Achtsamkeit und Depression als Mediatoren von Hilflosigkeit auf die Lebensqualität bei Krebspatienten

Ruth Metten

doi:10.1055/s-0033-1357657

Deutsche Zeitschrift für Onkologie, Inhaltsverzeichnis

Deutsche Zeitschrift für Onkologie 2014; 46(03): 112-120
DOI: 10.1055/s-0033-1357657

Forschung

Achtsamkeit und Depression als Mediatoren von Hilflosigkeit auf die Lebensqualität bei Krebspatienten

Ruth Metten

Abstract

Zusammenfassung

Insgesamt wurden ca. 50 Krebspatienten zu vier Messzeitpunkten über einen Zeitraum von jeweils 1 Jahr mit dem Freiburger Fragebogen zur Achtsamkeit (FFA; 56), der deutschen Version der Hospital Anxiety and Depression Scale (HADS-D; 19), der Schedule for the Evaluation of Individual Quality of Life − DW (SEIQoL-DW; 42) sowie nach der Psychoonkologischen Basisdokumentation (PO-BaDo) untersucht. Die Beziehungen zwischen Hilflosigkeit, Achtsamkeit, Depression und Lebensqualität wurden nach Hayes 17 mithilfe des computergestützten Instruments PROCESS analysiert. Es zeigte sich, dass die Verringerung der Hilflosigkeit die Lebensqualität der Krebspatienten nicht direkt, sondern indirekt erhöhte. Zwei indirekte Effekte wurden festgestellt: Zum einen wirkte sich − vermittelt durch die seriell wirkenden Mediatoren Achtsamkeit (Erhöhung) und Depression (Verminderung) − die Verringerung der Hilflosigkeit positiv auf die Lebensqualität der Krebspatienten aus. Zum anderen zeigte sich vorübergehend ein weiterer indirekter negativer Effekt, den Hilflosigkeit, unabhängig von Achtsamkeit, allein über Depression auf die Lebensqualität der Krebspatienten ausübte.

Summary

For a period of over one year, a total of 50 cancer patients were examined on four occasions with the „Freiburger Fragebogen zur Achtsamkeit“ (FFA; 56), the German version of the Hospital Anxiety and Depression Scale (HADS-D; 19), the Schedule for the Evaluation of Individual Quality of Life - DW (SEIQoL-DW; 42) as well as the Basic Documentation for Psycho-Oncology (PO-BaDo). The relationship between mindfulness, helplessness, depression and quality of life were analyzed according to Hayes 17 using the computer-assisted instrument; PROCESS. It turned out that the reduction of helplessness does not directly, but indirectly increase the quality of life of cancer patients. Two indirect effects were observed: The reduction of helplessness, transmitted by the mediators of mindfulness (increase) and depression (decrease) had a positive effect on the quality of life of cancer patients. On the other hand, the temporary indirect negative effect of helplessness, regardless of mindfulness, exerted depression on the quality of life of cancer patients.

Schlüsselwörter

Hilflosigkeit - Lebensqualität - Krebspatienten - Achtsamkeit - Depression - Mediator

Keywords

Quality of life - cancer patients - mindfulness - depression - helplessness - mediator

Volltext

Referenzen

Literatur
1 Angenendt G, Tschuschke V. Grundlagen der psychoonkologischen Behandlung. In: Angenendt G, Schütze-Kreilkamp U, Tschuschke V. Praxis der Psychoonkologie. Psychoedukation, Beratung und Therapie. Stuttgart: Hippokrates; 2007: 39-73
2 Bränström R, Kvillemo P, Moskowitz JT. A randomized study of the effects of mindfulness training on psychological well-being and symptoms of stress in patients treated for cancer at 6-month follow-up. Int J Behav Med 2012; 19(4): 535-542
3 Bränström R, Kvillemo P, Brandberg Y, Moskowitz JT. Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients - a randomized study. Ann Behav Med 2010; 39(2): 151-161
4 Browne JP, O’Boyle CA, McGee HM, McDonald NJ, Joyce CR. Development of a direct weight procedure for quality of life domains. Qual Life Res 1997; 6(4): 301-309
5 Di Clemente KJ. Temoshok L. Psychological adjustment to having cutaneous malignant melanoma as a predictor of follow-up clinical studies. Psychosom Med 1987: 47; 81.
6 Edenfield TM, Saeed S. An update on mindfulness meditation as a self-help treatment for anxiety and depression. Psychol Res Behav Manag 2012; 5: 131-141
7 Ell K, Sanchez K, Vourlekis B, Lee P-J. Dwight-Johnson M, Lagomasino I et al Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecological cancer. J Clin Oncol 2005; 23(13): 3052-3060
8 Epstein M. The deconstruction of the self: Ego and „egolessness“ in Buddhist insight meditation. J Transpersonal Psychol 1988; 20(1): 61-69
9 Foley E, Baillie A, Huxter M, Price M, Sinclaur E. Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: a randomized controlled trial. J Consult Clin Psychol 2010; 78(1): 72-79
10 Fromm EK. Self-Hypnosis - The Chicago Paradigm. New York: Guilford Press; 1990
11 Gander M-L, Kohls N, Walach H. Achtsamkeit und Krebs ― eine Übersicht. Dtsch Z Onkol 2008; 40: 158-162
12 Greer S, Morris T, Pettingale KW. Psychological response to cancer: effect on outcome. Lancet 1979; 314(8146): 785-787
13 Greer S, Morris T, Pettingale KW. Psychological response to breast cancer and 15 year outcome. Lancet 1990; 335(8680): 49-50
14 Greeson JM. Mindfulness Research Update: 2008. Complement Health Pract Rev 2009; 14(1): 10-18
15 Grossmann P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reductionand health benefits. A meta-analysis. J Psychosom Res 2004; 57(1): 35-43
16 Hayes AF. PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling. Retrieved from http://www.afhayes.com/public/process2012.pdf
17 Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York: Guilford Press; 2013
18 Herrmann C. Vorstellung und Validierung einer deutschen Version der „Hospital Anxiety and Depression Scale“ (HAD-Skala). Diagnostica 1994; 40(2): 143-154
19 Herrmann-Lingen C, Buss U, Snaith RP. HADS-D. Hospital Anxiety and Depression Scale ― Deutsche Version. Bern: Huber; 2005
20 Herschbach P, Marten-Mittag B. Manual und Interviewleitfaden zur Psychoonkologischen Basisdokumentation - Standardversion. Arbeitsgruppe PO-BaDo München 2009;
21 Hickey AM, Bury G, O’Boyle CA, Bradley F, O’Kelly FD, Shannon W. A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS. BMJ 1996; 313): 29-33
22 Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol 2010; 78(2): 169-183
23 Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science 2011; 6(6): 537-559
24 Jang JE, Kim SW, Kim SY, Kim JM, Park MH, Yoon JH et al Religiosity, depression, and quality of life in Korean patients with breast cancer: a 1-year prospective longitudinal study. Psychooncology 2013; 22(4): 922-929
25 Jensen MR. Psychobiological factors predicting the course of breast cancer. J Pers 1987; 55(2): 317-342
26 Keng S-L, Smoski M-J. Robins CJ. Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review 2011; 31(6): 1041-1056
27 Larbig W, Tschuschke V. Psychologische Interventionseffekte bei Krebs. Eine Einführung. In: Larbig W, Tschuschke V. Psychoonkologische Interventionen. Therapeutisches Vorgehen und Ergebnisse. München: Reinhardt; 2000: 12-20
28 Ledesma D, Kumano H. Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology 2009; 18(6): 571-579
29 Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobson PB, Klein TW et al Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychoocology 2009; 18(12): 1261-1272
30 Liossi C. Hypnosis in Cancer Care. Contemporary Hypnosis 2006; 23(1): 47-57
31 Lynn SJ. Mindfulness, acceptance and hypnosis: cogntive and clinical perspectives. Int J Clin Exp Hypn 2006; 54(2): 143-166
32 Lynn SJ, Kirsch I, Hallquist MN. Social cognitive theories of hypnosis. In: Nash MR, Barnier AJ. The Oxford Handbook of Hypnosis. Oxford: University Press; 2008: 111-139
33 Merwart M. Die Inanspruchnahme von psychosozialen Unterstützungsangeboten bei Krebskranken - eine geschlechtsspezifische Untersuchung. Würzburg: Dissertation an der Medizinischen Fakultät der Julius-Maximilians-Universität; 2012
34 Montgomery GH, Bovbjerg DH, Schnur JB, David D, Goldfarb A, Weltz CR et al A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Nat Cancer Inst 2007; 99(17): 1304-1312
35 Montgomery GH, David D, Winkel G, Silverstein J, Bovbjerg DH. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg 2002; 94: 1639-1645
36 Montgomery GH, Kangas M, David D, Hallquist MN, Green S, Bovbjerg DH et al Fatigue during breast cancer radiotherapy: an initial randomized study of cognitive-behavioral therapy plus hypnosis. Health Psychol 2009; 28(3): 317-322
37 Montgomery GH, Schnur JB, Kravits K. Hypnosis for Cancer Care: Over 200 Years Young. CA Cancer J Clin 2013; 63: 31-44
38 Montgomery GH, Weltz CR, Seltz G, Bovbjerg DH. Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. Int J Clin Exp Hypn 2002; 50: 17-32
39 Monti DA, Peterson C, Kunkel EJ, Hauck WW, Pequignot E, Rhodes L et al A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psychooncology 2006; 15: 363-373
40 Morris TA, Pettingale KW, Haybittle J. Psychological response to cancer diagnosis and disease outcome in patients with breast cancer and lymphoma. Psychooncology 1992; 1(2): 105-114
41 Musial F, Büssing A, Heusser P, Choic K-E. Ostermann T. Mindfulness-based stress reduction for integrative cancer care: a summary of evidence. Forsch Komplementmed 2011; 18: 192-202
42 O’Boyle CA, Browne J, Hickey A, McGee HM, Joyce CR. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL): a direct weighting procedure for quality of life domains (SEIQoL-DW) ― Administration Manual. Dublin: Department of Psychology, Royal College of Surgeons in Ireland; 1993
43 Peter B. Hypnose und die Konstruktion von Wirklichkeit. In: Revenstorf D, Peter B. Hypnose in Psychotherapie, Psychosomatik und Medizin. Heidelberg: Springer; 2009: 32-40
44 Pettingale KW, Morris T, Greer S, Haybittle JL. Mental attitudes to cancer: an additional prognosis factor. Lancet 1985; 325(8431): 750
45 Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008; 40(3): 879-891
46 Rajasekaran M, Edmonds PM, Higginson IL. Systematic review of hypnotherapy for treating symptoms in terminal ill adult cancer patients. Palliat Med 2005; 19(5): 418-426
47 Sedlmeier P, Eberth J, Schwarz M, Zimmermann D, Haarig F, Jaeger S et al The psychological effects of meditation: a meta-analysis. Psychol Bull 2012; 138: 1139-1171 Advance online publication. doi: 10.1037/a0028168
48 Shapiro SL, Carlson LE, Astin JA. Freedman B. Mechanisms of Mindfulness. J Clin Psychol 2006; 62(3): 373-386
49 Shennan C, Payne S, Fenlon D. What is the evidence for the use of mindfulness-based interventions in cancer care?. Psychooncology 2011; 20(7): 681-697
50 Shim E-J, Shin Y-W, Jeon HJ. Hahm B-J. Effects of mindfulness on psychological health: A review of empirical studies. Psychooncology 2008; 17(6): 548-555
51 Speca M, Carlson LE, Goodey E, Angen M. 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. Psychosom Med 2000; 62: 613-622
52 Spiegel D, Bloom JR. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosom Med 1983; 45(4): 333-339
53 Tellegen A, Atkinson G. Openess to absorbing and self-altering experiences („Absorption“), a trait related to hypnotic suggestion. J Abnormal Psychol 1974; 83(3): 268-277
54 Tschuschke V. Psychoonkologie. Stuttgart: Schattauer; 2011
55 Walach H, Buchheld N, Buttenmüller V, Kleinknecht N, Schmidt S. Measuring mindfulness ― the Freiburg Mindfulness Inventory (FMI). Personality and Individual Differences 2006; 40: 1543-1555
56 Walach H, Buchheld N, Buttenmüller V, Kleinknecht N, Grossmann P, Schmidt S. Empirische Erfassung der Achtsamkeit - Die Konstruktion des Freiburger Fragebogens zur Achtsamkeit (FFA) und weitere Validierungsstudien. In: Heidenreich T, Michalak J. Achtsamkeit und Akzeptanz in der Psychotherapie. Ein Handbuch. Tübingen: dgvt; 2004: 729-772
57 Watson M, Haviland JS, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet 1999; 354(9187): 1331-1336
58 Wettergren L, Kettis-Lindblad A, Sprangers M, Ring L. The use, feasibility and psychometric properties of an individualised quality of life instrument: a systematic review of the SEIQoL-DW. Qual Life Res 2009; 18: 737-746
59 Zigmond A, Snaith R. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67(6): 361-370