Leveraging social connection by including informal caregivers in an internet video conference-based compassion meditation intervention to reduce psychological distress in breast cancer survivors

通过让非正式护理人员参与基于互联网视频会议的同情冥想干预，利用社会联系来减少乳腺癌幸存者的心理困扰

• 批准号: 10518639
• 负责人: THADDEUS PACE
• 金额: $ 36.43万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-11 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10518639
• 关键词: Address; Adult; Aftercare; Anxiety; Attention; Breast Cancer survivor; Cancer Survivor; Caregiver well-being; Caregivers; Caring; Chemotherapy and/or radiation; Cognitive; Cognitive Therapy; Compassion; Diffusion; Distress; Diurnal Rhythm; Effectiveness; Ensure; Exhibits; Family member; Feeling; Goals; Health education; Home; Hydrocortisone; Instruction; Internet; Interpersonal Relations; Intervention; Mediating; Mediator of activation protein; Meditation; Mental Depression; Meta-Analysis; Modality; Operative Surgical Procedures; Pathway interactions; Personal Satisfaction; Pharmacotherapy; Physical activity; Physiology; Randomized; Research; Social isolation; Solid Neoplasm; Stress; Supportive care; Survivors; Technology; Testing; Training; Videoconferencing; Work; attentional control; base; cancer therapy; caregiver education; clinically significant; digital; experience; improved; informal caregiver; mindfulness; mindfulness meditation; negative affect; online intervention; pilot test; primary outcome; psychological distress; recruit; remote delivery; skills; social; synchronous contact; synchronous delivery

ABSTRACT Many breast cancer survivors (estimated 70% in some studies) experience clinically significant depression and/or anxiety (together psychological distress, hereafter distress) in the months and years after finishing cancer treatments. To address this important need, meditation interventions have been developed to reduce distress for breast cancer survivors, while also improving (or stabilizing) objective indicators of stress physiology (i.e., diurnal cortisol rhythm; DCR). In the last several years, progress has been made to deliver these meditation interventions through digital technology to improve scalability and accessibility (i.e., online and/or through apps) to reduce distress experienced by survivors. Online meditation interventions are especially important because they ensure ongoing viability of a popular integrative modality for many survivors who are unable to engage in face-to-face supportive care activities outside the home. Despite progress, existing online meditation interventions have several limitations that undercut their effectiveness to reduce survivor distress. Online meditation interventions have: 1) centered mostly on mindfulness, which does not actively work to cultivate prosocial and interpersonal relationship capacity and provides limited contemplative skills for survivors who may suffer from feelings of social isolation that contribute to distress; 2) often been asynchronous, with no direct interventionist contact over the course of meditation training; and 3) have often not included survivors' informal caregivers (i.e., adult family members who live with and typically provide half the care for survivors). This research will address these limitations. We will build on the rigor of prior research to reduce survivor distress with a compassion meditation intervention called CBCT (Cognitively-Based Compassion Training) for online synchronous delivery by trained interventionists that is also inclusive of caregivers. CBCT is an 8-week intervention that starts with attention and mindfulness but then builds to contemplation about compassion for the self and others, and is different from other meditation interventions (i.e., mindfulness meditation). The goal of CBCT is to directly enhance feelings of social connection, equanimity, and self-compassion, and reduce negative affect, and through these pathways lessen distress. We seek to determine if CBCT reduces distress and improves DCR for survivors compared to an active attention control (Health Education, HE) when delivered remotely by Zoom to both survivors and caregivers as a dyad (i.e., CBCT for dyads; CBCT-D). We will also test whether or not including caregivers in CBCT-D reduces distress and optimizes DCR more than when survivors receive CBCT by themselves alone (i.e., CBCT for survivors; CBCT-S). If successful, this research will provide evidence regarding efficacy of an online, synchronous dyadic CBCT intervention and the extent to which it does so through the mediational pathway of social connection with caregivers. This research will fill an important gap in evidence for interventions that can reduce distress, an NCI priority for the growing numbers of survivors and caregivers.

抽象的 许多乳腺癌幸存者（一些研究中估计为 70%）患有临床上显着的抑郁症 和/或癌症结束后数月和数年的焦虑（统称心理困扰，以下简称困扰） 为了满足这一重要需求，人们开发了冥想干预措施来减轻痛苦。 对于乳腺癌幸存者，同时还改善（或稳定）应激生理学的客观指标（即， 在过去的几年里，这些冥想已经取得了进展。 通过数字技术进行干预，以提高可扩展性和可访问性（即在线和/或通过应用程序） 减少幸存者经历的痛苦尤其重要，因为 对于许多无法参与的幸存者来说，它们确保了流行的综合模式的持续可行性。 尽管取得了进展，但现有的在线冥想仍然存在。 干预措施有一些局限性，削弱了其减少在线幸存者痛苦的有效性。 冥想干预有：1）主要集中在正念上，它并不积极地致力于培养 亲社会和人际关系能力，并为幸存者提供有限的沉思技能，他们可能 遭受社会孤立感，这会导致痛苦；2）经常是异步的，没有直接的影响； 冥想训练过程中的干预接触；3）通常不包括幸存者的非正式接触； 照顾者（即与幸存者住在一起并通常为幸存者提供一半照顾的成年家庭成员）。 我们将在先前研究的基础上解决这些局限性，以减少幸存者的痛苦。 在线进行慈悲冥想干预，称为 CBCT（基于认知的慈悲训练） CBCT 是由训练有素的干预专家进行的为期 8 周的同步分娩，其中也包括护理人员。 干预从注意力和正念开始，然后建立起对他人的同情心的沉思 自我和他人，并且不同于其他冥想干预（即正念冥想）的目标。 CBCT是直接增强社会联系感、平静感和自我慈悲感，减少负面情绪 我们试图确定 CBCT 是否可以减少痛苦并通过这些途径减轻痛苦。 与主动注意力控制（健康教育，HE）相比，幸存者的 DCR 得到改善 通过 Zoom 远程向幸存者和护理人员作为二人进行（即，二人的 CBCT；CBCT-D）。 与幸存者相比，是否将护理人员纳入 CBCT-D 可以减少痛苦并优化 DCR 单独接受 CBCT（即幸存者 CBCT；CBCT-S）。如果成功，本研究将提供。 关于在线、同步二元 CBCT 干预的有效性及其程度的证据 通过与照顾者的社会联系的中介途径来做到这一点这项研究将填补一个重要的空白。 减少痛苦的干预措施的证据存在差距，这是 NCI 对越来越多幸存者的优先事项 和护理人员。