Discussion
chronically ill, ’ emotional skills, cancer
CHRONICALLY ILL, CANCER
Our study is the first to evaluate the effect of MBATs on emotional regulation in chronically ill patients by use of a randomized clinical trial design. Our main quantitative analysis was inconclusive as it did not show a favourable effect of MBATs on emotional regulation, compared to the control intervention, as measured by the DERS questionnaire. However, a statistically significant difference was observed between participants who completed at least 80% of their activity program and the control group. Conversely, the qualitative analysis supported a positive effect of MBATs on emotional regulation: nearly half of the participants reported an improvement in their impulsiveness, emotional awareness and emotional clarity. Moreover, most of the participants reported having implemented new emotional regulation strategies.Regarding qualitative data, as no comparisons were planned between groups, every interviewee that had participated in MBAT interventions was interviewed and no patient from control group was. It is thus impossible to differentiate between our program’s effectiveness and the natural evolution of chronically ill patients’ emotional skills in a qualitative manner. Only the comparison between the qualitative and quantitative results in the intervention group was conducted and the difference in results observed between both approach need to be discussed.Several hypotheses can be put forward to explain these discrepancies. First, regarding our quantitative results, the intervention could have had a real effect on emotional regulation in participants, adequately measured but limited in size. Based on the existing literature, our study was designed to detect a between-group difference of 19 points [Second, this apparent paradox could be explained by changes that may have not been detected by the DERS. This could be due to limitations of the tool itself, or by the fact that the improvements reported by the participants only limitedly correspond to the emotional regulation model proposed by Gratz and Romer [Third, these discrepancies could be a result of effect dilution. Indeed, our intervention strategy relied on various MBATs and was applied to a rather heterogeneous study population. Indeed, the choice of this study population and the variety of activities was decided according to the pragmatic nature of the trial, which aimed at reproducing the conditions in which these interventions were already offered to chronically ill patients in Nantes within the FCS. However, the cost of this flexibility could have been paid on different aspects of the study. First, the heterogeneity of the studied population (pathologies’ type and duration, for example) may have contributed to a highly variable impact on patients’ emotional regulation. Some might have experienced an important benefit from it while others didn’t, partly due to the lack of adaptation of the intervention to their specific needs. On the other hand, the multiplication of interventions led to a multiplication of instructors, whose ability to elicit engagement amongst participants regarding the proposed content may have been unequal. All these elements may have led to the pooling of various effects of the different MBATs on various patient profiles, and thus turning effect of a particularly efficient MBAT on a particular clinical context indistinguishable, as our sample size did not permit stratification on each MBAT.When we limited our analysis to highly adherent patients, we observed a stronger and significant effect. This observation in the most adherent population is coherent with the elements described above, as the most adherent patients may have been the patients which found the best match between their personal situation, the proposed MBATs and the personality of their instructors, therefore boosting their will to pursue the intervention program to its end and get the most out of it. Unfortunately, a posteriori analysis revealed that the adherent participants did not differ from the rest of our sample, ruling out the possibility of detecting early on who could benefit the most of our intervention strategy.Finally, several limitations that could have had an impact on our results must be noted. First of all, we evaluated the effect of our MBT-based intervention after 6 months, which could be too short for developing significant changes in emotional regulation. Therefore, the participants may have notice small and encouraging changes that couldn’t yet have a sizeable effect that could be measured by the DERS. Another limitation is that the qualitative methodology involved undirected interviews, which means that the interviewers did not specifically question the participants on the dimensions identified in the DERS. Only the dimensions in which the participants observed or perceived major changes, were thus covered by the qualitative analysis. A last limitation to be noted is the subjectivity of one of the qualitative analysts, which was deeply involved in the diffusion and structuration of MBATs in our local setting. Despite efforts to adopt a neutral stance, this positive bias towards MBATs should be acknowledged.Some encouraging evidence is available regarding the effectiveness of MBT in improving some components involved in emotional regulation or similar concepts. A mapping review reported that art therapy interventions in cancer patients improved emotional condition [To our knowledge, our study is the first to assess impact of MBATs on emotional regulation as assessed by the DERS in a population of chronically ill patients. Existing research is mainly focused on the evaluation of alternatives to MBT in improving emotional regulation, for example Emotion Regulation Group Therapy, Acceptance and Commitment Therapy, Dialectical Behaviour Therapy and Cognitive Behavioral Therapy, showing evidences regarding their capacity to significantly improve emotional regulation ability [