A compassion-based treatment for couples with the female partner suffering from current depressive disorder: A randomized-controlled trial.

BACKGROUND: Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation. METHODS: In a pre-post-follow-up design, n = 53 different-sex couples including women with current depression were randomly assigned to a 10-week-long CBCT®-fC (Cognitively-Based Compassion Training/intervention for couples) or treatment-as-usual (TAU) condition. Multi-level linear regression models and post-hoc contrasts were calculated to determine changes in depressive symptoms, mindfulness and self-compassion, interpersonal functioning and neuroendocrine markers collected during a partnership appreciation task (PAT) in the laboratory before and after CBCT-fC treatment. RESULTS: While CBCT-fC led to a comparable decrease of depressive symptoms as TAU, the training specifically increased self-compassion and mindfulness versus TAU. Interestingly, interpersonal functioning did not improve, which was also reflected in participants' preferred self-focus in-between-session practices, instead of practices with interpersonal focus. There were no group-specific changes in psychobiological stress-marker reactivity. CONCLUSIONS: CBCT-fC was effective in decreasing current depressive symptomatology and increasing mindfulness, and self-compassion. Especially the motivation to participate, such as improving interpersonal functioning, should be addressed and intrinsic motives of the partners to be involved. In highly burdened individuals, self-regulation may need to be improved before co-regulation can be addressed, which would requiring longer treatments. Facilitating factors for engaging in the practice between-sessions seem meaningful.

Characteristics of salivary cortisol and alpha-amylase as psychobiological study outcomes in palliative care research.

BACKGROUND: Psychosocial interventions are rapidly emerging in palliative care. However, randomized trials often fail to provide evidence for their effectiveness with regard to patient-reported outcomes. Stress biomarkers could complement self-report data, but little is known about their feasibility, acceptance, and interpretability. METHODS: Therefore, we designed a randomized crossover trial in which 42 patients in a palliative care unit participated in both a brief mindfulness intervention (MI) and a resting state control condition (CC) on two consecutive afternoons. On each day, we collected four saliva samples in 20-min intervals using Salivettes© to determine salivary cortisol (sCort) and alpha-amylase (sAA) concentration levels. At all measurement points, self-rated well-being and stress as well as cardiovascular markers were assessed. Baseline measurements further included self-rated quality of life and clinician-rated functional status. RESULTS: 78.6% of the patients provided the maximum number of 8 saliva samples and 62.2% reported no subjective difficulties with the sampling procedures. 66.6% (sCort) and 69.6% (sAA) of all possible samples were finally included in the analysis. Xerostomia and nausea were the main reasons for missing data. Higher sCort levels were associated with higher heart rate and lower quality of life, functional status, and heart rate variability. Corticosteroid and sedative medication as well as time since last meal were identified as potential confounders. Regarding reactivity to the MI, we found an overall decrease in sCort levels over time (b = -.03, p = .01), but this effect did not differ significantly between the study conditions (b = .03, p = .21). sAA levels were higher in men than in women. Trajectories over time did not significantly differ between the two conditions (b = -.02, p = .80) and associations with other stress and health-related constructs were weak. CONCLUSIONS: Findings indicate that sCort might serve as a psychobiological outcome in future palliative care trials. However, future research should refine the exact measurement and conceptualization strategies for sCort in palliative care research. High attrition rates should be expected in patients with xerostomia or nausea. TRIAL REGISTRATION: Registered at the German Clinical Trials Registry (DRKS00013135) at 04/12/2017.

Feeling low and unhappy together? An actor-partner-interdependence model uncovering the linkage between different operationalizations of relationship quality and depression in different-sex couples.

Some studies suggest a bi-directional association between low relationship quality and depression. However, the social impact of depression and the potential preventative effects of healthy relationships are not yet sufficiently understood, as studies have shown heterogenous results for effects in both directions. Therefore, the main aim of this study was to differentiate the actor and partner effects of this association more comprehensively using two measures to capture characteristics of relationship quality-firstly regarding general aspects of social system quality and secondly considering specific aspects of the romantic relationship. 110 different-sex couples were included, being separated in partners with highly pronounced depressive symptoms in women (Cw/DW) versus partners with low depressive symptoms (LDCs). We investigated effects cross-sectionally using multi-group analyses to predict relationship (couple specific questionnaire: PFB) versus system quality (general system quality questionnaire: EVOS) in a step-by-step approach, modelling actor and partner effects with variation within and across both groups and then comparing the results to models with equal actor and partner effects. Depression was measured with the PHQ-9. With regard to the relationship between depressive symptoms and system quality, the model that constrained actor and partner effects to be equal across both groups was preferred and showed negative significant actor effects across gender and groups. Concerning the association between depressive symptoms and relationship quality, the model constraining actor and partner effects to be equal within groups had the best fit to the data and revealed a negative partner effect in LDCs. Conclusions Controlling for the moderating variable of clinically relevant depressive symptoms, we found evidence for actor and partner effects, which differed between the two relationship measures. This underlines the importance to reflect how relationship quality is operationalized. The negative partner effect on relationship quality in LDCs emphasizes that even in a non-clinical context, depressive symptoms negatively impact the perceived relationship quality of both women and men. This suggests that addressing the relationship is important in non-clinical preventive contexts and calls for integrating the partner into counselling or trainings.

Change Mechanism of Cognitively-Based Compassion Training for Couples with Depression: An Exploratory Empirical Investigation of Process Variables.

Objective: Compassion training seems to be a promising intervention for couples to improve individual psychopathology and relationship quality. Beyond studying the efficacy of training such as Cognitively-Based Compassion Training for Couples (CBCT-fC), it is important to gain insights into the putative mechanisms along the process. Methods: Theoretically derived presumed mechanisms of compassion training (clarification of values, self-regulation, decentering, and exposure) and additional therapeutic factors (emotional bond, social learning, and clarification of meaning) were studied over the course of a 10-session-long group-based CBCT-fC among women with depressive disorders. Results: Dyadic growth curve models indicated that emotional bond, social learning, and clarification of meaning increase over time in both partners. In decentering and clarification of values, women who suffered from depression showed a larger increase than men, while men had higher values at the start of the training. Conclusions: Women with depression seem to benefit from CBCT-fC in terms of an increase in decentering and value clarification, important mechanisms of compassion training. This study is the first to show that theoretically derived mechanisms of compassion and additional therapeutic factors can describe the process along secular contemplative training sessions, which are increasingly implemented in the health care system. Future studies should explore the relationship of mechanisms and the outcome along the process of the training. Study Registration: Trial registration number NCT03080025.

A new way to measure partner burden in depression: Construction, validation, and sensitivity to change of the partner burden in depression questionnaire.

Depression occurs in an interpersonal dynamic and living with a depressed person can lead to a significant burden on the partner. Instruments measuring burden do not address couples and often measure caregiving for individuals with schizophrenic disorders. The partner burden in depression (PBD) questionnaire is a new instrument measuring PBD by asking individuals, (1) which symptoms they can observe in their depressed partners and (2) to which degree this burdens them. Hence, PBD combines measuring the awareness of observed depressive symptoms and the resulting burden. Additionally, it addresses aspects unique to couple relationships. Our German validation confirmed a one-factor model with 12 items. The PBD had good psychometric properties and was sensitive to change. Partner burden predicted self-reported depressive symptoms (PHQ-9) over time. PBD is short, easily applicable in research and practice and can add to the understanding of partner effects in depression.

Psychoneuroendocrinological effects of music therapy versus mindfulness in palliative care: results from the 'Song of Life' randomized controlled trial.

PURPOSE: Although research on psychosocial interventions in palliative care provided evidence for their effectiveness regarding patient-reported outcomes, few studies have examined their psychobiological effects yet. Therefore, the purpose of the present work as part of an overarching study was to investigate differential effects of music therapy versus mindfulness on subjective distress and both neuroendocrine and autonomic stress biomarkers. METHODS: A total of 104 patients from two palliative care units were randomly assigned to three sessions of either music therapy or mindfulness. Before and after the second session (completed by 89 patients), participants rated their momentary distress and provided three saliva samples for cortisol and α-amylase analysis. Furthermore, photoplethysmography recordings were continuously assessed to calculate mean heart rate and heart rate variability. Data were analyzed using multilevel modeling of all available data and sensitivity analysis with multiply imputed data. RESULTS: Between 67 and 75% of the maximally available data points were included in the primary analyses of psychobiological outcomes. Results showed a significant time*treatment effect on distress (b = - 0.83, p = .02) indicating a greater reduction in the music therapy group. No interaction effects were found in psychobiological outcomes (all p > .05), but multilevel models revealed a significant reduction in cortisol (b = - 0.06, p = .01) and mean heart rate (b = - 7.89, p = .05) over time following either intervention. CONCLUSION: Findings suggest a beneficial effect music therapy on distress while no differential psychobiological treatment effects were found. Future studies should continue to investigate optimal stress biomarkers for psychosocial palliative care research. TRIAL REGISTRATION: German Clinical Trials Register (DRKS)-DRKS00015308 (date of registration: September 7, 2018).

Mindfulness-Based Couple Interventions: A Systematic Literature Review.

Over the past decades, mindfulness-based interventions have been shown to improve individual health and well-being in clinical and nonclinical settings. More recently, secular contemplative trainings were adapted to the couple context as research showed satisfying couple relationships to be one of the strongest predictors of physical and mental health. Mindfulness-based interventions hence seem to be a promising treatment in couple counseling and therapy in both clinical and nonclinical settings. Therefore, we conducted a systematic review to provide an overview of the emerging literature in the field of mindfulness-based interventions for couples and other dyads. Overall, sixteen studies met the inclusion criteria. To summarize the heterogeneous quantitative literature regarding individual outcomes, mindfulness interventions for couples seem to increase mindfulness, self-compassion, well-being, and quality of life. Additionally, we found initial evidence of beneficial effects on relieving psychopathological symptoms and psychobiological stress measures. Measures of relationship quality were the predominant dyadic outcome. Based on these studies, we cautiously conclude that mindfulness trainings can enhance relationship quality. Practitioners should be aware that mindfulness-based interventions for couples can potentially improve the perceived relationship quality between partners and the individual burden. Future studies should expand the field, particularly with regard to other contemplative practices for couples such as compassion interventions.

Durante las últimas décadas, se ha demostrado que las intervenciones basadas en la conciencia plena mejoran la salud y el bienestar en entornos clínicos y no clínicos. Recientemente, se adaptaron capacitaciones contemplativas seculares al contexto de la pareja, ya que las investigaciones demostraron que las relaciones satisfactorias de pareja son uno de los predictores más firmes de la salud mental y física. Por consiguiente, las intervenciones basadas en la conciencia plena parecen ser un tratamiento prometedor en la terapia de pareja, tanto en entornos clínicos como no clínicos. Por lo tanto, realizamos un análisis sistemático para ofrecer una descripción general de las publicaciones que han surgido en el ámbito de las intervenciones basadas en la conciencia plena para parejas y otras díadas. En general, dieciséis estudios cumplieron con los criterios de inclusión. Para resumir las publicaciones cuantitativas heterogéneas con respecto a los resultados individuales, las intervenciones de conciencia plena para parejas parecen aumentar la conciencia, la autocompasión, el bienestar y la calidad de vida. Además, descubrimos pruebas iniciales de efectos beneficiosos en el alivio de los síntomas psicopatológicos y en las valoraciones de estrés psicobiológico. Las valoraciones de la calidad de la relación fueron el resultado diádico predominante. Sobre la base de estos estudios, llegamos prudentemente a la conclusión de que las capacitaciones en conciencia plena pueden mejorar la calidad de la relación. Los profesionales deben estar al tanto de que las intervenciones para parejas basadas en la conciencia plena pueden mejorar la calidad de la relación percibida entre los integrantes de la pareja y el agobio individual. Los estudios futuros deben ampliar el ámbito, particularmente con respecto a otras prácticas contemplativas para parejas, como las intervenciones centradas en la compasión.

"Song of Life": Results of a multicenter randomized trial on the effects of biographical music therapy in palliative care.

BACKGROUND: Awareness for the importance of psychological and spiritual needs in patients with terminal diseases has increased in recent years, but randomized trials on the effects of psychosocial interventions are still rare. AIM: To investigate the efficacy of the "Song of Life" music therapy intervention regarding the emotional and psycho-spiritual dimensions of quality of life. DESIGN: Patients were randomly assigned to either "Song of Life" or a relaxation intervention. "Song of Life" is a novel three-session music therapy intervention working with a biographically meaningful song. Primary outcome was the improvement in psychological quality of life. Secondary outcomes included spiritual well-being, ego-integrity, momentary distress, and global quality of life and the explorative assessment of treatment satisfaction (patient and family member version). Intention-to-treat analysis was conducted including adjustment for multiple testing in secondary outcomes. SETTING/PARTICIPANTS: Between December 2018 and August 2020, 104 patients receiving specialized palliative care were recruited from two palliative care wards. RESULTS: No significant differences were found regarding psychological and global quality of life, but "Song of Life" participants reported significantly higher spiritual well-being (p = 0.04) and ego-integrity (p < 0.01), as well as lower distress (p = 0.05) than patients in the control group. Both patients' and family members' treatment satisfaction was higher after "Song of Life" with large between-group effect sizes on items asking for meaningfulness (d = 0.96) and importance (d = 1.00). CONCLUSIONS: Our findings provide evidence that "Song of Life" is an effective and meaningful biographical music therapy intervention to facilitate psycho-spiritual integration in terminally ill patients. TRIAL REGISTRATION: German Clinical Trials Register (DRKS)-DRKS00015308 (date of registration: September 7th 2018).

Corrigendum: Music Therapy in the Psychosocial Treatment of Adult Cancer Patients: A Systematic Review and Meta-Analysis.

[This corrects the article DOI: 10.3389/fpsyg.2020.00651.].

Instructed Partnership Appreciation in Depression: Effects on Mood, Momentary Relationship Satisfaction, and Psychobiological Arousal.

BACKGROUND: Depressive disorders are associated with attentional bias and social anhedonia. There is evidence supporting the hypothesis that depressed individuals participate less in potentially rewarding social situations and exhibit alterations in stress reactivity. With the present study, we aimed at investigating the affective and psychobiological response of couples with a depressed (female) partner in an instructed partnership appreciation task (PAT) that included positive and appreciative communication. METHODS: In a quasi-experimental repeated-measures design, depressive couples (DCs)-i.e., the female partner being diagnosed with a depressive disorder-were compared to non-depressive couples (NDCs). Study outcomes were the PAT-induced changes in state mood, momentary relationship satisfaction, salivary cortisol, and salivary alpha-amylase. Additionally, we assessed psychometric baseline data on depression, relationship quality, social support, and chronic stress. Data was analyzed using multilevel modeling. RESULTS: A total of 184 individuals from N = 47 DCs and N = 45 NDCs were included. DCs were characterized by higher depressiveness, lower relationship quality, less actually received social support from the partner, and higher chronic stress than NDCs. Manipulation checks led to the additional exclusion of two couples. Regarding mood, depressed women showed lower baseline scores and no significant differences in mood increase compared to non-depressed women (p = 0.107). Increases in relationship satisfaction were significantly stronger in the depressed group (p = 0.035). In addition, we found a significantly stronger cortisol increase in depressed women, but only if relationship duration was taken into account as a moderating factor (p = 0.022). No significant group differences were found for women's amylase trajectories or for sex-dependent interaction effects on the couple level (all p > 0.05). CONCLUSIONS: Instructed engagement in positive couple interaction may require high effort and increased psychobiological arousal, but may finally result in emotional and social benefits in depressed women. While these findings encourage speculations about the therapeutic application of instructed partnership appreciation, more research is needed on the effectiveness of such interventions and on the moderating role of relationship duration in depression and couple functioning.

Neuroendocrine mechanisms of grief and bereavement: A systematic review and implications for future interventions.

Bereavement is associated with many negative behavioural, psychological and physiological consequences and leads to an increased risk of mortality and morbidity. However, studies specifically examining neuroendocrine mechanisms of grief and bereavement have yet to be reviewed. This systematic review is a synthesis of the latest evidence in this field and aims to draw conclusions about the implications of neurobiological findings on the development of new interventions. PRISMA guidelines for systematic reviews were used to search for articles assessing neuroendocrine correlates of grief. Findings were qualitatively summarised. The National Heart, Lung, and Blood Institute Study Assessment Tool was used to assess the quality of the included studies. Out of 460 papers, 20 met the inclusion criteria. However, most were of fair quality only. As a neuroendocrine marker, the majority of the studies reported cortisol as the outcome measure and found elevated mean cortisol levels, flattened diurnal cortisol slopes and higher morning cortisol in bereaved subjects. Cortisol alterations were moderated by individual differences such as emotional reaction to grief, depressive symptoms, grief severity, closeness to the deceased and age or gender. Research on neuroendocrine mechanisms of grief is still in its early stages regarding grief measures and the use and timing of neuroendocrine assessments. Most of the studies focus on cortisol as outcome, and only limited data exist on other biomarkers such as oxytocin. Future research might consider assessing a broader range of neuroendocrine markers and use longitudinal designs with a focus on the psychobiological reactions to loss. Based on this, individually tailored psychosocial interventions, possibly in the palliative care context, might be developed to prevent prolonged grief disorder.

Stress-reducing effects of a brief mindfulness intervention in palliative care: Results from a randomised, crossover study.

OBJECTIVE: Mindfulness-based interventions are a widely used and highly accepted adjunct treatment in oncology. Due to a paucity of research in advanced cancer and other terminal illnesses, we aimed to evaluate the stress-reducing effects of a brief, standardised mindfulness intervention for use in palliative care. METHODS: This study was a randomised, crossover trial where patients participated in both a single mindfulness intervention and a resting state control condition. The order of the conditions was randomised. Study outcomes encompassed self-report data on stress and well-being and measures of heart rate variability. All outcome data were measured at four times per day. RESULTS: Forty-two patients participated in this study. We found significantly stronger reductions in self-rated stress and mean heart rate as well as an increase in heart rate variability after the mindfulness intervention. Psychophysiological effects were strongest in the immediate pre- to post-intervention comparison, while the effect on subjective stress persisted after 20 to 40 min. No significant differences were found for self-rated well-being. CONCLUSIONS: Despite the rather small magnitude of effects, the brief mindfulness intervention showed to be effective and accepted by patients in very advanced stages of a disease and could be offered by trained healthcare professionals in palliative care.

Music Therapy in the Psychosocial Treatment of Adult Cancer Patients: A Systematic Review and Meta-Analysis.

Introduction: Music therapy is used as an adjunct oncological treatment aiming at the improvement of psychological and physical well-being through music. A growing body of randomized and non-randomized controlled trials has been published and reviewed recently. However, a global, quantitative assessment of the effectiveness of music therapy in adult cancer care is missing. The present study thus aims to synthesize the evidence of music therapy in different oncological treatment phases. Methods: We conducted a pre-registered systematic review and meta-analysis (PROSPERO-ID: CRD42019133084) following standard guidelines. We searched electronic databases for studies on music therapy performed by a therapist with adult cancer patients. Results: The narrative synthesis included thirty studies showing that music therapy overall had positive effects on a broad range of outcomes, with techniques and effects varying in different phases. During curative treatment, results were most promising with regard to anxiety, depression, and pain medication intake, while in palliative settings, improvements with regard to quality of life, spiritual well-being, pain, and stress were reported. Twenty-one studies were included in the meta-analysis which showed small but significant effects of music therapy on psychological well-being (d = 0.35, p < 0.001), physical symptom distress (d = -0.26, p = 0.017), and quality of life (d = 0.36, p = 0.023). Heterogeneity between effect sizes was small to medium. Moderator analyses identified studies with a single session of music therapy and the use of receptive techniques to produce larger effects regarding psychological well-being. Conclusion: Music therapy can improve relevant health-outcomes in cancer patients and should therefore be offered in various treatment phases. Future research should include potential moderators such as individual information about patients to find out who benefits most from different kinds of music therapy.

Psychosocial Interventions for Pain Management in Advanced Cancer Patients: a Systematic Review and Meta-analysis.

PURPOSE OF REVIEW: This systematic review and meta-analysis aimed to synthesize the evidence on the effects of psychosocial interventions on pain in advanced cancer patients. RECENT FINDINGS: The included studies investigated the effects of relaxation techniques, cognitive-behavioral therapy, music therapy, mindfulness- and acceptance-based interventions, and supportive-expressive group therapy. Overall, we found a small, but significant effect on pain intensity (d = - 0.29, CI = - 0.54 to - 0.05). Effect sizes were highly heterogeneous between studies. We did not find evidence for the superiority of any of the intervention types. However, psychosocial interventions may be more effective if they specifically targeted pain distress as the primary outcome. Although findings were mixed, psychosocial interventions can be recommended to complement comprehensive care to alleviate pain in patients facing an advanced or terminal stage of the disease. Future research should develop innovative interventions tailored specifically for pain relief.

"Song of Life (SOL)" study protocol: a multicenter, randomized trial on the emotional, spiritual, and psychobiological effects of music therapy in palliative care.

BACKGROUND: Although patients in palliative care commonly report high emotional and spiritual needs, effective psychosocial treatments based on high quality studies are rare. First research provides evidence for benefits of psychosocial interventions in advanced cancer care. To specifically address end-of-life care requirements, life review techniques and creative-arts based therapies offer a promising potential. Therefore, the present study protocol presents a randomized controlled trial on the effectiveness of a newly developed music therapy technique that is based on a biographically meaningful song ("Song of Life"; SOL). METHODS: In a design with two parallel arms, 104 patients at two palliative care units will be randomly assigned to three sessions of either SOL (experimental group) or relaxation exercises (control group). Improvements in the psychological domain of quality of life will be the primary endpoint, while secondary outcomes encompass spiritual well-being, ego-integrity, overall quality of life, and distress. Additionally, caregivers will be asked to provide feedback about the treatment. Assessment of biopsychological stress markers and qualitative analysis of perceived strengths and weaknesses will complement data collection. DISCUSSION: Based on the results of a previous pilot study, we dedicated considerable efforts to optimizing the intervention and selecting appropriate outcomes for the present trial. We are confident to have designed a methodologically rigorous study that will contribute to the evidence-base and help to develop the potential of psychosocial interventions in palliative care. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) - DRKS00015308 (date of registration: September 07th 2018).

Enhancing Social Interaction in Depression (SIDE study): protocol of a randomised controlled trial on the effects of a Cognitively Based Compassion Training (CBCT) for couples.

INTRODUCTION: Positive social interactions (PSIs) and stable relationships can exert substantial benefits on health. However, patients suffering from depression benefit less from these health-promoting effects. Moreover, relationship quality and even partners' health has been found to be negatively affected by depressive symptomatology, which may result in overall impairments in social functioning of a romantic couple. Psychobiological research indicates that these impairments may be accompanied by a maladaptive regulation of the patient's neuroendocrine response to external stressors. Concerning the improvement of social functioning, first studies showed promising results of "Cognitively Based Compassion Training (CBCT®)". However, randomised trials are still scarce. Previous programmes did not involve participation of the patient's romantic partner. Therefore, the present study aims to investigate whether a CBCT® programme adapted for couples (CBCT®-fC) can improve depressive symptoms, distress, social interaction skills and the neurobiological regulation of stress. METHODS AND ANALYSIS: Couples with the female partner suffering from depression will be invited to participate in a pre-to-post intervention assessment on two consecutive days, respectively, involving a standardised PSI task, eye-tracking, ECG recordings, saliva-sampling, blood-sampling and questionnaire data. After baseline assessment, participating couples will be randomised to either a 10 week CBCT®-fC or to a treatment as usual control condition. The primary endpoint is the reduction of depressive symptoms measured by the Hamilton Depression Rating Scale. Secondary outcomes encompass self-rated depression (Beck Depression Inventory), attention towards the partners face during PSI (eye tracking), stress-related biomarkers (cortisol, α-amylase, interleukin (IL)-1ß/IL-6, heart rate variability), methylation of oxytocin-receptor-genes and serotonin-transporter-genes and self-ratings of psychological constructs such as relationship quality and empathy. ETHICS AND DISSEMINATION: Ethical approval has been obtained by the Ethics Committee of the Medical Faculty Heidelberg. Results will be presented in international, peer-reviewed journals and on conferences in the field of clinical psychology and psychiatry. TRIAL REGISTRATION NUMBER: NCT03080025.

'Song of Life': music therapy in terminally ill patients with cancer.

OBJECTIVES: Music therapy (MT) holds a promising potential to meet emotional and existential needs in palliative care patients. The aim of the present pilot study was to assess the feasibility, acceptance and potential effectiveness of a novel MT intervention to improve life closure and spiritual well-being of terminally ill patients with cancer receiving palliative care. METHODS: The 'Song of Life' (SOL) intervention was provided on two consecutive sessions containing a biographical interview and a live performance of a song with high biographical relevance to the patient in a lullaby style. Pre-to-post intervention assessments comprised brief self-report measures on life closure, well-being, stress, worry and pain. RESULTS: 13 out of 15 patients were able to complete the protocol as intended. The chosen songs were associated with a close person, an important place or event or with a religious belief. The results showed medium-sized improvements with regard to life closure, well-being, relaxation, worry and pain. CONCLUSION: 'SOL' proved to be a feasible and highly accepted intervention for patients approaching the end of their lives. Further consideration with regard to the procedures and outcomes is necessary before implementation of a randomised trial.

Insomnia and Autonomic Function Predict Well-Being in Patients Receiving Palliative Care.

BACKGROUND: The improvement of health-related quality of life (HRQOL) is one of the main treatment goals in end-of-life care. Although definitions and conceptualizations remain heterogeneous, many researchers proposed HRQOL to be considered as subjective patient well-being. However, research on its determinants in palliative care is rare, and little is known about the interplay between psychological and biological variables. OBJECTIVE: The aim of this study was to explain differences in terminally ill patients' acute well-being (AWB) by use of a multimethod approach, examining both self-ratings and physiological predictors. SETTING/SUBJECTS: The study was conducted on a palliative care unit in Heidelberg, Germany. A total of 69 adult patients receiving palliative care were included in the analysis. MEASUREMENTS: Patients filled out the EORTC QLQ-C15-PAL questionnaire and an additional single-item visual analogue scale on AWB. In addition, we recorded a five-minute segment of beat-to-beat fluctuations of heart rate (i.e., heart rate variability, HRV) and calculated three indices of cardiac autonomic function: mean heart rate, the root mean square of successive differences, and the standard deviation of normal-to-normal (SDNN) intervals. Exploratory, multiple regression analyses were used to identify significant predictors among the QLQ subscales and HRV parameters. RESULTS: Insomnia (p < 0.001) and SDNN (p < 0.001) were significantly associated with AWB and together explained 26.3% of the variance. All other predictors including pain, fatigue, and physical functioning failed to reach significance (all p > 0.05). CONCLUSION: Both autonomic dysfunction and sleep disturbances independently explained differences in patient's AWB among terminally ill patients. Their role within the concept of quality of life needs to be further addressed in future studies.