Phase I pilot of a Mindfulness-Based Stress Reduction intervention for Head and Neck Cancer patients receiving treatment of curative intent.

A Mindfulness-Based Stress Reduction (MBSR) program, adapted specifically for the needs of Head and Neck Cancer patients undergoing radiotherapy. This intervention consists of 7 sessions, lasting up to 90 minutes each, which are administered one-on-one to patients by an experienced mental health professional. In addition, these sessions are supplemented by practice at home of the skills learned in sessions. The first session of the MBSR program is administered before patients begin radiotherapy. Radiotherapy for patients being treated with curative intent generally runs for 7 consecutive weeks. The first session will be ideally be administered one week before patients begin radiotherapy. However, due to the difficulty of aligning the start of the MBSR intervention perfectly with the patient’s idiosyncratic radiotherapy schedules, patients may start the MBSR intervention more or less than a week prior to radiotherapy. It is our experience that patients begin to experience severe side effects from radiotherapy by week 4 of their treatment. We have designed the administration of the MBSR intervention so that patients receive the majority of the sessions of the MBSR intervention before this point, in order to give them time to familiarise themselves with the mindfulness skills being taught before they become ill. The MBSR intervention is therefore designed to be staggered so that patients receive sessions 1 to 5 of the MBSR intervention on a weekly basis, meaning they complete these sessions in week 4 of their radiotherapy treatment. We will then give patients sessions 6 and 7 on a fortnightly basis, meaning that patients will ideally finish their last session of MBSR in the week after they finish the MBSR intervention. This schedule means that patients have the maximum time to gain skills to help themselves before they become debilitated by radiotherapy side effects, but still have the support of the clinician administering the intervention throughout their whole radiotherapy treatment period. The MBSR sessions that are administered while patients are on active radiotherapy treatment do not need to be administered immediately before or after a patient's radiotherapy session, simply some time in the same week. Patients are asked to practice the skills they have learnt from their MBSR sessions at home using a CD of mindfulness meditations, as well as practice informal mindfulness (e.g., paying full attention to a routine task like showering). Patients are asked to practice mindfulness daily. The time that patients are asked to spend meditating a day depends on the specific meditations assigned as homework in a given week; however, it is generally at least 20 minutes a day. However, it is made clear to participants that they are to do what they can manage on a day-by-day basis and to try their best. The MBSR intervention used in this study uses the tool of mindfulness meditation to teach patients the skills of: (1) paying attention on purpose to the present moment experiences of thoughts, sensations, bodily states, and the environment; (2) with a particular attitude of openness, non-judgement, curiousness, and acceptance. Developing these skills assists with the emotional pain that can come with people's automatic tendency to relive the past, plan the future, judge their experiences, and act reflexively. The skills and understandings developed through MBSR have broad applicability for people experiencing cancer and their families/carers which includes, but is not limited to, stress reduction. Our aim is to help clients develop better coping and emotional regulation skills overall during radiotherapy, with a specific focus on addressing the changes to their body and the impact of treatment side-effects such as nausea, fatigue and pain over the course of radiotherapy. The contents of each session are as follows: Session 1: Introduction to Mindfulness Introduction to components of mindfulness; personal goals and therapy contract; introduction to formal and informal meditations in session; begin home practice of formal and informal meditation and monitoring feelings. Session 2: Breathing and Body Sensations Explanation of breathing and mindfulness; mindfulness and radiotherapy side effects; introduction to sitting meditations; awareness exercises (triangle of awareness and pleasant events); continuation of out-of-session practice and monitoring of pleasant events. Session 3: Stress Explanation of stress and its effect on the body and mind; introduction to moving meditation; continuation of awareness through unpleasant events; continuation of out-of-session practice and monitoring of unpleasant events. Session 4: Acceptance and Avoidance Use of breathing space to regulate the autonomic nervous system; discussion of acceptance versus experiential avoidance; focus on working with difficult emotions; continuation of out-of-session practice. Session 5: Cultivating Beneficial States of Heart and Mind Explanation of the role of thoughts in changing emotions; difficult thoughts and stories we tell ourselves; tools for dealing with difficult thoughts through cognitive therapy and mindfulness; continuation of out-of-session practice and monitoring thoughts. Session 6: Deepening and Expanding Move client towards unguided, independent practice; stressful communication and assertiveness; loving-kindness meditation; choiceless awareness meditation; continuation of out-of-session practice and monitoring stressful communication. Session 7: Moving into the World Review of the program and initial expectations; discuss strategies for maintaining mindful practice outside of therapy; client writes a letter to their future self, which is to be sent in 3 months time.