**2. Study 1 – Efficacy of Bedside Mindfulness Program on mood related with mental health status**

Firstly, we examined the efficacy of this program for college students, because we could obtained both subjective and objective data. Some previous studies examined efficacy of mindfulness including objective data.

Participants with alcohol use disorders received mindfulness program or cognitive behavior therapy. Psychological and physiological indices like **Galvanic Skin Response** of stress reduced in mindfulness program much more than cognitive behavior therapy (Brewer, et al., 2009). Or through mindfulness program, psychological distress like anxiety or depression reduced and also skin conductance level of women with chronic pain of fibromyalgia reduced (Lush, et al., 2009). These studies show that mindfulness reduced the skin conductance level which shows the stress level. Oppositely, healthy adults assigned a mindfulness group or a no mindfulness group. All participants viewed positive or negative films. Participants in the mindfulness group reported significantly greater positive affect in response to the positive film than those in the no mindfulness group. However, there was no significance between conditions on Galvanic Skin Response (GSR) or heart rate (Erisman & Roemer, 2010). That is, results of efficacy of mindfulness on skin conductance level are inconsistence.

About salivary cortisol as an indicator, for breast cancer outpatients MBSR program participants was associated with enhanced quality of life and decreased stress symptoms (Matchimy, et al., 2011), altered cortisol and immune patterns consistented with less stress 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 problems.

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 of amylase which measure level of stress.

#### **Participants and methods**

166 Topics in Cancer Survivorship

**2. Study 1 – Efficacy of Bedside Mindfulness Program on mood related with** 

Firstly, we examined the efficacy of this program for college students, because we could obtained both subjective and objective data. Some previous studies examined efficacy of

Participants with alcohol use disorders received mindfulness program or cognitive behavior therapy. Psychological and physiological indices like **Galvanic Skin Response** of stress reduced in mindfulness program much more than cognitive behavior therapy (Brewer, et al., 2009). Or through mindfulness program, psychological distress like anxiety or depression reduced and also skin conductance level of women with chronic pain of fibromyalgia reduced (Lush, et al., 2009). These studies show that mindfulness reduced the skin conductance level which shows the stress level. Oppositely, healthy adults assigned a mindfulness group or a no mindfulness group. All participants viewed positive or negative films. Participants in the mindfulness group reported significantly greater positive affect in response to the positive film than those in the no mindfulness group. However, there was no significance between conditions on Galvanic Skin Response (GSR) or heart rate (Erisman & Roemer, 2010). That is, results of efficacy of mindfulness on skin conductance level are

About salivary cortisol as an indicator, for breast cancer outpatients MBSR program participants was associated with enhanced quality of life and decreased stress symptoms (Matchimy, et al., 2011), altered cortisol and immune patterns consistented with less stress

Fig. 1. The Bed-side Mindfulness Program

mindfulness including objective data.

**mental health status** 

inconsistence.

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.

#### **Results**

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 large.

The Relationships Between Stress

the effect size was medium.

Reduction Induced by Bedside Mindfulness Program and Mental Health Status 169

The GSR of the non risk group decreased a very little from 241.9 to 240 and there was no effect. Oppositely the GSR of the risk group increased from 301 to 386.2 (t=-1.21, p=0.26) and

Non-risk group 0.02 None 0.32 Medium High-risk group 0.38 Medium 0.60 Large Table 2. Effect Sizes in GSR and Amylase changes after the Bedside Mindfulness Program

> pre post MP

Times

\*

non-risk group (n=10)

high risk group (n=10)

pre post

MP

Times

Effect size r Level Effect size r Level

GSR Amylase

0

100

0

Fig. 5. Changes of Salivary level of Amylase

20

40

60

80

100

120

Fig. 4. Changes of GSR scores

200

300

400

500

600


Table 1. Effect Sizes in Tense Arousal (TA) and Energetic Arousal (EA) after the Bedside Mindfulness Program

Fig. 2. Changes of Tense Arousal scores

Fig. 3. Changes of Energetic Arousal scores

The GSR of the non risk group decreased a very little from 241.9 to 240 and there was no effect. Oppositely the GSR of the risk group increased from 301 to 386.2 (t=-1.21, p=0.26) and the effect size was medium.


Table 2. Effect Sizes in GSR and Amylase changes after the Bedside Mindfulness Program

Fig. 4. Changes of GSR scores

168 Topics in Cancer Survivorship

Non-risk group 0.72 Large 0.74 Large High-risk group 0.84 Large 0.09 None Table 1. Effect Sizes in Tense Arousal (TA) and Energetic Arousal (EA) after the Bedside

Effect size r Level Effect size r Level

pre post

\*

pre post

MP

Times

\* \*

> non-risk group (n=10)

high risk group (n=10)

TA EA

Mindfulness Program

10

Fig. 2. Changes of Tense Arousal scores

10

Fig. 3. Changes of Energetic Arousal scores

15

20

25

EA Value

30

35

40

15

20

25

TA Value

30

35

40

Fig. 5. Changes of Salivary level of Amylase

The Relationships Between Stress

and after the program, they completed the JUMACL.

Table 3. Back ground of cancer patients.

**Results** 

30 to 40, from 34 to 39).

GHQ TA

range (10-40)

Patient A 1 10 10 39 36

Patient B 3 10 10 37 40

Patient C 6 14 10 34 39

Patient D 1 10 10 39 31

Table 4. Score of GHQ (pre), Tense Arousal (TA) and Energetic Arousal (EA)

**Participants and methods** 

Reduction Induced by Bedside Mindfulness Program and Mental Health Status 171

Four cancer patients participated in the study. Table 3 shows patients' back ground. We used the same questionnaire to patients as college students. The primary physician selected participants. A pastoral care worker conducted the BMP, in which she conducted the program about from 30 to 60 minutes. Before the program, patients completed the General Health Questionnare-30 and the Japanese UWIST Mood Adjective Check List (JUMACL),

Age Gender Disease Stage

Patient A 64 Female Breast Ⅳ

Patient B 45 Female Lung Ⅳ

Patient C 50 Female Breast Ⅳ

Patient D 34 Female Breast Ⅳ

Table 4 shows the results. We reviewed each patient, patient A, Patient B, Patient C, and patient D. The score of GHQ was low and under the cut-off point. The scores of Patient A and Patient D was 1 and they had no mental problems. The scores of Patient B and Patient C show a little mental problem. The score 10 of TA was the lowest in the JUMACL, thus, patients had originally low tense arousal except patient C. As for EA, the score of Patient A and patient D who had no mental problems decreased (from 39 to 36, from 39 to 31), however, those of patient B and Patient C who had a little mental problem increased (from

Pre post change Pre post changes

EA

range (10-40)
