**1. Introduction**

164 Topics in Cancer Survivorship

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Patients receiving anti-cancer treatment experience physical problems such as pain, fatigue and nausea, and psychological problems such as anxiety, depression, distress (Speca, et al., 2006) and spiritual pain. A mindfulness approach is one of the most effective interventions to alleviate these problems. The Mindfulness-Based Stress Reduction (MBSR) program was modeled on the work of Kabat-Zinn (Kabat-Zin, 1990; Kat-Zinn, et al., 1998) and colleagues at the Center for Mindfulness-Massachusetts Medical Center. The program is based on the principal of mindfulness, defined as moment-to-moment, present-centered, purposive nonjudgmental awareness. The goal of the MBSR program is to guide participants to achieve greater awareness of themselves, their thoughts, and their bodies through class discussion, meditation, and yoga exercises (Garland, et al., 2007).

For cancer patients, the MBSR have effects on mood disturbance stress symptoms (Speca, et al. 2000), or on QOL and the immune profile (Carlson, et al., 2004). The Mindfulness-Based Art-Therapy (MBAT), which includes mindfulness and art therapy, also produces a significant decrease in symptoms of distress and improvements in key aspects of healthrelated QOL (Monti, et al., 2006). Moreover, the MBSR affects stress symptoms, mood, posttrauma growth, and spirituality (Garland, et al., 2007; Matchim, et al., 2011).

However, since the duration of the program in these studies are from at least 4 weeks to 8 weeks, patients were sometimes hard to continue to participate. And they were easily to be tired because of chemotherapy or radiation therapy. Then we developed a mindfulness cyclic meditation program, in which participants could participate in the program even sitting on chair. After this program, anxiety and depression improved (Ando, et al., 2009).

However, some of patients with advanced cancer stage were hard to participate, because their physical strength was very low and they could not sit or walk. Thus we needed to develop a new program for cancer patient with advanced cancer stage, and we developed a novel mindfulness program, a Bedside Mindfulness program (Figure 1). A yoga instructor and a clinical psychologist discussed about program, and made the leaflet with drawing by an illustrator.

The Relationships Between Stress

of amylase which measure level of stress.

**Participants and methods** 

problems.

**Results** 

large.

Reduction Induced by Bedside Mindfulness Program and Mental Health Status 167

and mood disturbance (Carlson, et al., 2007). In the above studies, skin conductance or salivary level was used as indicators. Moreover, we thought that effects of a mindfulness program might be different by a level of mental health states, and we predicted that the Bedside Mindfulness Program might be more effective for people or patients with mental

Thus, in this study, we examined mental health and mood as psychological indicator. Mood consists of the tense arousal and the energetic arousal (Matthews, et al., 1990). Tense arousals show a level of tension and it is uncomfortable. Energetic arousal shows a level of activity. As physiological indicator, we used Galvanic Skin Response and the salivary level

The participants were Japanese college students in Western Japan consist of 4 males and 16 females; mean age 22.7±4.8. As questionnaires, we used the Japanese UWIST Mood Adjective Check List : JUMACLE (Shirasawa, et al. 1999). There are 20 items (10 each for Tense Arousal and Energetic Arousal). Items for Tense Arousal were [I am] "tense," "jittery," "nervous," and so on. Items about Energetic Arousal were [I am] "active," "vigorous," "energetic," and so on. Participants answered on a 4-point Likert scale ranging from 1= not at all to 4=exactly so. The range of scores for Tense Arousal and Energetic Arousal was from 10 to 40. To measure mental state, we used the Japanese version of the General Health Questionnare-30 (Goldberg & Hillier, 1979) which was developed from the original one by Nakagawa and Daibo (1985). We separated participants into a non-risk group and a high-risk group by the cut-off point. The Bedside Mindful Program BMP included meditation, moving their hands or legs to focus their attention on bed (Figure 1). The BMP takes about 30 to 60 minutes per session and was conducted by nurses or a clinical psychologist who received training for at least 3 hours. The training included basic communication skills and Yoga skills learned directly from a Yoga specialist or using a CD. In the class, students received this program and complete questionnaires pre- and postintervention. The study was approved by the appropriate institutional ethics committees and was performed in accordance with the ethical standards laid down in the Declaration of Helsinki. Statistical analysis, we separated participants into two groups, high risk group and non-risk group by cut off points of General Health Questionnaire. The t-test and the effects size test were performed on the scores of JUMACL, GSR, and salivary level of amylase.

The Tense Arousal of the non-risk group significantly decreased from 18.4±21.6 to 14.5 ±22.3 (t=3.1, p<0.01) (Figure 2) . The effect size was large (Table 1). The Tense Arousal of the high risk group also significantly decreased from 20.0±29.1 to 14±26 (t=4.68, p<0.001)(Figure 3) and the effect size was large. The Energetic Arousal of the non-risk group significantly decreased from 29.7±39.1 to 26.6±43.6 (t=3.31, p<0.01) (Figure 4) and the effect size was large. However, that of the high risk group increased from 27.9±37.4 to 28.5±52.7 (t=-0.27, p=0.79) (Figure 5), though it was not significant and there was no effect. The salivary level of amylase of the non-risk group decreased from 99.8 to 73.9 (t=1.01, p=0.34) and the effects size was medium (Table 2). The salivary level of amylase of the high risk group significantly decreased from 71.7 to 45.2 (t=2.27, p=0.05) and the effect size was

Fig. 1. The Bed-side Mindfulness Program
