Efficacy comparison of mindfulness-based cognitive therapy and routine support on anxiety and sleep quality in peritoneal dialysis patients

Abstract

BACKGROUND

Patients undergoing peritoneal dialysis (PD) frequently experience anxiety and sleep disturbances. However, the comparative efficacy of psychological interventions on these symptoms remains unclear.

AIM

To compare the efficacy of mindfulness-based cognitive therapy (MBCT) and routine psychological support (PS) on anxiety symptoms and sleep quality in patients undergoing PD.

METHODS

This retrospective cohort study included patients receiving PD from June 2022 to June 2025. The patients were divided into the MBCT (8-week structured program) and PS (routine support) groups. Assessments were conducted at baseline, treatment end, and 3 months postbaseline by using the Self-Rating Anxiety Scale, Pittsburgh Sleep Quality Index, Mindful Attention Awareness Scale, Self-Rating Depression Scale, and 36-Item Short Form Health Survey.

RESULTS

Compared with PS, MBCT was associated with significantly greater improvements in mindfulness (P < 0.001) and anxiety symptoms at treatment end and follow-up (both P < 0.001) and lower new-onset anxiety (P = 0.016). Sleep quality in the MBCT group at both time points improved more (P = 0.003 and P = 0.007) than that in the PS group. This change was accompanied with improved sleep onset latency (P = 0.001), total sleep time (P < 0.001), sleep disorders (P = 0.002), and daytime dysfunction (P = 0.004). Compared with PS, MBCT showed superior outcomes for depressive symptoms (P = 0.021) and mental and physical quality of life (P = 0.002 and P < 0.001).

CONCLUSION

In patients undergoing PD, MBCT is associated with superior improvements in anxiety, sleep quality, depressive symptoms, and quality of life compared with routine PS.

Key Words: Peritoneal dialysis; Mindfulness-based cognitive therapy; Routine psychological support; Anxiety; Sleep quality; Quality of life

Core Tip: This retrospective cohort study compared mindfulness-based cognitive therapy (MBCT) with routine psychological support in peritoneal dialysis (PD) patients. MBCT was associated with greater improvements in anxiety, sleep quality, depressive symptoms, and quality of life, and with a lower rate of new-onset anxiety. These findings suggest that structured MBCT may offer meaningful psychological benefits beyond routine support in PD care.

INTRODUCTION

Peritoneal dialysis (PD) is a crucial renal replacement therapy for patients with end-stage renal disease. It functions by using the peritoneum as a semipermeable membrane to remove solutes and fluid[1]. Compared with hemodialysis, PD provides more options for daily life and a chance at home dialysis[2], although it can have some effects in terms of regulating metabolism. Long-term disease frequently causes psychological pressure, such as anxiety, depression, and sleep problems[3,4], because it imposes long-term self-care requirements and dietary restrictions[5]. In addition, other highly threatening complications, such as abdominal infection, may occur. These psychological issues impair patients’ quality of life, reduce treatment adherence, increase infection risk, and may lead to worsened clinical outcomes[6].

Recognition that holistic patient care matters beyond biological stability alone is growing. However, in routine clinical practice, physicians tend to prioritize laboratory results over mental health assessments[7]. Standardized care primarily offers routine psychological support (PS) that generally includes education and emotional comfort but lacks structured therapeutic elements. As a result, it is insufficient to alleviate anxiety and insomnia[8,9]. Its broad dissemination indicates that it needs to be implemented universally with a single goal to solve the above problems in detail for everyone.

Emerging evidence underscores the critical role of psychological interventions in chronic disease management. Chronic stress and anxiety in patients undergoing PD has been hypothesized to involve neuro-endocrine pathways, including the dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis and increased activity in the amygdala-centered stress circuit, which could contribute to anxiety and sleep disturbances[10]. A persistent high-arousal condition due to anxiety might disrupt the body’s internal clock and prolong wakefulness[11]. Previous studies have suggested that mindfulness practices may influence neural systems in ways that potentially promote autonomic balance and reduce cortisol levels[12]. Similarly, cognitive behavioral interventions are thought to help modify maladaptive beliefs about one’s condition in patients undergoing PD, potentially interrupting the cognitive processes that sustain anxiety[13].

This study aims to evaluate the comparative efficacy of mindfulness-based cognitive therapy (MBCT) and routine PS on anxiety symptoms and sleep quality in patients undergoing PD. Its innovation lies in its focused comparison within the PD population, a group for which evidence is still limited. It has the potential to inform the development of highly effective, evidence-based psychological care models that can simultaneously address mental health and sleep quality issues, ultimately aiming to improve the mental well-being and overall treatment adherence of patients undergoing PD.

MATERIALS AND METHODS

Research design and ethical approval

This study is a retrospective cohort study aiming to compare the efficacy of MBCT with that of routine PS on anxiety symptoms and sleep quality in patients undergoing PD.

Patients who received regular PD treatment in Division of Nephrology, Nanfang Hospital, Southern Medical University from June 2022 to June 2025 were included in this study. They were divided into two groups in accordance with the actual psychological treatment methods that they received. Specifically, the MBCT group received an 8-week MBCT intervention, whereas the PS group received routine PS.

This study strictly adheres to the ethical principles of the Declaration of Helsinki. Given that it has a retrospective design, it only analyzed clinical data that were routinely collected during the treatment of patients who have completed treatment. All data were anonymized before analysis, making tracing them back to individual patient identities impossible, and the study does not involve any additional interventions or risks to the patients. Therefore, the Medical Ethics Committee of Nanfang Hospital, Southern Medical University approved a waiver of patient informed consent.

Inclusion and exclusion criteria

Patients were all aged 18 years or older, receiving stable dialysis treatment for at least three months. Included patients needed to have complete data in the electronic medical record system and psychological treatment records.

Exclusion criteria included patients with a history of or current severe mental illness (such as schizophrenia or bipolar disorder), severe cognitive impairment, or a history of drug or alcohol dependence; those who experienced acute complications, such as acute myocardial infarction or severe infections (such as peritonitis or sepsis) within 3 months prior to enrollment or required emergency hospitalization because of severe physical illness; those with missing follow-up data; and those who participated in other systematic psychotherapies or took antipsychotic, antianxiety, or antidepressant medications during the treatment period.

Treatment methods

Patients in the MBCT group received an 8-week MBCT program. The therapy was conducted by two clinical psychotherapists with national level-two counseling qualifications who had completed systematic training in MBCT. The intervention was provided in a group format, with each group consisting of 6 patients, meeting once a week for 60 minutes over 8 weeks. The treatment content combined mindfulness meditation training with cognitive-behavioral techniques. Each session included formal practice, informal practice guidance, group sharing, and thematic lectures. The first week’s theme was automatic pilot and awareness, guiding patients to identify automatic thoughts. The second week’s theme dealt with bodily discomfort, involving body scanning to address dialysis-related bodily sensations. The third week’s theme focused on gathering the scattered mind, enhancing focus through mindful breathing. The fourth week’s theme identified avoidance and aversion, focusing on becoming aware of avoidance reactions to disease-related stimuli. The fifth week’s theme centered on allowing things to be as they are, thus fostering an attitude of acceptance. The sixth week’s theme emphasized that thoughts are not facts, applying cognitive restructuring techniques to challenge negative automatic thoughts. The seventh week’s theme discussed how to best take care of oneself, involving developing personalized coping strategies. The eighth week’s theme incorporated mindfulness into future life, consolidating practices and preventing relapse. Formal practices included body scanning, mindful breathing, and mindful walking. Informal practice guidance helped patients integrate mindfulness into daily activities, such as eating and washing. After each session, patients were required to practice on their own for 15-30 minutes daily and submit a self-assessment form at the next session.

Patients in the PS group received conventional PS treatment. This support was also provided by two clinical psychotherapists with national level-two counseling qualifications, maintaining consistency with the MBCT group in terms of treatment frequency, session duration, total weeks, and group size. The support content consisted of nonstructured routine psychological care, mainly including disease adaptation guidance, dialysis-related knowledge education, empathy and listening, and emotional care and encouragement. Disease adaptation guidance leveraged a standardized question and answer approach to understand patients’ difficulties in adapting to PD treatment, providing targeted coping suggestions, such as dietary management techniques and home dialysis environment setup. Dialysis-related knowledge education employed a unified educational manual to explain PD operation standards, complication identification, and emergency handling. In the empathy and listening segment, therapists utilized nondirective listening, without interrupting or evaluating, and combined empathetic responses (e.g., “I understand the irritability you mentioned due to poor sleep at night”). In the emotional care and encouragement segment, any emotional distress expressed by patients was normalized (e.g., “Many dialysis patients have similar feelings”), and general encouragement was provided (e.g., “You are doing very well”). Throughout support, therapists did not introduce mindfulness practices, cognitive restructuring, or other structured techniques; did not set unified themes for each session; and did not require patients to complete homework assignments. Therapists adjusted their response focus on the basis of the issues raised by patients during each session, making the support content highly individualized and flexible.

Data acquisition

Baseline demographic features: The demographic characteristics and clinical data of patients were retrospectively collected from the electronic medical record system and nursing records of Nanfang Hospital, Southern Medical University. Demographic characteristics included age, gender, educational level, marital status, and primary dialysis cause and were all sourced from routine registration records at the time of patient admission. Clinical laboratory indicators were collected before the start of treatment. Blood samples were collected in the early morning on an empty stomach. Blood was drawn via the venipuncture of the elbow and collected in ethylenediaminetetraacetic acid anticoagulant tubes and coagulation-promoting tubes. Hemoglobin concentration was measured by using a fully automated blood analyzer (XN-9000, Sysmex Corporation, Japan). Meanwhile, serum albumin concentration was determined by employing a fully automated biochemical analyzer (AU5800, Beckman Coulter, United States) with the bromocresol green method. The urea clearance index (Kt/V) was calculated on the basis of the results of 24 hours dialysate and urine collection. Urea nitrogen concentrations in the dialysate and urine were measured though the urease method by using a fully automated biochemical analyzer, and Kt/V values were calculated in accordance with standard formulas. Dialysis duration was defined as the cumulative number of months from the patient’s first PD treatment to the baseline assessment of this study and was sourced from dialysis management system records.

Data collection for psychological assessments: All scales were administered at baseline (within 1 week before the start of psychological treatment) and at the end of treatment (within 8 weeks after the start of treatment). Among these scales, the Self-Rating Anxiety Scale (SAS) and the Pittsburgh Sleep Quality Index (PSQI) were additionally assessed during a follow-up visit at one month after the end of treatment. All scales were distributed by nephrology nurses who had received uniform training during patients’ outpatient follow-ups. Patients filled out the scales in an independent and quiet waiting area. If they had any questions during the process, then nurses provided neutral answers.

The Mindful Attention Awareness Scale (MAAS) was used to assess patients’ trait mindfulness levels[14]. This scale consists of 15 items, rated on a six-point scale (from 1, indicating “almost always”, to 6, representing “almost never”), with high total scores indicating high levels of mindfulness.

The SAS was employed to assess patients’ anxiety symptoms[15]. This scale consists of 20 items, rated on a four-point scale, with standard score ≥ 50 indicating the presence of anxiety symptoms. Patients with new-onset anxiety are defined as those without anxiety at baseline (SAS standard score < 50) who develop anxiety (SAS standard score ≥ 50) during the treatment period.

The PSQI is used to assess patients’ sleep quality[16]. This scale includes 19 self-rated items, divided into 7 dimensions, with a total score ranging from 0 to 21. High scores indicate poor sleep quality.

The Self-Rating Depression Scale (SDS) is employed to assess patients’ depressive symptoms[16]. This scale consists of 20 items, rated on a four-point scale, with standard score ≥ 53 indicating the presence of depressive symptoms.

The 36-Item Short Form Health Survey (SF-36) is utilized to assess patients’ quality of life[17]. This scale includes 36 items, covering two dimensions: The physical and mental health summary scores. High scores indicate a high quality of life.

Statistical analysis

All statistical analyses in this study were performed by using R software (Version 4.2.1, R Foundation for Statistical Computing, Vienna, Austria). Given that this study has a retrospective design and only includes patients with complete data, no missing value handling was performed. Continuous variables were first tested for normality through the Shapiro-Wilk test. Normally distributed continuous variables are presented as mean ± SD, and comparisons between the two groups were made through independent samples t-tests. Nonnormally distributed continuous variables are presented as median (interquartile range), and comparisons between the two groups were performed by using the Mann-Whitney U test. Categorical variables are presented as n (%), and comparisons between the two groups were conducted by using the χ² test or Fisher’s exact test (when expected frequencies are less than 5). P < 0.05 was considered statistically significant.

RESULTS

Characteristic profile of participants

No significant differences in baseline demographic or clinical characteristics were found between the MBCT and PS groups (Table 1). No statistically significant differences were found in demographic data, such as age, sex ratio, dialysis period, educational background, marital status, residence place, current smoking or drinking, and dialysis reason (P > 0.05). Hemoglobin concentration, serum albumin content, and urea elimination half-life did not significantly differ (all P > 0.05) between the two groups. The distribution of base characteristics is balanced between the two groups.

Table 1 Comparison of baseline demographic and clinical characteristics, n (%) or mean ± SD.

Index	PS group (n = 103)	MBCT group (n = 94)	t/χ2	P value
Age (year)	54.27 ± 8.57	55.14 ± 7.84	0.738	0.462
Gender (female/male)	35 (33.98)/68 (66.02)	36 (38.30)/58 (61.70)	0.397	0.528
Dialysis duration (month)	32.45 ± 8.65	31.87 ± 8.94	0.464	0.643
Education level			0.476	0.788
Junior high school or below	9 (8.74)	10 (10.64)
High school	58 (56.31)	55 (58.51)
College or above	36 (34.95)	29 (30.85)
Marital status			1.072	0.585
Single	53 (51.46)	47 (50.00)
Married	45 (43.69)	39 (41.49)
Divorced or widowed	5 (4.85)	8 (8.51)
Living arrangement (living alone/living with family)	35 (33.98)/68 (66.02)	29 (30.85)/65 (69.15)	0.219	0.639
Current smoking status	14 (13.59)/89 (86.41)	10 (10.64)/84 (89.36)	0.401	0.527
Current alcohol consumption	4 (3.88)/99 (96.12)	5 (5.32)/89 (94.68)	0.020	0.888
Reason for dialysis			0.585	0.900
Diabetic nephropathy	46 (44.66)	42 (44.68)
Glomerulonephritis	23 (22.33)	24 (25.53)
Hypertensive nephropathy	15 (14.56)	14 (14.89)
Other	19 (18.45)	14 (14.89)
Hemoglobin (g/L)	112.47 ± 8.51	113.65 ± 8.12	0.991	0.323
Serum albumin (g/L)	36.84 ± 4.21	37.24 ± 3.96	0.674	0.501
Urea clearance (Kt/V)	1.84 ± 0.29	1.88 ± 0.27	1.083	0.280

MBCT: Mindfulness-based cognitive therapy; PS: Routine psychological support.

Mindfulness level

In the comparison of MAAS scores, no significant difference was identified between the PS and MBCT groups at baseline (P = 0.718; Figure 1). Conversely, at the end of treatment, a significant difference emerged (P < 0.001), demonstrating that the MBCT group experienced a significantly greater increase in MAAS scores relative to the PS group. This result indicates that MBCT was more effective than PS in enhancing mindfulness awareness.

Figure 1 Comparison of Mindful Attention Awareness Scale scores. MBCT: Mindfulness-based cognitive therapy; PS: Routine psychological support.

Anxiety symptoms

Anxiety symptoms at baseline did not significantly differ between the PS and MBCT groups (P = 0.468; Table 2). Conversely, significant differences were observed at the end of treatment (P < 0.001), with the MBCT group exhibiting significantly lower anxiety scores than the PS group. Similarly, at three months postbaseline, the MBCT group showed a markedly lower level of anxiety symptoms (P < 0.001) relative to the PS group. Furthermore, the occurrence of new-onset anxiety during treatment was significantly less frequent in the MBCT group (P = 0.016) than in the PS group. That is, the MBCT group had a lower rate of new-onset anxiety during the observation period than the PS group. These findings indicate that compared with PS, MBCT was associated with significantly greater reductions in anxiety symptoms at treatment end and follow-up, as well as with a lower incidence of new-onset anxiety, in this study’s cohort.

Table 2 Comparison of anxiety symptoms, n (%) or mean ± SD.

Index	PS group (n = 103)	MBCT group (n = 94)	t/χ2	P value
At baseline	52.89 ± 4.98	53.42 ± 5.15	0.727	0.468
At the end of treatment	47.34 ± 5.76	43.65 ± 4.23	5.162	< 0.001
New-onset anxiety during treatment	13 (12.62)/90 (87.38)	3 (3.19)/91 (96.81)	5.857	0.016
At 3 months post-baseline	47.02 ± 6.05	41.28 ± 5.10	7.159	< 0.001

MBCT: Mindfulness-based cognitive therapy; PS: Routine psychological support.

Sleep quality

No significant differences were found in PSQI scores between the PS and MBCT groups at the beginning of treatment (P = 0.672; Table 3). The MBCT group had a lower PSQI score than the PS group at the end of therapy (P = 0.003) and 3 months after baseline (P = 0.007). These results indicate that compared with the PS group, the MBCT group had better sleep quality at both time points. These data suggest that MBCT was associated with greater improvements in sleep quantity and quality than PS, and these associations persisted at the followup assessment.

Table 3 Comparison of Pittsburgh Sleep Quality Index scores, mean ± SD.

Index	PS group (n = 103)	MBCT group (n = 94)	t value	P value
At baseline	9.18 ± 2.72	9.34 ± 2.84	0.424	0.672
At the end of treatment	7.85 ± 2.64	6.82 ± 2.15	3.010	0.003
At 3 months post-baseline	7.32 ± 2.45	6.45 ± 2.08	2.705	0.007

MBCT: Mindfulness-based cognitive therapy; PS: Routine psychological support.

In the comparison of PSQI component scores at the end of treatment, significant differences were observed across several metrics (Table 4). Compared with the PS group, the MBCT group showed significantly lower scores for sleep onset latency (P = 0.001), total sleep time (P < 0.001), sleep disorders (P = 0.002), and daytime dysfunction (P = 0.004). These componentlevel results further indicate that MBCT was associated with shorter sleep onset latency, longer total sleep time, fewer sleep disturbances, and lower daytime dysfunction compared with routine PS.

Table 4 Comparison of Pittsburgh Sleep Quality Index component scores at the end of treatment, mean ± SD.

Index	PS group (n = 103)	MBCT group (n = 94)	t value	P value
Sleep onset latency	1.84 ± 0.62	1.59 ± 0.45	3.298	0.001
Total sleep time	1.57 ± 0.58	1.25 ± 0.52	4.044	< 0.001
Sleep disorders	1.35 ± 0.45	1.18 ± 0.32	3.069	0.002
Daytime dysfunction	1.40 ± 0.49	1.22 ± 0.35	2.955	0.004

MBCT: Mindfulness-based cognitive therapy; PS: Routine psychological support.

Clinical indicators

In the comparison of clinical indicators at the end of treatment, no significant differences were observed between the PS and MBCT groups for hemoglobin levels (P = 0.121), serum albumin (P = 0.282), or urea clearance (P = 0.523; Table 5). These results indicate that in contrast to PS, MBCT did not have a distinct effect on these specific clinical indicators.

Table 5 Comparison of clinical indicators at the end of treatment, mean ± SD.

Index	PS group (n = 103)	MBCT group (n = 94)	t value	P value
Hemoglobin (g/L)	113.28 ± 10.54	115.48 ± 9.13	1.558	0.121
Serum albumin (g/L)	37.61 ± 4.58	38.29 ± 4.26	1.078	0.282
Urea clearance (Kt/V)	1.86 ± 0.31	1.89 ± 0.35	0.640	0.523

MBCT: Mindfulness-based cognitive therapy; PS: Routine psychological support.

Depressive symptoms

In the comparison of SDS scores, no significant difference was found between the PS and MBCT groups at baseline (P = 0.340; Figure 2). However, at the end of treatment, a significant difference emerged (P = 0.021), with the MBCT group showing lower SDS scores compared with the PS group. These results show that compared with PS, MBCT was associated with a greater reduction in depressive symptoms at the end of treatment.

Figure 2 Comparison of Self-Rating Depression Scale scores. MBCT: Mindfulness-based cognitive therapy; PS: Routine psychological support.

Quality of life

The PS and MBCT groups did not have significantly different scores on the mental (P = 0.594) or physical health components (P = 0.656; Table 6) of the SF-36 questionnaire at the start of treatment. However, at the end of treatment, significant differences were observed in both components. Compared with the PS group, the MBCT group showed significantly higher scores on the mental (P = 0.002) and physical (P < 0.001) health components. At the end of treatment, MBCT was associated with significantly higher mental and physical health summary scores on the SF-36 compared with PS, suggesting a potential association with improved selfreported quality of life.

Table 6 Comparison of 36-Item Short Form Health Survey scores, mean ± SD.

Index	PS group (n = 103)	MBCT group (n = 94)	t value	P value
At baseline
Mental health component	45.28 ± 6.16	44.82 ± 5.94	0.534	0.594
Physical health component	42.56 ± 6.54	42.14 ± 6.82	0.446	0.656
At the end of treatment
Mental health component	59.45 ± 6.85	62.15 ± 5.12	3.151	0.002
Physical health component	58.32 ± 7.12	62.14 ± 7.45	3.686	< 0.001

MBCT: Mindfulness-based cognitive therapy; PS: Routine psychological support.

DISCUSSION

The effects of MBCT and PS on reducing anxiety symptoms and promoting sleep improvement among patients undergoing PD were comprehensively compared. Integrating structured mindfulness practice with cognitive behavioral techniques in MBCT has additional applications for therapy and goes beyond the help provided by ordinary support. Traditional measures often lack the depth and systematic approach necessary to achieve sustained mental health benefits in this vulnerable population.

In this study, the MBCT group showed greater increases in MAAS scores than the PS group, suggesting that structured mindfulness training was associated with enhanced trait mindfulness. This finding aligns with the theoretical basis of MBCT, which aims to reduce patients’ sensitivity to the automatic negative thoughts that develop during prolonged illness[18]. Patients’ ability to maintain their consciousness may improve their own abilities of self-observation during diagnosis, thereby weakening the emotions induced by worries and fears arising from hemodialysis treatment[19]. This finding is in agreement with previous results indicating an increase in metacognitive skills among the population of patients with chronic illnesses after mindfulness training[20]. By contrast, the small increment in mindfulness shown by participants in the routine PS group is caused by a focus on emotional endorsement and disease knowledge dissemination rather than attention-regulation training[21]. Given the variation in mindfulness among each group, this potential component can influence later changes in emotions and sleep positively.

Compared with routine PS, MBCT showed a clearly superior effect on anxiety symptoms at immediate posttreatment and after one month because of the high prevalence of anxiety in people with PD and its relationship with reduced medication-taking compliance, as well as worsened therapeutic results. The observed superiority of MBCT to routine PS in reducing anxiety symptoms may be explained by the mechanisms proposed in previous studies; however, the present study did not directly measure physiological parameters[22]. Mindfulness practice may reduce HPA axis activation and cortisol levels, thereby potentially decreasing physiological reactivity[23]. Such neuro-endocrine modulation could, in theory, counteract the heightened sympathetic activity often observed in patients with anxiety undergoing PD. In addition, the cognitive component of MBCT is thought to help patients identify and reframe maladaptive illness-related cognitions, which might interrupt the cognitive cycles that sustain anxiety[24]. Similar findings have been observed in other chronic disease populations, including patients with cancer and cardiovascular disease, where MBCT has been more effective than supportive care measures in reducing anxiety[25]. The low incidence of new-onset anxiety disorders in the MBCT group during treatment further underscores the preventive potential of MBCT. However, given that this study relied solely on SAS and did not include biomarkers of stress or neuroendocrine function, these mechanistic interpretations remain speculative and require confirmation in future studies with physiological measurements.

The improvement in sleep quality in the MBCT group suggests that treatment effects may also apply to other aspects. Anxiety and sleep disorders often coexist and exacerbate each other[26]. The reduction in sleep onset latency and disruption of total sleep time is particularly noteworthy because difficulties falling asleep are common among patients undergoing PD and are often resistant to traditional supportive care[27]. The high improvement in self-reported sleep quality in the MBCT group warrants the consideration of potential mechanisms. However, caution is needed because no objective sleep monitoring was performed. Previous research has suggested that mindfulness practice may help reduce subjective hyperarousal and perceived sympathetic activity, thereby improving the subjective experience of sleep[28]. MBCT has also been proposed to reduce illness-related rumination, which is known to interfere with perceived sleep quality[29]. Moreover, acceptance-based strategies might alleviate secondary anxiety about insomnia itself[30]. Some related research findings indicate that various forms of mindfulness therapies are beneficial in enhancing sleep quality across multiple circumstances, such as serious illnesses arising from prolonged chronic pain or cancer[31]. By building on existing research, this study shows that MBCT outperformed the active psychological control condition and demonstrated several benefits beyond simple emotional assistance for individuals undergoing PD.

The reduction in depressive symptoms observed in the MBCT group, although statistically significant, warrants careful interpretation. The magnitude of the difference between the two groups was not large, and both treatment modalities resulted in clinically meaningful reductions from baseline. Routine PS can offer a sense of comfort and advice. Nevertheless, the lack of in-place mechanisms or talent training has been unable to help strengthen moods consistently[32]. MBCT, by combining cognitive restructuring with mindfulness practices, may address core emotional dysfunctions contributing to depression, with these dysfunctions including rumination and negative self-referential thinking[33]. Previous studies on dialysis populations have shown that depression is often under-recognized and undertreated, with numerous patients not receiving psychotherapy[34]. The current findings suggest that while structured and supportive approaches are beneficial, MBCT may offer particular advantages for patients with entrenched cognitive patterns associated with depression.

The SF-36 revealed that the quality of life of the MBCT group improved across mental and physical aspects. However, objective clinical indicators, including hemoglobin, serum albumin, and Kt/V, did not differ significantly between the two groups at the end of treatment. This result suggests that the observed improvement in the self-reported physical quality of life is unlikely to reflect changes in dialysis adequacy or nutritional status. Instead, it may be attributable to psychological factors, such as altered illness perception, reduced symptom catastrophizing, and enhanced self-confidence, that have been shown to influence how patients with chronic diseases perceive their physical functioning[35]. MBCT may help modify these cognitive-emotional processes, leading patients to experience reduced disability in bodily function subjectively, without necessarily altering underlying physiological parameters.

At this stage, this study faces several deficiencies regarding its limitations. Given its single-center, nonrandomized design, the generalizability of its results to other healthcare environments or diverse cultures is limited, and selection bias cannot be excluded. All observed group differences should therefore be interpreted as associations rather than causal effects. Issues with response bias, especially in a retrospective design without blinding, may persist as a result of the use of self-reports, although these self-reports have been validated. In addition, the follow-up period was brief, with only one month of observation after the end of treatment. Given this situation, whether the improvements associated with MBCT are maintained over a prolonged period cannot be determined. A particular concern is that long-term adherence to mindfulness practice is often poor after structured training ends, and benefits may diminish over time without continued practice. In the future, researchers can conduct multicenter prospective randomized controlled clinical studies involving additional subjects to extend observation periods further. Research on the physiological mechanism of psychological effects on PD, such as alterations in inflammatory factors and autonomic function, are necessary to reveal its effect on PD holistically through psychology.

CONCLUSION

In this retrospective cohort of patients undergoing PD, MBCT was associated with greater improvements in anxiety symptoms, sleep quality, depressive symptoms, and quality of life compared with routine PS.