br Testing these pathways has particular relevance in
Testing these pathways has particular relevance in the context of cancer. In a sample of breast cancer patients, reductions in the CTRA following CBSM were associated with longer disease-free survival over 8–15 years of follow-up (Antoni et al., 2016). Lower CTRA gene ex-pression profiles were also associated with reduced risk of leukemia recurrence and mortality in patients receiving hematopoietic cell transplants (Knight et al., 2016). In breast cancer survivors, mind-fulness meditation and yoga can reduce pro-inflammatory gene ex-pression, concomitant with improvements in depressive symptoms and enhanced well-being (Bower et al., 2014, 2015). More broadly, in-flammatory signaling is associated with cancer recurrence and tumor progression, as well as lingering post-treatment symptoms like fatigue, cognitive complaints, and depression (Hanahan et al., 2011; Irwin et al., 2013; Miller et al., 2008a).
Thus, the purpose of the current study was to use a psychological intervention to test for associations between increases in eudaimonic Psychoneuroendocrinology 103 (2019) 173–179
well-being and change in CTRA gene GelRed in a sample of younger breast cancer survivors. We also examined whether change in depres-sive symptoms, which are particularly elevated among younger survi-vors (Avis et al., 2013; Champion et al., 2014) and associated with higher mortality in cancer survivors (Pinquart and Duberstein, 2010), were associated with the CTRA. Research from our lab and others in-dicates that mindfulness has consistent effects on both well-being and depressive symptoms in this population (Bower et al., 2015; Schellekens et al., 2016); thus, mindfulness meditation was used as the treatment of interest here. We recruited younger breast cancer survivors naïve to mindfulness practice to participate in a single-arm longitudinal pre-post intervention trial. This design was appropriate given our aim to ex-amine within-subject associations between psychological variables and the CTRA. We hypothesized that increases in eudaimonic well-being from pre- to post-intervention would correlate with reductions in CTRA gene expression. To examine whether changes in psychological pro-cesses more broadly were associated with the CTRA, we conducted secondary analyses to test whether increases in hedonic well-being or decreases in depressive symptoms were associated with alterations in the CTRA.
2.1. Participants, recruitment, and procedure
The findings in the current report come from a study designed to examine neural processes linking stress reduction to inflammation re-duction following mindfulness meditation. Participants were women diagnosed with early stage breast cancer (Stage 0-III) at or before age 50, who had completed primary treatment (i.e., surgery, chemotherapy, and/or radiation) at least 3 months previously and had no evidence of active disease. Exclusion criteria included previous mindfulness medi-tation experience, presence of inflammatory disease and conditions related to safety for neuroimaging (e.g., left-handed, presence of claustrophobia).
Potential participants were identified through the UCLA Tumor Registry and through physician referral. Letters describing the study were mailed to 512 women, 197 responses were received, and 49 women did not meet inclusion criteria, primarily due to claustrophobia (n = 16), left-handedness (n = 13), or prior mindfulness experience (n = 8); 126 declined to participate, primarily because they were too busy or lived too far away (n = 89) or were unable to be reached after expressing initial interest (passive refusal; n = 20). This left a sample of 22 women who were eligible and able to participate.
After providing informed consent, eligible participants completed an in-person assessment before and after a standardized mindfulness intervention at UCLA. At each assessment (within two weeks before and after the intervention), participants provided a morning blood sample, underwent a 90-minute fMRI scanning session (results reported sepa-rately), and completed questionnaires. Study procedures were approved by the UCLA IRB and no adverse events were reported during the in-tervention. Participants were compensated $100.
2.2. MAPs intervention
Participants completed a 6-week mindfulness meditation-based in-tervention, Mindful Awareness Practices (MAPs), developed by Diana Winston and colleagues at the Mindfulness Awareness Research Center at UCLA. Participants met for 6 weekly, 2-hour group sessions and were additionally instructed to practice and document minutes spent on formal mindfulness exercises at home, beginning with 5 min and in-creasing to 20 min daily. The current study included three cohorts of women, with group size ranging from 6 to 10, conducted between May and November of 2015.