Using Mindfulness to Control Worry and Live Well with Cancer

1. Using Mindfulness to Control Worry and Live Well with Cancer Aleezé Moss Sattar, Ph.D., Research Associate, Myrna Brind Center of Integrative Medicine, Thomas Jefferson University

2. Stress is… • the perception of a threat to our physical or psychological well-being • coupled with the belief that our resources are inadequate to cope with this threat. • worrying – engaging in the what-ifs – can make us feel stressed

3. Fight or Flight Response • When we feel stressed we have a physiological response in the body. We are hard wired for this stress response. It is evolutionary and useful when we are facing a real physical threat.

4. Fight or Flight Reactivity • The autonomic nervous system (ANS): • The sympathetic branch of the ANS is activated in response to stress, while the parasympathetic branch is suppressed.

5. Sympathetic Nervous System Activation • Increased • Heart Rate • Blood Pressure • Breathing Rate • Muscle Tension • Decreased • Digestive Function • Immune Function • Reproductive Function

6. Stress Response Activation • We can actually turn on the stress response simply by thinking of something stressful. Stress hormones get released and we have the same physiological response as if we were actually under threat. • Why Zebras Don’t Get Ulcers, Robert M. Sapolsky, 2004 (3rd edition).

7. Work With the Mind • If the mind is an important factor in determining if something is experienced as “stressful”…where is the mind?...and what is it up to?

8. Mind Time Travel • The mind is usually “rehashing,” or “rehearsing.” Its either in the past or in the future, and rarely are we right here now.

9. Stress Response • When the stress response is frequently and/or chronically activated, it can become more damaging than the stressor itself.

10. Impact of Stress • Research shows the negative impact of stress on health outcomes in cancer patients. • Reiche EM, Nunes SO, Morimoto HK. (2004) Stress, depression, the immune system, and cancer, Lancet Oncol, 5:617-25. • Witek-Janusek L, Gabram S, Mathews HL, (2007). Psychologic stress, reduced NK cell activity, and cytokine dysregulation in women experiencing diagnostic breast biopsy. Psychoneuroendocrinology, 32:22–35.

11. Stress Reduction • We can reduce the negative impact of stress by learning to regulate the sympathetic nervous system and promote the activation of the parasympathetic nervous system.

12. Parasympathetic Nervous System • The parasympathetic nervous system regulates the relaxation response. • We are hard-wired for both responses. • And importantly, we have some control over the autonomic nervous system.

13. The Relaxation Response • We can activate the parasympathetic nervous system through certain behaviors, including deep, slow breathing, yoga and other forms of mindful movement, meditation, prayer, laughter, art, etc.

14. Parasympathetic Nervous System Activation • Decreased • Heart Rate • Blood Pressure • Breathing Rate • Muscle Tension • Increased • Immune functioning • Reproductive functioning

15. Stress Reduction • Cultivating mindfulness can help us reduce the negative impact of stress.

16. What is Mindfulness? • Moment to moment, non-judgmental awareness. • Cultivated by paying attention, on purpose, in the present moment.

17. Paying Attention • Cultivating mindfulness can help us reappraise our situation and learn to cope more effectively with stress. • Jon Kabat-Zinn, Full-Catastrophe Living: Using the Wisdom and of Your Body and Mind to Face Stress, Pain, and Illness (first published 1990).

18. A Taste of Mindfulness • Brief practice of paying attention to the present moment, without judgment, with an open and kind attitude

19. Mindfulness-Based Stress Reduction • Developed as an outpatient program for heterogeneous patient populations over 30 years ago by Jon Kabat-Zinn and colleagues at the University of Massachusetts. • Now offered at more than 300 institutions • Thomas Jefferson University Hospital’s MBSR program founded 1996. • Typical course: 8 weeks, 2.5 hour classes, plus an all-day silent retreat.

20. Benefits of Mindfulness • Many published studies have documented the benefits of MBSR and other mindfulness-based programs: • decreased stress symptoms • decreased anxiety • decreased depressive symptoms • improved sleep quality • enhanced emotional processing • enhanced coping with the effects of chronic illness • enhanced immune and brain functioning

21. Benefits of Mindfulness • Positive benefits for cancer patients including significant improvements in mood, stress-symptoms, sleep, health related quality of life, immune functioning and even brain function. • MontiD, Kash K, Kunkel E, Brainard G, Wintering N, Moss A, Newber A. Changes in Cerebral Blood Flow and Anxiety Associated with an 8-week Mindfulness Programme in Women with Breast Cancer. Stress and Health 2012. • LedesmaD, Kumano H. Mindfulness-based stress reduction and cancer: A meta-analysis. Psycho-oncology 2009. • Monti, Peterson, Kunkel, et al,). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psychooncology 2006.

22. Benefits of Mindfulness • Shapiro, Bootzon, Figueredo, et al, The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. J Psychosom Res, 2003. • Speca, Carlson, Goodey, et al, A randomized wait-list controlled clinical trial: the effects of a mindfulness-based stress reduction program on mood and symptoms of stress in cancer patients. Psychosom Med, 2002. • Saxe, Hebert, Carmody, Kabat-Zinn, et al, Can diet in conjunction with stress reduction affect the rate of increase in prostate specific antigen after biochemical recurrence of prostate cancer?J Uro 2001. • Tacón, Caldera, Ronaghan, Mindfulness-based stress reduction in women with breast cancer. Families, Systems and Health, 2004.

23. Benefits of Mindfulness • Demonstrated improvements in the immune profiles of people with breast or prostate cancer, which correspond with decreased depressive symptoms • Carlson LE, Speca Speca, M., Faris, P., & Patel, K. (2007). One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer patients. Brain, Behavior, and Immunity, 21, 1038-1049. • Carlson, Speca, Patel, et al, Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outsubjects.Psychosom Med, 2003. • Witek-Janusek,  Albuquerque,  et al, Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, Behav, Immunity, 2008.

24. Deep RelaxationPractice: Using the breath • Learning to activate the relaxation response through the breath. • The breath is available to us in each moment. • Relaxing sighs: • Inhale through the nose. • Exhale with through an open mouth, sighing gently. • Repeat as needed. • Deep/Diaphragmatic breathing.

25. Practice: Mindful Attention to Body Sensations • In the body scan we systematically move our attention through various parts of the body, exploring what is already here. • The quality of the attention is important – it is open, curious, nonjudgmental and accepting of what is already here in the present moment.

26. Resources • Three brief practices handout

27. Resources • The Mindfulness Institute, Jefferson-Myrna Brind Center of Integrative Medicine. www.jeffersonhospital.org/mindfulness/