Written by Holger Cramer, Ann-Christine Moenaert and the CAM-Cancer Consortium.
Updated October 24, 2016

Mindfulness

What is it?

Description

Mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) are multi-component mind-body modalities, encompassing psycho-educational elements, mindfulness meditation exercises, cognitive-behavioral interventions and movement exercises. Core practices are: sitting meditation (focused attention, breath awareness), body scan (awareness of sensations in the body, 45 minute exercise), Hatha Yoga (mindful movement), walking meditation and insight meditation. The founder of MBSR, Jon Kabat-Zinn, uses the following operational definition for mindfulness: “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” 1.

MBSR was first introduced as a clinical intervention for patients with chronic pain by Kabat-Zinn in 1979, in the Stress Reduction Clinic of the University of Massachusetts Medical Center. MBCT was developed by Zindel Segal, Mark Williams and John Teasdale, based on Jon Kabat-Zinn’s MBSR programme 2.

The MBCT programme was designed specifically to help people who suffer repeated bouts of depression, and includes more psycho-educational elements than MBSR. MBCT also adds short formal meditation exercises to the program. 

Application and dosage

The standard MBSR program (as developed by Kabat-Zinn delivered in groups of 6 to 30 patients) encompasses 8 weekly class sessions with a duration of 2 ½ to 3 ½  hours, plus an additional retreat day of six hours between weeks 6 and 7 of the program (20 to 35 ½ hours class time). Shortened versions for cancer patients have been tested in clinical trials 3. A review on the relationship between class contact hours and effect sizes for psychological outcomes 4 did not find any evidence that reduction of class hours might lead to decreased reduction of psychological distress 4. Programs with fewer contact hours may be able to engage more cancer patients, because disease and treatment-related symptoms (including fatigue) sometimes present a barrier to take part in longer sessions.

In order to integrate mindfulness into everyday life, patients are usually asked to practice mindfulness exercises 45 minutes per day, 6 days per week during the program. A higher amount of home practice seems to increase self-reported mindfulness. It has been suggested that this may lead to improvements in psychological outcome 4.

Some clinics provide day retreats and regular drop-in sessions for patients who completed the MBSR program 5.

History/providers

MBSR and MBCT are based on the ancient Buddhist practice and concept of mindfulness. Kabat-Zinn points out that mindfulness includes an “affectionate and compassionate quality within the attending and openhearted presence” 1. The underlying ethical framework is built on the principles of non-harming. Kabat-Zinn notes the challenges posed to clinical implementation and research of mindfulness in the face of different epistemologies 1.

A mindfulness teacher needs a foundation of personal practice (having experienced the radical transformational essence of mindfulness, as Kabat-Zinn states 1 and is required to embody the core concepts of mindfulness.

There are adaptations and modifications of the original program manuals of MBSR and MBCT for cancer patients 5-11

Claims of efficacy/Alleged indications

MBSR and MBCT are implemented mind-body modalities in supportive cancer care. They are used in oncology settings because they have been suggested to have beneficial effects on various symptoms connected to cancer: emotional distress, mood, anxiety, depression, sleeping disorders, fatigue, quality of life 6-19. Some studies point to a possible effect on immunological parameters 3, 20-22

Mechanisms of action

Complex psycho-physiological connections and interactions are regarded as basic foundations of the effects of mind-body modalities 23. Mindfulness meditation is assumed to promote regulation of emotions, this leads to a down regulation of the sympathetic nervous system and to a reduction of stress hormone levels 24-26. Psycho-neuro-immunology research on the effect of mindfulness-based interventions on brain structure and functions and immunological status is in its infancy. Shapiro et al. point out that research on mindfulness requires a variety of methodological and theoretical approaches to develop testable hypotheses 27

Prevalence of use

A growing number of integrative oncology hospitals offer their patients mindfulness-based clinical interventions. Books on mindfulness for cancer patients have been published, leading to the use of mindfulness exercises as a self-help-technique. In 2012, 1.9% of the general US adult population had used mindfulness meditation (including MBSR and MBCT but also Buddhist mindfulness meditation). Among cancer survivors, 2.4%, 2.6%, and 1.8% of those with less than 1 year, between 1 and 5 years, and 5 or more years of survivorship, respectively, had used mindfulness meditation 28.

Legal issues

Training for MBSR and MBCT teachers is not legally regulated, however, the University of Massachusetts Medical School’s Center for Mindfulness in Medicine, Health Care, and Society requires prospective teachers to meet the Qualifications and Recommended Guidelines for MBSR Teachers 29. These include a 6-course educational pathway over 36 months 30. While other MBSR/MBCT associations have adopted comparable educational guidelines, required training hours for certification vary depending on the organization providing the training. Practical experience in meditation (previous own meditation practice, attendance of teacher-led silent retreats) is under discussion, ranging from virtually no requirements to prerequisites of at least 2 years prior mediation practice and attendance of at least 2 five-day retreats.

Costs and expenditures

Fees for the 8 week-program (normally one weekly 2.5- to 3.5-hour class, often combined with a 6- to 7.5-hour full day retreat; a total of 20 to 35.5 class hours) 29 of MBSR/MBCT range between € 200 and € 500, dependent on the setting. Partial or full reimbursement is available in some countries. Sometimes the programs are integrated into the general hospital services and are offered with reduced fees. 

Citation Holger Cramer, Ann-Christine Moenaert, CAM-Cancer Consortium. Mindfulness [online document]. http://ws.cam-cancer.org/The-Summaries/Mind-body-interventions/Mindfulness. October 24, 2016.

References

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