Existential and Spiritual Outcomes

Our more recent work has evolved to investigate the effects of MBSR on the types of existential outcomes described in the introduction. One way of examining these personally meaningful outcomes is through patient self-assessment using questionnaires developed to measure constructs such as benefit-finding and spirituality. We assessed posttraumatic growth using the Post-Traumatic Growth Inventory (PTGI) and Spirituality using the Functional Assessment of Chronic Illness Therapy-Spiritual Well Being (FACIT-Sp) scale in 28 MBSR class participants with mixed cancer diagnoses an average of about 1.5 years since diagnosis, before and after program participation (paper under review). Stress-specific symptoms and mood disturbance were also assessed. Participants' scores on the spirituality measure improved significantly over time, while nonsignificant increases in posttraumatic growth were observed. Overall, improvements in symptoms of stress and mood disturbance, depression and anger, confirmed our previous findings within a new group of patients.

In order to investigate the phenomenon of enhanced spirituality and posttrau-matic growth in greater depth, we chose to conduct qualitative interview research with a specific subgroup of our MBSR participants.122 Nine cancer patients who had participated in the 8-week MBSR program, and who continued to attend weekly drop-in MBSR sessions, which consist of meditation and yoga practice, were interviewed for this study. Qualitative research was conducted using a grounded theory model. Participants were between 43 and 77 years in age (average age 60.8 years). Additionally, participants had been active in the drop-in group for between 1 and

6 years (average time 2.8 years). Of the nine participants, four had breast cancer, two had prostate cancer, one had ovarian cancer, one had a malignant melanoma, and one had multiple cancers (lung, thyroid, and Hodgkin's disease). Participants had been first diagnosed between 31 years (with a recent recurrence) and 4 years previously (median, 5 years), and were well into survivorship mode.

Within semistructured interviews and a focus group, patients were invited to describe how adding meditation to their lives had affected them. Through analysis of the transcripts, five major themes were identified, labeled as: (1) Opening to change; 2) Self-control; 3) Shared experience; 4) Personal growth; and; 5) Spirituality. This information was used to develop specific theory concerning mechanisms whereby MBSR effects change for cancer patients. In this theory the initial participation in the 8-week program is seen as only the beginning of an ongoing process of self-discovery, a slight shift in orientation that begins the growth process. At that time patients feel isolated, scared and unsure of what to do in the face of a cancer diagnosis. The MBSR program helps to meet their needs for understanding they are not alone in their journey, teaches concrete tools for self-regulation, and introduces ways to look at the world they may not have previously considered. This results in benefits such as reduced stress symptoms and lower levels of mood disturbance.

As practice progresses in the drop-in group, social support deepens as relationships are further developed, and people begin to learn to be less reactive and exercise more diffuse self-regulation across a wider variety of life circumstances. Underlying this process is a theme of personal transformation, of feeling part of a larger whole. With this comes the development of positive qualities of personal growth and positive health, beyond merely the symptom reduction documented over the course of the initial program. A growing spirituality of finding meaning and purpose in one's life and feeling increasingly interconnected with others is part of this personal transformation. Qualities of gratitude, compassion, and equanimity may be the ultimate culmination of practice—very similar, in fact, to the goals of many of the Eastern practices upon which MBSR is based. Although this theory of the development of mindfulness practice is stated in linear terms, all of these processes likely occur simultaneously to varying degrees. Accordingly, the emphasis or importance of different aspects may oscillate depending on the life circumstances of each individual.

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