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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
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

the haven breast cancer support centres
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

mindfulness at the haven
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
what is mindfulness
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

what is mindfulness5
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

mindfulness training is worldwide
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)
aim of mbsr study
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.

numbers of study participants
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)
age and socioeconomic status
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)

measurement tools
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)

mbsr programme taught
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
contents of mbsr programme
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

mbsr spaces at the haven in london
MBSR spaces atThe Haven in London

Group Room

Reception area

home practice
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
profile of mood states poms primary outcome
Profile of mood states (POMS) (primary outcome)
  • Total Mood Disturbance
  • Subscales Anxiety

Depression

Anger

Vigour

Fatigue

Confusion

slide17
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

slide18
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

fact quality of life measure
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)
fact b results
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

fact subscales
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

minimally important differences scores mids for fact
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

who 5 item wellbeing questionnaire
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.

scores for who 5 wellbeing questionnaire
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

clinical significance for who 5
Clinical significance for WHO-5

T1 = weeks -2 to 0, T2 = weeks 8 to 10, T3 = weeks 12 to 14

measurements of illness stress and life stress
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?
perceptions of difficulty or stress caused by breast cancer independent sample t tests
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.

slide29
‘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’
how mindfulness helped with pain stress and anxiety
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.