Impact of Yoga on Posttraumatic Growth Among an Ethnically Diverse Sample of Breast Cancer Patients: Is Social Support a Mediator?

Abstract

Recent literature in the field of Psycho-oncology suggests that a cancer diagnosis may serve as a catalyst for positive change and personal growth. Mainly, breast cancer survivors may experience "posttraumatic growth", i.e., a changed sense of self, altered personal relationships and existential and spiritual growth as a result of living with cancer. This study sought to examine the impact of yoga on posttraumatic growth among an underserved ethnically diverse population of survivors diagnosed with breast cancer. Furthermore, this study examined a meditational model of posttraumatic growth, with social support or spiritual well-being as the hypothesized mediators of the relation between a group-based yoga intervention and posttraumatic growth. The sample consists of 88 ethnically diverse women (39% African American, 29% Hispanic, 30% Caucasian) diagnosed with breast cancer (Stages I-III), 53 assigned to a 12-week yoga intervention group and 35 assigned to a wait-list control.;The following measures were utilized to assess posttraumatic growth, social support and spiritual well-being: The Stress-Related Growth Scale, The Medical Outcomes Study (MOS) Social Support Survey and The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-FACIT-Sp. It was hypothesized that yoga participants would experience more posttraumatic growth from baseline to 12 weeks than those in the control group.;For the sample as a whole this hypothesis was not supported. However, a subgroup analysis of variance based on ethnicity revealed that African American yoga participants demonstrated greater posttraumatic growth (F=4.77, p<0.36) and spiritual well-being (F=4.65, p<0.03) at 3 months than African American control group participants. In examining a possible mediation model of posttraumatic growth it was hypothesized that social support based on the MOS would act as a mediator between a yoga intervention and posttraumatic growth. This hypothesis was not supported. However, in post hoc analysis, a regression analysis indicated that the yoga intervention led to a significant increase in posttraumatic growth for those who were single, divorced or widowed relative to those who were married (R 2=.40 p=.00, p<0.01). Furthermore, it was hypothesized that participation in a yoga intervention would enhance spiritual wellbeing, which would facilitate posttraumatic growth. This hypothesis was not supported. A final aim of this study was to develop a predictive model of posttraumatic growth among breast cancer survivors in the yoga intervention. A stepwise regression analysis was conducted to determine which variables may improve prediction of T3 posttraumatic growth beyond that afforded by differences in T1 posttraumatic growth. For the yoga intervention group T1 posttraumatic growth, marital status and T1 spiritual well-being were predictors of T3 posttraumatic growth. Thus, those who were single, divorced, or widowed and had higher spiritual well-being before the yoga intervention, were more likely to experience greater levels of posttraumatic growth after the yoga intervention. Overall, this study provided a preliminary analysis of the role a yoga intervention can play in the attainment of posttraumatic growth among an ethnically diverse sample of breast cancer survivors. The exploration of other factors (marital status, spiritual well-being, faith) provided preliminary data on the roles these variables may play in the experience of posttraumatic growth after breast cancer. A more robust sample size along with a more detailed assessment of posttraumatic growth may further elucidate the efficacy of a yoga intervention on the experience of posttraumatic growth among breast cancer survivors.