Improve Mindfulness’ Benefits for Cancer Survivors with Smart-Messaging

Improve Mindfulness’ Benefits for Cancer Survivors with Smart-Messaging


By John M. de Castro, Ph.D.


“Cancer is a traumatic event that changes a person’s life. Utilizing mindfulness tools can provide peace and hope. Practicing mindfulness on a daily basis can assist with long term effects of happiness and positivity.” – Erin Murphy-Wilczek


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. 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. But, surviving cancer carries with it a number of problems. Anxiety, depression, fatigue and insomnia are common symptoms in the aftermath of surviving breast cancer. These symptoms markedly reduce the quality of life of the patients.


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 depressionMindfulness-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. MBCT has been found to help relieve the symptoms of cancer survivors. It makes sense to explore ways to improve the effectiveness of MBCT for cancer patients.


In today’s Research News article “Using smart-messaging to enhance mindfulness-based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation.” (See summary below or view the full text of the study at: ) Wells and colleagues evaluated whether providing text message reminders could enhance the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for the relief of anxiety and depression in cancer patients. They recruited adult cancer patients with mild to moderate anxiety and/or depression and provided them with 8 weekly sessions of MBCT along with 40 minutes daily home practice. The patients could refuse messaging or opt to receive text messages 3 times per week reminding them of their home practice and could request up to 9 more messages per week. They were measured before and after each session and 1 month after the completion of the training for depression, anxiety, and general mental health.


They found that 87% of the patients receiving smart messaging completed the 8-week Mindfulness-Based Cognitive Therapy (MBCT) program while only 38% of the non-messaging patients completed the MBCT program. Both groups had significant reductions in anxiety and depression that were maintained 1 month after treatment. But the smart messaging group had significantly greater reductions in depression.


This is a proof of concept study which demonstrated that smart messaging could be effectively used in conjunction with Mindfulness-Based Cognitive Therapy (MBCT). The results, though, need to be interpreted with great caution. The patients decided whether to receive the messages or not and very different patients might have opted in compared those that refused the messaging. These differences in the groups could account for the observed differences in participation and depression. But this study establishes that this smart messaging method is feasible with cancer patients with suggestions of improved impact of the therapy. A randomized controlled trial is now needed.


So, improve mindfulness’ benefits for cancer survivors with smart-messaging.


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


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


Wells, C., Malins, S., Clarke, S., Skorodzien, I., Biswas, S., Sweeney, T., Moghaddam, N., & Levene, J. (2020). Using smart-messaging to enhance mindfulness-based cognitive therapy for cancer patients: A mixed methods proof of concept evaluation. Psycho-oncology, 29(1), 212–219.




Depression and anxiety lead to reduced treatment adherence, poorer quality of life, and increased care costs amongst cancer patients. Mindfulness‐based cognitive therapy (MBCT) is an effective treatment, but dropout reduces potential benefits. Smart‐message reminders can prevent dropout and improve effectiveness. However, smart‐messaging is untested for MBCT in cancer. This study evaluates smart‐messaging to reduce dropout and improve effectiveness in MBCT for cancer patients with depression or anxiety.


Fifty‐one cancer patients attending MBCT in a psycho‐oncology service were offered a smart‐messaging intervention, which reminded them of prescribed between‐session activities. Thirty patients accepted smart‐messaging and 21 did not. Assessments of depression and anxiety were taken at baseline, session‐by‐session, and one‐month follow‐up. Logistic regression and multilevel modelling compared the groups on treatment completion and clinical effectiveness. Fifteen post‐treatment patient interviews explored smart‐messaging use.


The odds of programme completion were eight times greater for patients using smart‐messaging compared with non‐users, controlling for age, gender, baseline depression, and baseline anxiety (OR = 7.79, 95% CI 1.75 to 34.58, p = .007). Smart‐messaging users also reported greater improvement in depression over the programme (B = ‐2.33, SEB = .78, p = .004) when controlling for baseline severity, change over time, age, and number of sessions attended. There was no difference between groups in anxiety improvement (B = ‐1.46, SEB = .86, p = .097). In interviews, smart‐messaging was described as a motivating reminder and source of personal connection.


Smart‐messaging may be an easily integrated telehealth intervention to improve MBCT for cancer patients.


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