Receiving a diagnosis of cancer can be highly stressful, requiring psychological and behavioral adjustments to cope effectively with increased levels of stress that subsequently may affect psychological functioning  and cancer symptom severity . The prevalence of clinical levels of distress in individuals with cancer is in the 35%–45% range [3–6]. Distress in these individuals most commonly presents as anxiety and mood disorders across stage and site of illness [3, 7–9]. Therefore, the development and testing of accessible psychosocial interventions intended to reduce stress and improve mood and quality of life are important .
Interest in the potential health benefits of mindfulness meditation within the western medical system has increased with the development and proliferation of interventions modeled after the original Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts Medical Center, developed in the late 1970s by Jon Kabat-Zinn and colleagues [10, 11]. Mindfulness meditation is the practice of cultivating moment-to-moment awareness of internal and external experience in an accepting and open manner . MBSR is an 8-week group intervention consisting of intensive training in mindfulness meditation and Hatha yoga that is designed to treat symptoms of stress, pain and chronic illness . Attitudes of open inquiry, patience, suspended judgment and compassion are encouraged and cultivated through the program during class and also through assigned daily homework. Individuals are taught to focus attention on sensations of the breath, body, and objects that enter awareness, such as thoughts and emotions, with the intention to fully experience the present moment . One result of such focused attention in the present moment is reduction of rumination on the past or persistent worry about the future, as well as increased tolerance of uncomfortable emotional experiences (improved emotional regulation), which can result in decreases in symptomatology.
Research indicates F2F MBSR interventions are efficacious for treating a variety of symptoms associated with a range of chronic medical and psychiatric problems, including cancer [13–20]. Current literature, including the body of work from our research team on MBSR in oncology shows participation in F2F MBSR results in decreased stress symptoms, mood disturbance, anger, and fatigue, with concurrent increases in sleep quality, post-traumatic growth, spirituality and enhanced quality of life [14, 21–29], as well as changes in several potentially important cancer biomarkers including immune function and stress hormones [30, 31]. Several meta-analytic and comprehensive reviews of the effects of F2F MBSR in cancer concluded that it is a clinically valuable evidence-based intervention for cancer patients [16–18, 20] with average Cohen’s d effect sizes for improving psychological and physical well-being of 0.48 and 0.18, respectively .
Despite their proven efficacy, there may be practical and psychological barriers to participation in F2F MBSR programs, such as geographic distance, cancer-related illness, fatigue, limited mobility or disability, child care, transportation, time, and self-consciousness, to name but a few. The Internet represents a promising method of delivering psychosocial interventions such as MBSR to underserved cancer patients who are unable to attend F2F programs. With the increase in Internet use and capabilities, psychosocial interventions are beginning to be offered online , and the use of synchronous online therapy that takes place in “real time” has increased. Fast broadband connection allows auditory and video exchanges that simulate the speed of F2F conversations, and videoconferencing using a broad range of software and programs is gaining greater use in therapy contexts [33, 34]. In a meta-analysis, Barak et al., in 2008, compared the effectiveness of F2F psychological interventions such as Cognitive Behavioral Therapy (CBT) or Prolonged Exposure (PE) to Internet versions, and overall revealed comparable results . Most similar to the proposed online MBSR study, Gardner-Nix and colleagues evaluated a non-randomized 10-week Mindfulness-Based Chronic Pain Management (MBCPM) intervention for chronic pain patients. The MBCPM program was based on the MBSR program, but additional emphasis was placed on learning to observe emotions associated with pain and general health education . Patients received MBCPM via traditional F2F teaching, via videoconferencing at their local hospital, or were wait-listed. Baseline and post intervention measures showed patients in the F2F and videoconferencing groups achieved similar gains in mental health and pain catastrophizing relative to controls. However, the F2F group obtained significantly higher scores on the physical dimension of quality of life and lower pain intensity ratings than the videoconferencing group . The authors concluded that while Internet interventions show potential for treating chronic pain patients, results may be better in person for some outcomes. While this study did use videoconferencing technology, advancements in sophisticated “real-time” technology since 2008 are significant and have potential to substantially enhance patient interaction and the overall patient experience. Our current study represents an advance over this methodology for several reasons: randomization of our participants, elimination of the need for patients to travel to treatment centres - increasing rural and remote individuals’ access despite geographic location, transportation issues, fatigue etc. We are also able to capitalize on the current technology for improved speed and quality of online communication in our trial.
The positive benefits of MBSR in individuals living with cancer have been well documented by our research team. However, practical and psychosocial barriers may impede participation and access to our popular F2F programs [34, 36]. The Internet represents a promising method of delivering empirically supported psychosocial interventions such as MBSR to this underserved cancer population who are otherwise unable to participate, but it has never been evaluated in this context.
In this paper, we describe an ongoing trial to assess the efficacy of an online adaptation of an MBSR intervention for individuals diagnosed with cancer, online MBCR; the first of its kind. Participants are randomized to either an adapted online MBSR condition or a wait-list control condition. This study will help set the direction for future treatment studies to further evaluate online MBSR.