfulness: online mindfulness-based cancer recovery program for underserved individuals living with cancer in Alberta: protocol development for a randomized wait-list controlled clinical trial. BMC Complementary and Alternative Medicine, 13(34) doi:10.1186/1472-6882-13-34.

  • Zernicke, K., Campbell, T., Speca, M., McCabe-Ruff, K., Flowers, S., & Carlson, L. (2014). A randomized wait-list controlled trial of feasibility and efficacy of an online mindfulness-based cancer recovery program: the etherapy for cancer applying mindfulness trial. Psychosomatic Medicine, 76(4), 257–267.

    Article  PubMed  Google Scholar 

  • Zwahlen, D., Hagenbuch, N., Carley, M., Jenewein, J., & Buchi, S. (2010). Posttraumatic growth in cancer patients and partners—effects of role, gender and the dyad on couples’ posttraumatic growth experience. Psycho-Oncology, 19(1), 12–20.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr. Linda Carlson holds the Enbridge Research Chair in Psychosocial Oncology, co-funded by the Canadian Cancer Society Alberta/NWT Division and the Alberta Cancer Foundation. Kristin Zernicke held an Alberta Innovates–Health Solutions Full-Time Studentship, a Canadian Institute of Health Research–Frederick Banting & Charles Best Canada Graduate Scholarship Doctoral Award, a Psychosocial Oncology Research Training Fellowship, and the Mind and Life Francisco J. Varela Research Award to facilitate this research. The authors would like to thank the Psychosocial Resources Department at the Tom Baker Cancer Centre, Alberta Health Services Cancer Care in Calgary, Alberta, Canada, which has been supportive throughout the development of this online MBCR program, as well as the Calgary Office of the Alberta Cancer Registry. The authors would like to thank the participants for making this study possible through their willingness and generosity.

Author information

Authors and Affiliations

  1. Department of Psychology, University of Calgary, Calgary, Alberta, Canada

    Kristin A. Zernicke & Tavis S. Campbell

  2. Department of Psychosocial Resources, 2202-2nd Street SW, Calgary, Alberta, T2S 3C1, Canada

    Kristin A. Zernicke, Tavis S. Campbell, Michael Speca, Rie Tamagawa & Linda E. Carlson

  3. Department of Oncology, University of Calgary, Calgary, Alberta, Canada

    Michael Speca, Rie Tamagawa & Linda E. Carlson

  4. eMindful Inc., Vero Beach, FL, USA

    Kelley McCabe Ruff

  5. Mindful Living Programs, Chico, CA, USA

    Steven Flowers

  6. Enloe Medical Center, Chico, CA, USA

    Steven Flowers

Authors
  1. Kristin A. Zernicke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tavis S. Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Speca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kelley McCabe Ruff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven Flowers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rie Tamagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Linda E. Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Linda E. Carlson.

Ethics declarations

Conflicts of Interest and Source of Funding

Kelley McCabe-Ruff is the CEO and Founder of eMindful. KMR has a financial investment in eMindful. KMR provided support for the facilitation of the MBCR programs through eMindful, with a technical role in study design, however she was not involved in data analysis or interpretation. Steven Flowers (SF) is employed through Mindful Living Programs. SF was involved in the delivery of this trial by teaching the online mindfulness classes, and aided in interpretation by editing manuscripts. SF did not have involvement in obtaining funding for this trial or data analysis and interpretation. A draft of this manuscript was included in a dissertation submitted to the University of Calgary for first author’s (KZ) doctoral degree requirements and specified as manuscript in preparation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zernicke, K.A., Campbell, T.S., Speca, M. et al. The eCALM Trial: eTherapy for Cancer Applying Mindfulness. Exploratory Analyses of the Associations Between Online Mindfulness-Based Cancer Recovery Participation and Changes in Mood, Stress Symptoms, Mindfulness, Posttraumatic Growth, and Spirituality. Mindfulness 7, 1071–1081 (2016). https://doi.org/10.1007/s12671-016-0545-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12671-016-0545-5

Keywords

Search

Navigation