Role of Mindfulness‐Based Cognitive Therapy in Alleviating Psychological Distress among Cancer Patients

The purpose of this research was to examine the research literature on role of Mindfulness-Based Cognitive Therapy in alleviating psychological distress among cancer patients. World Health Organization and medical experts have expressed alarm about constantly the growing problem of cancer patients in the world. The researcher emphasize that the diagnosis of cancer not only has obvious physical ramifications for the patient, but also the trauma of a diagnosis produces psychological problem such as somewhat hardly manageable distress as well, and in the face of psychological stressors that negatively impact the patient’s overall quality of life. The present study examined the results of various studies, for identifying the potential efficacy of MBCT as it could be applied to patients with cancer which presents psychological distress. Research on Mindfulness-Based Cognitive Therapy has supported the safety and effectiveness of this approach might be used with distress associated problems among cancer patients also other studies obtained results signified the effectiveness of this therapy while dealing with cancer patients showed significant impact in alleviating different type of problems associated with this disease. It suggests need for a comprehensive solution that combines medical, psychological, social and behavioral approach to this complex problem in initiating the distress of cancer patients. .

1. What is the Psychological distress in cancer Patients? 2. Is MBCT effective at treating psychological distress in cancer patients? 3. Is MBCT safe for cancer patients? 4. Is MBCT the best solution? The experience of receiving a diagnosis of cancer is an intensely stressful experience for every person (Matchim & Armer, 2007), and for their family members and support system. The initial reaction to cancer diagnosis is shock and confusion. Cancer might be associated with many potentially distressing thoughts that come to patients mind such as: Why me? Did I get cancer because of something I did? Did I cause it through being stressed? Or through my lifestyle? Am I making it worse through my worry? Similarly during remission, fears of recurrence might become overwhelming. Often such questions cannot be answered and trying to resolve them can lead to extensive rumination, a style of repetitive evaluative thought that has been shown to exacerbate and maintain low mood (Watkins, 2008), including in breast cancer patients (Segerstrom, Stanton, Alden, & Shortridge, 2003). Meta-cognitive insight allows a new perspective on thinking that appears to disrupt rumination (Shapiro, Oman, Thoresen, Plante, & Flinders, 2008) and allow potentially distressing thoughts or perceptions to be experienced without overwhelming distress.

Meta-cognitive insight
Observing without judgment

Wise responding
According to McGregor BA and Antoni MH (2009) cancer patients are confronted with many stressors. In addition to the excessive physiologic stress caused by the disease and its treatment, many patients experience psychological stress regarding worries about diagnosis and prognosis, demanding treatments and treatment decisions, and disruption of ordinary life functions and roles. As a psychological support the use of mindfulness based interventions has grown exponentially across health care, and particularly in the cancer area. Mindfulness has a 3,500 year history within Buddhist tradition, and has been widely embraced within Western healthcare over the past three decades. Mindfulness has been defined as non-judgmental, present-moment awareness and is comprised of two components: (1) self-regulation of attention so that there is focus on the current experience, and (2) adoption of a curious, open, and accepting orientation to the present (Bishop, Lau, Shapiro, Carlson, Anderson, Carmody, 2004). MBCT is skills-based group was developed by Segal, Williams and Teasdale, 1995 as a successful tool to treat chronic or recurrent depressive patients. It combines elements of Cognitive Behavioral Therapy (CBT) and the practice of mindfulness meditation into an eight week program that emphasizes the internal processes of depression-related recidivism .

Doing Mode
Being Mode Goal oriented Focus on disconnection of thought and feeling from goal-related action Driven to reduce the gap between how things are and how we would like them to be Focus is on "accepting" and "allowing" what is, without any immediate pressure to change it Attention is devoted to the narrow focus on discrepancies between desired and actual states Direct, immediate, intimate experience of the present The diagnosis of cancer is a situation that understandably arouses a considerable amount of distress in patients. Mindfulness has been used to ease depression, anxiety and distress associated with this diagnosis (Kabat-Zinn, 2009).

Cancer and Psychological Distress in People with Cancer
The U.S. National Center for Health Statistic described chronic disease as a disease that persists for 3 months or more, that cannot be prevented by vaccines or cured by medication and does not resolve spontaneously, cardiovascular disease, chronic respiratory disease and diabetes, now cancer ranks as a chronic disease. Health damaging behavior particularly tobacco use, lack of physical activity and poor eating habits is a major and modifiable contributor to chronic diseases (WHO, 2010; Phillips & Currow, 2010; Strong, Mathers, Leeder, Beaglehole, 2005). Cancer refers to a group of illnesses that result from cells in the body growing abnormally. These cells divide and produce new cells in an uncontrolled way that can spread throughout the body and cause damage to essential organs. Normal cells are constantly subject to signals that dictate whether the cell should divide, differentiate into another cell or die. Cancer cells develop a degree of autonomy from these signals, resulting in uncontrolled growth and proliferation. In this proliferation is allowed to continue and spread, it can be fatal. In fact almost, 90% of cancer related deaths are due to tumor spreading a process called metastasis (Momna & Ventuse, 2010).
Clinical factors such as stage and course of the disease, site of cancer, and medical and surgical treatment required have been shown to be of importance. Also, patient-related factors in the form of age-specific developmental life tasks that are threatened by the diagnosis, availability of social support and rehabilitative options have been suggested to influence psychosocial adjustment to cancer (Bottomley, 1997;Goldberg & Cullen, 1985;Holland & Rowland, 1990). A cancer diagnosis can bring up a wide range of difficult emotions and significantly impact many areas of a person's life; it can have negative implications for psychological health, physical symptoms and may also adversely affect quality of life. Coping with a cancer diagnosis is known to be a traumatic event that can be related to declines in personal well-being and increases in distress. Effective coping is associated with a reduction of stress, depression, hopelessness or anxiety in response to a stressor. Many cancer patients experience psychological distress that distress is unlikely to be exclusively related to their disease or its treatment. Distress in cancer is defined as: "a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, and emotional), social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and its treatment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panics, social isolation, and existential and spiritual crisis."(National Comprehensive Cancer Network [NCCN] Clinical Practice Guidelines, 2007). Coping with a cancer diagnosis is known to be a stressful experience that can be related to declines in personal well-being and increases in distress. Researchers Trish Bartley and Ursula Bates (2012) have noted that Cancer is often associated with psychological distress as showed with the help of pie-diagram. The risk of psychological distress varies between different cancer patients and at different points in the cancer journey such as: characteristics of the individual and characteristics of disease and treatment. Middelboe T and his colleagues (1994) have noted while the symptoms of psychological distress in cancer patients may closely mirror those seen in other groups their etiology, characteristics, and assessment and treatment needs may sometimes be quite different Cancer diagnosis and treatment is associated with a significant potential for psychological impact, so much in fact that some individuals will meet prevalence rate and criteria for anxiety, depression, or another mental health disorder (Van't,

MBCT Effectiveness at Treating Psychological Distress in Cancer Patients
Treatment of cancer is the series of interventions, including psychosocial support, surgery, and radiotherapy, chemotherapy that is aimed at curbing the disease or prolonging life considerably while improving the patient's quality of life (WHO, 2009).
This research was based on a psycho-educational intervention that incorporated mindfulness meditation skills which reviewed effectiveness of MBCT.

MBCT Safe for Cancer Patients
Review of literature showing the effectiveness of MBCT for a variety of issues clients face in psychological distress. A successful stress reduction treatment is MBCT, which has been found to improve both physical and mental health outcomes ( The study findings suggest that MBCT is a safe program for cancer patient with psychological distress and it has psychological benefits to cancer patients.

MBCT the Best Solution
The review study on the efficacy and safety on MBCT treatments of cancer patients raise the question of whether MBCT is the best solution for reducing mitigating the psychological distress in cancer patients. MBCT is a supportive and holistic psychotherapeutic service to patients with medical illnesses and related psychological distress that may improve coping through increased sense of control, relaxation, and distraction. Whilst mindfulness-based interventions are proving effective in ameliorating existing psychological and distress they are also beginning to be used in a preventative framework, giving people the skills they need to protect themselves from developing poor psychological and emotional health (Warriner, Williams, Bardacke & Dymond, 2012).
The MBCT have clear costs for individual cancer patients, little information about longterm use, and uncertainty that they will yield significant reduction psychological distress.

CONCLUSION
In the last ten years mindfulness-based intervention has not only proven to be a feasible and acceptable intervention in cancer patients, but it also seems to be effective in reducing psychological distress. In general, the results suggest that MBCT is an acceptable and credible treatment that was associated with significant psychological distress symptoms, quality of life and physical health improvement. MBCT could be a helpful program in a large health care system.
Psychosocial interventions that effectively reduce the burden of disease associated with cancer are a priority in cancer care. MBCT originally developed to target ruminative processes associated with relapse to distress, has recently been modified for use in oncology. MBCT is one distinct method that has been proven effective against distress, depression, anxiety, and the symptoms that go along with them. It is a structured plan that helps people be in control of their thoughts and their reactions to them and with practice can thus eliminate the body's natural but costly stress reaction responses. Mindfulness-based intervention is frequently described in psycho-oncology literature, but little is known of the effectiveness of MBCT, more research should be conducted to ensure the efficacy of this treatment in helping professions to treat impact of cancer s. Professionals, cancer patients, their families, and agencies have much to gain from further research in this field. Understanding the limitations of psychological treatments for cancer, because of their weakness highlights the complexity of the cancer problem in the world and the need for opting psycho-oncologist and scientist search for other solutions along with medical treatment.