The intimate connection between mind and body has gradually become more broadly accepted in Western medicine over the past few decades. Today, it is no longer considered radical for a patient to incorporate a mind–body intervention into a treatment plan to complement “traditional” medical approaches for healing. This shift in medical mindset was highly influenced by the work of Jon Kabat-Zinn and colleagues, and the mindfulness-based stress reduction (MBSR) program in particular.
MBSR is an 8-week standardized program that teaches participants mindfulness practice, or the act of being in the moment. Through mindfulness practice, participants come to identify automatic reactions and reflexive thoughts occurring in response to external and internal events. Empirical data indicate that MBSR participants experience enhanced psychosocial and physical functioning.1–4
Specific psychosocial improvements include improved quality of life and reductions in psychologic distress.4,5
Indeed, meta-analyses of MBSR studies concluded that MBSR is associated with robust effects on psychosocial well-being across studies of patients with a wide range of health conditions and disorders.1,6
For example, it has been demonstrated that mindfulness training can be helpful in reducing the stress that accompanies cancer diagnosis and treatment.7
Given that stress is associated with immune dysregulation,8
it has been proposed that participation in MBSR can lead to not only decreased stress,1
but also enhanced immune functioning. Findings from a variety of studies provide evidence for the existence of a stress-immunity pathway.9–13
Psychologic stress may lead to changes in immune functioning via two pathways: (1) through the central nervous system with the activation of the sympathetic nervous system; or (2) through neuroendocrine-immune pathways (i.e., the release of hormones).14
Indeed, a number of studies have shown that psychologic responses to stressful events can produce immunologic changes in both healthy and patient populations.15–17
For example, significant declines in natural killer (NK) cell numbers and activity have been observed during periods of high stress (e.g., marital conflict18,19
). Stress-related alterations in immune functioning have also been observed among patients undergoing diagnosis of,20
and treatment for,21
cancer. Among breast cancer patients undergoing surgical treatment, self-reported levels of stress were associated with immune downregulation, including reduced NK cell cytotoxicity, even after controlling for potential confounding variables such as patient age and disease stage.21
Therefore, based on the body of work demonstrating a stress-immune pathway, interruption of the stress-response (through mindfulness practice) could potentially have physiologic implications for immune functioning. Guided by a psychoneuroimmunologic framework that proposes that psychosocial factors may influence immunologic outcomes via sympathetic nervous system and neuroendocrine pathways,22
it is proposed that changes in psychologic well-being are likely to be associated with corresponding changes in immunologic functioning.
At present, few studies have directly examined the association between change in psychosocial well-being and immune parameters following MBSR. Several studies have reported improved immune functioning among MBSR participants, but these same studies either showed no association between immune functioning and psychosocial well-being post-MBSR7,23
or failed to assess this relationship.24
For example, significant improvements in quality of life and stress symptoms as well as a general shift away from a proinflammatory (or Th1) response to an anti-inflammatory (Th2) type response were identified among breast and prostate cancer patients following participation in MBSR.7,25
Moreover, significant increases in immunologic functioning (i.e., NK cell activity) were also reported among HIV+ patients following participation in MBSR.23
An association between immune functioning and psychosocial well-being was not identified in either study. Furthermore, recent research by Witek-Janusek and colleagues24
showed a re-establishment of NK cell activity and cytokine production levels over time as well as reductions in cortisol levels among 75 early-stage breast cancer patients participating in MBSR compared to non-MBSR controls. However, the relationship between immune functioning and psychosocial well-being was not assessed.
Thus, we conducted a pilot study to examine whether improvement in psychosocial well-being is associated with enhanced immune functioning among a heterogeneous patient population participating in a MBSR program. Specifically, it was hypothesized that immunologic changes would most likely be observed among the MBSR participants who showed improvement in psychosocial functioning.