Cancer

Reduce Fear of Cancer Return with Mind-Body Practices

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Reduce Fear of Cancer Return with Mind-Body Practices

 

By John M. de Castro, Ph.D.

 

“the mind and body are really one entity, not two separate parts. Stated simply, there is no separation or division between the mind, body, spirit, and emotions. The best stress management program is one that moves you from fear toward peace, however you understand that concept.” – Health Encyclopedia

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. But over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. Cancer survivors are also at greater risk for developing second cancers and other health conditions and as a result fear of cancer recurrence is a major problem that can interfere with recovery. Hence there is a need to identify safe and effective treatments to reduce fear of cancer return.

 

Mindfulness training has been shown to help with cancer recovery and help to relieve chronic pain. It can also help treat the residual physical and psychological symptoms, including stress,  sleep disturbance, fear, and anxiety and depression. There has been considerable research conducted on the effectiveness of mind-body practices in treating fear of cancer return. So it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488231/), Hall and colleagues reviewed, summarized, and performed a meta-analysis of the published randomized controlled trials (RCTs) of the effects of mind-body practices on the fear of cancer recurrence. They included studies employing meditation, yoga, Tai Chi and Qigong, cognitive-behavioral skills, spirituality, relaxation, and various art therapies. They uncovered 18 published RCTs that included 2806 total participants.

 

They found that mind-body practices produced significant reduction in fear of cancer recurrence regardless of whether the comparison condition was an active control condition, whether the treatment occurred in group or individual format, whether the treatment contained cognitive behavioral skills or not, or whether the treatment contained meditation practice or not. These reductions were still present, albeit at reduced magnitude, up to 2 years after treatment.

 

Fear of cancer recurrence can produce behaviors that interfere with cancer recovery including increased stress, worry, rumination, etc. So, reducing this fear not only improves the psychological health of the patients but also improves their prognosis. These results suggest that mind-body are safe and effective, and have lasting effects reducing fear of cancer recurrence and thus should be incorporated in the treatments for patients recovering from cancer.

 

So, reduce fear of cancer return with mind-body practices.

 

“It is not usually possible for doctors to say for certain that your cancer has been cured. They can’t definitely say that it will never come back. Living with this uncertainty is one of the most difficult things about having cancer.” – Cancer Research UK

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Hall, D. L., Luberto, C. M., Philpotts, L. L., Song, R., Park, E. R., & Yeh, G. Y. (2018). Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis. Psycho-oncology, 27(11), 2546–2558. doi:10.1002/pon.4757

 

Abstract

Objective

Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind-body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR.

Methods

Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind-body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes on self-report measures of FCR were computed by using random-effects models.

Results

Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in-person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind-body components (53%), commonly cognitive-behavioral skills (58%), or meditative practices (53%). Small-to-medium pooled effect sizes were observed post-intervention (Hedges’ g = −0.36, 95% CI = −0.49, −0.23, P < .001) and at follow-up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive-behavioral or mindfulness skills, number of mind-body components, cancer treatment status, and number of sessions) did not reach statistical significance.

Conclusions

Mind-body interventions are efficacious for reducing FCR, with small-to-medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind-body practices for managing fundamental uncertainties and fears during cancer survivorship.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488231/

 

Improve the Physical and Psychological Health of Cancer Patients with Mindfulness

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Improve the Physical and Psychological Health of Cancer Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“It turns out that some of the most difficult elements of the cancer experience are very well-suited to a mindfulness practice.” – Linda Carlson

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including fatigue, stress,  sleep disturbance, fear, and anxiety and depression. The evidence is accumulating. So, it is timely to review and summarize what has been learned.

 

In today’s Research News article “Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916350/), Cillessen and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials (RCTs) on the effectiveness of mindfulness training in treating the symptoms of cancer and its treatment. They found 29 RCTs that included a total of 3224 participants.

 

The summary of the published research reflected that mindfulness training produced significant reductions in psychological distress in the cancer patients including reductions in anxiety, depression, fatigue, and fear of cancer reoccurrence with small to moderate effects sizes. These improvements were found both immediately after treatment and also at follow-up from 3 to 24 months later. Further they found that mindfulness trainings that adhered to the protocols for Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT) had the greatest effect sizes.

 

It has been repeatedly demonstrated that mindfulness training is effective in reducing psychological distress including reductions in anxiety, depression, fatigue, and fear in a wide variety of individuals with and without disease states. The present meta-analysis demonstrates the effectiveness of mindfulness training for the relief of psychological and physical suffering of cancer patients. It does not affect the disease process. Rather, it reduces the patients psychological suffering and does so for a prolonged period of time.

 

So, improve the physical and psychological health of cancer patients with mindfulness.

 

“patients who practice mindfulness begin to feel better despite their medical problems. Physical symptoms don’t necessarily go away, but that’s not the aim of mindfulness. Rather, the goal is to help you find a different perspective and a new way of coping with your illness.” – Eric Tidline

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Cillessen, L., Johannsen, M., Speckens, A., & Zachariae, R. (2019). Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. Psycho-oncology, 28(12), 2257–2269. doi:10.1002/pon.5214

 

Abstract

Objective

Mindfulness‐based interventions (MBIs) are increasingly used within psycho‐oncology. Since the publication of the most recent comprehensive meta‐analysis on MBIs in cancer in 2012, the number of published trials has more than doubled. We therefore conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs), testing the efficacy of MBIs on measures of psychological distress (primary outcome) and other health outcomes in cancer patients and survivors.

Methods

Two authors conducted independent literature searches in electronic databases from first available date to 10 October 2018, selected eligible studies, extracted data for meta‐analysis, and evaluated risk of bias.

Results

Twenty‐nine independent RCTs (reported in 38 papers) with 3274 participants were included. Small and statistically significant pooled effects of MBIs on combined measures of psychological distress were found at post‐intervention (Hedges’s g = 0.32; 95%CI: 0.22‐0.41; P < .001) and follow‐up (g = 0.19; 95%CI: 0.07‐0.30; P < .002). Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain (g: 0.20 to 0.51; p: <.001 to.047). Larger effects of MBIs on psychological distress were found in studies (a) adhering to the original MBI manuals, (b) with younger patients, (c) with passive control conditions, and (d) shorter time to follow‐up. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.

Conclusions

MBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916350/

 

Therapeutic Alliance is Important for Mindfulness Training to Improve the Psychological Health of Cancer Patients

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Therapeutic Alliance is Important for Mindfulness Training to Improve the Psychological Health of Cancer Patients

 

By John M. de Castro, Ph.D.

 

“Both face-to-face and internet-based mindfulness-based cognitive therapy (MBCT) reduced psychological distress compared with usual care in patients with cancer.” – Matthew Stenger

 

Receiving a diagnosis of cancer has a huge impact on most people. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. But, surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress,  sleep disturbance, and anxiety and depression. Mindfulness-Based Cognitive Therapy (MBCT) consists of mindfulness training and Cognitive Behavioral Therapy (CBT). During therapy the patient is trained to investigate and alter aberrant thought patterns underlying their reactions to cancer. It is thought that the alliance between therapist and patient that is formed during treatment is important for the effectiveness of therapy. So, it would make sense to study the effectiveness of MBCT and the therapeutic alliance on the psychological distress of cancer patients.

 

In today’s Research News article “Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827984/), Bisseling and colleagues recruited adult cancer patients and randomly assigned them to either a wait list control condition or to receive Mindfulness-Based Cognitive Therapy (MBCT) in a group setting in 8 weekly 2.5 hour sessions with daily homework or online in 8 weekly practice sessions with therapist feedback emails. The participants were measured before and after training for anxiety, depression, mental well-being, and therapeutic alliance consisting of questions on “(1) how closely client and therapist agree on and are mutually engaged in the goals of treatment; (2) how closely client and therapist agree on how to reach the treatment goals; and (3) the degree of mutual trust, acceptance, and confidence between the client and therapist.”

 

Of the Mindfulness-Based Cognitive Therapy (MBCT) participants significantly more dropped out of the online version (12.1%) than the group version(5.6%). The therapeutic alliance increased significantly over the intervention and did not differ between MBCT groups. They found that relative to baseline and the wait list control group MBCT training produced significant reductions in psychological distress and increases in mental well-being. In addition, the higher the level of therapeutic alliance at week 2 of the intervention the greater the reduction in psychological distress and increase in mental well-being over the program. Finally, they found that if the therapeutic alliance was weak at week 2 then there was less improvement in psychological distress in the group version of MBCT than the online version.

 

These results are in line with previous findings that mindfulness training produces improves mental well-being and decreases psychological distress in cancer patients, that online mindfulness training is effective, and that therapeutic alliance is important for the effectiveness of mindfulness training. These results suggest that the development of therapeutic alliance be emphasized in mindfulness training. It is interesting that therapeutic alliance can be just as effectively developed online as in person and that it is less responsive to early low therapeutic alliance. This may explain, in part, why online mindfulness training is very effective.

 

So, therapeutic alliance is important for mindfulness training to improve the psychological health of cancer patients.

 

“mindfulness-based therapy is an effective way of treating anxiety and depression in cancer patients.” – Robert Zachariae

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Bisseling, E., Cillessen, L., Spinhoven, P., Schellekens, M., Compen, F., van der Lee, M., & Speckens, A. (2019). Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial. Journal of medical Internet research, 21(10), e14065. doi:10.2196/14065

 

Abstract

Background

Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs.

Objective

This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions.

Methods

This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of MBCT or eMBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form.

Results

The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=−.39; P=.21). Therapeutic alliance increased over time in both conditions (F2,90=16.46; Wilks λ=0.732; P<.001). This increase did not differ between eMBCT and MBCT (F1,91=0.114; P=.74). Therapeutic alliance at week 2 predicted a decrease in psychological distress (B=−.12; t 114=−2.656; P=.01) and an increase in mental well-being (B=.23; t 113=2.651; P=.01) at posttreatment. The relationship with reduction of psychological distress differed between treatments: a weaker early therapeutic alliance predicted higher psychological distress at posttreatment in MBCT but not in eMBCT (B=.22; t 113=2.261; P=.03).

Conclusions

A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827984/

 

Have Higher Job Satisfaction with Cancer Survivors with Spirituality

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Have Higher Job Satisfaction with Cancer Survivors with Spirituality

 

By John M. de Castro, Ph.D.

 

“Although addressing spiritual concerns is often considered an end-of-life issue, such concerns may arise at any time after diagnosis. Acknowledging the importance of these concerns and addressing them, even briefly, at diagnosis may facilitate better adjustment throughout the course of treatment and create a context for richer dialogue later in the illness.” – National Cancer Institute

 

Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. Cancer survivors are often challenged with a wide range of residual issues including chronic pain, sleep disturbance, sexual problems, loss of appetite, and chronic fatigue. Cancer survivors are also at greater risk for developing second cancers and other health conditions. Hence there is a need to identify safe and effective treatments for the physical, emotional, and financial hardships that can persist for years after diagnosis and treatment.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including fatigue, stress,  sleep disturbance, and anxiety and depression. In addition, religion and spirituality become much more important to people when they’re diagnosed with cancer or when living with cancer. It is thought that people take comfort in the spiritual when facing mortality. Hence, spirituality may be a useful tool for the survivors of cancer to cope with their illness. A very important issue for cancer survivors is returning to work. Thus, there is a need to study the relationships of spirituality to cancer survivors’ ability to adjust to their work situations.

 

In today’s Research News article “.” The Mediating Effect of Workplace Spirituality on the Relation between Job Stress and Job Satisfaction of Cancer Survivors Returning to Work. (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6846173/), Jin and Lee recruited cancer survivors who had returned to work for at least 6 months following treatment. They completed measures of job stress, job satisfaction, and workplace spirituality.

 

They found that the higher the levels of spirituality in the cancer survivors, the lower the reported levels of job stress and the higher the reported levels of job satisfaction. They also noted that higher the levels of job stress were associated with lower levels of job satisfaction. In addition, a mediation analysis revealed that the negative relationship of job stress with job satisfaction was in part mediated by spirituality, such that high levels of job stress was directly negatively related to job satisfaction and was also related indirectly by being associated with lower levels of spirituality which were, in turn, related to lower levels of job satisfaction.

 

These findings are correlational and as such causation cannot be determined. But it can be speculated that for cancer survivors stress on the job is detrimental to satisfaction with the job and that being spiritual helps to buffer the influence of stress on satisfaction. Hence, being spiritual may help cancer survivors to better weather stress effects and thus be happier with their work. This may assist the survivors in overcoming some of the residual problems and being better able to return to their occupations.

 

So, have higher job satisfaction with cancer survivors with spirituality/

 

“Spirituality and religion can be important to the well-being of people who have cancer, enabling them to better cope with the disease. Spirituality and religion may help patients and families find deeper meaning and experience a sense of personal growth during cancer treatment, while living with cancer, and as a cancer survivor.” – National Comprehensive Cancer Network

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Jin JH, Lee EJ. The Mediating Effect of Workplace Spirituality on the Relation between Job Stress and Job Satisfaction of Cancer Survivors Returning to Work. Int J Environ Res Public Health. 2019 Sep 20;16(19):3510. doi: 10.3390/ijerph16193510. PMID: 31547142; PMCID: PMC6801382.

 

Abstract

This study aimed to investigate the mediating effect of workplace spirituality in the relation between job stress and job satisfaction as well as the level of job stress, job satisfaction, and workplace spirituality of cancer survivors returning to work. A total of 126 cancer survivors who returned to work more than six months prior to the research participated in this study. Participants were recruited through snowball sampling; they were visiting the outpatient clinic at two general hospitals located in a metropolitan city and their clinical stage was stage 0 or stage 1. The collected data were analyzed using SPSS 22.0. Job stress, workplace spirituality, and job satisfaction had a negative correlation, whereas workplace spirituality and job satisfaction had a positive correlation. The Sobel test was performed to verify the significance of the mediating effect size of workplace adaptation, the results confirmed a partial mediating effect of workplace spirituality on the relation between job stress and job satisfaction (Z = –4.72, p < 0.001). This study confirmed the mediating effect of workplace spirituality in the relation between job stress and job satisfaction. A systematic program needs to be developed to enhance workplace spirituality, a spiritual approach, to relieve job stress and increase job satisfaction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801382/

 

Improve Cancer Patients Physical and Psychological Health with Spiritual Care

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Improve Cancer Patients Physical and Psychological Health with Spiritual Care

 

By John M. de Castro, Ph.D.

 

“Spirituality and religion can be important to the well-being of people who have cancer, enabling them to better cope with the disease. Spirituality and religion may help patients and families find deeper meaning and experience a sense of personal growth during cancer treatment, while living with cancer, and as a cancer survivor.” – National Comprehensive Cancer Network

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.

 

Religion and spirituality become much more important to people when they’re diagnosed with cancer or when living with cancer and also for their caregivers. It is thought that people take comfort in the spiritual when facing mortality. But, spiritual concerns, such as feelings of being abandoned by god or needing forgiveness for actions in their lives might lead to anxiety and worry rather than comfort and can exacerbate the psychological burdens of cancer or on the quality of life of cancer patients. The research is accumulating. Hence, there is a need to step back and summarize what has been learned regarding the effects of spiritual care on the cancer patient.

 

In today’s Research News article “). Interprofessional spiritual care in oncology: a literature review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435249/), Puchalski and colleagues review and summarize the published research literature on the relationship of spirituality to cancer treatment. They define spirituality as ‘Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.’

 

They report that the published literature finds that spirituality is related to improved psychological and physical well-being of cancer patients across a wide variety of cancers at a wide variety of stages. Greater levels of spirituality are related to greater levels of quality of life during and after cancer treatment. On the other hand, cancer often results in higher levels of spiritual distress, including existential distress, hopelessness, despair and anger at God. Spiritual distress is, in turn, associated with poorer physical, social and emotional distress. Hence, spiritual care is important for the well-being of the cancer patient.

 

The published research makes a clear case that spirituality is related to better physical and psychological well-being in cancer patients while spiritual distress is related to worse outcomes. This underscores the need for training of healthcare workers in spiritual care. It is also clear that more research is needed to discover best practices for spiritual care for a variety of different patients.

 

So, improve cancer patients physical and psychological health with spiritual care.

 

“It is not known for sure how spirituality and religion are related to health. Some studies show that spiritual or religious beliefs and practices create a positive mental attitude that may help a patient feel better and improve the well-being of family caregivers.” – National Cancer Institute

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Puchalski, C. M., Sbrana, A., Ferrell, B., Jafari, N., King, S., Balboni, T., … Ripamonti, C. I. (2019). Interprofessional spiritual care in oncology: a literature review. ESMO open, 4(1), e000465. doi:10.1136/esmoopen-2018-000465

 

Abstract

Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care.

Conclusion

Our literature review demonstrates that spirituality is an important component of health and general well-being of patients with cancer, and that spiritual distress has a negative impact on quality of life of patients with cancer. This makes the implementation of spirituality-based interventions essential in order to support the spiritual well-being of patients with cancer. Spirituality and spiritual well-being have been proven to have a positive effect on patients with cancer. Many national (eg, Great Britain) and international oncology palliative care as well as supportive care societies (ie, MASCC) have already created specific recommendations, guidelines and working groups on this matter, but it is important to widen oncology health professionals’ knowledge about spirituality and to implement spirituality as a cornerstone of oncological patients’ care. More research is needed to further our understanding of the role of spirituality in different cultural and clinical settings and to develop standardised models and tools for screening and assessment. Findings from this literature review also point to the need for more robust studies to assess the effectiveness of spiritual care interventions in improving patient, family and clinician’s outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435249/

 

Improve the Symptoms of Myeloproliferative Neoplasm Patients with Online Yoga

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Improve the Symptoms of Myeloproliferative Neoplasm Patients with Online Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga classes specifically created for cancer patients offer more than a traditional support group. Yoga creates a sense of belonging, reduces feelings of stress and improves quality of life.” – Sara Szeglowski

 

“Myeloproliferative Neoplasms (MPNs) are blood cancers that occur when the body makes too many white or red blood cells, or platelets” (Cancer Support Community). It typically occurs in older adults and is fairly rare (1-2 cases/100,000 per year) and has a very high survival rate. It produces a variety of psychological and physical symptoms including fatigue, anxiety, pain, depression, and sleep disturbance, reduced physical, social, and cognitive functioning resulting. This produces a marked reduced in the patient’s quality of life.

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health including fatigue, anxiety, depression, pain, and sleep disturbance, and improves physical, social, and cognitive functioning as well as quality of life in cancer patients. Yoga practice also improves the physical and mental health of cancer patients. The vast majority of the yoga practice, however, requires a trained instructor. It also requires that the participants be available to attend multiple sessions at particular scheduled times that may be difficult for myeloproliferative neoplasm patients to attend and may or may not be compatible with their schedules and at locations that may not be convenient.

 

As an alternative, online yoga trainings have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But the question arises as to the effectiveness of these online programs in relieving the psychological and physical symptoms of myeloproliferative neoplasm patients and improving their quality of life.

 

In today’s Research News article “Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556039/), Huberty and colleagues recruited adult myeloproliferative neoplasm patients and randomly assigned them to either receive online yoga training or to a wait-list control condition. Yoga training occurred via streamed videos for a total of 60 minutes training per week for 12 weeks. The individual training videos increased in duration from 5 minutes to 30 minutes over the 12 weeks. The participants were measured for adverse events and yoga participation by self-report and by clicking on the video links and over the training period. Before and after training they were measured for total symptoms, fatigue, pain intensity, anxiety, depression, sleep disturbance, sexual function, and quality of life. In, addition, blood was drawn and assayed for inflammatory cytokines.

 

They found that 79% of the patients in the yoga group completed participation averaging 42 minutes per week and there were no adverse events reported. Self-reports of yoga participation were over-reported by on average 10 minutes as assessed by actual clicks on the yoga video links. They found that in comparison to baseline and the wait-list group, the yoga group reported a moderate decrease in depression and small decreases in anxiety, pain intensity, sleep disturbance, and in TNF-α blood levels.

 

This was a pilot feasibility study and did not have a sufficient number of participants to detect small effects. It also lacked an active control, such as aerobic exercise. Nevertheless, the trial suggests that teaching yoga online is feasible and can successfully improve the psychological health of myeloproliferative neoplasm patients and reduce inflammation. This is potentially important as yoga treatment can be successfully employed remotely, inexpensively, and conveniently and can reduce the suffering of myeloproliferative neoplasm patients. A large randomized clinical trial with an active control condition is justified by these encouraging results.

 

So, improve the symptoms of myeloproliferative neoplasm patients with online yoga.

 

“Some people with cancer say it helps calm their mind so that they can cope better with their cancer and its treatment. Others say it helps to reduce symptoms and side effects such as pain, tiredness, sleep problems and depression.” – Cancer Research UK

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Huberty, J., Eckert, R., Dueck, A., Kosiorek, H., Larkey, L., Gowin, K., & Mesa, R. (2019). Online yoga in myeloproliferative neoplasm patients: results of a randomized pilot trial to inform future research. BMC complementary and alternative medicine, 19(1), 121. doi:10.1186/s12906-019-2530-8

 

Abstract

Background

Myeloproliferative neoplasm (MPN) patients suffer from significant symptoms, inflammation and reduced quality of life. Yoga improves these outcomes in other cancers, but this hasn’t been demonstrated in MPNs. The purpose of this study was to: (1) explore the limited efficacy (does the program show promise of success) of a 12-week online yoga intervention among MPN patients on symptom burden and quality of life and (2) determine feasibility (practicality: to what extent a measure can be carried out) of remotely collecting inflammatory biomarkers.

Methods

Patients were recruited nationally and randomized to online yoga (60 min/week of yoga) or wait-list control (asked to maintain normal activity). Weekly yoga minutes were collected with Clicky (online web analytics tool) and self-report. Those in online yoga completed a blood draw at baseline and week 12 to assess inflammation (interleukin-6, tumor necrosis factor-alpha [TNF-α]). All participants completed questionnaires assessing depression, anxiety, fatigue, pain, sleep disturbance, sexual function, total symptom burden, global health, and quality of life at baseline, week seven, 12, and 16. Change from baseline at each time point was computed by group and effect sizes were calculated. Pre-post intervention change in inflammation for the yoga group was compared by t-test.

Results

Sixty-two MPN patients enrolled and 48 completed the intervention (online yoga = 27; control group = 21). Yoga participation averaged 40.8 min/week via Clicky and 56.1 min/week via self-report. Small/moderate effect sizes were generated from the yoga intervention for sleep disturbance (d = − 0.26 to − 0.61), pain intensity (d = − 0.34 to − 0.51), anxiety (d = − 0.27 to − 0.37), and depression (d = − 0.53 to − 0.78). A total of 92.6 and 70.4% of online yoga participants completed the blood draw at baseline and week 12, respectively, and there was a decrease in TNF-α from baseline to week 12 (− 1.3 ± 1.5 pg/ml).

Conclusions

Online yoga demonstrated small effects on sleep, pain, and anxiety as well as a moderate effect on depression. Remote blood draw procedures are feasible and the effect size of the intervention on TNF-α was large. Future fully powered randomized controlled trials are needed to test for efficacy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556039/

 

Improve Personal Growth in Cancer Survivors with Mindfulness and Spirituality

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Improve Personal Growth in Cancer Survivors with Mindfulness and Spirituality

 

By John M. de Castro, Ph.D.

 

“religion and spirituality can help cancer patients find meaning in their illness and provide comfort in the face of fear.” – American Cancer Society

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including fatigue, stress,  sleep disturbance, and anxiety and depression. In addition, religion and spirituality become much more important to people when they’re diagnosed with cancer or when living with cancer. It is thought that people take comfort in the spiritual when facing mortality. Hence, spirituality and mindfulness may be useful tools for the survivors of cancer to cope with their illness. Thus, there is a need to study the relationships of spirituality and mindfulness on the ability of cancer survivors to positively adjust to their situation.

 

In today’s Research News article “Spiritual coping, perceived growth, and the moderating role of spiritual mindfulness in cancer survivors.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340393/), Rudaz and colleagues recruited cancer survivors and had them complete questionnaires measuring spiritual coping (using spirituality as a comfort during difficulties), spiritual mindfulness, personal growth, and positive reinterpretation (interpreting stressful events in a positive way).

 

They found that for the cancer survivors, the greater the levels of mindfulness, the greater the levels of personal growth and the greater the levels of positive reinterpretation. Hence mindfulness was associated with positive adjustments to their illness. Further they found that higher levels of spiritual coping were associated with higher levels of personal growth and higher levels of positive reinterpretation only when mindfulness was high. No relationship was present when mindfulness was low. Younger participants and those with higher levels of education had significantly higher levels of personal growth.

 

It has to be kept in mind that the study was correlational and as such no conclusions about causation can be reached. But the results suggest that spiritual mindfulness is associated with two positive characteristics in cancer survivors, personal growth and positive reinterpretation. In other words, being mindful was associated with an ability to interpret the illness in a positive way and use it as a springboard for greater personal growth. Being able to take solace in spirituality (spiritual coping) was only an effective strategy when the cancer survivors had high levels of mindfulness. Hence, mindfulness is an important characteristic on its own but also one that allows for spirituality to be associated with growth. They appear to have to work together.

 

So, improve personal growth in cancer survivors with mindfulness and spirituality.

 

“Results show promise for mindfulness-based interventions to treat common psychological problems such as anxiety, stress, and depression in cancer survivors and to improve overall quality of life.” — Linda E. Carlson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Rudaz, M., Ledermann, T., & Grzywacz, J. G. (2018). Spiritual coping, perceived growth, and the moderating role of spiritual mindfulness in cancer survivors. Journal of psychosocial oncology, 36(5), 609–623. doi:10.1080/07347332.2018.1464091

 

Abstract

Purpose.

This study examined the moderating role of spiritual mindfulness on the association between spiritual coping and perceived growth in individuals with and without current treatment for cancer.

Design/Sample.

Adults with a cancer history (N = 534) from the Midlife in the United States study completed a telephone interview and self-administered questionnaires.

Methods/Findings.

Moderated regression analyses, controlled for age and educational attainment, showed that mindfulness moderated the effect of spiritual coping on personal growth and on positive reinterpretation. High mindfulness amplified the effect of spiritual coping on both personal growth and positive reinterpretation. Further, this moderating effect was significantly different for adults with versus without current treatment for cancer for positive reinterpretation but not for personal growth.

Conclusions/Implications.

These findings highlight the potential amplifying effect of spiritual mindfulness on the effect of spiritual coping on perceived growth in cancer survivors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340393/

 

Improve the Psychological Health of Cancer Patients with Psilocybin

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Improve the Psychological Health of Cancer Patients with Psilocybin

 

By John M. de Castro, Ph.D.

 

“Our research has shown that, in a medically controlled setting with expert screening and preparation, psilocybin can relieve the symptoms of anxiety and depression often found in patients with a cancer diagnosis.” – Heffter Research Institute

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. Psychedelics produce effects that are similar to those that are reported in spiritual awakenings. They report a loss of the personal self. They experience what they used to refer to as the self as just a part of an integrated whole. They report feeling interconnected with everything else in a sense of oneness with all things. They experience a feeling of timelessness where time seems to stop and everything is taking place in a single present moment. They experience ineffability, being unable to express in words what they are experiencing and as a result sometimes producing paradoxical statements. And they experience a positive mood, with renewed energy and enthusiasm.

 

It is easy to see why people find these experiences so pleasant and eye opening. They often report that the experiences changed them forever. Even though the effects of psychedelic substances have been experienced and reported on for centuries, only very recently have these effects come under rigorous scientific scrutiny.

 

Psilocybin is a psychedelic substance that is found naturally in a number of varieties of mushrooms. It has been used for centuries particularly by Native Americans for their spiritual practices. When studied in the laboratory under double blind conditions, Psilocybin has been shown to “reliably occasion deeply personally meaningful and often spiritually significant experiences (e.g. mystical-type experiences).”

 

In today’s Research News article “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367557/), Griffiths and colleagues recruited patients with a potentially life threatening cancer diagnosis and high levels of anxiety and/or a mood disorder. They were randomly assigned to receive psilocybin in the lab in a living room type highly supportive environment with either a low dose in the first session and the high dose in the second 5 weeks later or in reverse order with the high dose first followed by low dose. Doses were administered double blind.

 

They were measured during the session for heart rate and respiration and ratings by attending monitors. After the drug effects subsided (7 hours after administration) they were measured for hallucinogen ratings, altered states of consciousness, mystical experiences, states of consciousness, and mysticism. They were also measured at baseline and five weeks after each session and 6 months later for anxiety, depression, mood, psychiatric symptoms, quality of life, optimism, spirituality, death acceptance, death transcendence, purpose in life, life coherence, and persisting effects of psilocybin. Family friends, and co-workers were also asked to rate the participant’s behavior and attitudes.

 

After the sessions no continuing adverse events were detected. During the sessions there were significant dose dependent increases in heart rate, blood pressure, joy and happiness, and visual experiences, and all ratings by the session monitors of behavior and mood. These effects all dissipated by the end of the session.

 

In comparison to baseline at all time points after psilocybin administration there were clinically significant decreases in anxiety, depression, psychiatric symptoms and significant increases in mood, quality of life, optimism, spirituality, death acceptance, death transcendence, purpose in life, and life coherence. Family friends, and co-workers also reported significant improvements in mood and behavior in the cancer patients. They also found that the greater the mystical experiences that the cancer patients had during the sessions the greater the levels of meaningfulness, spiritual significance, increased life satisfaction, meaningful existence, death acceptance, death transcendence, purpose in life, and coherence and the lower the levels of anxiety and depression.

 

The results suggest that psilocybin administration to patients with life threatening cancer diagnoses who also had high levels of anxiety and/or mood disturbance produced large and clinically significant improvements in their psychological and spiritual well-being. These benefits were observed by clinicians, session monitors, family, friend, and co-workers, and the patients themselves. These results are remarkable particularly due to the magnitude of the effects, the breadth of the benefits, their obviousness to all concerned, and the persistence of the effects, generally still large and significant 6 months after the session. This suggests that psilocybin treatment may be greatly beneficial to relieve the psychological suffering and the spiritual difficulties precipitated by cancer diagnosis.

 

So, improve the psychological health of cancer patients with psilocybin.

 

“a substantial majority of people suffering cancer-related anxiety or depression found considerable relief for up to six months from a single large dose of psilocybin — the active compound in hallucinogenic “magic mushrooms.” – Vanessa McMains

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., … Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of psychopharmacology (Oxford, England), 30(12), 1181–1197. doi:10.1177/0269881116675513

 

Abstract

Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety. This randomized, double-blind, cross-over trial investigated the effects of a very low (placebo-like) dose (1 or 3 mg/70 kg) vs. a high dose (22 or 30 mg/70 kg) of psilocybin administered in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up. Instructions to participants and staff minimized expectancy effects. Participants, staff, and community observers rated participant moods, attitudes, and behaviors throughout the study. High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety. Participants attributed improvements in attitudes about life/self, mood, relationships, and spirituality to the high-dose experience, with >80% endorsing moderately or greater increased well-being/life satisfaction. Community observer ratings showed corresponding changes. Mystical-type psilocybin experience on session day mediated the effect of psilocybin dose on therapeutic outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367557/

 

Treat Cancer with Mindfulness

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By John M. de Castro, Ph.D.

 

“A cancer diagnosis brings an awareness of the preciousness of life,” Fine explains. “And mindfulness can help us to experience that precious life with greater clarity, balance, and gratitude, one moment at a time.” – Micki Fine

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. In addition, cancer patients are often challenged with a wide range of residual issues including chronic pain, sleep disturbance, sexual problems, loss of appetite, and chronic fatigue. Cancer survivors are also at greater risk for developing second cancers and other health conditions.

 

But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. Hence there is a need to identify safe and effective treatments for the physical, emotional, and financial hardships that can persist for years after diagnosis and treatment.

 

Mindfulness training has been shown to help with cancer recovery and help to relieve chronic pain. It can also help treat the residual physical and psychological symptoms, including stress,  sleep disturbance, and anxiety and depression. The evidence is rapidly accumulating, so it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6623989/), Mehta and colleagues review and summarize the published research literature on the effectiveness of mindfulness practice to relieve the physical and psychological suffering of cancer patients. They identified 124 published research studies using a variety of mindfulness training programs, most of which involved either the Mindfulness-Based Stress Reduction (MBSR) program or Mindfulness-Based Cognitive Therapy (MBCT) or versions of MBSR. or MBCT that were modified for the needs of cancer patients.

 

They report that the published research finds that mindfulness training is safe, resulting in few if any negative effects and effective, producing significant improvements in cancer-related stress, depression, pain intensity, fatigue, loss of appetite and weight loss, insomnia, immune responses, and psychological responses to chemotherapy. Mindfulness training also improved the ability of caregivers for cancer patients to deal with the psychological stresses. They also report that studies indicate that mindfulness training is cost effective in treating cancer patients compared to other approaches. Hence, the research to date suggests that mindfulness training is a safe, effective, and cost effective treatment for a variety of cancer-related problems in cancer survivors and their caregivers.

 

So, treat cancer with mindfulness.

 

“results show promise for mindfulness-based interventions to treat common psychological problems such as anxiety, stress, and depression in cancer survivors and to improve overall quality of life.” – Linda Carlson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Mehta, R., Sharma, K., Potters, L., Wernicke, A. G., & Parashar, B. (2019). Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques. Cureus, 11(5), e4629. doi:10.7759/cureus.4629

 

Abstract

Mindfulness is being used increasingly in various aspects of cancer management. Benefits of mindfulness practices are being observed to manage the adverse effects of treatment, symptoms from cancer progression, and the cost-effectiveness compared to conventional contemporary management strategies. In this review article, we present clinical trial data showing the benefits of mindfulness in various aspects of cancer management as well as techniques that have been commonly used in this practice.

Conclusions

Mindfulness-based practices are being increasingly utilized in various aspects of cancer management. It has shown utility in multiple prospective trials and continues to be explored. Most of the evidence of the benefit of mindfulness in cancer is to reduce toxicity and stress. There is a need for more prospective trials exploring its use in reducing cancer incidence or preventing its recurrence.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6623989/

 

Therapeutic Alliance is Important for Success in Treating Cancer Patients with Mindfulness

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Therapeutic Alliance is Important for Success in Treating Cancer Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Compared with [treatment as usual], MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.” – Felix Compen

 

Receiving a diagnosis of cancer has a huge impact on most people. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. But, surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress,  sleep disturbance, and anxiety and depression. Mindfulness-Based Cognitive Therapy (MBCT) consists of mindfulness training and Cognitive Behavioral Therapy (CBT). During therapy the patient is trained to investigate and alter aberrant thought patterns underlying their reactions to cancer. So, it would make sense to study the effectiveness of MBCT and the characteristics of the therapy the psychological distress of cancer patients.

 

In today’s Research News article “Therapeutic alliance-not therapist competence or group cohesion-contributes to reduction of psychological distress in group-based mindfulness-based cognitive therapy for cancer patients.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680267/ ), Bisseling and colleagues recruited cancer patients who were high in anxiety and depression and randomly assigned them to receive Mindfulness-Based Cognitive Therapy (MBCT) delivered either face-to-face in groups or online or to continue receiving treatment as usual. MBCT was delivered in 8 weekly 2.5 hour sessions along with audio guided home practice. They were measured before and after treatment for psychological distress, group cohesion, therapeutic alliance, and therapist competence.

 

Only the data from patients who had completed therapy were included in the analysis. They found that following treatment there was a significant decrease in anxiety and depression (psychological distress). They also found that the higher the levels of therapeutic alliance the greater the reduction in psychological distress. This was not true for either the group cohesion or the therapist competence.

 

Therapeutic alliance consists of “how closely client and therapist agree on and are mutually engaged in the goals of treatment; how closely client and therapist agree on how to reach the treatment goals; and the degree of mutual trust, acceptance, and confidence between client and therapist.” So, the results suggest that this relationship between patient and therapist is an important factor in the effectiveness of mindfulness treatment to improve the psychological distress of cancer patients. It is not how good the therapist is, but how well they create a mutual agreement regarding the therapy that is important for the effectiveness of the therapy.

 

This agreement may signal a buy-in by the patient to the efficacy of the therapy. This, in turn, can drive a positive expectation for therapeutic success both from the patient and the therapist. It has been demonstrated that the beliefs of the patient and the therapist have powerful effects on the outcome. So, it is possible that the therapeutic alliance is simply a measure of the power of those expectations and, in turn, the effectiveness of the program.

 

“Mindfulness-based cognitive therapy (MBCT) and individual Internet-based MBCT (eMBCT) had comparable efficacy in improving psychological distress among patients with cancer.” – James Nam

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Bisseling, E. M., Schellekens, M., Spinhoven, P., Compen, F. R., Speckens, A., & van der Lee, M. L. (2019). Therapeutic alliance-not therapist competence or group cohesion-contributes to reduction of psychological distress in group-based mindfulness-based cognitive therapy for cancer patients. Clinical psychology & psychotherapy, 26(3), 309–318. doi:10.1002/cpp.2352

 

Abstract

Mindfulness‐based cognitive therapy (MBCT) is an innovative evidence‐based intervention in mental and somatic health care. Gaining knowledge of therapeutic factors associated with treatment outcome can improve MBCT. This study focused on predictors of treatment outcome of MBCT for cancer patients and examined whether group cohesion, therapeutic alliance, and therapist competence predicted reduction of psychological distress after MBCT for cancer patients. Moreover, it was examined whether therapist competence facilitated therapeutic alliance or group cohesion. Multilevel analyses were conducted on a subsample of patients collected in a larger randomized controlled trial on individual internet‐based versus group‐based MBCT versus treatment as usual in distressed cancer patients. The current analyses included the 84 patients who completed group‐based MBCT out of 120 patients who were randomized to group‐based MBCT. Group cohesion and therapist competence did not predict reduction in psychological distress, whereas therapeutic alliance did. In addition, therapist competence did not predict therapeutic alliance but was associated with reduced group cohesion. Our findings revealed that therapeutic alliance significantly contributed to reduction of psychological distress in MBCT for cancer patients. Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT.

Key Practitioner Message

  • Mindfulness‐based cognitive therapy (MBCT) is an innovative evidence‐based intervention in mental and somatic health care and has been increasingly applied in oncology to reduce psychological distress.
  • Therapeutic alliance predicts reduction in psychological distress after MBCT for cancer patients, whereas group cohesion and therapist competence did not.
  • Therapist competence did not appear to be a precondition for a good therapeutic alliance and high group cohesion.
  • Contrary to expectation, we found competence to be negatively related to group cohesion.
  • Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT for cancer patients.
  • The current findings should be taken into account in the training of MBCT therapists.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6680267/