Abstract
Objectives
Breast cancer is a life-threatening disease that leaves survivors vulnerable to clinical levels of psychological disorder. Expanding on recent research that indicates both mindfulness and working memory training can reduce levels of emotional vulnerability separately, we investigate how the combined effects of these interventions impact emotion regulation in female survivors of breast cancer.
Methods
Participants completed a 10-day course of either mindfulness-based meditation (Mindfulness), mindfulness-based meditation and working memory training (Mindfulness N-Back), working memory training (N-Back) or, for the control group, a 1-back task (1-back). Assessment of emotional vulnerability took place at pre- and post-intervention, as well as at 1- and 6-month follow-up time points to assess whether any observed effects would persist.
Results
Findings indicated that an independent course of either mindfulness-based meditation or working memory training, as well as a combined course of both, can result in reductions in anxious symptomatology compared to an active control group. Whilst effects were sustained for all experimental training groups (Mindfulness, N-Back, Mindfulness N-Back) at 1-month post-intervention, at 6-month follow-up effects were only apparent for the independent groups (Mindfulness, N-Back).
Conclusions
This study suggests that the engagement of attentional control processes through both independent and combined courses of mindfulness-based meditation and adaptive working memory training can result in sustained reductions in anxiety symptomatology in women diagnosed with breast cancer.
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References
Ahles, T. A., & Root, J. C. (2018). Cognitive effects of cancer and cancer treatments. Annual Review of Clinical Psychology, 14(1), 425–451. https://doi.org/10.1146/annurev-clinpsy-050817-084903.
Allen, M., Dietz, M., Blair, K. S., van Beek, M., Rees, G., Vestergaard-Poulsen, P., Lutz, A., & Roepstorff, A. (2012). Cognitive-affective neural plasticity following active-controlled mindfulness intervention. The Journal of Neuroscience, 32(44), 15601–15610. https://doi.org/10.1523/JNEUROSCI.2957-12.2012.
Bennike, I. H., Wieghorst, A., & Kirk, U. (2017). Online-based mindfulness training reduces behavioral markers of mind wandering. Journal of Cognitive Enhancement, 1(2), 172–181. https://doi.org/10.1007/s41465-017-0020-9.
Berggren, N., & Derakshan, N. (2013). Attentional control deficits in trait anxiety: Why you see them and why you don’t. Biological Psychology, 92(3), 440–446. https://doi.org/10.1016/j.biopsycho.2012.03.007.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2006). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077.
Blacker, K. J., Negoita, S., Ewen, J. B., & Courtney, S. M. (2017). N-back versus complex span working memory training. Journal of Cognitive Enhancement: Towards the Integration of Theory and Practice, 1(4), 434–454. https://doi.org/10.1007/s41465-017-0044-1.
Cancer Research UK. (2020). https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/incidence-invasive, Accessed Apr 2020.
Carreira, H., Williams, R., Müller, M., Harewood, R., Stanway, S., & Bhaskaran, K. (2018). Associations between breast cancer survivorship and adverse mental health outcomes: A systematic review. Journal of the National Cancer Institute, 110(12), 1311–1327. https://doi.org/10.1093/jnci/djy177.
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7.
Cohen, N., Margulies, D. S., Ashkenazi, S., Schaefer, A., Taubert, M., Henik, A., Villringer, A., & Okon-Singer, H. (2016). Using executive control training to suppress amygdala reactivity to aversive information. NeuroImage, 125, 1022–1031. https://doi.org/10.1016/j.neuroimage.2015.10.069.
Course-Choi, J., Saville, H., & Derakshan, N. (2017). The effects of adaptive working memory training and mindfulness meditation training on processing efficiency and worry in high worriers. Behaviour Research and Therapy, 89, 1–13. https://doi.org/10.1016/j.brat.2016.11.002.
Davidson, R. J., & Kaszniak, A. W. (2015). Conceptual and methodological issues in research on mindfulness and meditation. The American Psychologist, 70(7), 581–592. https://doi.org/10.1037/a0039512.
Derakshan, N. (2020). Attentional control and cognitive biases as determinants of vulnerability and resilience in anxiety and depression. In T. Aue & H. Okon-Singer (Eds.), Cognitive biases in health and psychiatric disorders. Academic Press.
Dolcos, F., Katsumi, Y., Moore, M., Berggren, N., de Gelder, B., Derakshan, N., Hamm, A. O., Koster, E. H. W., Ladouceur, C. D., Okon-Singer, H., Pegna, A. J., Richter, T., Schweizer, S., Van den Stock, J., Ventura-Bort, C., Weymar, M., & Dolcos, S. (2020). Neural correlates of emotion-attention interactions: From perception, learning and memory to individual differences and training interventions. Neuroscience and Biobehavioral Reviews. https://doi.org/10.1016/j.neubiorev.2019.08.017.
Economides, M., Martman, J., Bell, M. J., & Sanderson, B. (2018). Improvements in stress, affect, and irritability following brief use of a mindfulness-based smartphone app: A randomized controlled trial. Mindfulness, 9(5), 1584–1593. https://doi.org/10.1007/s12671-018-0905-4.
Engen, H., & Kanske, P. (2013). How working memory training improves emotion regulation: Neural efficiency, effort, and transfer effects. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 33(30), 12152–12153. https://doi.org/10.1523/JNEUROSCI.2115-13.2013.
Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7(2), 336–353. https://doi.org/10.1037/1528-3542.7.2.336.
Ferrell, B. R., & Hassey Dow, K. (1997). Quality of life among long-term cancer survivors. Oncology, 11(4), 565–568 571; discussion 572, 575–576.
Gross, J. J. (2013). Emotion regulation: Taking stock and moving forward. Emotion, 13(3), 359–365. https://doi.org/10.1037/a0032135.
Guendelman, S., Medeiros, S., & Rampes, H. (2017). Mindfulness and emotion regulation: Insights from neurobiological, psychological, and clinical studies. Frontiers in Psychology, 8, 220. https://doi.org/10.3389/fpsyg.2017.00220.
Hagen, K. B., Aas, T., Kvaløy, J. T., Eriksen, H. R., Søiland, H., & Lind, R. (2016). Fatigue, anxiety and depression overrule the role of oncological treatment in predicting self-reported health complaints in women with breast cancer compared to healthy controls. Breast, 28, 100–106. https://doi.org/10.1016/j.breast.2016.05.005.
Haller, H., Winkler, M. M., Klose, P., Dobos, G., Kümmel, S., & Cramer, H. (2017). Mindfulness-based interventions for women with breast cancer: An updated systematic review and meta-analysis. Acta Oncologica, 56(12), 1665–1676. https://doi.org/10.1080/0284186X.2017.1342862.
Härtl, K., Schennach, R., Müller, M., Engel, J., Reinecker, H., Sommer, H., & Friese, K. (2010). Quality of life, anxiety, and oncological factors: A follow-up study of breast cancer patients. Psychosomatics, 51(2), 112–123. https://doi.org/10.1016/S0033-3182(10)70671-X.
Henson, K. E., Brock, R., Charnock, J., Wickramasinghe, B., Will, O., & Pitman, A. (2019). Risk of suicide after cancer diagnosis in England. JAMA Psychiatry, 76(1), 51–60. https://doi.org/10.1001/jamapsychiatry.2018.3181.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016.
Kane, M. J., Bleckley, M. K., Conway, A. R., & Engle, R. W. (2001). A controlled-attention view of working-memory capacity. Journal of Experimental Psychology. General, 130(2), 169–183.
Koster, E. H. W., Hoorelbeke, K., Onraedt, T., Owens, M., & Derakshan, N. (2017). Cognitive control interventions for depression: A systematic review of findings from training studies. Clinical Psychology Review, 53, 79–92. https://doi.org/10.1016/j.cpr.2017.02.002.
Malinowski, P. (2008). Mindfulness as psychological dimension: Concepts and applications. The Irish Journal of Psychology, 29(1–2), 155–166. https://doi.org/10.1080/03033910.2008.10446281.
Mani, M., Kavanagh, D. J., Hides, L., & Stoyanov, S. R. (2015). Review and evaluation of mindfulness-based iPhone apps. JMIR mHealth and uHealth, 3(3), e82. https://doi.org/10.2196/mhealth.4328.
Mrazek, M. D., Franklin, M. S., Phillips, D. T., Baird, B., & Schooler, J. W. (2013). Mindfulness training improves working memory capacity and GRE performance while reducing mind wandering. Psychological Science, 24(5), 776–781. https://doi.org/10.1177/0956797612459659.
Peckham, A. D., & Johnson, S. L. (2018). Cognitive control training for emotion-related impulsivity. Behaviour Research and Therapy, 105, 17–26. https://doi.org/10.1016/j.brat.2018.03.009.
Pitman, A., Suleman, S., Hyde, N., & Hodgkiss, A. (2018). Depression and anxiety in patients with cancer. BMJ (Clinical Research Ed.), 361, k1415. https://doi.org/10.1136/bmj.k1415.
Plaza García, I., Sánchez, C. M., Espílez, Á. S., García-Magariño, I., Guillén, G. A., & García-Campayo, J. (2017). Development and initial evaluation of a mobile application to help with mindfulness training and practice. International Journal of Medical Informatics, 105, 59–67. https://doi.org/10.1016/j.ijmedinf.2017.05.018.
Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method bias in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903.
Rosen, K. D., Paniagua, S. M., Kazanis, W., Jones, S., & Potter, J. S. (2018). Quality of life among women diagnosed with breast Cancer: A randomized waitlist controlled trial of commercially available mobile app-delivered mindfulness training. Psycho-Oncology, 27(8), 2023–2030. https://doi.org/10.1002/pon.4764.
Shani, R., Tal, S., Zilcha-Mano, S., & Okon-Singer, H. (2019). Can machine learning approaches lead toward personalized cognitive training? Frontiers in Behavioral Neuroscience, 13, 64. https://doi.org/10.3389/fnbeh.2019.00064.
Simard, S., & Savard, J. (2009). Fear of cancer recurrence inventory: Development and initial validation of a multidimensional measure of fear of cancer recurrence. Supportive Care in Cancer, 17(3), 241–251. https://doi.org/10.1007/s00520-008-0444-y.
Smith, H. R. (2015). Depression in cancer patients: Pathogenesis, implications and treatment. Oncology Letters, 9(4), 1509–1514. https://doi.org/10.3892/ol.2015.2944.
Sood, A., & Jones, D. T. (2013). On mind wandering, attention, brain networks, and meditation. Explore (New York, N.Y.), 9(3), 136–141. https://doi.org/10.1016/j.explore.2013.02.005.
Stark, D. P., & House, A. (2000). Anxiety in cancer patients. British Journal of Cancer, 83(10), 1261–1267. https://doi.org/10.1054/bjoc.2000.1405.
Swainston, J., & Derakshan, N. (2018). Training cognitive control to reduce emotional vulnerability in breast cancer. Psycho-Oncology, 27(7), 1780–1786. https://doi.org/10.1002/pon.4727.
Tang, Y.-Y., Yang, L., Leve, L. D., & Harold, G. T. (2012). Improving executive function and its neurobiological mechanisms through a mindfulness-based intervention: Advances within the field of developmental neuroscience. Child Development Perspectives, 6(4), 361–366. https://doi.org/10.1111/j.1750-8606.2012.00250.x.
Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33(1), 25–39.
Teper, R., & Inzlicht, M. (2013). Meditation, mindfulness and executive control: The importance of emotional acceptance and brain-based performance monitoring. Social Cognitive and Affective Neuroscience, 8(1), 85–92. https://doi.org/10.1093/scan/nss045.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247–259.
Wagner, L. I., Sweet, J., Butt, Z., Lai, J., & Cella, D. (2009). Measuring patient self-reported cognitive function: Development of the functional assessment of cancer therapy-cognitive function instrument. Journal of Supportive Oncology, 7(6), W32–W39.
Wang, X., Wang, N., Zhong, L., et al. (2020). Prognostic value of depression and anxiety on breast cancer recurrence and mortality: A systematic review and meta-analysis of 282,203 patients. Molecular Psychiatry, 25, 3186–3197. https://doi.org/10.1038/s41380-02000865-6.
Weiss, D. S. (2007). The impact of event scale: Revised. In J. P. Wilson & S-K. C. Tang (Eds). Cross-cultural assessment of psychological trauma and PTSD (pp. 219–238). Springer.
Wielgosz, J., Goldberg, S. B., Kral, T. R. A., Dunne, J. D., & Davidson, R. J. (2019). Mindfulness meditation and psychopathology. Annual Review of Clinical Psychology, 15, 285–316. https://doi.org/10.1146/annurev-clinpsy-021815-093423.
Xiu, L., Zhou, R., & Jiang, Y. (2016). Working memory training improves emotion regulation ability: Evidence from HRV. Physiology & Behavior, 155, 25–29. https://doi.org/10.1016/j.physbeh.2015.12.004.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.
Acknowledgements
This research was supported by a 1 + 3 ESRC PhD Studentship awarded to Jessica Swainston and a Wellcome Trust ISSF funding awarded to Nazanin Derakshan. The research was carried out under the supervision of Nazanin Derakshan. We would like to thank Headspace for providing app subscriptions to study participants.
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JS and ND: research question, funding, study design and analysis plan. JS: preparation of data, data collection and drafting initial and final version of the manuscript. JS and ND: statistical analysis and critical review of early and final versions of the manuscript.
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All procedures performed in this study involving human participants were in accordance with the ethical standards of the Research Ethics Committee of Birkbeck, University of London, as well as the Economic and Social Research Council. Informed written consent was obtained from all participants included in the study.
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Swainston, J., Derakshan, N. Reduced Anxiety Following Mindfulness and Adaptive Working Memory Training in Women with Breast Cancer. Mindfulness 12, 1928–1939 (2021). https://doi.org/10.1007/s12671-021-01651-3
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DOI: https://doi.org/10.1007/s12671-021-01651-3