English summary

Summary
During the past 20 years the survival rate of cancer has increased due to advancements in the diagnosis and treatment of cancer. Therefore, cancer is increasingly approached as a chronic illness. A significant share of the cancer patients suffers from psychological complaints. Recent figures show that the mean prevalence of depression in cancer patients is estimated between 8 and 24% depending on the diagnostic instrument used. Since the absolute prevalence of cancer is rising, the need for psychological help for cancer patients will rise too in the upcoming years. Therefore, we are in need of effective and broadly available psychological services.

The clinical application of mindfulness techniques as means to improve psychosocial functioning have increasingly gained attention in oncological settings. One could see mindfulness as a state of consciousness which involves consciously attending to one’s moment-to-moment experience in a non-judgemental, mild and accepting way. Developing mindfulness can contribute to the ability to recognize destructive thought patterns, and to act upon these in a skillful manner.

Mindfulness-Based Cognitive Therapy (MBCT) is an intervention has shown promising results in terms of improvement in psychosocial well-being in oncological settings. Orginally designed to prevent relapse of depression, MBCT combines mindfulness meditation techniques with cognitive behavioural therapy-elements and psycho-education. For an interesting review of research on mindfulness applications in oncology, see Piet et al., 2012.
Thus, MBCT shows promising results. Online applications of MBCT could contribute to its accessibility and possibly even cost-effectiveness. Research on online applications of mindfulness techniques in oncology is virtually absent, however.

Therefore, the current study aims at investigating whether:
1. Individual online mindfulness-based cognitive therapy (MBCT)
2. And MBCT offered face-to-face in groups
Are superior to:
3. A waiting list-control group

In terms of improvement of:
Depression and anxiety, fatigue, psychological health, quality of life, mindfulness skills and cost-effectiveness. We will also examine the predictors and mediators of treatment effect in both individual MBCT online and MBCT group training. With regard to prediction of treatment effect, we will investigate socio-demographic variables such as age and education level. With regard to mediation, we will look at mindfulness skills, working alliance between client and professional and group cohesion.

Who can participate?
Patients are included if:

- they have a cancer diagnoses (any stage)
- they suffer from psychological distress
- they have been on a stable dose for at least three months  if they are using psychopharmacological medication
- if they have access to internet and are computer literate
- they are capable of filling out questionnaires in Dutch.

Excluded are all patients with:
- Previous experience with mindfulness
- Severe psychiatric comorbidity such as psychoses and suicidal ideation

The interventions
The face-to-face group MBCT training will consists of 8 weekly sessions of 2,5 hours each and a silent day of 6 hours of meditation practice. Participants will be asked to practice at home for 45 minutes, 6 days a week. They will receive CD sets with exercises to support this. The individual online MBCT programme will have the same content as the face-to-face MBCT.

In the individual online condition, clients will practise exercises at home guided by audio files and written instructions that are included in a reader. For example, clients will start the intervention by studying the reader’s chapter for that first week and by downloading an MP3 file with the body scan exercise, which they are asked to practice every day for 45 minutes. They register their experiences in their homework logs during the week. The therapist will react to the homework logs with a written reply, sent to the patient on a predetermined day of the week. Patients continue with the next week  downloading a new chapter of the reader and new mindfulness exercises for that week, and so on for all nine weeks. Clients can only continue with the next session after they have recorded their homework experiences of the previous week. Clients complete the programme in 9-12 weeks.