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Mindfulness Based Stress Reduction (MBSR) in breast cancer: research and practice

Mindfulness Based Stress Reduction (MBSR) in breast cancer: research and practice. Caroline Hoffman, PhD Clinical Director & Research Co-ordinator The Haven Breast Cancer Support Centres London - Hereford - Leeds www.thehaven.org.uk caroline.hoffman@thehaven.org.uk.

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Mindfulness Based Stress Reduction (MBSR) in breast cancer: research and practice

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  1. Mindfulness Based Stress Reduction (MBSR) in breast cancer: research and practice Caroline Hoffman, PhD Clinical Director & Research Co-ordinator The Haven Breast Cancer Support Centres London - Hereford - Leeds www.thehaven.org.uk caroline.hoffman@thehaven.org.uk

  2. The Haven (Breast Cancer Support Centres) • Free programmes of emotional support and complementary therapies for breast cancer • Also an outreach programme called The Haven at Home (2.5h DVD and 1h CD) The Haven in London

  3. Mindfulness at The Haven • MBSR has been taught to 500 people at the Haven. • Mindful movement and meditation practice classes (drop-in) are also available twice a month

  4. What is mindfulness? • Mindfulness means paying attention (being aware) in a particular way:on purpose,in the present moment,and non-judgmentally. Dr Jon Kabat-Zinn Founder Mindfulness-Based Stress Reduction Programme

  5. What is mindfulness? “Mindfulness is about being fully awake in our lives. It is about perceiving the exquisite vividness of each moment. We feel more alive. We also gain immediate access to our own powerful inner resources for insight, transformation, and healing.” Jon Kabat-Zinn

  6. Mindfulness training is worldwide • Up to 3,000 health professionals among 18,000 participants in the MBSR programme at the Center for Mindfulness, University of Massachusetts, USA • www.bemindful.co.uk lists mindfulness courses available by area in Great Britain (GB) • Mindfulness at Monash University, Melbourne, Australia Professional teacher training centres: • University of Massachusetts USA (MBSR) • University of Oxford, G.B. (MBCT) • University of Bangor, G.B. (MBSR and MBCT)

  7. Aim of MBSR study The aim of this randomised controlled trial was to determine if and how much MBSR affects mood, disease-related quality of life, including endocrine symptoms, and wellbeing in women with stages 0 to III breast cancer.

  8. Numbers of study participants • 229 women who had attended the Haven • Computer randomised into blocks of four • 114 in intervention group • 115 in wait-list control group • Sample size calculated for 80% power from Profile of Mood States (Speca et al 2000)

  9. Age and socioeconomic status Mean age 49 years (Intervention Group) 50 years (Control Group) Socio-economic status AB: (Higher and intermediate manager/ administrator/ professional) Intervention Group 84 (73.7) Control Group 90 (78.3) C1: (Supervisory clerical junior managerial/ administrator/ professional) Intervention Group 20 (17.5) Control Group 16 (13.9)

  10. Measurement tools • Profile of Mood States (POMS) (65 item) Primary outcome measure • Quality of Life measures: FACT-B (Breast) (37 item) FACT-ES (Endocrine Symptoms) (19 item) WHO-5 Wellbeing questionnaire (5 item)

  11. MBSR Programme taught 8-week MBSR programme • Week 1 and 8: 2 and a quarter hours (Uni. Mass 3 hrs) • Week 2 to 6: 2 hours per week (Uni.Mass 2.5 hrs) • 6-hour day of mindfulness in week 6 on a Saturday: 10am to 4pm (both groups together for this) Number of groups • Pilot group • 7 cycles of 8 week programmes (13 groups) in 2005 -2006 • Regular clinical supervision for clinician-researcher

  12. Contents of MBSR programme Ways of seeing – how we perceive our world Awareness of thoughts, emotions and body sensations Mindful body scan, mindful stretches, mindful sitting practice Understanding stress Awareness of habitual thought patterns and emotional reactions Mindfulness in everyday life

  13. MBSR spaces atThe Haven in London Group Room Reception area

  14. Home Practice • Home Practice Manual included photos of stretching exercises, meditation sitting positions, information on stress, some stories, exercises, tips • 4 x 45 minute CDs: Mindful Body Scan, Mindful Lying Stretches, Mindful Sitting Meditation, Mindful Standing Stretches • Home practice sheets • Record of formal home mindfulness practice

  15. Profile of mood states (POMS) (primary outcome) • Total Mood Disturbance • Subscales Anxiety Depression Anger Vigour Fatigue Confusion

  16. POMS T1 = weeks -2 to 0, T2 = weeks 8 to 10, T3 = weeks 12 to 14 *p<0.05, **p<0.01, *** p<0.001

  17. POMS T1 = weeks -2 to 0, T2 = weeks 8 to 10, T3 = weeks 12 to 14 *p<0.05, **p<0.01, *** p<0.001

  18. FACT - quality of life measure FACT-B (breast) and FACT ES (endocrine symptoms) Subscales: • Physical wellbeing • Social and family wellbeing • Emotional wellbeing • Functional wellbeing • Breast-specific subscale (B) • Endocrine-specific subscale (ES)

  19. FACT-B results T1 = weeks -2 to 0, T2 = weeks 8 to 10, T3 = weeks 12 to 14 *p<0.05, **p<0.01, *** p<0.001

  20. FACT subscales T1 = weeks -2 to 0, T2 = weeks 8 to 10, T3 = weeks 12 to 14 *p<0.05, **p<0.01, *** p<0.001

  21. Minimally important differences scores (MIDs) for FACT * denotes significant values T1= weeks -2 to 0, T2= weeks 8 to 10, T3 = weeks 12 to 14

  22. WHO 5-item wellbeing questionnaire For each of the five statements below, please put a circle round one number, which is closest to how you have been feeling over the last week. Notice that the higher numbers mean better well-being.

  23. Scores for WHO-5 wellbeing questionnaire T1 = weeks -2 to 0, T2 = weeks 8 to 10, T3 = weeks 12 to 14 *p<0.05, **p<0.01, *** p<0.001

  24. Clinical significance for WHO-5 T1 = weeks -2 to 0, T2 = weeks 8 to 10, T3 = weeks 12 to 14

  25. Measurements of illness stress and life stress • How difficult or stressful is your illness for you at the moment? • Apart from your illness, have you had any recent events in your life which has affected you strongly or been particularly stressful?

  26. Perceptions of difficulty or stress caused by breast cancer(independent sample t-tests) *p<0.05, **p<0.01, *** p<0.001 T1 = weeks -2 to 0, T2 = weeks 8 to 10, T3 = weeks 12 to 14 Perceptions of difficulty or stress from other live events did not give significant results.

  27. Themes from qualitative data (intervention group only)

  28. ‘Great to be supported through a difficult time and this (MBSR) has truly been a gift that I will always have and I think not only support me, but my family and friends because I will be in a better place’

  29. How mindfulness helped with pain, stress and anxiety ‘I at first wondered if the programme was for me. After the first session, I was in tears, but Caroline convinced me to continue with the body scan and I did. It has helped me greatly with my pain (peripheral neuropathy for 18 months). Other practices have helped me with daily stress and remaining calm’ More aware now of anxious thoughts and their effects on the body. Aware of when I am reacting to thoughts in a stressed and anxious manner.

  30. Köszönöm

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