1. Introduction

 Mindfulness is believed to have originated in Buddhist philosophy and practice of meditation over 2500 years ago, it’s meaning and mission being that of lowering the suffering caused by dysfunctional ways in which people tend to respond to experiences. Simplifying and popularizing this concept was initiated in 1970 by Jon Kabat-Zinn. The first short course which he supported showed demonstrable, significant and relatively rapid decreases in psychological symptoms and often physical ones in a group of patients who were experiencing severe pain and stress caused by a variety of medical chronic physical conditions (Kabat-Zinn, 1996 as cited in Weare, 2013).

Practice based on mindfulness is intimately connected with neuroscience, imaging studies of the adult brain, showing that mindfulness meditation can deeply and constantly change the structure and operation of the brain and produce, for example, increase blood flow and thickening of the cerebral cortex in areas associated with attention and emotional integration. The changes are even more dramatic in those who meditate long term, but also perceptible in the short term, and the participants in the eight weeks course showed at the analysis pre-post intervention an increased density of gray matter in areas of the brain associated with learning, memory, self-awareness, compassion, insight, and the decrease of density in areas associeted anxiety and stress. (Davidson & Lutz, 2008 as cited in Weare, 2013) [[i]]

A study that investigated the effects of participation in a program of stress reduction based on Mindfulness (MBSR) on mood disorders and symptoms of stress from former cancer patients, had as a resulted a significant decrease in the total score of declared mood disorder and its subscales,depression, anxiety, anger and confusion (as compared to the control group). Also, patients who participated in the weekly schedule of meditation for 1.5 hours over seven weeks, continuing and having an individual meditative practice at home, declared, overall, fewer symptoms of stress, a lower emotional irritability, as well as the diminishing of depression, cognitive disorganization and fewer habitual patterns of stress. Reducing the overall mood disorders was 65% and 31%  in stress symptoms [[ii]].

Another study that used clinical intervention MBSR for seven weeks showed reduced levels of mood disorders and stress symptoms in the group of patients with cancer, and these improvements were maintained six months later. The most increased benefits were the decreased subscale scores which measured depression, anxiety and anger [[iii]]

In a meta-analysis concerning the effectiveness of MBSR programs on breast cancer patients it indicated a positive reaction, moderate to high, in reducing perceived stress, depression and anxiety (Match et al, 2010, Zainal, 2013) [[iv]]. Spec and colleagues (2000) found that the degree of adherence to schedule and practice time are significant predictors of change scores mood disorders and stress symptoms [[v]].

According to Emmons and McCullough (2003), increased gratitude is a common result of mindfulness practice. As we begin to pay more attention to our thoughts, we can see exactly where we block ourselves to appreciate the good things in life [[vi]].

Wood and his colleagues (2009) have determined that higher levels of recognition are the best predictors of the subjective quality of sleep and sleep duration [[vii]]. Gysels and his colleagues (2008) showed, among patients with cancer, that gratitude was one of the motivations in participating a study on palliative care [[viii]].

 Research has shown the benefits of the program Reduction of Stress based on Mindfulness (MBSR) over a variety of psychiatric conditions (Chiesa & Serretti 2011 as cited in Carlson, 2013) and psychological (Carlson, 2012 as cited in Carlson, 2013), and were made specific adjustments to be addressed for relapsing in depression (Segal et al, 2002 as cited in Carlson, 2013), in addictions (Chiesa, A., Serretti 2013 and Witkiewitz et al, 2012 as cited in Carlson, 2013) and specific medical conditions such as adaptation for cancer patients called Oncology Recovery Based on Mindfulness (MBCR) (Carlson & spec 2012 as cited in Carlson, 2013). Neural imaging and mechanistic studies are beginning to converge showing the effects of mindfulness program over the brain areas and the improvement of mental processes related to emotionl adjustment strategies, attention and social relationships (Vago & David, 2012 as cited in Carlson, 2013) [[ix]].

MBSR adaptation for oncology patients (MBCR)

There are a number of difficult issues that make tackling cancer experience of mindfulness-based stress reduction (MBSR) a suitable experience. Lack of control, uncertainty and constant change are three of the aspects that stand out, and are often the most challenging aspects of coping with cancer experience.

Mindfulness elements of accepting things as they are, going back to the difficult emotional experiences rather than against them, and embracing change as a constant, are helpful antidotes for these difficult realities. Coping strategies focused on emotions of the mindfulness-based interventions help prevent future worries and ruminations on the past events, and helping people to live fully in the present moment, no matter the outcome.

Spec et al (2000, as cited in Carlson, 2013) have examined the impact of the seven weeks program on 89 patients with various cancer diagnoses,with results focused on dispositional disorders and stress symptoms. MBCR program patients had improvements in 65% to 35% in the mood symptoms of stress, compared with control group results. Similar benefits were observed and maintained for 6 months (Carlson, 2001 as cited in Carlson, 2013) [[x]].

2. Clinical intervention program through mindfulness techniques in teenagers with cancer

Based on the concepts and results of the above studies, we designed a program of clinical intervention which was applied experimentally on three adolescent patients with cancer. 

The program's aim was to explore along with the patients the psychological effects of clinical intervention through mindfulness techniques.   

Participants

Participants of the study were three teenage girls,  aged 15, 16 and 19 years, patients of the Oncology Pediatric Institute of Bucharest. Sampling survey was random, depending on the availability of the patient to declare personal information and to attend each meeting of the program.

Evaluation Tools

Outlining the personal history of life and the history of the oncology diagnosis and, in order to assess the current level of gratitude and attention and the presence of awareness (mindful awareness Alert), Clinically Interview Questionnaire accompanied by Gratitude Questionnaire (The Gratitude Questionnaire-Six Item Form- GQ- 6 McCullough et al, 2002) [[xi]]. and the Scale of Presence and Attention Awarness (MAAS Scale - Mindful Attention Awareness, Brown and Ryan, 2003) have been used [[xii]].

Anxiety and stress level assessment was done through ASQ Questionnaire (Anxiety Symptom Questionnaire Scholing & Emmelkamp 1992) [[xiii]]. and Perceived Stress Scale (PSS Cohen, 2008) [[xiv]]. Also, to assess patients' coping strategies, the Questionnaire for Assessing Cognitive and Emotional Coping (CERQ) was applied. These tests have been applied to adolescents in the first and ninth session.

Procedure

In order to conduct this study each of the three participants took part in nine individual meetings (each lasting between 1 hour to 1 hour and a half). The meetings took place either in "Sensory room" from the Oncology Institute of Bucharest (P.A.V.E.L. Association) or in their  hospital ward (without the physical possibility or medical permission to leave the Oncology Pediatric Department). The first two meetings (meeting I and meeting II) and well as the last two meetings (meeting VIII and meeting IX) were held on consecutive days for all three participants and the remaining meetings were held at a variable time distance, depending on their physical or psychological availability.

Intervention plan

The size of this article does not allow the placement of all proposed exercises in the nine meetings of the intervention plan. We chose to present those experiences that were most appreciated by adolecents.

Firts Meeting  "Life story"

General Purpose: Outlining the context and history of previous life diagnosis.

The adolescent has given her consent regarding the informed agreement read, was made aware of the potential benefits, of anonymity participation and possibility of withdrawing from the study at any time. She was informed about the duration of  the meetings and about the general topic of future meetings and the meeting in progress.

The first meeting we called it "Life story" as it was to achieve the clinical interview (anamnesis). Highlighting the unconscious aspects of personality or relationship with family members was based on projective methods: Incomplete Sentence - Rotter, "Drawing Person" test (DAP) and "Drawing family” test.

Second Meeting  "Meeting your own breath"

General Purpose: Clinical assessment and observation of owns breath.

A. Discussion – The metaphor " breathing that puts out the fire " .

* Adaptation discussion in The Mindfulness Summit 2015 Day 23: Mindful parenting Kristen Race Ph.D. Retrieved from Http://themindfulnesssummit.com/sessions/kristen-race/

Purpose: The metaphorical understanding of the connection between breathing and emotions.

"Have you ever noticed how your breathing changes when your emotions are intense? How is it for you? For example, how is your breathing when you're angry?

I would like you to take one of your palms to your mouth and inhale and exhale deeply through your nose, feeling the air. I would now like to ask you ... how do you extinguish a fire? (With water or suffocating it!) But if it is the fire of candles or on a cake? (Are you blowing out the candles!) What would happen if you extinguish the fire with water or suffocating it? (Would the cake be "affected" ...)

Just as the cake would be affected if you put out the fire of the candles with water or by suffocating it,in the same way you yourself would be affected if you turn off the "inner fire" such as anger, rejecting it or suffocating it ... Just as the candles are extinguished by blowing on them, in the same manner it can be extinguished the inner fire, of anger for example by altering the respiration.

Therefore, not only the emotions can alter our breath, but also the breathing can alter our emotions. I want you to remember this metaphor, which we named it the metaphor of "breathing that extinguishes fire", and turn to your own breathing awareness whenever your emotions seem to ignite you.

In the next meeting we'll talk more about how we breathe, about the relationship of breathing with our body and the postures we adopt. "

B. Exercise "10 conscious breathing"

* Adapting the text after the presentation of the The Mindfulness Summit 2015 Day 25: Guidance on mindfulness for children, teens and those who work and learn with them - exercise proposed by Katherine Weare (Professor of Education at the University of Southampton, England) (Retrieved from http : //themindfulnesssummit.com/sessions/katherine-weare/)

Purpose: Familiarization with breathing by observing and tracking it through movements.

"Bringing attention to your hands and spread your fingers slightly. Then,on inhale, with your index finger from the right hand go up on the outside of the thumb of the left hand. The movement follows the rhythm of your breath, and not vice versa. On exhale go down on the inside until the next finger. Regulate the movement according to your own in and out breathing. With inhale resume ascent and with exhale descent until the little finger. After the completion of  the five breaths on your left hand, on inhale, begin to go up with your index finger on the outside of the little finger of the right hand. Navigate in the same way the following five breaths on the right hand, from the little finger to the thumb. In the end, put your hands on the knees, observing your breathing for a few seconds and how you feel in your own body. "

D. Exercise concentrating on your own breathing

Purpose: Increasing control over the body and on the present emotional state.

Achievement: The participant sits in a comfortable position on the chair (if he/she stayed longer on the chair the recommendation is to stand up - if physically possible for him to make a few steps in the room to revive and sit back) after this being invited to close her eyes. After a few seconds of closing the eyes,the psychologist begins to say slowly, with a subdued tone (between normal and softly spoken), with diction, the following:

"Sit comfortably on a chair. You increasingly calm down more and more, leave behind what we have done together so far, just like getting on a bus and going on a journey. (Pause) Put behind you the thoughts, worries, moods of all kind that keep you in place. (Pause) You become attentive just on the way you breath ... (pause) I invite you to focus on your nostrils and observ that at inhale the cold air enters through and at the exhale the hot air comes out from your nostrils - (suggestion: repeat it several times during the exercises) .You realize the way you breathe now ... (pause) You're the way you are... You allow yourself to be as you are ...Continue to be aware of your breath.... (longer pause) ".

The participant is left, as its breathing creates its own orientation a few minutes until she willingly opens her own eyes or is invited by the psychologist to slightly open the eyes.

After this phase, the psychologist asks the participant about the sensations she had throughout the exercise.

* Practical exercise leisure: "Stop two or more times a day, sit down and notice your breathing. You can stay that way for five seconds or five minutes. Do not try to change the present moment, just relax. "

Following this exercise the participant receives a table (Calendar of pleasant events/ Calendar of unpleasant events), in which, cultivating the conscious presence status, she can note until the study ends, the pleasant events and the unpleasant events, following the grid observation of her emotions, feelings and thoughts during certain personal experiences.

D. Gratitude exercise

Purpose: Training the observation of  present pleasant aspects (growing recognition)

"I invite you now to choose one of these colored sheets and fill in" I am grateful for ... "at least three things you are grateful for in this moment, here and now, and you would like to share with me after . They can be small or specific things like gratitude for the heat you feel in your hands, or general things like gratitude for the good health you feel. You can also express gratitude for the inner acceptance of something that is not necessarily pleasing to you or to overcome an unpleasant sensation as gratitude requires assessing this as it is to you now in the present. "

* Practical exercise leisure: "I offer you an envelope with colored sheets and I invite you to fill in every night before going to sleep, at least three things you expressed gratitude for that day. Therefore, I invite you to observe yourself during the day as often as possible what happens inside of you when you do your daily activities(the thoughts, emotions, needs, expectations and desires). Of these, in the evening (or at any time during the day you feel the need) you can note on the color sheet chosen for that certain day, everything that you remember expressing gratitude for. At the next meeting you can share your notes and see together how was this activity for you. At the end of our meeting you’re going to have a small journal of things that you were thankful every day starting today. Therefore: Write the date of the day when you complete the grid (if you wish you can also write the time).” Today....I’m grateful for...” at least three things you feel grateful for.

Finally the participant is invited to provide feedback on the experience of this meeting: "How was it for you? Would you have wanted some aspects to be different? "

The Third Meeting  "Breathe throughout the entire body"

General purpose: Learning body scanning technique through breathing.

A. Discussion: Practical exercises leisure

Purpose: Feedback

Exercise observation experiences like / dislike (Events): The patient is asked if she managed to do the assignment. Was it easy or hard? (Allowed to freely say what she means and is encouraged to express her opinion)

Exercise of gratitude - free expression: frequency, difficulties, predisposing factors, effects observed.

B. Exercise concentrating on their own breathing

Purpose:  Increasing the capacity to control the body and present emotional state.

 Resuming the meeting II, following a slight increase of the breaks between instructions.

 * Practical leisure exercise (same as meeting II)

C. Guided somatic meditation or Body Scan

Purpose: Body awareness and connecting to every part of the body, anchoring in the present, releasing physical tension.

The adolescent is guided to feel sensations in every part of the body, imagining that she breathes only with that area. Starting with the toes and ending with the head. At the end, imagines breathing with the whole body.

The Fourth Meeting  "To manage the emotional and physical pain "

Overall goal: Learning mindfulness strategies of pain management .

A. Discussion: Practical leisure exercises

B. Exercise concentrating on its own breathing

Purpose: Increasing control over the body and present emotional state.

 Resuming the meeting II exercise, following a slight increase in breaks of instructions.

  * Practical leisure exercise (same as meeting II)

C. Manage physical and emotional pain.

The process of pain - Management Strategy in 5 Step

This process summarizes the 5 steps of mindfulness found in Chapter 5 of the Living Well With Pain & Illness of Vidyamala Burch. Start with a break to record what happens (Step 1) and ends with an opening to the outside world and new possibilities (Step 5), and this process is specific to very difficult physical pain (or painful emotions).

Step 1 (Start Step Awareness)

"Come into the present moment bringing your awareness onto your thoughts (what you say to yourself), emotions (happiness, anger, excitement, sadness, fury, etc.) and the physical sensations (tightness, tension, relief). You may also notice where you are, what you see and feel in the outside world (the sun on your face, what are your hands touching, seeing other people..)”

Exercise - Present moment awareness

"Notice what you experience right now. Shoulders are relaxed or tense? But your abdomen: soft or tense? What happens when you bring attention to these areas? Relax a little? Feel free to change your position in any way you want as you become more aware.

Now notice the sensations of contact between your body and the space where you are sitting on. Your body feels heavy or light, relaxed or tense? Just notice how your body feels without judging your experience. How is your breathing in your body right now? What part of your body moves in the same time with your breathing? What sounds and smells do you feel? How many colors can you see? Can you enjoy them by just observing different shades and textures?

As you approach this experience, see if you can carry with you this quality of attention for the rest of the day, being alert, engaged, and curious about your experience. "

Step 2 (Go towars the unpleasent)

Normally we react to pain in two ways: (1) try to block or divert ourselves from discomfort, or (2) we swallow it, suffocating in discomfort and fears associated ( "If this continues!" etc.). This step provides a third option that may sound like the option (2), but the fact is quite different. Rather than let yourself be swallowed by discomfort and associated fears, you move your attention away from the story that you say and fearful interpretations, and instead of this, you  precisely notice the corresponding sensations of discomfort.

What exactly are these sensations (fire, cuts, tingling, burning, etc.)?

Where exactly are they located?

What is the form discomfort takes?

Where are the boundaries?

How thick, thin, deep or shallow is the discomfort?

Exercise - Going to Unpleasant

"As you stay sitting or lying, gently open your attention to include any discomfort or pain. Let them come into your area of awareness with an attitude of tenderness and benevolent curiosity. Remember to breathe still! We often strained against pain and we hold our breath, but see if you can ease the pain by breathing easier.

Maybe you are more aware of some sense of resistance or tension than the pain itself. If so, see if you can investigate this resistance by targeting more direct attention to them, and to direct a gentle light to something that is hidden in the shadows. Maybe you'll learn to lean on it with your attention, as you easily support a dense object, yet that folds. Let it soften slightly with each inhale and exhale. You may feel resistance to softening as you let your body settle to earth with each exhale.

As you open to your own pain, observe how are the real sensations and feel them change constantly. Perhaps they feel difficult and tense at a time, a little softer then? Or are they sharp at a time and then tickeling?

Can you tell exactly where is the pain localized in your body? Be precise in this regard. You may notice that the pain is more localized than you had previously thought. This may be the first time you directly investigate your pain, so be patient with any thought or disturbing emotion of fear or anxiety that may arise. Notice how they change constantly. See if you can relax least with any bad experience you can see and remember to let your body weight to stabilize on the area beneath you and soak your breath every time you notice you're tense. "

Step 3 (Find The Pleasent)

At any time, there are thousands of places where we can take our attention, and pain is a cry to give attention to a particular area, whether physical sensations and our thoughts tell us how bad it feels. This step invites you to explore your inner voice and the outside world, looking for something pleasant in your experience. "Searching for the pleasent is like being an explorer searching for hidden treasures. It can be as simple as to observe the heat of your hands or a good feeling in the abdomen, or seeing sunlight entering through the window. "

Looking for The pleasant

"You start by being conscious of your entire body while you're sitting or lying. Notice the breath up and down, and allow your body to rest on the space you are with each inhale and exhale.

If pain is present, let go of  any tendency to tighten and gently move your attention to notice whatsoever is pleasant at the moment - as you focus the lens of a camera on a beautiful object.

Notice pleasant physical sensations, above all, no matter how subtle they may be. It could be a feeling of warmth in your hands, an enjoyable trembling somewhere in your body, or a sense of relief around the area of heart now that you can afford to rest on your experience as a whole: Maybe it's a curious feeling in left earlobe that you believe is good! Spend some time with your attention by moving throught your body and take a break doing something you find enjoyable.

Now expend your attention and observe any pleasant sounds. Spend just a few moments appreciating them as sounds. Notice any tendency to be caught thinking about them or wanting them to last. Just let them appear and disappear.

Look around and notice anything nice or pleasant in your proximity. It can be the light in the room or a drawing on the wall. Just appreciate like this is the first time you see them."

Step 4 (Widening awareness)

Now broaden your awareness to include aspects both pleasant and unpleasant of your experience, including your whole body and everything surrounding you, so that you be larger than / above an unpleasant or pleasant aspect of your experience.

Opening yourself up to the entire experience

"Bring your attention on your entire experience as sitting or lying. Notice contact between your hands and the area that is available and obvious feeling of your body on the chair or bed. Gather your attention around breathing for a few moments. See if you can feel the breath move easily inside the body and stabilize yourself on the ground with every breath. Can you imagine floating on a gentle wave of the ocean being constantly moved, rhythmically. Imagine that all the different aspects of the experience from this moment on are taking place with a clear and comprehensive attention. Leave it to rise and fall with a sense of change and fluid flow without pushing aside any painful experience or cling to things you find enjoyable. You'll probably find yourself relaxed for a moment and then caught again in particular experiences. It doesn’t matter. Every time you see a moment of resistance or clinging you can relax again in a sense of the breadth and openness. Allow your awareness to cross the abdomen.

Leave your attention to be open and inclusive, including everything, even if it’s an internal experience or something you perceive through the senses, such as sound. "

Step 5 (Choice: Answer rather than React)

Let your attention now to move the world around you, allowing yourself to respond naturally rather than react habitually to where you are, curious and open, perhaps with more options and choices than you had before this exploration. You may even be surprised by what happens next after creating this break ...

The participant receives a card containing the 5 Steps in pain management (pain process - management strategy)

Finally the participant is invited to provide feedback on the experience of this meeting:

"How was it for you? Would you have wanted some aspects to be different? "

The Fifth Meeting  "Inner Mountain" (guided meditation) (Kabat-Zinn, 1995) [[xv]]

General purpose: Experimenting and anchoring in the qualities of interior "mountain" (stability, rezistance, internal strength)

Discussion: Practical free time exercises

The Sixth Meeting  "Inner Lake" (guided meditation) (Kabat-Zinn, 1995)

General Purpose: Experiencing and anchoring in the "lake"’s inner qualities(deep inner resources, flexibility, acceptance)

Discussion: Practical free time exercises

The Seventh Meeting  "Loving-kindness "(guided meditation)

General purpose: Experimentation and anchoring in the internal qualities such as acceptance, gratitude and love (to themselves and to others).

A. Discussion: Practical leisure exercises

B. Loving-kindness meditation.

* Meditation taken and adapted from the loving-kindness meditation (Kabat-Zinn, 1995)

"This meditation is typically in any position. You start by feeling the support surface of your body, directing your attention to your sensations given by the contact with the surface of support. Find a position of stability and break, the upper body and shoulders being in a comfortable position, but alert, hands on your lap or knees, arms hanging under its own weight just like some heavy curtains, but stable and relaxed ... even feeling your body, feeling your legs, hips, abdomen, chest, hands, arms, shoulders, neck and head. And when you're ready allow your eyes to close. Bring your conscious attention on the breath, the actual physical sensation, feeling every breath in and out ... You let the breath to be exactly as it is, without trying to change or to adjust it in any way ... allow to flow it easily and naturally with the rhythm of breathing quietly, knowing that you breathe perfectly and there is nothing more for you to do..

Start by being centered in position and breathing. Then, starting from the heart or abdomen, ask feelings or images full of kindness and love to radiate you until your whole being will be full of them. Allow yourself  to be swang by your own presence status, like you were just as worthy to receive kindness-loving as any child ...

When you are ready bring to your mind the image of a person who you know or knew as being loving and kind to you,someone who can easily evoke inside you feelings of warmth or love,it can be a parent, a family member,a mentor or a close friend...someone who was good to you,helped you feel safe and complete...And if a person from the past or present dosen’t come to mind,then you can imagine a person who you could easily turn your wishes of good and love to,and if you connect with that, you can picture yourself saying to him/her”May you be hap, y,healthy and complete”.While you say that imagine that person reciving your good wishes,imagine him/her close to your,listening to your good whispers,”May you have love,warmth,affection!May you be protected from dangers and free from fears!May you be full of life and joyfulness!And may you experience inner peace and nonchalance!” You can have your own words or wishes for that person,feel free to use the words that you relate to. Now take a few moments to allow yourself to feel how it is to wish those things for someone,let yourself feel the good feelings floating from inside you to the other,connecting yourself to that person. Notice how you feel inside as you send these thoughts to the person you love or care about.

And when you are ready, see if you can imagine this person wishing you the very same things to yourself ... Knowing that is your well wishes in her heart, imagine that she/he tells you "Be happy, healthy and complet! Have love, warmth and affection in your life! "As you imagine her telling you these words, feel it almost like you feel her presence, unconditional love ... as they say" Be protected from hazards and free from fear! Be lively and happy! And to experience inner peace and detachment "Leaving those feelings to wash, feeling their unconditional love, kindness, allow love and security to grow inside you, knowing that there is nothing you need to do to deserve these feelings and good wishes, these being offered free of conditions ...

Now see if you have these good wishes about yourself: "To be happy, healthy and loved! To be safe and protected! To be lively and free! To have some inner peace and detachment "

Once you have stabilized as a center of love and goodness radiating into your whole being, reaching to be cradled in the goodness-loving and acceptance, you can stay in this state for a long time, drinking from this spring, bathing yourself in it, renewing youself, feeding youself, cheering youself . This can be a practice of deep healing of the body and soul.

You can direct loving-kindness to your parents, wishing them good, wishing them not to be alone or suffering, honoring and respecting them. If you're able and you find something healthy and liberating for you, find strength in your heart to forgive them for their limitations to their fears, and any wrong actions and suffering that they have caused you .. "To be happy, healthy and complet! Have love, warmth and affection in your life! To be protected from hazards and freed from fear! Being lively and happy! And to experience inner peace and detachment".  

And there’s no need to stop there ... You can direct loving-kindness to everyone, to people you know personally and to those you meet from time to time, such as a saleswoman, nurse, neighbor .... and even if good wishes are not infused with the same feelings of love and warmth that accompanied wishes to loved ones, see if you can extend these good wishes without expecting you or them to feel in any way towars eachother... connecting you with these desires, these people taking your attention as you send good wishes ... wishing them to be happy and complete, full of life and have love in their lives...   

Take a few moments to feel what aroused in you ... and even if this practice had difficult parts, remember that it has the potential to increase your feeling of enthusiasm, connection and belonging ... and when you're ready, let yourself feel your physical presence again, sensations of your body: legs, hips, chest, shoulders, neck ... begin to notice your own breathing movement that brings life and care to your body completely, just as good wishing brings enthusiasm and care to those around you ... "

Finally the patient is asked to provide feedback on the experience of this meeting:

"How was it for you? Would you have wanted some aspects to be different? "

The Eighth Meeting VIII  " Mindful eating "

Purpose: To connect an informal mindfulness practice in a daily activity (mindful eating)

A. Discussion: Practical leisure exercises

B. Exercise concentrating on their own breathing

C. Exercise aware tasting (mindful eating)

* Taken from video demonstration online https://www.youtube.com/watch?v=7CCr5w3ox_4, hosted by Arnie Allice facilitator in The Mindfulness Clinic http://www.themindfulnessclinic.ca/

General Purpose: Cultivation of pleasure and gratitude by learning to enjoy food, eating intentionally.

"Close your eyes, breathe relaxed two or three times ... Become aware of your breathing, how it goes in and out ... Your chest, your abdomen rises slightly ... and down with each breath ... Now open your eyes and take a slice of orange in your hand, looking at it as if you've never seen it. Imagine that it’s completely unknown to you. Notice the shape, texture, wrinkles, colors ... Now close your eyes and breathe again several times ... Feel the slice of orange on your lips while you get it closer to your mouth. You can have thoughts that you like it or do not like it. Notice any thoughts or feelings about eating a slice of orange. Keeping your eyes closed, put a slice of orange in the mouth without chewing it, and just notice how it feels ... You can pass it through your mouth and notice the sensations and textures. Now you begin to chew it easily, feeling its flavor ... Notice where exactly are you chewing it in the mouth... Consider that chewing a slice of orange and retrieve its energy, which it wore in the place it grew up where you are right now ... As you prepare to swallow, observe the feeling that gives you the impulse to swallow. How is this? Swallow it when you're ready and note that point when you no longer feel it being in your throat. Notice the sensations that might appear ... Be aware of the sensations in your body, your mind, and be aware that your body takes the energy that the fruit gave it... Now pay attention for a moment to your breath, your thoughts, the emotions you have, the feeling you sens in your mouth. You can swallow again..Now you bring back your attention awarness over your breathing.When you are ready,you can slowly move your fingers and your eyes.”

After this stage, the patient is asked about feelings she experienced during this session.

The Nineth Meeting: "Exploring the effects of meditation experience"

Overall goal: Clinical evaluation and exploration of intervention effects.

3. The Effects of the Program and Discussions

After the clinical intervention through mindfulness techniques, patients who had increased levels of anxiety or perceived stress, declared either a lowering or keeping this levels to the medium. The relatively limited involvement of patients in the practice of meditative exercise suggested to be done at home, can be one of the explanations for the small changes to low scores reported in pre-post intervention measurement of anxiety and perceived stress.

Also the conscious awareness and the level of attention seemed to increase in the post-intervention assessment evaluation and was maintained at high level. Regarding measured gratitude and cognitive-emotional coping strategies, they ranged, not seeming to be in connection with the intervention of mindfulness, but with the medical context of the patients and the low individual practice.

Benefits observed by the patients, participating in mindfulness techniques, involved in this study, were to learn to calm down by observing their breathing, to be able to relieve their negative emotions, learning at the same time to observe the good things, not only the bad things, that to feel relaxed and peaceful, to learn to relax just by trying to observe their breathing and to control their breathing when they feel the need. One of the patients indicated that the mainly benefit of the therapeutic relationship, was fulfilling the need for communication and using the therapist as an anchor that helps her pay attention to breathing spontaneously or use the attention on breathing to calm down. 

A limitation of this study was the variable duration of breaks between the clinical intervention meetings, this not being able to run weekly in the context of the oncology treatment at variable intervals, both inter-patient as well as at each patient at a time. In this way, mindfulness techniques were practiced with their patients at each of their hospitalization, the study not having the rigorous weekly meetings structure of the programs of the stress reduction based on mindfulness.

Another limitation of this study was that generated by different medical contexts of each patient, which can generate significant changes in their psychological state and being difficult to follow the extent to which intervention or the deeply life context connected with the medical context influenced post-intervention assessment results.

These two limitations are related to conducting clinical intervention during a cancer treatment, which was one of the rare intentions in specialty literature: practicing mindfulness techniques during acute treatment and not post-treatment.

Thusly, the context given by the oncological medical acute treatment,influenced the clinical intervention, requiring future similar studies, to highlight clearly the effects of mindfulness, indicated by specialty literature, for patients who have completed oncological treatment.