Interview with
Dr. Linda Carlson
Dr. Linda Carlson Ph.D. C. Psych
Dr. Linda Carlson holds the Enbridge Research Chair in Psychosocial Oncology, is Full Professor in Psychosocial Oncology in the Department of Oncology, Cumming School of Medicine at the University of Calgary, and Adjunct Professor in the Department of Psychology. She is the Director of Research and works as a Clinical Psychologist at the Department of Psychosocial Resources at the Tom Baker Cancer Centre (TBCC). Dr. Carlson's research in Psychosocial Oncology, Integrative Oncology and Mindfulness-Based Cancer Recovery has been published in many high-impact journals and book chapters, and she published a patient manual in 2011 with Michael Speca entitled: Mindfulness-Based Cancer Recovery: A step-by-step MBSR approach to help you cope with treatment and reclaim your life, in addition to a professional training manual in 2009 (2nd Edition 2017) with Shauna Shapiro entitled The Art and Science of Mindfulness: Integrating mindfulness into psychology and the helping professions.
Some parts of this interview have been edited for length and clarity.
What is psychosocial oncology and why is this field important?
Psychosocial oncology is the study of the social, emotional, and interpersonal aspects of dealing with cancer from the point of diagnosis through treatment, post-treatment, survivorship, and end of life. We’re looking at the impacts of the cancer diagnosis with regards to things like symptoms and side effects, which are very common such as high levels of distress, anxiety, depression, and symptoms such as fatigue, difficulties with sleeping, and pain. These kinds of problems tend to be long lasting well after treatment completion. Even if people have been treated with curative intent, and there’s a good prognosis, many still suffer with a lot of these lingering problems including fear of cancer recurrence. That’s what led to the need to have psychosocial interventions to support people, typically through cancer, but often post cancer in the survivorship phase.
What is Mindfulness-based Cancer Recovery (MBCR) and what led to its inception?
We need to step back a few decades first. I did my PhD in Clinical Psychology in the 1990’s, at McGill University. During that time, I became familiar with Jon Kabat-Zinn and his MBSR program. As a student, I also started meditating. I had an interest even though my PhD was in psychoneuroimmunology. So it was looking at the mind-body connection more broadly, and I had a personal interest in mindfulness and yoga. When I moved to Calgary and started working at the cancer center, there was a group of other clinicians who also had a personal interest in meditation and yoga. I brought some knowledge of the MBSR paradigm. We came up with this intervention, specific to people with cancer that addressed some of the issues I outlined earlier.
In addition to the expected symptoms people are dealing with, there are also existential issues around uncertainty, loss of control and mortality. Those kinds of bigger picture issues, as well as just day-to-day coping with stress, pain, and fatigue, needed addressing. We adapted the MBSR model specifically for people with cancer, and just started doing clinical trials. This was about 1998. Our first study was published in the year 2000. That was actually the first study of mindfulness for people with cancer in the literature, and since then, through the next almost 25 years, we’ve just continued to do more and different types of studies, as have other people all around the world. Now there’s a very strong evidence base to support mindfulness-based interventions for people with cancer.
What is Tai Chi and Qigong and what potential does it have for psychosocial oncology?
There are a whole range of different mind-body therapies or energy therapies that have been investigated for people with cancer, and these include mindfulness, yoga, imagery, relaxation, hypnosis, and another one from traditional Chinese medicine is Tai Chi, which was originally a form of martial art that was used in defense, but it’s since been adapted as a health practice. There’s also Qigong, which actually comes directly from traditional Chinese medicine.
Tai Chi you might think of as older people in the park doing all this slow choreographed movement. Those are called forms. And in traditional Tai Chi, there’s something like 24 forms and it’s quite complex to learn them all. Qigong tends to be simpler. Each move has a posture that might be flowing, or it might be static, and then there’s a breathing pattern that goes with it, and a focus on directing energy. And so the intervention we’ve been studying we call TCQ, for Tai Chi Qigong, it’s like a simplified version that my colleague Peter Wayne at Harvard developed as an adaptation. So in a study we’ve done (called the MATCH Study), we compared this TCQ program to our Mindfulness-Based Cancer Recovery program in over 600 cancer survivors in a multisite trial in Calgary and Toronto, looking at a really broad range of different outcomes- psychosocial, physical, and biomarker as well. The study is done but we haven’t published any of the results yet.
“I find it interesting that people seem so excited when you show that a mindfulness-based intervention can change cytokines like immune function, telomere length, or affect gene expression. That’s cool, but what’s important to me is that a person feels better; that their anxiety has gone down, they can cope, have a better quality of life, they’re sleeping better, and that their pain is managed.”
How can technology help deliver mindfulness interventions to cancer patients?
There are issues around accessibility, scalability, sustainability, basically, access issues. In-person programs are only accessible to people who happen to live in a city where the programs are available. As we know, they’re not everywhere. There are also other barriers around cost and time and transportation. So really, if you want to get these types of interventions out to a lot of people at a low cost, technology is one way to do that. So we’ve developed both online interactive Mindfulness-Based Cancer Recovery as well as through an app, where weadapted the program into an app format. We’ve done studies on both of those. We have also developed and are testing a virtual reality version of mindfulness for pain management.
What is the AmDTx app?
It’s called AmDTx (like “I am“). It’s a larger generic mindfulness app that has been developed by a company we’ve worked with called Mobio Interactive . The Am app itself is really cool. It offers consecutive ‘journeys’ you can take, has a whole library of different meditations, teachings, as well as practices. It has ways to interact with the app like a feature where it uses the camera to measure blood flow, and comes up with a biological stress score. It also has a mood board where you can map your mood, and then it suggests meditations based on how you’re feeling. Within that, it’s got these series of journeys. And so ours is called the Mindfulness-Based Cancer Survivorship Journey. It’s within the larger AmDtx app.
Do you envision that mindfulness apps would eventually become a free tool for the public?
Many apps already are a free tool for the public. Everybody has access! What’s lacking is a rigorous investigation of who they help and in what ways do they help? Science is beginning to catch up with the commercialization of it. We’re starting to see some evidence that there may be benefits, but we still need to do a lot more research. You know, it’s not anywhere near the evidence base that we have for in-person programs right now. I’m from Canada, where healthcare is public and free. I believe that anything that’s part of our healthcare system should not be at cost.
Do you think that mobile health (mHealth) mindfulness-based interventions will replace traditional in person mindfulness programs?
I hope not. There’s always a place for in-person programs. One of the questions around designing mobile apps is how much of that relationship with the teacher or the instructor can we incorporate, and is there a real need to incorporate that? In my opinion, it’s never going to be the same. If it’s just a series of guided meditations, that’s the very lowest common denominator. I feel like guided meditations are just the tip of the iceberg. The philosophy behind the practices are just as important. So apps that include that would likely be better.
What we’re really doing is creating a shift in how people think about the universe, how they live their lives. It’s as Dr. Jon Kabat-Zinn would always say, ‘an orthogonal rotation of consciousness,’ like you are approaching life in a completely different way after you participate in a mindfulness-based intervention. If you just listen to some guided meditations on an app, it might be helping you regulate your level of physiological arousal but it may not be shifting your consciousness in the same way as practicing through a program does. In a program there is a lot more discussion around application and theoretical concepts around mindfulness, what causes suffering, and the intersection of a mindfulness-based approach and the cessation of suffering. It’s not something you necessarily get from doing a guided body scan. So you need to be experiential, but also understand the theoretical underpinnings.
For the people who’ve been through our program, we follow them up years later. And many of them are not still practicing formally. But they still report lasting benefits because they live their life more in accordance with the attitudes that we teach: acceptance, letting go, and non-attachment, for example. Those things are fundamental, especially for people who are going to spend the rest of their lives worrying about cancer coming back. So I don’t see apps ever replacing that. Maybe there’s a possibility, but the digital health interventions would have to be quite different than the mindfulness apps are now.
“…many of them are not still practicing formally. But they still report lasting benefits because they live their life more in accordance with the attitudes that we teach: acceptance, letting go, and non-attachment, for example. Those things are fundamental, especially for people who are going to spend the rest of their lives worrying about cancer coming back.”
If there’s one scientific discovery that you hope to make in your lifetime, what would it be?
I don’t think about it that way, like there’s something out there to discover; it’s problems that need to be solved. I guess the fundamental problem I’ve been trying to solve my entire career is how to live your life in a way that is joyful, with ease, compassionately, that helps you get through whatever life throws at you, whether it’s a cancer diagnosis, or whether it’s a mental health problem, whatever it is. Those are the bigger problems I hope to address in my life’s work.
“What we’re really doing is creating a shift in how people think about the universe, how they live their lives. It’s as Dr. Jon Kabat-Zinn would always say, ‘an orthogonal rotation of consciousness,’ like you are approaching life in a completely different way after you participate in a mindfulness-based intervention.”
Read her Books
Mindfulness-Based Cancer Recovery: A Step-by-Step MBSR Approach to Help You Cope with Treatment and Reclaim Your Life
If you have received a cancer diagnosis, you know that the hundreds of questions and concerns you have about what's to come can be as stressful as the cancer treatment itself. But research shows that if you mentally prepare yourself to handle cancer treatment by getting stress and anxiety under control, you can improve your quality of life and become an active participant in your own recovery.
The Art and Science of Mindfulness: Integrating Mindfulness Into Psychology and the Helping Professions
Intention is fundamental to any project, endeavor, or journey. Related to intention is the concept of mindfulness - the awareness that arises through intentionally attending to oneself and others in an open, caring, and nonjudgmental way. Authors Shapiro and Carlson draw from Eastern wisdom and practices as well as Western psychological theory and science to explore why mindful awareness is integral to the therapeutic healing process and to show clinicians how to connect with this deeper awareness.
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Michael Juberg
Michael is the Founder & Chief Editor of the Science of Mindfulness.
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