In this guest blog, Trish Bartley, an expert in mindfulness-based cognitive therapy for cancer (MBCT-Ca) calls for the psychological needs of cancer patients to be more fully addressed:
Over the past 20 years there has been increasing recognition of the traumatic impact of cancer on those affected. However, despite this, evidence shows that the level of psychological distress experienced by cancer patients is generally under-diagnosed by medical staff.
The serious nature of cancer can lead to a profound sense of uncertainty and (for some) a fear of imminent death. This can be accompanied by physical suffering often through the treatments themselves, increasing dependence, vulnerability and, often, a sense of isolation. Distress is made worse by the twin mechanisms of avoidance (trying to ignore or escape from painful feelings) and rumination (getting caught up in endless cycles of thinking and worry).
The effectiveness of mindfulness-based approaches is increasingly recognised. Mindfulness is about training the mind to relate to experiences and thoughts differently, to interrupt automatic processes that can often spin off into anxiety and despair. By learning to interrupt these automatic processes and recognise what is happening, we are given a chance to approach our lives differently.
In the late 1990s I became aware of mindfulness-based cognitive therapy (MBCT), which was showing impressive results for people with depression. I wanted to explore how the approach could be extended to help people with cancer and in 2001 I started to teach a mindfulness course to cancer patients.
A few years later, in collaboration with Ursula Bates, director of psychosocial and bereavement services at Blackrock Hospice in Dublin, we developed a new model of MBCT for cancer (MBCT-Ca) as a way of understanding and mapping the ways that people with cancer suffer and the means whereby the MBCT-Ca intervention relieves some of that suffering.
The MBCT-Ca course shares the 3 main practices of mindfulness-based stress reduction (MBSR) and MBCT, namely the body scan, mindful movement and the sitting practice. But we made changes to enable the programme to be more relevant to people with cancer, for example, there are many more short practices.
People with cancer, especially those with poor prognoses, haven’t the time, energy or motivation to commit to lots of meditation. They want their practice to be in the service of living as full a life as possible. Short practices ‘in the back pocket’ can be used at any time to support and steady the mind, when difficult thoughts and feelings arise; or challenging situations occur, such as waiting in clinics for results. The programme brings a special emphasis to the everyday cultivation of self-compassion and kindness. People with cancer have many opportunities to feel a sense of guilt or to blame themselves in some way for getting cancer. Helping them to relate to themselves with more kindness can have a significant impact on their wellbeing and quality of life.
Many participants who have attended the programme report that they:
• Feel more calm, balanced and personally resourceful to cope with what might arise in the future
• Have a greater appreciation for the present richness of their lives, whether through enjoying nature or experiencing deep love for family and friends
• Feel less alone in the world and more connected to other people and what matters most to them now.
My own experience of teaching these programmes combined with other teachers’ experiences and a growing body of research evidence demonstrates the widespread value of mindfulness specifically for people with cancer. This suggests that MBCT-Ca has much promise in being an effective means of reducing distress in cancer patients.
Mindfulness can also prove to be useful to health professionals themselves as they negotiate the considerable demands and stresses of their own working lives. As with cancer patients, short accessible practices may prove most useful in certain situations. Breathing spaces can help us to feel steadier, more calm and mindful. Times when we have to communicate bad news or are managing high levels of stress are ideal opportunities for practicing mindfulness. Developing more kindness towards ourselves enables us to be more able to stay open to others and perhaps more likely to avoid the risk of “compassion fatigue.”
Information about some of the research evidence on mindfulness and cancer can be found here - www.paulscancersupport.org.uk/mindfulness/research.
About the author
Trish Bartley has taught mindfulness-based cognitive therapy to people with cancer in a regional oncology unit in Wales since 2001. She is the author of Mindfulness-Based Cognitive Therapy for Cancer: Gently Turning Towards (Wiley-Blackwell, 2012). Her website is www.trishbartley.co.uk.
Paul’s Cancer Support Centre, located in Wandsworth, London, provides a mindfulness course based on Trish Bartley’s MBCT-Ca approach, which is offered at the Centre and at St George’s Hospital, Tooting. The Centre recently sponsored a training workshop led by Trish Bartley on mindfulness and cancer for health professionals. For more information, visit www.paulscancersupportcentre.org.uk/mindfulness.html. Paul’s is also setting up a network with The Haven Breast Cancer Support Centre, London, to encourage more mindfulness for cancer courses in London.