| Objective:Breast cancer is the most common type of cancer in Chinese women.During treatment and recovery,breast cancer patients experience both tangible and intangible changes in their bodies.Tangible changes such as temporary or permanent hair loss,skin retraction,scarring,and breast asymmetry,as well as many intangible changes such as menstrual cessation,numbness,chronic pain,metabolic changes,fatigue,sexual dysfunction,and sleep difficulties,may bring about long-term negative body image for the patient,which in turn affects the patient’s psychological health.The purpose of this study is to investigate the characteristics of negative body image in breast cancer patients and its relationship with potential influencing factors(perceived stress,self-compassion,self-acceptance,and implicit attitudes),and then develop an online Mindful Self-Compassion(MSC)training program to reduce negative body image and to explore its effects on negative body image of breast cancer patients through online Mindful Self-Compassion training practice.Methods:1.The Chinese Perceived Stress Scale,the Self-Compassion Scale-Short Form,the Self-Acceptance Questionnaire,and the Body Image scale were used to investigate 347 breast cancer patients,and 343 valid questionnaires were obtained.The negative body image characteristics of 343 breast cancer patients and their relationship with perceived stress,self-compassion,and self-acceptance were analyzed.The relationship between negative body image and implicit attitudes was analyzed by using the Implicit Association Test,and breast cancer patients were divided into subgroups with negative body image <10(n=32)and negative body image ≥10(n=33)with a critical score of 10 on the Body Image Scale to compare the differences in implicit attitudes between the two groups.2.A controlled study design was used,with the intervention group(n=29)participating in six weeks of online Mindful Self-Compassion training and the control group(n=28)not receiving any training.The Chinese Perceived Stress Scale,the Self-Compassion Scale-Short Form,the Self-Acceptance Questionnaire,and the Body Image Scale were assessed before(T1),after(T2),and one month after(T3)the intervention to access the effect of the online Mindful Self-Compassion training.Results:1.In terms of demographic variables,there were significant differences in negative body image among patients in different age subgroups and different employment status subgroups(P<0.05).The differences in negative body image of breast cancer patients were shown in the group aged 40 years and younger > 50 years and older,jobless group > retired group.There was no significant difference in negative body image among breast cancer patients grouped by education,marital status,surgical procedures,and time of diagnosis(P>0.05).2.Correlation analysis showed that perceived stress was positively correlated with negative body image(r=0.49,P<0.01).Self-compassion and self-acceptance in breast cancer patients showed a positive correlation(r=0.62,P<0.01).Self-compassion(r=-0.67,P<0.01)and self-acceptance(r=-0.65,P<0.01)displayed a negative correlation with perceived stress,correspondingly.Self-compassion(r=-0.49,P<0.01)and self-acceptance(r=-0.46,P < 0.01)were negatively correlated with negative body image.Negative body image was negatively correlated with implicit self-positive attitudes(r=-0.26,P<0.05).3.Mediation analysis revealed three mediating pathways in the mediated relationship between perceived stress affecting negative body image,a separate mediating effect of self-compassion and self-acceptance,and a chain mediating effect of self-compassion and self-acceptance.The total mediating effect accounted for 56% of the entire effect.4.The results of the Implicit Association Test showed a significant main effect for the attitude category [F(1,63)=150.306,P<0.001] and a significant interaction effect for attitude category × grouping [F(1,63)=4.701,P=0.034] on reaction time.Both the negative body image <10 subgroups and the negative body image ≥10 subgroups had faster reaction times in the self-positive condition than in the self-negative condition(P< 0.05).In terms of correctness,the main effect of the attitude category was significant[F(1,63)=16.417,P<0.001],with all subjects having higher correctness in the self-positive condition than in the self-negative condition.On the D-score(implicit association test effect index),breast cancer patients in the negative body image <10 subgroups had a significantly higher D-score than the negative body image ≥10 subgroups(P<0.05).5.A repeated-measures ANOVA was conducted on the data both before and after the Mindful Self-Compassion training and one-month post-intervention.The results indicated a significant time × grouping interaction for self-compassion [F(2,54)= 5.747,P = 0.010].The time × grouping interaction for self-acceptance was significant [F(2,54)= 5.998,P =0.005].The time × grouping interaction for perceived stress was significant [F(2,54)=8.436,P = 0.001].The time × grouping interaction for negative body image was significant[F(2,54)= 4.949,P = 0.009].According to the simple main effects analysis,Only the intervention group had a significant difference in self-compassion,self-acceptance,perceived stress,and negative body image at T1 versus T2 and T1 versus T3(P<0.01).While all outcome variables in the control group were not significantly different at all three-time points(P>0.05).Conclusion:1.Age and employment status may be important influences on negative body image in breast cancer patients.2.Negative body image was significantly associated with perceived stress,self-compassion,self-acceptance,and implicit attitudes.Self-compassion and self-acceptance mediated the relationship between perceived stress and negative body image.There were significant differences in implicit attitudes among breast cancer patients with different negative body image subgroups.This suggests the possibility of increasing self-acceptance and implicit self-positive attitudes by enhancing self-compassion,reducing perceived stress and negative body image,and maintaining psychological well-being in breast cancer patients.3.Six weeks of online Mindful Self-Compassion training can enhance self-compassion and self-acceptance,reduce perceived stress and negative body image in the intervention group of breast cancer patients,and maintain positive effects at the 1-month post-intervention follow-up. |
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