A recent issue of the well-respected Journal of Consulting and Clinical Psychology has an article on the use of Mindfulness-Based Cognitive Therapy (MBCT) for people with cancer. MBCT is an adaptation of Mindfulness-Based Stress Reduction (MBSR) and was developed to reduce depressive relapse. MBSR has already been used with good results in people with cancer across several studies (Carlson et al, 2003; Tacon et al., 2004), including one randomized controlled trial (RCT; Speca et al., 2000). Although it's not the first study employing a mindfulness-based treatment with an oncology population, this new study is the first controlled study of MBCT for people with cancer.
The authors of this study, a group of Australian researchers lead by Dr. Elizabeth Foley, call MBCT a “refinement” of MBSR twice in the article, which I found a strange choice of words. It could imply that MBCT may be better suited to addressing the needs of cancer patients; however, the authors don’t actually say this and the design of the study doesn’t allow for these conclusion to be drawn. Instead, the authors suggest that because depression and anxiety are common in cancer patients, and because MBSR has been shown to be helpful in people with cancer, using MBCT may also be beneficial.
The sample consisted of 115 patients across a range of cancer types. They were randomly assigned to either MBCT or a wait-list condition. The wait-list group received MBCT after the data was collected.
MBCT involves 8 weekly 2-hour sessions in groups of 8-12 people. MBCT was modified in several ways for these participants. Didactic information focused on common problems associated with cancer, including depression, anxiety, and pain. One change that particularly struck me was the body scan. The body scan involves mindfully moving your attention from your toes to the crown of your head. Apparently this was very difficult for many participants, for whom bringing awareness to the cancerous part of the body was very painful and difficult. Consequently, participants had the option of a “graded practice,” which might begin with awareness of the sensation of one’s clothing in the cancerous area. Sensitivity was paid to the physical difficulties of practice and to fatigue. Lastly, 32% of participants had people who cared for them also participate in MBCT per invitation by the researchers. Overall, I was really impressed by the sensitivity in adapting this treatment for cancer patients.
The results of the study indicated that, compared to the wait-list group, people who participated in MBCT showed improvements in anxiety, depression, and distress. These improvements were maintained at a 3-month follow-up. One thing I found impressive is that at 3 months, 62% reported regular meditation practice and 31% reported occasional practice. This means that over 90% found value in continued mindfulness practice.
Given that MBSR has already been used successfully with cancer patients in previous studies, I personally think comparing MBCT to MBSR (as opposed to a wait-list) would have been much more interesting. The authors note that the impact of treatment is comparable to the MBSR RCT by Speca et al. (2000). Consequently, I don’t think this study is particularly groundbreaking. That said, it’s always interesting to encounter a RCT for a mindfulness-based treatment, and the study adds to the growing literature in the use of mindfulness-based interventions for cancer patients.
Full citation for the MCBT study:
Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Mindfulness-Based Cognitive Therapy for individuals whose lives have been affected by cancer: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 78(1), 72-79.
Citations for studies of MBSR with cancer patients (links are included to free PDF's of articles ):
Tacón, A. M., Caldera, Y. M., & Ronaghan, C. (2004). Mindfulness-based stress reduction in women with breast cancer. Families, Systems, & Health, 22(2), 193-203.
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Interesting post. Agree with your comments that a comparison of MBSR and MBCT would have been more interesting.
ReplyDeleteI think it is wonderful that this study supports the use of mindfulness in cancer. I wonder whether comparing MBSR and MBCT is a little like splitting hairs. It may be better for us clinicians to pull together in one tribe of mindfulness facilitators. Great that there is more evidence for its use in oncology, great that this trial had a relatively big sample size and great that clinicians who have trained in MBCT (which is more accessible for many) have some more empirical support.
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