In addition to MBSR, one can learn and practice mindfulness meditation in classes or "sitting groups" led by experienced teachers in the community, at hospitals or universities, or at Buddhist meditation centers. In some clinical settings, mindfulness practices are taught on an individual level and are designed to meet particular patient needs. [18] There are also innumerable books and guided meditation audio recordings available, although working with a teacher and having the support of other meditation practitioners is helpful.
MBSR and other introductory classes are simply an entry into mindfulness meditation. Sustain and maximum benefits occur with ongoing practice. Research clearly demonstrates a direct relationship between the amount of formal meditation practice and the magnitude of positive effects, as demonstrated by changes in brain structure[8] and function[9] and outcomes associated with sense of well-being. [19] The goal is to have mindfulness infuse one's way of being in and relating to the world in everyday life, which is developed and sustained through regular, ongoing meditation practice.
Mindfulness practices are accessible to anyone regardless of physical condition and are inexpensive to do. MBSR, meditation retreats, and introductory classes range in cost from free of charge (offered at some hospitals and centers) to hundreds of dollars. Once one learns the basic skills, mindfulness meditation can be practiced anywhere. Some people use meditation cushions and mats, though these are not essential. While mindfulness meditation is generally practiced in a seated position, it can be done lying down, which may be preferred by some cancer patients. It is important to be in a comfortable and stable position with minimal distractions and where one will not likely fall asleep. Also, informal practices, like mindful eating or walking, are options for deepening skills and integrating mindfulness into one's life.
Here is a practical example of a cancer patient using mindfulness: a man in his 50s with a history of colorectal cancer who handles the experience of a new twinge differently before vs after mindfulnessmeditation training. Before learning mindfulness, the man automatically reacted and went into a tailspin by creating a mental story about the pain; he interpreted it to mean that his cancer had recurred, and the rest of his life unpleasantly flashed in his mind. His body tensed up and contracted around the pain, which seemed to make his pain worse.
After learning mindfulness, he intentionally brought awareness to what he was experiencing. He noticed that his mind was racing and catastrophizing, that his heart was pounding, and his breathing was shallow. He re-centered himself by taking a deep breath and then gently focused on the sensations of breathing, one breath at a time. He felt more in control, relaxed, and grounded. He then recognized how irrational his thoughts were. He gradually brought his attention to the area of the pain; he noticed that the sensations, dull throbbing, were not constant. He was surprised and relieved; in that moment the sensation was not as uncomfortable or scary as he had thought.
WHAT IS THE EVIDENCE RELATED TO MINDFULNESS MEDITATION FOR CANCER PATIENTS?
Systematic reviews[20-22] and a recent meta-analysis [1] provide reasonably strong evidence supporting the use of mindfulness meditation and related practices for cancer patients/survivors. The meta-analysis of 10 studies found large effects for mental health outcomes like anxiety, depression, stress, and distress (d = 0.48 overall, 0.35 randomized trials and 0.50 observational studies) and small effects for physical health variables such as immune function, blood pressure, and tumor markers (d = 0.18, no difference between randomized or observational studies). [1]
Several studies have been done exclusively with breast cancer survivors. [23-27] One single-arm pre-post design study demonstrated less stress, hopelessness, and anxious preoccupation about cancer, and greater internal locus control after MBSR training. [23] In a similar study, Matousek and Dobkin identified significant reductions in self-reported stress, medical symptoms, and depression, and improvements in sense of coherence post intervention. [24] Lengacher and colleagues, in a randomized controlled trial comparing a 6-week MBSR program to usual care, found statistically significant differences with lower depression, anxiety, and fear of recurrence, and higher energy and physical functioning in those who participated in the mindfulness training. [25] Witek-Janusek et al found improvements in biological measures (specifically Cortisol, natural killer cell cytotoxicity, gamma interferon, IL -4, IL-6, and IL-10) as well as in quality of life and optimistic coping in early-stage breast cancer patients who self-selected participation in MBSR, compared with those who did not. [26]
Carlson, Speca, and colleagues have conducted a number of studies evaluating MBSR for cancer patients. [28-34] In their first study, patients with mixed cancer diagnoses who participated in mindfulness training had lower mood disturbance and symptoms of stress at post-intervention[28] and 6 months later. [29] Subsequent work by the same group with early-stage breast and prostate cancer patients revealed improvements in quality of life, symptoms of stress, and sleep quality, as well as trends toward improvements in neuroendocrine and immune measures postintervention,[30,31] with sustained effects at 1-year follow-up. [32]
Other studies have explored innovative approaches of delivering mindfulness interventions to cancer patients. In a randomized controlled trial, Monti and colleagues found that Mindfulness Based Art Therapy lowered psychological distress and improved quality of life for women with cancer. [35] Loizzo et al found similar findings along with trends in improvements in biological stress measures (morning salivary Cortisol and resting heart rate), but no change in IL-6, natural killer cells, or Cortisol diurnal rhythm, in early-stage breast and gynecologic cancer survivors who participated in a 20-week meditation-based self-care intervention. [36] A dietary intervention (high vegetable protein and nutrients, low animal fat) combined with MBSR was found to slow prostate specific antigen (PSA) growth in men with prostate cancer. [37] Specifically, the PSA doubling time for the men in the MBSR plus nutrition group was nearly threefold longer after the intervention compared to controls; PSA doubling time is an indicator of risk of recurrence and disease progression. Other studies have explored and demonstrated feasibility and promising findings of individual mindfulness training for cancer patients undergoing hematopoietic stem cell transplant.[18,38]
WHAT ARE THE POTENTIAL RISKS?
Mindfulness meditation is very safe and has few associated risks. Sometimes people may experience a transient increase in anxiety when learning it, as they let go of usual busyness and distractions and become aware of unsettling thoughts and feelings. Advanced meditation practitioners who engage in long and intensive meditation (hours per day and months at a time) have added risks and need to work closely with an experienced teacher during such intense training periods.
WHAT IS THE BOTTOM-LINE MESSAGE?
Mindfulness meditation and mindfulness-based clinical interventions are low-cost and low-risk mindbody practices that have been shown to positively affect quality of life and biological outcomes in many different populations, including cancer patients and healthcare professionals.
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Financial Disclosure: The author has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.
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ONCE ONE LEARNS THE BASIC SKILLS needed for mindfulness meditation, it can be practiced anywnere
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SYSTEMATIC REVIEWS provide reasonably strong evidence supporting mindfulness meditation for cancer patients/survivors