MINDFULNESS-BASED STRESS REDUCTION AND DIVERSIONAL THERAPIES IN THE MANAGEMENT OF PSYCHOLOGICAL DISTRESS AMONG CERVICAL CANCER PATIENTS IN LAGOS AND IBADAN, NIGERIA

Abstract

Psychological distress, an affective, cognitive and behavioural response to crisis precipitating events, is manifested by anxiety and depressive symptoms. Evidence has shown that cervical cancer patients in Lagos and Ibadan, Nigeria exhibit psychological distress after diagnosis. Previous research efforts focused on the predisposing factors to psychological distress, with little attention paid to psychological interventions in managing the psychological distress among cancer patients. This study, therefore, was carried out to determine effects of Mindfulness-based Stress Reduction (MbSR) and Diversional Therapy (DT) in the management of psychological distress among women diagnosed of cervical cancer in Lagos and Ibadan, Nigeria. It also examined the moderating effects of Health Self-efficacy (HSe) and Social Support (SS). The study was anchored to Stress Process Model, while the mixed methods design (QUAN+qual) was adopted. The multi-stage sampling procedure was used. The purposive sampling technique was utilised to select three teaching hospitals (Lagos University Teaching Hospital, Idi Araba, Lagos, Lagos State Teaching Hospital, Ikeja, Lagos and University College Hospital, Ibadan) that provide comprehensive cancer treatment from Lagos and Ibadan, Nigeria. The cancer patients attending these teaching hospitals were screened with Distress Thermometer (α=0.75) and those who scored above the threshold of four were selected. The teaching hospitals were randomly assigned to MbSR (24), DT (21) and control (16) groups. The instruments used were Kessler Psychological Distress (K10) (α=0.81); Health Self-efficacy (α=0.84), Social Support (α=0.89) scales and training manual. Focus group discussions were held with 10 cervical cancer patients in Ibadan. The intervention lasted eight weeks. The quantitative data were analysed using descriptive statistics, Analysis of covariance and Scheffe post-hoc test at 0.05 level of significance, while the qualitative data were content analysed. The participants‘ age was 48.00±3.60 years. There was a significant main effect of treatment on psychological distress among cervical cancer patients (F(2;44) =79.73, partial 2 = 0.7l). The participants exposed to MbSR had the lowest psychological distress mean score (17.96), as against those in the DT (20.76) and control (43.19) groups. Health Self-efficacy had a significant main effect on psychological distress (F(1;44)=6.68, partial  2 =0.13). The participants with high HSe recorded lower psychological distress mean score (18.00) than those with low HSe (20.20). There was no significant main effect of social support on psychological distress of the cervical cancer patients. The two-way and three-way interaction effects were not significant. Financial help facilitated cervical cancer patients‘ adjustment to the diagnosis, while frequent awareness programmemes; free vaccine and cervical cancer screening were suggested ways in which cervical cancer could be prevented. Mindfulness-based stress reduction and diversional therapy were effective in reducing psychological distress among cervical cancer patients in Lagos and Ibadan, Nigeria. Clinical and counselling psychologists should adopt these two therapies in the treatment of psychological distress among cervical cancer patients.