A technique based on a 12-week inquiry-based stress reduction (IBSR) program has been found by Tel Aviv University (TAU) researchers to improve the emotional well-being and quality of sleep and assist in making medical decisions by women who carry the BRCA gene.
Women were randomly assigned either to the IBSR program based on the skills of mindfulness, inquiry and cognitive reframing or to standard care.
With regard to medical decisions – whether to perform surgical procedures such as removing the breasts or taking out the ovaries, the technique helped the women make rational medical decisions. It was also found that a clear change in attitude had occurred among the participants – in some cases from the position that a risk-reducing procedure is out of the question to making a doctor’s appointment to discuss it.
Who was the study led by?
The study was led by Dr. Shahar Lev-Ari of TAU’s Sackler Faculty of Medicine at Tel Aviv University, in cooperation with Prof. Eitan Friedman of Sheba Medical Center and assistance from other researchers, as part of doctoral student Clara Landau’s dissertation.
The study was published in the prestigious JAMA Network Open medical journal under the title “Effect of Inquiry-Based Stress Reduction on Well-being and Views on Risk-Reducing Surgery Among Women With BRCA Variants in Israel: A Randomized Clinical Trial.”
Lev-Ari explained that in many cases, young women who carry BRCA1/BRCA2 genes suffer from a state of uncertainty about their future, mainly due to the realization that they are highly likely to contract breast cancer and/or ovarian cancer.
At present, there is no effective treatment for preventing these illnesses, and the only active procedure for reducing the risk of cancer is a risk-reducing mastectomy and/or oophorectomy around the age of 40. It was this procedure that actress Angelina Jolie underwent in 2013.
Researchers add that due to fear and uncertainty in many cases, the carriers suffer psychological and physical symptoms that seriously disrupt their normal lives.
In the present study, the researchers sought to examine whether workshops and tools for promoting personal health, relief of stress and tension, and strengthening of mental soundness can improve the emotional well-being and quality of sleep of these young women.
The study included 100 carriers of BRCA1/BRCA2 genes currently under supervision at the Meirav Breast Center at Sheba Medical Center in Tel Hashomer. As part of the study, the women learned and practiced the IBSR method, which is aimed at providing self-practice techniques based on increased mindfulness, work on stress-causing beliefs and cognitive reframing.
The primary outcome was psychological well-being, including six parameters: autonomy, personal growth, positive relationships, control of the environment, goals in life and self-acceptance. Secondary outcomes included sleep quality, attitudes toward risk-reducing surgical procedures and psychosocial variables.
The results were very impressive, the team wrote. After participating in the workshops and practicing it themselves at home for 12 weeks, the carriers showed after a three-month follow-up period significant improvement in all aspects of personal growth, positive relations with others, life goals and self-acceptance. In addition, a clear improvement was seen in quality of sleep, which returned to normal.
The researchers said these findings indicate that study and practice of IBSR techniques might improve the psychological well-being of women with BRCA1/BRCA2 gene mutations and form the basis (in conjunction with other studies) for recommending to consider providing this technique to women, along with oncogenetic consultation.
“To the best of our knowledge, this is the largest-ever study in the world in the framework of such an experiment, as far as the number of participants is concerned,” concluded Lev-Ari.
“We think that healthcare services in Israel and worldwide should evaluate the impact of coping with the genetic information and surgical procedures offered to asymptomatic women carriers on their emotional well-being and quality of life, and offer them interventions to promote their health on the individual level, such that have been scientifically proven in improving the quality of life and emotional well-being of these women.”