Projekt Krop & SindInternet-delivered Mindfulness-Based Cognitive Therapyfor women treated for breast cancer and men treated for

prostate cancer

Eva Rames Nissen, MSc Psychology, PhD-Student enissen@psy.au.dk

Unit for Psychooncology and Health Psychology, AU, AUH

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The present project

Internet-delivered Mindfulness-Based Cognitive Therapy for symptoms of depression, anxiety and stress among women treatedfor breast cancer and men treated for prostate cancer

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• Psychological distress among cancer survivors

• Effective treatment: Mindfulness-BasedCognitive Therapy (MBCT)

• Use of MBCT is limited because:• Lack of educated intructors

• Practical implications for patients

→ Internet-delivered MBCT (I-MBCT)

ClinicalTrials.org NCT03100981, Piet, Würtzen & Zachariae (2012), Johannsen et al. (2016)

The present project

• Project and intervention planning– in collaboration with patient representatives

• Intervention platform– Collaboration with the Internet Psychiatry at Karolinska Institutet and Psykiatri

Sydväst, Stockholm, Sweden

• Intervention content– Development of a text-based intervention based on the manual for

Mindfulness-Based Cognitive Therapy

• Study– Randomized Controlled Trial of the efficacy of the intervention

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Project and intervention planning

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Meeting 1:- Introduction to project- Preparation of interviews

Meeting 2:- Evaluation of interviews- Discussing program material

Meeting 3:- Test of program draft- Information material

- Video recordings with members of the sharedworking group

Interviews

DevelopingI-MBCT

RCT

FeasibilityStudy

Meeting 4:- Feedback on program- Results from feasibility study- Evaluation of working group

FinalizingI-MBCT

Involvement of a shared working group with patient representatives and researchers

3 women treated for breast cancer2 men treated for prostate cancer4 researchers1 research assistant

Patient Involvement in Research

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What we can affect

”Circle of control”

What we cannotaffect

MBCT manual

Project economy

Timeframe of project

Platform

Information material

Formulations in program

Video material

How and when weapproach patients

Patient Involvement in Research

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”What does ‘cognitive’ mean?(in Mindfulness-Based Cognitive Therapy)

”Why do you ‘request people to participate’ instead of offering them

a really valuable intervention?”

”Why do you present the hardwork first and the potential

benefits last?”

”It feels like the hormones are

rushing in my bodyand that the

deamons are rushingin my head”

Framing and facilitation

What we did• Facilitation of

collaboration• Atmosphere• Meal• Introduction round• Name tags• Sense of equality• Practical help

Nissen et al. (2018)

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Key changes

I-MBCT program• Text• Cases• Visual structure• Video examples

RCT• Interview guide• Recruitment procedure• Information material• Outcome measures

Overall• How we think about and do research• Contribution to others• New perspectives

Nissen et al. (2018)

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Project and intervention planning

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Platform

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• Erfaringer• Ressourcer

• Oversættelse• Tværfaglighed

Platform

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• Begrænsninger• Data

Intervention Content

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• Manualbaseret• Terapi på skrift

Intervention Content

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• Formuleringer og hensigter

• Opsætning og struktur

Intervention Content

• Omfang af tekstmateriale

Efficacy study – preliminary results

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n=1284 (BC: 987 PC:297)

n=150(BC: 137 PC:13)

n=104 ; n=46(BC: 96 ; 41 PC: 8 ; 5)

n=74 ; n=37(BC: 66 ; 32 PC: 8 ; 5)

Prospective considerations

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• Why does it seem to work better for men/prostate cancer patients?

• Will a more user-friendly platform improve feasibility and reduce drop-out-rate?

• How can we implement the intervention more broadly?

• Is I-MBCT the ”best” intervention for this patient population?

AcknowledgementsFunding:• The Danish Cancer Society• TrygFonden• Central Region Denmark

Collaborators:• Unit for Psychooncology and Health

Psychology– Prof. Bobby Zachariae– Dr. Mimi Mehlsen– Dr. Maja O’Connor– Ms. Anne Kathrine Østerby Muldbjerg

• Department of Oncology, Aarhus University Hospital

– Dr. Inger Højriis

• Department of Urology, Aarhus University Hospital– Prof. Michael Borre

• Karolinska Institutet and Psykiatri Sydväst, Stockholms Läns Landsting, Sweden

– Prof. Viktor Kaldo– Prof. Nils Lindefors

• Research Programme for Patient Involvement, Aarhus University and Aarhus University Hospital

– Prof. Kirsten Lomborg– Dr. Vibeke Bregnballe

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