Improving emotional well-being, quality of sleep, and decision making in patients at risk for breast cancer

A new study conducted at Tel Aviv University has determined that use of the Inquiry Based Stress Reduction (IBSR) technique among women with increased risk of breast cancer (carriers of BRCA1/BRCA2 genes) can be very helpful in coping with stressful events, enhance emotional and psychological well-being, improve quality of sleep, and assist in decision making.

The study was led by Dr. Shahar Lev-Ari of the 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 Ph.D. student Clara Landau's dissertation. The study was published in the prestigious JAMA Network Open medical journal.

Dr. Shahar Lev-Ari explains that in many cases, young women, carriers of BRCA1/BRCA2 genes, suffer from a state of uncertainty with regard to their future, mainly due to the realization that they are highly likely to contract breast cancer and/or ovarian cancer. Furthermore, at present there is no effective treatment for preventing the illness 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 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. As part of this, 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 carriers.

The study included 100 women carriers of BRCA1/BRCA2 genes currently under supervision at the Meirav Breast Center at Sheba Medical Center. As part of the study, the carriers learned and practiced the IBSR method (mindful self-inquiry for reduction of stress, the clinical application of "The Work" by Byron Katie), aimed at providing the participants with self practice techniques based on increased mindfulness, work on stress-causing beliefs (the "Inquiry" process), and cognitive reframing.

The results were very impressive. After participating in the workshops and self practice, the carriers showed great 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.

Furthermore, with regard to doubts over whether to undergo surgical procedures such as mastectomy and oophorectomy, a clear change of attitude was found among the participants, with some from a position of ruling out any procedure to making an appointment.

Therefore, the researchers are of the opinion that these findings indicate that study and practice of IBSR techniques may improve the psychological well-being of women with BRCA1/BRCA2 gene mutations, and constitute the basis (in conjunction with other studies) for recommending to consider providing this technique to women, along with oncogenetic consultation.

Dr. Shahar Lev-Ari says, "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. 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."