Mindfulness-based stress reduction training for oncology patients: Patients’ appraisal and changes in well-being
Introduction
Cancer and its treatment make great demands on patients’ coping abilities. The confrontation with cancer can be considered a traumatic event, due to the often life-threatening character and the far-reaching physical consequences of the treatment, the perceived lack of control and the uncertainty about the outcome of the disease [1]. Stress symptoms range from 20% in patients with early stage cancer to 80% in patients with a recent recurrence [1], [2]. Screening studies indicate that about 35% of cancer patients experience significant general psychological distress [3], [4].
Several types of psychological interventions have been developed to help patients in the adjustment to their disease and treatment [5]. A promising, relatively new therapeutic approach, developed to help people in their adjustment to cancer, is mindfulness-based stress reduction training, which is successfully used in chronically ill patients and cancer patients [6], [7], [8], [9], [10], [11]
The mindfulness-based stress reduction training (MBSR) developed by Kabat-Zin et al. [7] is designed to support people who face stress, pain and illness, making use of the classic principles of mindfulness meditation. Mindfulness means paying attention to what is present in the moment and registering with full awareness without making any judgment about the relevance, cause or consequences of the experiences [6]. Training to develop the capacity to evoke and apply mindfulness is done with the help of meditation exercises. In these exercises patients pay direct attention to bodily sensations, thoughts, and emotions and learn to distinguish them from the associated attributions and evaluations. Through careful and detached observation patients learn to recognize the onset of symptoms (e.g., pain, depressive thoughts, anger, fatigue), and to change or enhance coping strategies to deal with them [7]. People can learn to “live in the moment,” which is especially advantageous in times of doubt, fear and confusion “to notice what are, for them, stressful conditions” and to respond to these conditions mindfully instead of reacting automatically and unconsciously [8]. Teasdale et al. [12] included cognitive elements in the mindfulness-based approach, which they used in their treatment of depression. Patients are taught to view their thoughts and feelings as passing mental events, rather than aspects of themselves or facts reflecting the reality, in order to prevent the rumination of negative thoughts. This is also a useful element for cancer patients, who are particularly vulnerable of becoming absorbed in anxiety, worries and depressive thoughts.
There are a growing number of studies on the effects of mindfulness training for cancer patients. Only two studies that concerned cancer patients were included in Baer's 2003 review of 21 studies about the effects of mindfulness training [13], [14]. These two studies showed that patients who had followed mindfulness meditation training reported fewer mood disturbances, measured by the POMS [15] and lower stress levels, measured by the SOSI [16]. Brown and Ryan later confirmed these findings [10]. A later review of MBSR intervention studies for cancer patients [17] included four other published studies and three ongoing ones. Outcomes of MBSR for cancer patients showed significant improvements in quality of life and decreased symptoms of stress, which lasted over a 6-month follow-up period [13], [18], [19]. In another recent review, Ott et al. [9] described the results of nine studies, consistently showing an improvement in psychological functioning, reduction of stress symptoms, increased well-being and enhanced coping skills in cancer outpatients following a mindfulness meditation training. A study of Carlson showed better sleep quality and a decrease in fatigue, stress and mood disturbance in cancer outpatients after following MBSR [19]. However, in a randomized controlled trial of Shapiro et al. [20] no differences in sleep efficacy were found between the patients who followed MBSR and the control group. Nevertheless, there was a positive relation in these MBSR groups between the amount of meditation practice and sleep quality.
The reviewed studies show some methodological weaknesses. First, studies applied a follow-up no longer than 6 months [9], [14]. Second, the spectrum of measured effects is often limited to distress, while measures of quality of life and positive feelings are often missing [9]. Third, there is a need for more insight into the goals of patients who participate in MBSR and how satisfied they are with this training [9], [17].
We have studied the goals of cancer patients participating in a MBSR training and satisfaction after the training. We also measured changes in their well-being on a wide spectrum of indicators from pre- to post-treatment, and at 1 year follow-up. We expected to find a reduction in mood disturbance and physical symptoms and an improvement in overall quality of life, joy and meaning in life.
Section snippets
Intervention
The MBSR training consists of eight weekly sessions of 2.5 h. Clients are encouraged to practice at home daily for 3/4 h using an exercise CD and to do other homework assignments. In the sixth week of the training course, participants practice meditation in silence for a whole day of 8 h, which is a standard component of the Kabat-Zinn training. Each training group is guided by two therapists; both are experienced in working with cancer patients and one of them has been trained in MBSR.
The
Reliability and influence of social desirability
Cronbach's alpha was >0.80 for all well-being scales, except for meaning in life (alpha = 0.63). This scale was not removed in the analysis, because reliability was sufficient in other studies [26], [27], [28] None of the well-being scales appeared to be significantly associated with the social desirability scores.
Participants
Demographic and medical characteristics are listed in Table 2. The group of 47 participants consisted of 34 women and 13 men; mean age at the start of the training was 48 years (S.D. =
Discussion and conclusion
The aim of this study was to evaluate a mindfulness-based stress reduction training for cancer patients and to explore changes in well-being. Data of 47 participants were available at pre-, post- and follow-up measurements. Participants were highly satisfied and reported that they had reached their goals by following the training. These goals included coping with their illness, finding inner tranquility and raising self-esteem.
The questionnaire data showed a positive shift over time on several
Conflict of interest
There is no conflict of interest.
Acknowledgements
We strongly acknowledge the participation of the patients and the therapists. The appreciated language help was provided by Elisabeth Duverlie, Baltimore, USA.
Role of funding: There was no external financial support for the conduct of the research
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