Mindfulness-based cognitive therapy reduces parenting anxiety and enhances quality of life in patients with breast cancer

Abstract

BACKGROUND

Breast cancer is one of the most common cancers among women worldwide, often leading to significant emotional and psychological stress. This stress is compounded by concerns about parenting roles and the potential impact on children. Mindfulness-based cognitive therapy (MBCT) has shown promise in addressing anxiety and depressive symptoms. However, its effects on parenting anxiety and self-efficacy in patients with breast cancer are underexplored.

AIM

To evaluate the effects of MBCT on parenting anxiety, negative emotions, quality of life (QoL), and self-efficacy in patients with breast cancer.

METHODS

This retrospective study involved 249 patients with breast cancer admitted between January 2024 and December 2024. Participants were divided into two groups: The conventional treatment group (n = 123) and the MBCT group (n = 126), based on chosen treatment methods. Interventions lasted 8 weeks, with one session per week. Outcomes were measured using standardized questionnaires, including parenting anxiety [parenting concerns questionnaire (PCQ)], parenting sense of competence [parenting sense of competence scale (PSOCS)], negative emotions (self-rating anxiety scale and self-rating depression scale), hospital anxiety and depression [hospital anxiety and depression scale (HADS)], trauma-related distress [impact of event scale-revised (IES-R)], mindfulness (five-facet mindfulness questionnaire), QoL [functional assessment of cancer therapy-breast (FACT-B)], symptom severity (numeric rating scales), and self-efficacy [general self-efficacy scale (GSES)].

RESULTS

Post-treatment, the MBCT group showed a marked reduction in parenting anxiety scores (PCQ: MBCT 50.54 ± 4.65 vs conventional 52.12 ± 5.53, P = 0.016) and notable improvement in parenting competence (PSOCS total: MBCT 61.56 ± 4.65 vs conventional 59.75 ± 4.96, P = 0.003). The MBCT group also exhibited significant reductions in anxiety (HADS anxiety: MBCT 6.78 ± 1.65 vs conventional 7.31 ± 2.08, P = 0.027) and trauma-related distress (IES-R intrusion: P = 0.030; avoidance: P = 0.004; hyperarousal: P = 0.035). QoL scores significantly improved in the MBCT group in terms of physiological condition (FACT-B: MBCT 13.85 ± 3.93 vs conventional 12.55 ± 2.75, P = 0.003) and functional status (P = 0.010). Enhanced self-efficacy was observed in strategic effectiveness (GSES: MBCT 9.87 ± 0.75 vs conventional 9.72 ± 0.13, P = 0.029).

CONCLUSION

MBCT significantly reduces parenting anxiety and enhances self-efficacy, QoL, and emotional regulation in patients with breast cancer.

Key Words: Mindfulness-based cognitive therapy; Breast cancer; Parenting anxiety; Quality of life; Self-efficacy; Psychological stress

Core Tip: This study demonstrates that mindfulness-based cognitive therapy (MBCT) significantly reduces parenting anxiety and improves emotional regulation, self-efficacy, and quality of life in breast cancer patients. Unlike conventional care, MBCT specifically targets parenting-related distress and enhances mindfulness skills, offering a holistic approach to psychological support during cancer treatment.

INTRODUCTION

Breast cancer is a highly prevalent malignancy among women globally, posing a significant public health challenge. Its diagnosis and treatment involve life-altering events that frequently cause considerable emotional and psychological distress[1-3]. Patients are confronted with the physical demands of treatment and significant psychological sequelae, including heightened anxiety, depression, and fear of cancer recurrence[4,5]. This psychological burden is frequently exacerbated by specific concerns related to their parenting roles, particularly anxieties about the potential effects of their illness and treatment on their children's well-being; this aspect is termed "parenting anxiety"[6,7]. Parenting anxiety includes concerns about the actual consequences on the child (e.g., disruptions in care and routines) and the emotional repercussions for the child (e.g., distress and fear), contributing substantially to overall distress and potentially diminishing quality of life (QoL) and parental self-efficacy. Current approaches for managing psychological distress in patients with cancer often include pharmacotherapy for symptom relief and various forms of psychotherapy or supportive counseling[8,9]. Although these interventions are beneficial for general anxiety and depression, they may not fully address the unique and complex nature of parenting-related anxieties experienced by mothers with breast cancer.

Mindfulness-based cognitive therapy (MBCT) has emerged as a promising psychosocial intervention. Originally developed to prevent relapse in recurrent depression, MBCT integrates principles of cognitive behavioral therapy with mindfulness meditation practices. Its core principles involve fostering non-judgmental awareness of current experiences (thoughts, emotions, and physical sensations) and developing skills to detach from habitual, often negative, cognitive patterns. By fostering acceptance and altering the relationship to distressing thoughts and feelings, MBCT aims to enhance emotional regulation and reduce vulnerability to anxiety and depressive symptoms. Preliminary evidence supports its efficacy in reducing distress, anxiety, and depression in various populations, including individuals with cancer[10-12].

Although MBCT's benefits for general anxiety and depression in patients with breast cancer are widely recognized, its specific effects on parenting anxiety and perceived self-efficacy remain underexplored. These domains are crucial because they encompass emotional well-being and the patients' perception of their ability to effectively manage their role as parents amid ongoing treatment for cancer. Self-efficacy, or the belief in one's capacity to conduct actions necessary to achieve specific outcomes, is an important psychological asset that can enhance emotional resilience and encourage proactive involvement in life's challenges[13,14]. Enhancing self-efficacy among patients with breast cancer may facilitate improved coping strategies, thereby reducing the psychological burden associated with their illness and its perceived effects on their children.

Furthermore, the QoL in patients with breast cancer is a pressing concern, influencing treatment outcomes and overall patient satisfaction. QoL includes various characteristics, including physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship to environmental factors[15]. MBCT offers an approach that may improve QoL by promoting psychological flexibility and emotional well-being, helping patients in managing the complex issues associated with breast cancer and its treatment.

This study aimed to evaluate the effect of MBCT on parenting anxiety, negative emotions, QoL, and self-efficacy in patients with breast cancer. By addressing these complex dimensions through MBCT, this study contributes to the expanding body of evidence supporting psychosocial interventions in cancer care. It hypothesizes that MBCT leads to significant improvements in reducing parenting anxiety and negative emotions while enhancing self-efficacy and QoL compared with conventional treatments. The findings from this investigation may guide comprehensive therapeutic strategies that address the physical, psychological, and social needs of patients with breast cancer, thereby promoting holistic and patient-centered care.

This research represents a critical step toward understanding and addressing the complex needs of patients with breast cancer, providing evidence-based insights into innovative interventions that support mental and physical health outcomes.

MATERIALS AND METHODS

Case selection

The study samples were chosen from a cohort of 249 patients with breast cancer admitted to the Fourth Hospital of Hebei Medical University between January 2024 and December 2024. These patients displayed varying levels of concerns related to parenting. Demographic data were collected from the hospital's case system. Patients were categorized into two groups based on their selected treatment options: The conventional treatment group (n = 123) and the MBCT group (n = 126).

This retrospective study utilized de-identified patient data, which did not affect the medical care of patients; thus, informed consent was not required. The study was approved by the ethics committee of the Fourth Hospital of Hebei Medical University and adhered to the guidelines outlined in the Declaration of Helsinki.

Inclusion and exclusion criteria

Inclusion criteria: (1) Participants eligible for this study were those who had been diagnosed with breast cancer by a physician[16]; (2) In stage I or II of the disease; (3) Possessed adequate cognitive and language abilities to comprehend the intervention content and complete the study questionnaires; (4) No history of drug or alcohol abuse; and (5) No previous psychotherapy.

Exclusion criteria: (1) Impaired consciousness; (2) Pre-existing mental disorders; (3) Other severe illnesses; (4) Failure to complete more than one session; (5) Experienced irritation or deterioration during the study; and (6) Recent traumatic or distressing events within the past 6 months (e.g., loss of a close person, non-cancer diagnosis, divorce, or chronic illness other than cancer).

Treatment strategies

Patients were assigned to either a conventional treatment group or an MBCT group, depending on their chosen treatment method. The total duration was 8 weeks, with sessions once a week. Specific treatment approaches were as follows:

Conventional treatment group: This group received routine nursing care, which included standard health education regarding breast cancer, treatment side effects, and self-management; daily care support, including hygiene and comfort measures; dietary guidance tailored to nutritional needs during cancer treatment; and medication management, including adherence counseling and side effect monitoring. Each session lasted 2-2.5 hours and was conducted once per week for 8 weeks.

MBCT group: In addition to conventional treatments, this group received MBCT, which was delivered over eight weekly sessions. The intervention was facilitated by a multidisciplinary team led by a research leader and included psychologists with over 2 years of clinical experience as mentors, along with experienced nurses. The MBCT program's psychological care process was conducted over eight weekly sessions, each lasting 2-2.5 hours. The content was structured to progressively enhance mindfulness skills.

Foundation and present-moment awareness (weeks 1 and 2): Week 1: Recognizing habitual patterns (e.g., through blind food observation using non-visual senses). Week 2: Cultivating present-moment focus through core practices: Sitting meditation (focusing on breath/body sensations), walking meditation (mindful awareness of movement/environment), and mindful listening (attending to sounds and internal states).

Deepening attention and working with thoughts/emotions (weeks 3 and 4): Week 3: Developing concentration and body awareness through observation meditation (observing breath) and body scan exercises (systematically scanning bodily sensations). Week 4: Recognizing and allowing emotional experiences without judgment (emotion perception exercise) and observing the flow of thoughts without attachment (mindfulness exercise).

Integration and application (weeks 5-8): Week 5: Practicing acceptance ("allowing") using integrated practices like mindful eating, body scan, and listening. Week 6: Understanding the nature of thoughts (distinguishing thoughts from reality), including a dedicated "mindfulness day". Week 7: Cultivating self-compassion and self-care through sitting, walking, and general mindfulness meditation. Week 8: Consolidating learning and integrating mindfulness practices into daily life, encouraging ongoing practice.

Questionnaire

Before and after treatment, relevant questionnaire surveys were administered to participants in the conventional treatment group and the MBCT group.

Parenting concerns questionnaire: This tool assessed parenting concerns across three dimensions: Actual impact on children, emotional impact on children, and concerns from the parents. It included 15 items rated on a 5-point Likert scale, where "not worried" was assigned a score of 1 and "extremely worried" was assigned a score of 5. The score for each dimension was calculated as an average, with elevated values indicating increased parental anxiety among patients with cancer. The Cronbach's alpha coefficient in this study was 0.94[17].

Parenting sense of competence scale: This scale measured parents' perceptions of their competence in the parenting role. It consisted of 17 items rated on a 6-point Likert scale, with higher scores indicating greater parenting self-efficacy. The scale included two subscales: Satisfaction (9 items) and efficacy (8 items). The Cronbach’s alpha of this scale was 0.872[18].

Self-rating anxiety scale: This scale evaluated the subjective anxiety level of patients through 20 items rated on a 4-point Likert scale. The total gross score was multiplied by 1.25 to obtain a standard score. Scores of 50 and above indicated anxiety, with categories of mild (50-59), moderate (60-69), and severe anxiety (≥ 70). Elevated scores reflected increased severity of anxiety levels. The Cronbach's alpha for self-rating anxiety scale (SAS) was 0.911[19].

Self-rating depression scale: This scale assessed subjective depression over 20 items, each rated on a 4-point Likert scale. The standard score was calculated by multiplying the total gross score by 1.25, with a cutoff of 53. Scores of 53 or above indicated depression, categorized as mild (53-62), moderate (63-72), and severe (≥ 73). Higher scores signified greater severity of depression. The Cronbach's alpha for the self-rating depression scale (SDS) was 0.74[20].

Hospital anxiety and depression scale: This 14-item scale assessed symptoms of anxiety (7 items) and depression (7 items) in non-psychiatric hospital settings. Each item was scored from 0 to 3, with subscale scores ranging from 0 to 21. Elevated scores indicated increased symptom severity. The Cronbach’s alpha for the anxiety and depression subscales were 0.80 and 0.76, respectively[21].

Impact of event scale-revised: This 22-item self-report measure evaluated subjective distress in response to traumatic events. It included three subscales: Intrusion (8 items), avoidance (8 items), and hyperarousal (6 items). Items were rated on a 5-point scale from 0 (“not at all”) to 4 (“extremely”). Total scores ranged from 0 to 88, with elevated scores indicating increased distress. The Cronbach's alpha of each subscale was 0.88-0.94[22].

Five-facet mindfulness questionnaire: The five-facet mindfulness questionnaire (FFMQ) is a 39-item self-report instrument designed to assess five distinct dimensions of mindfulness: Observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience. Each item was rated on a 5-point Likert scale ranging from 1 (“never or very rarely true”) to 5 (“very often or always true”). Subscale scores were calculated by summing the items within each facet, with high scores indicating enhanced mindfulness abilities. The FFMQ has demonstrated good internal consistency and validity in clinical and non-clinical populations. The Cronbach’s alpha for the total scale was 0.72-0.91, indicating excellent reliability[23].

Functional assessment of cancer therapy-breast: This scale included a general component and a breast cancer-specific subscale, spanning five dimensions and 36 items: Physical status, social and family status, emotional status, functional status, and additional concerns. Responses ranged from 0 to 4, with reverse-scored items. The total score ranged from 1 to 144, with higher scores indicating better QoL. The total functional assessment of cancer therapy-breast (FACT-B) had a Cronbach's alpha of 0.87[24].

Numeric rating scales: The numeric rating scales (NRSs) were used to subjectively assess the intensity of various symptoms, such as pain, fatigue, or distress, on an 11-point scale from 0 to 10, where 0 represents “no symptom” and 10 represents “the worst imaginable symptom”. Participants were asked to circle the number that best corresponds to their current experience. The NRSs are widely used in clinical settings due to their simplicity, ease of administration, and strong correlation with comprehensive measures of symptom burden[25].

General self-efficacy scale: This scale measured self-efficacy across 10 items using a 4-point scoring method, yielding total scores ranging from 10 to 40. Higher scores indicated greater self-efficacy. The Cronbach's alpha for general self-efficacy scale (GSES) was 0.89[26].

Statistical analysis

Data were collected at three stages: Pre-treatment, post-treatment, and follow-up, from the conventional treatment group and the MBCT group. The completed questionnaires were scored and analyzed using SPSS software version 20 (Released 2011. IBM SPSS Statistics for Windows, Version 20.0, Armonk, NY, United States: IBM Corp). Statistical measures including mean, standard deviation, frequency, and percentage were employed to describe the data. A χ² test was used to compare the demographic characteristics of the groups. To evaluate differences between groups across the different time points (pre-treatment, post-treatment, and follow-up), we conducted repeated measures ANOVA. Tukey’s test was applied to assess differences between the groups before and after treatment. A P value of less than 0.05 was considered statistically significant.

RESULTS

Analysis of differences in general information of patients

Sociodemographic characteristics were comparable between the MBCT and conventional treatment groups (Table 1). No significant differences were observed in age, religious affiliation, education level, employment status, number of underage children, age of the youngest child, or average monthly income (all P > 0.05), indicating that the groups were well-matched at baseline.

Table 1 Comparison of sociodemographic characteristics between two groups, n (%).

Indicator	Conventional treatment group (n = 123)	MBCT group (n = 126)	t/χ2	P value
Age (years), mean ± SD	56.70 ± 8.10	56.80 ± 9.99	0.083	0.934
Religion			0.494	0.482
No	101 (82.11)	99 (78.57)
Yes	22 (17.89)	27 (21.43)
Education level			0.215	0.643
Less than high school	69 (56.10)	67 (53.17)
Some college or higher education	54 (43.90)	59 (46.83)
Employment status			1.681	0.641
Full- or part-time used	47 (38.21)	53 (42.06)
Unemployed or on sickness -benefit	16 (13.01)	21 (16.67)
Retired	51 (41.46)	43 (34.13)
Missing	9 (7.32)	9 (7.14)
Number of underage children			4.31	0.116
1	89 (72.36)	79 (62.70)
2	23 (18.70)	25 (19.84)
≥ 3	11 (8.94)	22 (17.46)
The age of the youngest minor child (year)			4.549	0.103
< 6	21 (17.07)	33 (26.19)
6-12	32 (26.02)	37 (29.37)
12-18	70 (56.91)	56 (44.44)
Average monthly income in RMB			0.976	0.614
≥ 5000	33 (26.83)	29 (23.02)
3000-4999	61 (49.59)	61 (48.41)
≤ 3000	29 (23.58)	36 (29.57)

MBCT: Mindfulness-based cognitive therapy.

Clinical characteristics of two groups of patients

In this study, clinical characteristics of patients in the MBCT group and the conventional treatment group were compared (Table 2). Breast cancer stage distribution was similar, with stage I encompassing 15.45% in the conventional group and 16.67% in the MBCT group, and stage II comprising 84.55% and 83.33%, respectively, showing no significant difference (χ² = 0.069, P = 0.793). The duration of disease and body mass index (BMI) were comparable across groups (disease duration: χ² = 0.406, P = 0.816; BMI: = 1.369, P = 0.172). Relapse rates were low and similar (conventional: 1.63%, MBCT: 2.38%; χ² = 0.000, P = 1.000). Tumor size did not differ significantly between groups, but a tendency toward significance was observed (χ² = 5.319, P = 0.070). The TNM classification also showed no significant difference (χ² = 0.549, P = 0.76). However, significant differences were observed in the type of surgery, with a higher rate of lumpectomy in the MBCT group (57.94%) than in the conventional group (52.72%) and a diminished rate of mastectomy (MBCT: 42.06%, conventional: 55.28%; χ² = 4.355, P = 0.037). Chemotherapy regimens, rates of breast reconstruction, and axillary lymph node dissection (ALND) were similar between the groups, with no statistically significant differences observed (chemotherapy scheme: χ² = 2.553, P = 0.279; breast reconstruction: χ² = 3.089, P = 0.079; ALND: χ² = 0.096, P = 0.953). These findings indicated the two groups were largely comparable in terms of their clinical profiles, except for the difference in surgical approaches.

Table 2 Clinical characteristics of participants, n (%).

Indicator	Conventional treatment group (n = 123)	MBCT group (n = 126)	t/χ2	P value
Breast cancer stage			0.069	0.793
I	19 (15.45)	21 (16.67)
II	104 (84.55)	105 (83.33)
Disease duration (year)			0.406	0.816
1-5	35 (28.46)	40 (31.75)
5-10	40 (32.52)	41 (32.54)
10-15	48 (39.02)	45 (35.71)
BMI, mean ± SD	22.90 ± 3.60	22.30 ± 3.30	1.369	0.172
Relapse			0.000	1.000
Yes	2 (1.63)	3 (2.38)
No	121 (98.37)	123 (97.62)
Tumor size (mm)			5.319	0.07
≤ 20	51 (41.46)	59 (46.83)
20-50	57 (46.34)	42 (33.33)
> 50	15 (12.20)	25 (19.84)
TNM			0.549	0.76
T1N1M0	13 (10.57)	17 (13.49)
T2N1M0	64 (52.03)	65 (51.59)
T2N0M0	46 (37.46)	44 (34.92)
Type of surgery			4.355	0.037
Mastectomy	68 (55.28)	53 (42.06)
Lumpectomy	65 (52.72)	73 (57.94)
Chemotherapy scheme			2.553	0.279
AC-T	86 (69.92)	83 (65.87)
TAC	9 (7.32)	17 (13.49)
TC	28 (22.76)	26 (20.63)
Breast reconstruction			3.089	0.079
Yes	16 (13.01)	27 (21.43)
No	107 (86.99)	99 (78.57)
ALND			0.096	0.953
Yes	58 (47.15)	57 (45.24)
No	63 (51.22)	67 (53.17)
Not reported	2 (1.63)	2 (1.59)

MBCT: Mindfulness-based cognitive therapy; BMI: Body mass index; ALND: Axillary lymph node dissection; AC-T: Use doxorubicin and cyclophosphamide, followed by paclitaxel or sometimes docetaxel after completing the AC phase; TAC: Simultaneously using Adriamycin, Cytoxan, and Docetaxel; TC: Simultaneously using Taxotere and Carboplatin.

Parenting anxiety of the two groups of patients

Prior to treatment, total scores for the parenting concerns questionnaire (PCQ) were 58.35 ± 10.54 for the conventional group and 59.65 ± 9.52 for the MBCT group (t = 1.025, P = 0.306; Table 3). In terms of specific concerns, scores for actual impact on children were 22.76 ± 4.65 in the conventional group compared with 23.32 ± 3.65 in the MBCT group (t = 1.050, P = 0.295), whereas concerns about the emotional impact on children were 25.76 ± 4.75 in the conventional group and 25.52 ± 4.36 in the MBCT group (t = 0.413, P = 0.680). Although we noted a trend toward significance in concerns regarding the parental role, with scores of 14.65 ± 3.65 in the conventional group and 13.75 ± 3.65 in the MBCT group (t = 1.948, P = 0.053), the difference did not reach statistical significance. Additionally, the parenting sense of competence scale (PSOCS) total scores showed no significant difference, with scores of 53.67 ± 3.28 for the conventional group and 52.76 ± 4.54 for the MBCT group (t = 1.814, P = 0.071). Sub-scores for parenting effectiveness and satisfaction were similarly non-significant across groups. Thus, these results suggested baseline equivalence in parenting anxiety and perceived competence between the two groups.

Table 3 Parenting anxiety and competence scores before and after treatment.

Item	Time	Conventional treatment group (n = 123)	MBCT group (n = 126)	t value	P value
PCQ (score)
Total	Before	58.35 ± 10.54	59.65 ± 9.52	1.025	0.306
	After	52.12 ± 5.53	50.54 ± 4.65	2.431	0.016
Concerns about the actual impact on children	Before	22.76 ± 4.65	23.32 ± 3.65	1.050	0.295
	After	20.85 ± 0.69	19.65 ± 7.96	1.679	0.096
Concerns about the emotional impact on children	Before	25.76 ± 4.75	25.52 ± 4.36	0.413	0.680
	After	23.91 ± 4.79	22.56 ± 4.56	2.269	0.024
Concerns about the father/mother of the child	Before	14.65 ± 3.65	13.75 ± 3.65	1.948	0.053
	After	11.36 ± 3.60	10.64 ± 3.34	1.626	0.105
PSOCS (score)
Total	Before	53.67 ± 3.28	52.76 ± 4.54	1.814	0.071
	After	59.75 ± 4.96	61.56 ± 4.65	2.969	0.003
Parenting effectiveness	Before	24.78 ± 2.86	24.78 ± 3.65	0.000	1.000
	After	29.24 ± 1.22	30.76 ± 9.28	1.824	0.07
Parenting satisfaction	Before	30.15 ± 0.46	29.57 ± 8.52	0.753	0.453
	After	34.51 ± 3.00	34.67 ± 2.83	0.446	0.656

MBCT: Mindfulness-based cognitive therapy; PCQ: Parenting concerns questionnaire; PSOCS: Parenting sense of competence scale.

After treatment, total scores on the PCQ showed a significantly greater reduction in the MBCT group (50.54 ± 4.65) than in the conventional treatment group (52.12 ± 5.53; t = 2.431, P = 0.016). Specifically, concerns about the emotional impact on children significantly decreased in the MBCT group (22.56 ± 4.56) vs the conventional group (23.91 ± 4.79; t = 2.269, P = 0.024). However, concerns regarding the actual impact on children and the parental role were not statistically different between the groups. On the PSOCS, the MBCT group reported significantly higher total scores (61.56 ± 4.65) than the conventional group (59.75 ± 4.96; t = 2.969, P = 0.003), indicating enhanced overall parenting competence post-treatment. We found a trend toward improved parenting effectiveness in the MBCT group, but the difference did not reach statistical significance (P = 0.07). Parenting satisfaction remained similar between the groups. These results suggested that MBCT was effective in reducing certain aspects of parenting anxiety and enhancing perceived parenting competence among patients with breast cancer.

Psychological status of the two groups of patients

Prior to treatment, the SAS total scores were comparable between the conventional treatment group (66.83 ± 3.25) and the MBCT group (67.56 ± 8.45; t = 0.898, P = 0.371; Table 4). Similarly, total scores for the SDS and the hospital anxiety and depression scale (HADS) showed no significant differences between the groups (SDS total: t = 0.887, P = 0.376; HADS total: t = 0.713, P = 0.477). Specific subscales for HADS, including anxiety and depression scores, were similar across groups (HADS anxiety: t = 0.517, P = 0.606; HADS depression: t = 0.675, P = 0.500). The impact of event scale-revised (IES-R) scores, including subdivisions for intrusion, avoidance, and hyperarousal, did not vary significantly between the groups (IES-R total: t = 0.620, P = 0.536; intrusion: t = 0.665, P = 0.507; avoidance: t = 0.999, P = 0.319; hyperarousal: t = 1.345, P = 0.180). Total scores on the FFMQ also showed no significant differences (t = 0.397, P = 0.692). These results indicated that participants in both groups were similar in terms of their baseline psychological states, facilitating the evaluation of treatment effects without bias from initial disparities.

Table 4 Psychological status scores before and after treatment.

Item	Time	Conventional treatment group (n = 123)	MBCT group (n = 126)	t value	P value
SAS (score)	Before	66.83 ± 3.25	67.56 ± 8.45	0.898	0.371
	After	59.74 ± 10.41	57.28 ± 9.74	1.924	0.055
SDS (score)	Before	72.95 ± 2.83	73.56 ± 7.12	0.887	0.376
	After	65.86 ± 5.41	64.84 ± 5.87	1.425	0.155
HADS (score)
Total	Before	17.32 ± 3.45	17.62 ± 3.17	0.713	0.477
	After	15.63 ± 3.65	14.71 ± 3.89	1.930	0.055
Anxiety	Before	8.95 ± 4.16	9.22 ± 3.96	0.517	0.606
	After	7.31 ± 2.08	6.78 ± 1.65	2.226	0.027
Depression	Before	8.14 ± 3.22	7.89 ± 2.53	0.675	0.500
	After	6.42 ± 2.34	5.89 ± 2.12	1.882	0.061
IES-R (score)
Total	Before	36.84 ± 7.54	37.54 ± 10.16	0.620	0.536
	After	29.35 ± 6.64	27.65 ± 7.14	1.945	0.053
Intrusion	Before	14.86 ± 3.56	14.56 ± 3.64	0.665	0.507
	After	14.86 ± 5.46	13.56 ± 3.64	2.191	0.030
Avoidance	Before	11.84 ± 2.54	12.17 ± 2.75	0.999	0.319
	After	11.35 ± 1.38	10.84 ± 1.35	2.906	0.004
Hyperarousal	Before	10.35 ± 4.64	11.04 ± 3.38	1.345	0.180
	After	7.53 ± 2.97	6.86 ± 1.84	2.123	0.035
FFMQ (score)	Before	111.64 ± 18.76	112.56 ± 17.58	0.397	0.692
	After	125.68 ± 23.79	133.57 ± 19.63	2.853	0.005

MBCT: Mindfulness-based cognitive therapy; SAS: Self-rating anxiety scale; SDS: Self-rating depression scale; FFMQ: Five-facet mindfulness questionnaire; HADS: Hospital anxiety and depression scale; IES-R: Impact of event scale-revised.

Following treatment, although total scores on the SAS, SDS, HADS, and IES-R did not show statistically significant differences (SAS total: t = 1.924, P = 0.055; SDS total: t = 1.425, P = 0.155; HADS total: t = 1930, P = 0.055; IES-R total: t = 1.945, P = 0.053), the HADS anxiety subscale demonstrated a significant reduction in the MBCT group (6.78 ± 1.65) compared with the conventional group (7.31 ± 2.08; t = 2.226, P = 0.027). Additionally, within the IES-R, substantial improvements were noted for the MBCT group, with low scores in the intrusion and avoidance subscales (intrusion: t = 2.191, P = 0.030; avoidance: t = 2.906, P = 0.004) and a significant reduction in hyperarousal (t = 2.123, P = 0.035), indicating decreased psychological distress. The total scores for FFMQ showed significant improvements in the MBCT group compared with the conventional group (P = 0.005).

Comparison of QoL scores between the two groups of patients before and after treatment

Prior to treatment, the FACT-B scale revealed no significant difference in physiological condition (t = 1.038, P = 0.300), social family well-being (t = 1.402, P = 0.162), emotional well-being (t = 0.392, P = 0.695), breast symptoms (t = 1.151, P = 0.251), or total score of QoL (t = 0.328, P = 0.743) between the MBCT group and the conventional treatment group. Functional status scores were also not significantly different (t = 1.962, P = 0.051; Table 5). The NRS total score indicated no significant difference in discomfort levels (t = 1.755, P = 0.081) between the two groups. Grip strength showed no significant difference (t = 0.440, P = 0.660). Shoulder flexion and shoulder abduction did not show significant differences (P > 0.05) between the two groups.

Table 5 Quality of life scores before and after treatment.

Item	Time	Conventional treatment group (n = 123)	MBCT group (n = 126)	t value	P value
FACT-B (score)
Physiological Condition	Before	12.58 ± 4.08	13.13 ± 4.22	1.038	0.300
	After	12.55 ± 2.75	13.85 ± 3.93	3.012	0.003
Social family	Before	20.13 ± 5.77	19.25 ± 3.87	1.402	0.162
	After	18.18 ± 4.13	18.55 ± 1.26	0.955	0.341
Emotional well-being	Before	10.85 ± 2.45	11 ± 3.51	0.392	0.695
	After	11.95 ± 0.32	12.25 ± 2.51	1.325	0.188
Functional Status	Before	11.33 ± 4.05	12.28 ± 3.57	1.962	0.051
	After	16.98 ± 0.31	17.74 ± 3.22	2.620	0.010
Breast symptoms	Before	18.00 ± 3.90	18.60 ± 4.29	1.151	0.251
	After	19.52 ± 1.56	20.13 ± 1.58	3.045	0.003
Total score of quality of life	Before	75.30 ± 14.70	74.78 ± 9.65	0.328	0.743
	After	80.85 ± 14.22	82.46 ± 12.51	0.948	0.344
NRSs (score)
Total	Before	5.23 ± 1.85	4.81 ± 1.94	1.755	0.081
	After	3.24 ± 1.48	2.82 ± 0.52	2.962	0.004
Grip strength difference (kg)	Before	6.10 ± 1.70	6.21 ± 2.18	0.440	0.660
	After	5.80 ± 0.57	5.56 ± 0.67	3.140	0.002
Shoulder flexion difference (°)	Before	54.24 ± 5.19	53.68 ± 7.96	0.664	0.507
	After	41.67 ± 7.35	39.50 ± 5.34	2.662	0.008
Shoulder abduction difference (°)	Before	71 .00 ± 4.50	70.50 ± 4.34	0.888	0.376
	After	56.67 ± 13.56	55.50 ± 6.24	0.871	0.385

MBCT: Mindfulness-based cognitive therapy; FACT-B: Functional assessment of cancer therapy-breast; NRSs: Numeric rating scales.

After treatment, on the FACT-B scale, the MBCT group demonstrated markedly better physiological condition scores (13.85 ± 3.93) than the conventional group (12.55 ± 2.75), with a significant difference (t = 3.012, P = 0.003). Functional status also improved significantly in the MBCT group (17.74 ± 3.22) than in the conventional group (16.98 ± 0.31; t = 2.620, P = 0.010). Breast symptoms showed a notable improvement in the MBCT group (20.13 ± 1.58) vs the conventional group (19.52 ± 1.56; t = 3.045, P = 0.003). However, total scores for QoL and social family well-being did not differ significantly between groups. The NRSs indicated lower levels of discomfort in the MBCT group (2.82 ± 0.52) than in the conventional group (3.24 ± 1.48), with a significant difference (t = 2.962, P = 0.004). Regarding physical function, the MBCT group had a slight reduction in grip strength (5.56 ± 0.67 kg) than the conventional group (5.80 ± 0.57 kg; t = 3.140, P = 0.002), but shoulder flexion showed a significant improvement in the MBCT group (39.50° ± 5.34°) than in the conventional group (41.67° ± 7.35°, t = 2.662, P = 0.008). Shoulder abduction differences were not statistically significant. These results underscore the beneficial effects of MBCT in enhancing specific aspects of QoL and reducing physical discomfort in patients with breast cancer.

Comparison of self-efficacy scores between the two groups of patients before and after treatment

Prior to treatment, the GSES revealed that patients in the MBCT group showed no statistically significant difference in strategic effectiveness (5.99 ± 1.48) compared with those in the conventional group (5.92 ± 1.39, t = 0.396, P = 0.692; Figure 1). The differences in scores for strain force efficiency (MBCT: 4.07 ± 1.11, conventional: 3.95 ± 1.18), motivational efficacy (MBCT: 6.13 ± 1.22, conventional: 5.89 ± 1.37), and execution efficiency (MBCT: 4.13 ± 0.97, conventional: 3.94 ± 0.85) were not statistically significant.

Figure 1 Evaluate the general self-efficacy scale of two groups of patients (before treatment). A: Strategic effectiveness; B: Strain force efficiency; C: Motivational efficacy; D: Execution efficiency. GSES: General self-efficacy perception scale; MBCT: Mindfulness-based cognitive therapy.

After treatment, on the GSES, the MBCT group scored significantly higher in strategic effectiveness (9.87 ± 0.75) than the conventional group (9.72 ± 0.13), with a statistically significant difference (t = 2.205, P = 0.029; Figure 2). Similarly, motivational efficacy was significantly higher in the MBCT group (9.48 ± 0.54) than in the conventional group (9.37 ± 0.18), with notable statistical significance (t = 2.002, P = 0.047). Additionally, execution efficiency was higher in the MBCT group (5.71 ± 0.48) than in the conventional group (5.53 ± 0.83; t = 2.064, P = 0.040). Conversely, scores for strain force efficiency did not show a statistically significant difference between the groups (t = 1.130, P = 0.260). These results indicated that MBCT effectively enhanced specific aspects of self-efficacy among patients with breast cancer, particularly in strategic effectiveness, motivational efficacy, and execution efficiency.

Figure 2 Evaluate the general self-efficacy scale of two groups of patients (after treatment). A: Strategic effectiveness; B: Strain force efficiency; C: Motivational efficacy; D: Execution efficiency. ^aP < 0.05. GSES: General self-efficacy perception scale; MBCT: Mindfulness-based cognitive therapy.

DISCUSSION

Breast cancer, a highly prevalent malignancy among women worldwide, imposes significant physical burdens and psychological distress, particularly among patients who are mothers. These individuals often deal with parenting-related anxieties, concerns regarding the effects of their illness and treatment on their children’s well-being, and general emotional disturbances such as anxiety and depression[4,5]. The present study explored the effects of MBCT compared with those of conventional treatments in managing parenting anxiety, alleviating negative emotional states, improving QoL, and enhancing self-efficacy among patients with breast cancer.

One of the most notable outcomes of this study was the reduction in parenting anxiety observed in the MBCT group (PCQ total: MBCT 50.54 ± 4.65 vs conventional 52.12 ± 5.53, P = 0.016). Patients with breast cancer often experience heightened anxiety related to their parenting roles due to concerns about their children's emotional and practical well-being. Our results suggested that MBCT, by fostering non-judgmental present-moment awareness, may help mitigate these specific anxieties; this result was consistent with prior studies showing that mindfulness-based approaches improve emotional regulation in cancer populations[27,28].

Moreover, MBCT demonstrated considerable effectiveness in reducing anxiety levels and stress-related responses such as intrusion, avoidance, and hyperarousal. The therapeutic mechanisms of MBCT involve the cultivation of a present-focused mindset, which allows patients to recognize and interrupt habitual patterns of negative thinking that often exacerbate anxiety and depressive symptoms. The reduction in anxiety symptoms may be primarily attributed to the program’s emphasis on mindfulness and its ability to restructure cognitive processes via enhanced attention control and emotional regulation. Training patients to focus on the “here and now” enables them to disengage from distressing anticipatory and ruminative thoughts, which are common among individuals coping with cancer[29,30].

The observed improvements in depressive symptoms and general psychological distress offer further evidence supporting the efficacy of MBCT. This can be partly attributed to the way mindfulness encourages acceptance rather than avoidance of unpleasant experiences, facilitating adaptive emotional processing. Cognitive restructuring via enhanced self-awareness and acceptance may enable patients to reinterpret their understanding of stressors associated with their illness and parenting responsibilities, leading to reduced depressive symptoms[31-33].

In terms of QoL improvements, the MBCT group showed significant enhancements in several domains, including physiological condition, breast symptoms, and functional status. The holistic approach of MBCT, which integrates physical, cognitive, and emotional well-being, likely contributes to these improvements. For example, mindfulness activities, such as mindful walking and body scanning, integrate gentle physical engagement with cognitive exercises that promote a positive physiological feedback cycle, potentially reducing somatic symptom severity[34,35].

The role of mindfulness in improving perceived functional status and physiology among patients with cancer must not be neglected. Regular practice may have contributed to this outcome by decreasing physiological stress responses, alleviating the physical symptoms associated with breast cancer and its treatment. Encouraging physical awareness and acceptance may reduce symptom-related distress by shifting the individuals’ focus from pain and discomfort to functionality and competence[36-38].

The significant enhancement in self-efficacy observed post-MBCT, particularly in strategic effectiveness (GSES: MBCT 9.87 ± 0.75 vs conventional 9.72 ± 0.13, P = 0.029), suggests that mindfulness training may strengthen patients’ belief in their ability to manage cancer-related challenges. This is critical for patients with breast cancer, who often struggle with perceived loss of control over their health and family roles. By promoting self-regulation and cognitive flexibility, MBCT may empower patients to adopt proactive coping strategies[39,40].

Interestingly, MBCT led to statistically significant improvements in the measured outcomes, but total scores of QoL and some emotional well-being metrics did not show drastic changes. These outcomes might reflect the complex nature of QoL indices in breast cancer survivors, which include diverse aspects that may be differentially affected by cognitive-behavioral interventions. The holistic nature of MBCT suggests it may require additional time or supplementary interventions to show substantial changes across all areas of life.

Our study clarifies the underlying mechanisms that contribute to the observed benefits of MBCT and highlights potential areas for improvement. The intricate structure of MBCT enables it to effectively target specific life domains; yet, the implementation in clinical practice could benefit from individualized adjustments to further maximize its effects on overall QoL. Further investigations should explore the long-term effects of such interventions, focusing on the durability of outcomes in chronic disease management strategies.

This study offers valuable insights into the benefits of MBCT for patients with breast cancer, but several limitations should be acknowledged. First, the sample size was relatively small, potentially limiting the generalizability of the findings to a broad population of patients with breast cancer. Second, the study relied on self-reported measures, which may introduce bias or inaccuracies due to subjective interpretations and recall issues. Third, the follow-up period was limited, restricting the ability to assess the long-term sustainability of the intervention's effects. Future studies should consider employing large, diverse cohorts and extended follow-up durations to corroborate and expand upon these findings. Lastly, the absence of a control group receiving an alternative psychological intervention leaves room for further comparison and deep insights into the unique contributions of MBCT compared with other therapeutic options.

CONCLUSION

This study contributes to the existing literature on psychosocial interventions in cancer care, offering valuable insights into MBCT as a multifaceted approach for managing complex psychological and quality-of-life challenges in patients with breast cancer. The integration of MBCT alongside traditional therapeutic practices represents a promising pathway toward comprehensive and personalized patient care, addressing not the physical symptoms and intricate psychological challenges faced by patients as they navigate illness, treatment, and familial roles. Future research endeavors should assess long-term sustainability, aiming to understand how continued mindfulness practice induces lasting change while refining these interventions to improve accessibility and adherence.