A patient-centered approach to developing a mobile-based mindfulness and social support intervention for adolescents and young adults with sarcoma
Elizabeth Donovan, Ph.D.
Participants: Ten AYA with sarcoma (50% female; 50% adolescents); parents of the five adolescents, and six healthcare providers (N=21).
Design and Methodology: Formative research involved three steps: (1) In-depth interviews were conducted with ten AYA with sarcoma; parents of the five adolescents, and six healthcare providers (N=21). (2) Adaptations were made to an existing mindfulness app (Whil Concepts, Inc.), which offers a program for youth called “Grow.” Modifications included creating a 4-week “Mindfulness for Resilience in Illness” program, with 28 relaxation exercises, and the addition of videos featuring two sarcoma survivors as program hosts. (3) A private Facebook usability group was organized to (i) elicit beliefs about the mindfulness app and potential future enhancements, and (ii) promote social support.
Mindfulness component/intervention: Content was informed by the mindfulness curriculum for adolescents, Learning to Breathe.
Main findings: Results of the in-depth interviews revealed themes around adolescents’ functioning and coping, including body image concerns; recurrence-related anxiety; anger over loss; and being overwhelmed by medical information. Themes from the interviews were incorporated into a demonstration version of the mobile app.
Discussion: A patient-centered approach is widely recommended in the development of mobile-based health behavior change interventions and may be a useful way to inform development of a mobile-based mindfulness and social support intervention for AYA with cancer.
Elizabeth Donovan Ph.D. is the Director of Research and Evaluation for BodiMojo, Inc. in Boston, MA and an Instructor at Simmons College in Boston. She is a developmental psychologist with expertise in health psychology. Her work focuses on the development and evaluation of health behavior change programs delivered through mobile technology. Dr. Donovan’s research interests are in the management of chronic health conditions, particularly conditions involving chronic pain. Her current research goals include qualitatively describing experiences of people living with chronic pain and creating and evaluating interventions to improve the lives of people living with chronic pain.She is currently an investigator on four grants, working in collaboration with researchers from various medical schools and is Principal Investigator on two of these grants. The goal of the first project is to develop and pilot test an intervention designed to increase social support for adolescents and young adults with sarcoma. The goal of the second project is to develop and pilot test an intervention for parents of children with chronic pain. She is also a co-investigator on two grants. The goal of the first project is to increase the provision of pharmacy-based naloxone to reduce overdose deaths from opioids. The goal of the second project is to create and evaluate a text-message based program designed to increase engagement in a state Medicaid pain management program. Dr. Donovan’s research is funded by grants from the National Cancer Institute; the Eunice Kennedy Shriver Institute of Child Health and Human Development; the Agency for Healthcare Research and Quality; and the Patient Centered Outcomes Research Institute.
A Randomized Clinical Trial of an Adapted Mindfulness-based Cognitive Therapy for Internalizing and Attention Problems in Children with Cancer
Randye J. Semple, Ph.D.
Many youth diagnosed with cancer also suffer from anxiety, depression, and attentional problems, which often further impairs the quality of life of these children and adolescents. Mindfulness-based Cognitive Therapy for Children (MBCT-C) is a group psychotherapy developed to enhance self‐management of attention, improve emotional self‐management, and bolster social-emotional resiliency. MBCT-C was adapted to meet the needs of hospitalized cancer patients. The adapted program consisted of 20 sessions, each lasting 45-minutes. Sessions were conducted 5 times weekly for 4 weeks. Forty pre-adolescent youth (ages 11 to 13), diagnosed with cancer, were randomly assigned to either an adapted MBCT-C group (n = 20) or treatment-as-usual (TAU) control group (n = 20). Primary outcome measures were the Child Behavior Checklist Parent Report (CBCL) and its companion instrument, the Youth Self-Report (YSR). Data were collected pre- and post-intervention, and 2 months following the intervention. Repeated measures ANOVAs showed that, as compared to TAU controls, significant reductions in internalizing and attention problems were achieved by the MBCT-C group. Those gains were maintained at the 2-month follow-up. These results further support the efficacy of an adapted MBCT-C program and encourage further research on the effectiveness of MBCT-C to remediate internalizing and attentional problems in youth diagnosed with serious medical illnesses.
Randye J. Semple, Ph.D. is Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Southern California (USC) in Los Angeles. She earned her doctorate in clinical psychology from Columbia University and is licensed to practice in New York and California.Dr. Semple’s research and clinical interests are in the development and application of mindfulness-based interventions to psychological health and well-being. She is co-developer of the evidence-based mindfulness intervention: Mindfulness-Based Cognitive Therapy for Children (MBCT-C) and co-author of the treatment manual Mindfulness-Based Cognitive Therapy for Anxious Children (Semple & Lee, 2011). With Dr. Christopher Willard, she is currently co-authoring a training manual for a school-based adaptation of MBCT-C: Mindfulness Matters that will be published by Guilford Press in 2018. Professor Semple is past-President of the Mindfulness and Acceptance special interest group of the Association for Behavioral and Cognitive Therapies; has been Associate Editor of the peer-reviewed journal Mindfulness; is Consulting Editor for Spirituality in Clinical Practice; serves on the steering committee of Mindful USC; and on the research committee of the American Mindfulness Research Association. She has also been a grant reviewer for the National Institutes of Health, the British Medical Research Council, and the U.S. Army.
Dr. Semple’s research and teaching on mindfulness with youth has been at the forefront of international interest in mindfulness-based interventions for nearly two decades. She has presented at national and international conferences and has more than thirty published scientific papers and book chapters.
A Qualitative Analysis of Young Adult Cancer Survivors’ Experiences with a Mindful Self-Compassion Video-Chat Intervention
Christine Lathren, M.D., MSPH and Karen Bluth, Ph.D.
In this presentation, we describe the unique psychosocial needs of young adults who have been treated for cancer. We then describe the study design and methods of a pilot study examining an 8-week mindful self-compassion (MSC) video chat intervention for a group of 20 nationally recruited young adult female cancer survivors. Five main themes emerging from transcripts of the intervention sessions will be explored: relations with non-cancer surviving peers, common humanity within the cancer survivor community, mindful self-compassion for a changed body, trust in health, and benefits and challenges of practicing MSC during daily life. Finally, the implications for the usefulness and relevance of MSC skills to meet the unique needs of young adults cancer survivors, including potential cautions for use, will be discussed.
Christine Lathren, MD, MSPH is currently a post-doctoral research fellow in the Program in Integrative Medicine and the University of North Carolina at Chapel Hill. Her research interests include mindfulness and self-compassion in youth, and interventions to promote mindfulness and self-compassion within families raising youth, particularly those families who are at higher risk for negative long-term psychosocial and health outcomes.
Dr. Karen Bluth is Assistant Professor at the University of North Carolina at Chapel Hill in the Program on Integrative Medicine and the Department of Physical Medicine and Rehabilitation and a certified instructor of Mindful Self-Compassion, an internationally acclaimed 8-week course created by Dr. Kristin Neff and Dr. Chris Germer. She is co-creator of the curriculum Making Friends with Yourself: A Mindful Self-Compassion Program for Teens, the teen adaptation of Mindful Self-Compassion for adults, and author of the forthcoming book “The Self-Compassion Workbook for Teens: Mindfulness and Compassion Skills to Overcome Self-Criticism and Embrace Who You Are” (New Harbinger Publishers). Dr. Bluth’s research focuses on the roles that self-compassion and mindfulness play in promoting well-being in youth; a new line of her research centers on the role of self-compassion in caregiving. In addition, she is Associate Editor of the academic journal Mindfulness and co-editor of a special issue of the academic journal Self and Identity on self-compassion with Dr. Kristin Neff.
As a mindfulness practitioner for 40 years, a mindfulness teacher, and a lifelong educator with 18 years of classroom experience, Dr. Bluth frequently gives talks, conducts workshops, and teaches classes in self-compassion and mindfulness in educational and community settings. In addition, she trains teachers in Making Friends with Yourself internationally.
Are Adolescents who have Greater Self-Compassion More Resilient and More Likely to Embrace New Experiences?
Karen Bluth, Ph.D. and Michael Mullarkey, M.A.
Due to the physiological and environmental changes taking place during adolescence, this period of development can be challenging for many teens. Although previous research has demonstrated that self-compassion acts as a protective factor buffering the effects of emotional challenges, little research to date has examined the link between strengths-based attributes such as resilience and positive risk-taking (e.g. curiosity and exploration) and self-compassion, and whether age or gender moderates these relationships.
To examine these relationships, we explored results of 787 public school adolescents and 271 private school female adolescents (68% white, 65% female, Mage=15.6) who responded to questions in an online survey. The survey contained the Self-Compassion scale-short form (predictor), Brief Resilience scale and the Curiosity and Exploration II scale (outcomes).
Regression results indicate that self-compassion was significantly and positively associated with positive risk-taking, including subscales of stretching and embracing, and trait resilience. Further, results indicated that gender moderated the latter relationship such that the association between self-compassion and resilience among males was stronger than that of females. Thus, at higher levels of self-compassion, males experience greater resilience than females.
Implications for these findings are that adolescents who are more self-compassionate have a greater capacity to be resilient and to navigate the difficulties faced during this developmental stage. Further, interventions that strengthen self-compassion can help to build resilience and increase adolescents’ capacity to be curious, to take positive risks and to challenge themselves in ways that foster growth and maturity. Further research is needed to test the longitudinal effects of self-compassion on resilience and curiosity and exploration, as well as other strengths-based attributes.
Dr. Karen Bluth is Assistant Professor at the University of North Carolina at Chapel Hill in the Program on Integrative Medicine and the Department of Physical Medicine and Rehabilitation and a certified instructor of Mindful Self-Compassion, an internationally acclaimed 8-week course created by Dr. Kristin Neff and Dr. Chris Germer. She is co-creator of the curriculum Making Friends with Yourself: A Mindful Self-Compassion Program for Teens, the teen adaptation of Mindful Self-Compassion for adults, and author of the forthcoming book “The Self-Compassion Workbook for Teens: Mindfulness and Compassion Skills to Overcome Self-Criticism and Embrace Who You Are” (New Harbinger Publishers). Dr. Bluth’s research focuses on the roles that self-compassion and mindfulness play in promoting well-being in youth; a new line of her research centers on the role of self-compassion in caregiving. In addition, she is Associate Editor of the academic journal Mindfulness and co-editor of a special issue of the academic journal Self and Identity on self-compassion with Dr. Kristin Neff. As a mindfulness practitioner for 40 years, a mindfulness teacher, and a lifelong educator with 18 years of classroom experience, Dr. Bluth frequently gives talks, conducts workshops, and teaches classes in self-compassion and mindfulness in educational and community settings. In addition, she trains teachers in Making Friends with Yourself internationally.
Michael Mullarkey, M.A.: Not provided.
Mindfulness-Based Teacher Training and Social Emotional Competence in the Classroom
Elizabeth R. Mackenzie, Ph.D., Jenny Mills, M.Ed., and Alexandra Smith, MS.Ed., MPhil.Ed.
Everyday Mindfulness for Schools is a training designed for groups of teachers, counselors, and school personnel that takes place twice a month for 90-minutes for a total of 8 classes in one semester. The course includes traditional mindfulness practices (sitting and walking meditation, body scan) and practical in-the-moment strategies that streamline into everyday life. Participants gain insight into their own habitual thoughts and behavioral patterns, and ways in which mindfulness practices rewire the brain to support new neural pathways.
We used a mixed methods approach to assess the impact of Everyday Mindfulness for Schools on the professional development experience and quality of life of 27 teachers at three schools (one private and two public). Our findings suggest that a relatively short duration mindfulness-based teacher training program can have a significant impact on the lived experience of teachers, which appears to ripple out into their personal and professional lives in prosocial ways. Most intriguing, is the possibility that mindfulness-based professional development training for teachers could significantly transform classroom culture, without imposing new rules from above or requiring teachers to follow externally sourced guidelines. More research is needed to explore exactly how and in what circumstances mindfulness training can help teachers cultivate social-emotional competence, thereby improving classroom culture, but the preliminary indications are promising.
Elizabeth R. Mackenzie, PhD is an Adjunct Associate Professor and the Manager of the Human Development Programs at the Graduate School of Education, University of Pennsylvania. Dr. Mackenzie’s areas of teaching expertise include contemplative sciences, mindfulness meditation, mind-body medicine, and healthy development. For five years, she was a Research Assistant Professor in the division of Geriatric Medicine at the University of Pennsylvania, where she conducted research on mental health and spirituality. She is also member of the Associated Faculty in the Health and Societies Program at Penn’s School of Arts and Sciences where she teaches undergraduate courses on mind-body medicine and the social context of health. She is the author of over 20 original research articles, review articles, and book chapters, and the co-editor of a book on healthy aging. Her dissertation was published as Healing the Social Body: A Holistic Approach to Public Health Policy. Dr. Mackenzie is a Certified Koru Mindfulness Teacher, a form of mindfulness practice designed specifically for Emerging Adults, and she regularly teaches Koru Mindfulness to graduate and undergraduate students at Penn.
Jenny Mills, M.Ed. is the founder of Roots & Wings, LLC whose mission is to make mindfulness accessible to teachers, youth, and families. She has a Masters in Special Education and a BA in Psychology from Rutgers University and is dually certified in special and general education. Before opening Roots & Wings, Jenny served as a mindfulness instructor and literacy specialist at Arise Academy High School, a unique inner-city charter school designed for 14-21 year olds served by the Department of Human Services. Jenny has presented at international, national, and local conferences on the topics of literacy, formative assessment, and mindfulness. She has practiced meditation since 2005, and has received extensive training in mindfulness under many teachers including Ahn Huong, Thu Nguyen, Michael Baime, Tish Jennings, and more. Jenny co-teaches in the Penn Literacy Network, a University of Pennsylvania initiative that serves local K-12 teachers. In 2015, Jenny published her first children’s book, Mindful Moments: Trevor’s Tale and in 2013 produced her first guided meditation CD, Roots & Wings Mindfulness Meditations.
Alexandra Smith, MS.Ed., MPhil.Ed. is a recent graduate of the Professional Counseling Program at the University of Pennsylvania’s Graduate School of Education. She interned at the Monte Nido Eating Disorder Center of Philadelphia where she used her mindfulness-based skills to support clients with eating disorders. Alex is a long-time student of yoga and meditation, with a keen interest in how to integrate these practices into psychotherapy as she pursues licensure.