Mindfulness-Based Cognitive Therapy for Cancer

Gently Turning Towards

Trish Bartley

• Publisher: Wiley-Blackwell
• Year: 2011
• Print ISBN: 9780470683835, 9781119954057
• eBook ISBN: 9781119954958
• Edition: 1
• Topic: Psychology
• Subtopic: Cognitive Psychology & Cognition
• Index: Psychology

Mindfulness-based Cognitive Therapy for Cancer presents an eight-week course for MBCT which has been tried and tested over ten years of clinical use, and is targeted specifically for people with cancer.

• There is growing evidence of mindfulness as a successful and cost-effective intervention for reducing the negative psychological impact of cancer and treatment
• Draws upon the author's experience of working with people with cancer, and her own recent experience of using mindfulness with cancer diagnosis and treatment
• Stories from cancer patients illustrate the learning and key themes of the course
• Includes new short practices and group processes developed by the author

Part One: Mindfulness and The Cancer Journey

Chapter One

Mindfulness and Cancer

Mindfulness practice is really a love affair with what we might call truth, which includes beauty, the unknown and … how things actually are, all embedded here in this very moment.

(Kabat-Zinn, 1990)

Mindfulness practice is central to my own experience of being with cancer. In the previous section, I write about this and the ways that cancer and mindfulness have impacted on me personally.

Now, in this first chapter, we ponder questions, such as:

What is mindfulness?

What does a mindfulness-based course involve?

What might a mindfulness practice offer someone with cancer?

After suggesting some basic descriptions of mindfulness, we look through the eyes of three different people with cancer, all of whom made their way to a Mindfulness-Based Cognitive Therapy for Cancer (MBCT-Ca) course in North Wales. Their stories will help to orient us towards what mindfulness offers those who are living with cancer.

Introduction

Being mindful is to be fully present with your direct experience, whatever you are doing, thinking or feeling – here and now.

Mostly, we are not aware. We are rarely fully with the experience we are having now. We tend to wander back, dwelling in the past – or run forward, anticipating the future. We can be driving a car, but functioning on automatic and only partly aware, whilst worrying about something about to happen, or thinking about something someone said earlier.

When we practise being mindful, we do something and know that we are doing it – like eating and actually tasting the food – or going for a walk and noticing the full scope of the view – or turning on the radio and actually hearing the programme. Becoming more mindful offers us many possibilities. It helps us to become more aware, centred and balanced. We may find more to appreciate in the ordinary experiences of our day.

Mindfulness also helps us learn to respond differently to difficult situations. Instead of reacting, in a knee jerk way, immediately imagining the worst – we learn to stop, and come back to the direct experience we are having now. This changes things and gives us an opportunity to find other ways of managing what is challenging us.

We now turn to the experience of three people. Their stories will help us begin to understand what mindfulness might offer people with cancer.

Will Mindfulness Help Me?

Jane was only 32 when she was told that she would probably not survive breast cancer. A single parent with three young children, she tolerated nearly twelve months of an aggressive treatment regime and seemed to manage pretty well. After it was all finished, her doctor told her that she might be fine after all.

Almost immediately, Jane started feeling awful. ‘My head is all over the place’, she told me. ‘I’m angry – not sleeping well – and horrible with the kids’.

Family and friends had withdrawn, assuming she was alright now that treatment had finished and her prognosis was so much better. In reality, Jane was only just beginning to get in touch with her feelings and finding them hard to manage. She could not understand what was happening and thought she was being ‘really stupid’.

After a clinic appointment with her oncologist, she was referred to a mindfulness course.

When Jane heard that what she was experiencing was entirely normal, and that others also get in touch with strong emotion after the end of treatment, she immediately felt a bit better.

On hearing about mindfulness and the course, she could see that it might help her to be more ‘present’, although just talking about it did not give her much of a clue as to how she could do that. However, she was well aware that she was spending a lot of the time anxiously brooding on what might happen – worrying about the children, and fretting over every twinge of pain thinking it might be the beginning of the cancer returning.

In describing persistently critical thoughts, ‘that do my head in’, Jane can connect with the possibility that learning to stop and be more aware of the habits of her mind, might be a first step in helping her to develop ways of being kinder to herself. She knows that she blames herself for everything – getting cancer, losing patience with the children, and even for feeling so awful. She would love not to do that and feel more herself again. It is a long time since she has felt happy.

‘Count me in’, she tells me ‘I can’t wait to start’.

What Does Mindfulness Offer? Is It Safe?

David is a retired professional man in his sixties with incurable cancer. He finished a recent round of treatment last year and is currently in remission. He is a fairly cautious person, who does not easily engage with new people or situations. His doctor referred him for a mindfulness course, because he is not sleeping well, and is feeling low and lethargic.

David meets me to hear about the course. He is not sure it will help him, but he says he thinks he ought to give it a go. ‘I haven’t much to lose’, he says ‘I wonder if it will work for me’.

What might mindfulness offer someone like David? And how could he be helped to commit to the vital home practice involved. On the face of it, he is very different to Jane. He is a lot older, more set in his ways, and clearly sceptical about the approach.

David was not much interested in hearing about learning to be more present. It did not sound like his sort of thing, and anyway he did not understand. He became a bit more engaged when he was told about some research, which demonstrated evidence of the benefits of mindfulness. This was more his line.

The first mindfulness-based course was developed by Jon Kabat-Zinn in Massachusetts over thirty years ago, for groups of people with a wide range of different health conditions. Since then, Mindfulness-Based Stress Reduction, (MBSR for short) has spread to many parts of the world (Kabat-Zinn, 1990). Part of that development includes some research undertaken by a leading psycho-oncology team with cancer patients in Calgary, Canada over the last ten years. They are getting some good outcomes from MBSR. Evidence is building that mindfulness holds much promise for cancer patients (Shennan et al., 2010).

David was relieved to hear this. He had already decided to take the course, because his doctor advized it, but if mindfulness was not the flaky, touchy feely approach that he first assumed, it might have something genuine to offer him. The news got better the more he heard. A form of mindfulness for people with depression, known as Mindfulness Based Cognitive Therapy (MBCT) has been found to significantly reduce the risk of relapse in people with a history of depression (Segal et al., 2002). NICE (the National Institute for Clinical Excellence), the UK health standards body, explicitly recommends MBCT for people who have had three or more depressions.

David was currently on medication for depression. He heard that the mindfulness course he would be going on had been adapted directly from MBCT for Depression, and targeted to the needs of people with cancer. It had been running for over ten years. Regular evaluations of course outcomes suggest that participants experience improved levels of sleep and wellbeing after attending. ‘I could do with that’, said David wistfully ‘I wonder if it will work for me’.

What is Involved on the Course?

The last person we meet is Sheila. A married woman in her early 40s, with two children, she was traumatized by a diagnosis of ovarian cancer, eighteen months earlier. She has never forgotten the look on her mother’s face when the doctor told them.

After treatment, her prognosis was said to be fairly good, but she did not believe it. Sheila is convinced that she is going to die, but can’t bear to think about it. She dreads going to bed at night. As soon as she closes her eyes, everything crowds in – especially that expression on her mother’s face.

She broke down when she last saw her specialist nurse. Sheila admitted to be feeling terribly tense. ‘It is as if there is a dark cloud blocking out the light’, she said ‘I know I can’t go on like this. It is making me ill. Even my husband, who is very laid back, is really worried’.

When Sheila met me, we discussed how she was feeling and touched on what she had been through. It was hard for her to talk about it, but she said that she was desperate to feel better. She had been referred to counselling but had not chosen to continue. ‘Talking about it doesn’t help’, she told me.

Like David, she would have to develop some confidence in mindfulness before she could commit to the course. Unlike David, hearing about research findings would not be much help to her. Sheila needed to make a personal connection with me, her teacher, and feel that she could trust the course. It helped her to hear about practical details, such as what to expect, and how the sessions were structured.

I told her that the course ran for eight weeks, with a session every week lasting for two and a half hours, with about ten people in the group. Sheila admitted that she was quite nervous with people she did not know. I explained that it was not a self help support group. We practise a mindfulness-based exercise, guided by me, the teacher, and then we explore our experience of it. Then we experience another practice or exercise and discuss that. ‘There is no need for you to say anything unless you want to’, I told her. At times the group breaks into pairs or small groups to discuss the mindfulness exercise, and sometimes we stay in the larger group.

Sheila quickly appreciated that she would have to commit herself to the home practice. I was clear that whatever she got out of the course was mainly up to her – and the home practice was an important ingredient in it all. She said that she was so desperate to feel better that she would do whatever was needed. I explained that she would follow one of the thirty minute practices every day at home using a CD.

There are also a number of short practices which she would learn to weave into her day. Some of these could be helpful to turn to when things felt tough. It seemed very important to explain to Sheila that mindfulness involves having the courage to turn towards what is difficult little by little, with sense of friendliness and kindness for herself. She said that ‘turning towards’ sounded scary, and she was not sure she could do that, but something inside told her that learning to be kinder to herself was probably exactly what she ne...

Table of contents

• Cover
• Praise for Mindfulness-Based Cognitive Therapy for Cancer
• Title page
• Copyright page
• Dedication
• Contributors
• Foreword
• Preface
• Acknowledgements
• Introduction
• Personal Story
• Part One: Mindfulness and The Cancer Journey
• Part Two: The Mindfulness-Based Cognitive Therapy for Cancer Programme
• Part Three: The Practitioner Teacher
• Epilogue
• Resources and Links
• Bibliography
• Sources and Permissions
• Subject Index