Mindfulness in Cancer Care. Christina Shennan Psychotherapist UKCP Dip MBAs CancerHelp

Transcription

1 Mindfulness in Cancer Care Christina Shennan Psychotherapist UKCP Dip MBAs CancerHelp

2 Cancer and suffering Cancer is frequently accompanied by psychological suffering, often long lasting (1) 10 20% of patients go onto to develop psychiatric disorders of depression and anxiety (2) Macmillan Cancer Support s Worried Sick report (2006) found that more than 45% of patients with cancer found the emotional effects of the disease more difficult to deal with than the physical or practical effects (3)

3 Mindfulness One of the rapidly emerging influences in the field of health care and psychological suffering is mindfulness (4) Mindfulness Based Stress Reduction MBSR Mindfulness Based Cognitive Therapy MBCT 8 week structured researched programmes formal and informal mindfulness practice

4 What is mindfulness? Mindfulness is a means to free oneself from adding suffering to existing difficulty and pain (5) Mindfulness is about allowing and accepting rather than avoiding, suppressing or holding on to experience

5 What is mindfulness? paying attention in a particular way: on purpose, in the present moment, and non-judgmentally (6).

6 Mindfulness in oncology Living in the moment, non-judgmentally, has particular resonance for many cancer patients, vulnerable to anxious preoccupation about past life style decisions and future illness and treatment (7)

7 Mindfulness in oncology 2009 Cancer Experiences Collaborative (CECo) Scholarship Aim: to review the evidence for the use of mindfulness-based interventions in cancer care Reference Shennan, C., Payne, S. and Fenlon, D., What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psycho-Oncology, n/a. doi: /pon.1819

8 Results 13 research papers 4 conference abstracts since papers 3 Randomised Control Trials 2 Non Randomised Control Trials 5 Pre Post test design 2 Qualitative studies

9 Participant groups Mixed cancer diagnosis and stage Gynaecological cancer Early diagnosis breast cancer Undergoing acute treatment Post treatment breast cancer Terminal cancer

10 Mindfulness Interventions Mindfulness Based Stress Reduction Mindfulness Based Cognitive Therapy Psycho-educational programme with mindfulness component Brief mindfulness training One to one mindfulness instruction

11 Mindfulness Interventions Variations Individual and group Number of sessions 3-8 Duration 3-12 weeks Contact time 3-28 hours Invited daily practice 5-60 minutes

12 Findings Psychological Significant improvements in depression, anxiety and distress post intervention Physical effects Positive effects on immune function and physiological sexual arousal Quality of Life Overall findings for quality of life and well being show a trend for improvement

13 Conclusion collective evidence supports the view that mindfulness is a promising intervention in cancer care, potentially across the cancer trajectory need for more randomised control trials, longer follow-up, comparison groups and larger sample sizes in quantitative research studies, as well as a more diverse participant base delivery of mindfulness in cancer care is not limited to MBSR and MBCT

14 Conclusion More research is needed on simplified mindfulness interventions, which may be appropriate for those who are sick, undergoing intensive treatment, or in terminal stages Need for more qualitative research on participants experience Research on the mindfulness facilitator is recommended

15 Further research More than 5o papers in the field published since this review.

16 Mindfulness Based Cognitive Therapy for Cancer at Cancer Help Mindfulness Based Cognitive Therapy for Cancer MBCT CA 8 weeks of weekly 2 ½ hour sessions with one full practice day Formal mindfulness practices Body scan Sitting meditation Mindful movement Mindful walking Short practices Poetry Informal practices Daily home practice supported by CDs and manual

17 Too stressed for stress reduction? Taking the mindfulness based stress reduction programme can be stressful (JKZ) Is the course right for me right now?

18 Orientation Levels of distress Support structures Ability to sustain weekly class and home practice Rigours of treatment Shock Coping strategy Experience of teacher

19 Participants CancerHelp services are free of charge to anyone affected by a diagnosis of cancer Patients with a diagnosis of cancer Early diagnosis Undergoing treatment Survivorship Palliative Carers Bereaved

20 Participants Mainly female, white, in middle age Age range from early 20s to 70s Breast cancer the most common diagnosis

21 Findings Of the 27 participants that who completed pre and post questionnaires WHO Well Being Scale 85% significant increase well being 15% non significant decrease DASS21 S pre mild post normal A pre moderate post mild D pre moderate post normal

22 Patient comments This course has taught me to be kind to myself has given me the knowledge to allow myself space and time and not to react instantly It has given me tools for life - greatly heightened my awareness of how I am and to live life as much as possible in the present moment helping me feel more grounded I think it might have helped me turn the corner to get on with the rest of my life to live for now and not in the past. I want to help myself

23 Before coming here I was very stressed, angry with myself, full of guilt feelings I feel much calmer and able to cope and I sleep so much better than before which is a very positive thing for me How I respond to situations has changed, my perspective on my daily life is much more aware. Thanks. I know things are not going to improve much but feel I can go forward now rather than be angry and upset all the time

24 Realisation need to address issues that I do not understand but are causing me distress I appreciate the little and big things in life and value every moment. Feel a lot calmer about everyday life in general and very happy about getting some kind of control with my OCD I have slowed down, I have a more controlled pace where in the past I would have been overwhelmed

25 Ongoing programmes MBCT Ca 2 programmes a year Monthly ongoing facilitated practice sessions Weekly self run drop in group

26 Mindfulness for the care giver

27 Mindfulness for the caregiver It is well documented that those working with people that are ill and distressed are vulnerable to stress related illness and burnout

28 Practice of mindfulness meditation in heathcarers Has been proposed as one means of giving self care and enhancing communication with patients (13)

29 Review of effectiveness of mindfulness training (MBSR ) on health professionals, 2009 (14) psychology students medical & nursing students physicians nurses social workers hospital employees

30 Findings Increase positive affect self-compassion relaxation empathy Decrease negative affect anxiety symtoms of burn out emotional exhaustion overall psycological distress

31 Limitations Small sample sizes Lack of comparison studies No research into potential harmful effects Lack of information about teacher Conclusion Mindfulness training can serve as a tool to promote self care and wellbeing in health professionals

32 Effects of MBSR on family caregivers, 2011 (15) Post MBSR and 1 month follow up Decreases in depression, perceived stress, burden Increase of calmness

33 Mindfulness training for carers of adults with disabilities, 2004 (16) Increased mindfulness of caregiver = increased happiness of those being cared for

34 Mindfulness in hospice studies Mindfulness in Hospice Care: Practicing Meditation-in-Action Anne Bruce Betty Davies A philosophical exploration Mindfulness meditation was practiced by hospice caregivers and fostered internal and external environments wherein ambiguous, nondual, and paradoxical human experiences were supported. QUALITATIVE HEALTH RESEARCH, Vol. 15 No. 10, December

35 Poster Presentations Mindfulness Based Stress Reduction (MBSR) for Hospice Staff A Pilot Study Susie Chater Gemma Griffith significant reduction in perceived stress immediately after the MBSR course and a significant increase in both mindfulness and self compassion after the course and at 3 months Clinical Compassion: Mindfulness in end of life care an evaluated pilot of mindfulness based cognitive therapy training for Hospice at Home nurses Dr Eileen Palmer FRCP (London) Hospice at Home West Cumbria and the University of Oxford MBCT is a promising approach for developing workforce wellbeing, compassion and clinical empathy.

36 References 1. Ross L, Boesen EH, Dalton SO, Johansen C. Mind and cancer: does psychosocial intervention improve survival and psychological well-being? Eur J Cancer 2002;38(11): Lloyd-Williams, M. (2006). Depression, Anxiety and Confusion. In M. Fallon & J. Hanks (Eds.), ABC of Palliative Care (Second Edition ed., pp ): Blackwell Publishing 3. Macmillan. Worried Sick The Emotional Impact of Cancer. Macmillan Cancer Support, Dryden W, Still A. Historical aspects of mindfulness and self-acceptance in psychotherapy. J Ration Emotive Cogn Behav Ther 2006;24(1): Gunaratana H. Mindfulness in Plain English. Wisdom Publications: Boston, MA, Baer R, Krietemeyer J. Overview of mindfulness and acceptance based treatment approaches. In Mindfulness Based Treatment Approaches; Clinician s Guide to Evidence Base and Applications, Baer R (ed.). Elsevier Academic Press: Burlington, MA, Kabat-Zinn, J. (1994) Wherever You Go There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion. 7. Speca M, Carlson LE, Mackenzie MJ, Angen M. Mindfulness-based stress reduction (MBSR) as an intervention for cancer patients. In Mindfulness Based Treatment Approaches: Clinician s Guide to Evidence Base and Applications, Baer R (ed.). Elsevier Academic Press: Burlington, MA, p

37 References 8. Ott MJ, Norris RL, Bauer-Wu S. Mindfulness Meditation for Oncology Patients: A Discussion and Critical Review. Integrative Cancer Therapies. 2006;5(2): Ledesma D, Kumano H. Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology. 2009;18(6):571-9.DOI /pon Smith JE, Richardson J, Hoffman C, Pilkington K. Mindfulnessbased stress reduction as supportive therapy in cancer care: systematic review. Journal of Advanced Nursing. 2005;52(3): Matchim Y, Armer JM. Measuring the psychological impact of mindfulness meditation on health among patients with cancer: a literature review. Oncol Nurs Forum Sep;34(5): DOI 43M [pii] 12.Mackenzie MJ, Carlson L, Speca M. Mindfulness-Based Stress Reduction (MBSR) in Oncology. Rationale and Review. Evidence- Based Integrative Medicine. 2005;2(3)

38 References 13. Epstein RM. Mindful practice. Journal of the American Medical Association 1999;282: Irving, J.A., P.L. Dobkin, and J. Park, Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR). Complementary therapies in clinical practice, (2): p G Epstein-Lubow, L.M., E Darling, M Armey, A Pilot Investigation of Mindfulness-Based Stress Reduction for Caregivers of Frail Elderly Mindfulness, : p Singh, N.N., et al., Mindful caregiving increases happiness among individuals with profound multiple disabilities. Research in Developmental Disabilities, (2): p