Children with cancer often have significant cognitive, emotional, behavioral, and academic problems. These result not only from the illness itself, but also the anxieties associated with diagnosis and prognosis, the negative side-effects of oncology treatments, and the lengthy separations from familiar settings and social supports entailed by hospitalization. Psychosocial interventions are needed that can more effectively bolster children’s resilience over the course of arduous treatment.
Abedini et al. [Mindfulness] assessed the value of a modified version of Mindfulness-Based Cognitive Therapy for Children (MBCT-C) in reducing internalizing psychological problems (anxiety, depression, and somatization) and attentional problems in school-age children undergoing hospitalization for cancer.
The researchers randomly assigned 40 Iranian children hospitalized for cancer (age range = 11-13 years; 53% male) who met the diagnostic criteria for acute stress disorder and showed elevated internalizing and attentional problems to a modified version of MBCT-C or to treatment as usual. The children were continuously hospitalized throughout the length of the intervention.
MBCT-C was delivered in the Farsi language to small groups of 2-4 participants meeting 5 times a week. The standard MBCT-C protocol was modified to meet the children’s physical, motivational, and attentional needs and the demands of the hospital schedule. Group sessions were shortened to 45 minutes each, delivered over a shortened 4-week time-course, and without the usual raisin, yoga, and mindful movement meditations.
Treatment as usual included limited medical social worker support and a playroom available for 2 hours daily. Children were assessed before and after treatment and at 2-month follow-up for internalizing behavioral problems and attentional difficulties using a parent-completed behavioral checklist, and a child-completed self-report inventory.
The results showed significantly greater reductions in parent-rated (η2=.53) and child-rated (η2=.57) internalizing symptoms for the mindfulness group compared to controls. Parent-rated symptoms decreased 19 points and child-rated symptoms 20 points, while control parent- and child-rated symptoms dropped only 1 point.
The mindfulness group also showed significantly greater decreases in attentional problems compared to controls on both parental (η2=.76) and child ratings (η2=.36). Parent-rated attentional problems decreased 15 points and child-rated attentional problems decreased 19 points for the mindfulness group while the control group remained essentially unchanged.
The study shows that MBCT-C modified to meet the needs of hospitalized children with cancer and acute stress disorder can significantly improve symptoms of anxiety, depression, somatization, and impairments in attention compared to treatment as usual. These improvements are sustained for at least 2-months after intervention.
The study is limited by the absence of post-intervention outcome ratings by clinicians blind to group assignment, and the lack of an active control group which also promoted social interaction with other children with cancer.
Reference:
Abedini, S., Habibi, M., Abedini, N., Achenbach, T. M., & Semple, R. J. (2020). A Randomized Clinical Trial of a Modified Mindfulness-Based Cognitive Therapy for Children Hospitalized with Cancer. Mindfulness.
