静观正念减压显著改善乳腺癌生存者广泛症状

　　城市急速的生活步伐，常令人迷失方向，容易跌入不快情绪的漩涡中。愈要达到心目中理想境界，愈企图控制生活中种种不能确定的事物，就愈容易变得沮丧、无助、不安。不知不觉中，很容易被潜藏的恐惧和不安驱使，引发出无意识的负面行为。即使发现自己处理事情的方法不奏效，但在压力下，惯性的机械反应仍然会重复出现。若不正视和处理，久而久之，心境愈来愈困扰，失去寻求满足和快乐的力量，甚至出现种种身心病症。

　　1979年，美国麻省（马萨诸塞州）大学医学院教授乔·卡巴金博士（Jon Kabat-Zinn, Ph.D.）创立静观正念减压（MBSR），结合西方医学、心理学研究与东方禅修传统，协助参与者以正念内观处理压力、疼痛和疾病，多年来西方科学界已发表数百篇的研究文献，证实其为一套有效的训练方法。静观（港译）正念（台译）译自「mindfulness」，其他译法包括「内观」、「专注觉察」等。

　　2016年5月31日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表南佛罗里达大学、佛罗里达大学、美国国家癌症研究所、德克萨斯女子大学、弗吉尼亚大学等机构学者的随机对照研究报告（155例∶167例），发现乳腺癌生存者接受6周乳腺癌静观正念减压课程训练，显著改善广泛症状，总体效果通常小到中等。

J Clin Oncol. 2016 May 31. [Epub ahead of print]

Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial.

Lengacher CA, Reich RR, Paterson CL, Ramesar S, Park JY, Alinat C, Johnson-Mallard V, Moscoso M, Budhrani-Shani P, Miladinovic B, Jacobsen PB, Cox CE, Goodman M, Kip KE.

University of South Florida College of Nursing; H. Lee Moffitt Cancer Center and Research Institute; University of South Florida Morsani College of Medicine, Tampa; University of South Florida Sarasota-Manatee, Manatee; University of Florida, College of Nursing, Gainesville, FL; National Cancer Institute, Rockville, MD; Texas Woman's University, Nelda C. Stark College of Nursing, Houston, TX; University of Virginia, Charlottesville, VA.

PURPOSE: The purpose of this randomized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program in improving psychological and physical symptoms and quality of life among breast cancer survivors (BCSs) who completed treatment. Outcomes were assessed immediately after 6 weeks of MBSR(BC) training and 6 weeks later to test efficacy over an extended timeframe.

PATIENTS AND METHODS: A total of 322 BCSs were randomly assigned to either a 6-week MBSR(BC) program (n = 155) or a usual care group (n = 167). Psychological (depression, anxiety, stress, and fear of recurrence) and physical symptoms (fatigue and pain) and quality of life (as related to health) were assessed at baseline and at 6 and 12 weeks. Linear mixed models were used to assess MBSR(BC) effects over time, and participant characteristics at baseline were also tested as moderators of MBSR(BC) effects.

RESULTS: Results demonstrated extended improvement for the MBSR(BC) group compared with usual care in both psychological symptoms of anxiety, fear of recurrence overall, and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference (P < .01). Overall effect sizes were largest for fear of recurrence problems (d = 0.35) and fatigue severity (d = 0.27). Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC).

CONCLUSION: The MBSR(BC) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC) training, with generally small to moderate overall effect sizes.

PMID: 27247219

PII: JCO657874

DOI: 10.1200/JCO.2015.65.7874