Gently Turning Towards
Trish Bartley and Ursula Bates
The Three Circles Model
The Circle of Suffering
Distress in oncology patients
Reactive anxiety &
Major depression
Organic mental
Patients coping
Personality disorders
Anxiety disorders
Avoidance coping strategies include behavioral or
cognitive efforts to keep oneself from thinking about a
stressful problem or situation. Avoidant coping strategies
can also be associated with withdrawal from valued social
support resources, particularly following traumatization
Rumination is a way of responding to distress that involves repetitively
(and passively) focusing on the symptoms of distress, and on its
possible causes and consequences. Rumination is more common in
people who are pessimistic, and who have negative attributional
styles. The tendency to ruminate is a stable constant over time and
serves as a significant risk factor for clinical depression. Not only are
habitual ruminators more likely to become depressed, but
experimental studies have demonstrated that people who are
induced to ruminate experience greater depressed mood. There is
also evidence that rumination is linked to general anxiety, post
traumatic stress, binge drinking, eating disorders, and self-injurious
Some survivors of cancer experience trauma -related symptoms
similar to symptoms experienced by people who have survived
highly stressful situations, such as military combat, natural disasters,
violent personal attack, or other life-threatening events. This group
of symptoms is called post-traumatic stress disorder (PTSD) and
includes avoiding situations related to the trauma, continuously
thinking of the trauma, and being overexcited.
People with histories of cancer are considered to be at risk for
PTSD. The physical and mental shock of having a life-threatening
disease, of receiving treatment for cancer, and living with repeated
threats to one's body and life are traumatic experiences for many
cancer patients.
Distress in Cancer Patients
It is estimated that 10% - 50% palliative care patients have significant
anxiety and depression, 35% have unmet emotional needs and 2070% have inadequate pain relief
(Bradley, Fried, Kasl, & Idles, 2000).
The variation in rates depends on the stage of the illness, level of
disability and degree of pain. These needs. include many co morbid
mental health disorders which are often undetected, complex
bereavements and end of life issues (NCHSPCS 2000).
A Cognitive Model of Cancer Distress
Moorey, S & Greer, S, (2002) , Cognitive behaviour therapy for people with cancer . Oxford: OUP.
The Circle of Practice
The Middle Ring - Four Movements
Coming Back
Turning Towards
The Circle of Presence
The Middle Ring - Four Qualities
Appreciating the Richness of Experience
Experiencing the Ground of Clarity
Confidence to be with Experience
Connecting to our Common Humanity
The Three Circles Model
Going Across the Circles
Trauma >Intention >Appreciating the Richness of Experience
Rumination >Coming Back >Experiencing the Ground of Clarity
Avoidance> Turning Towards> Confidence to be with Experience
Distress> Kindness> Connecting to our Common Humanity
Resources and References
Shennan, C., Payne, S., Fenlon, D., (2010).What is the evidence for the use of
mindfulness-based interventions in cancer care? A review. Psycho-Oncology
DOI: 10.1002/pon.1819
[email protected]
Bartley, T., (in press), Mindfulness-Based Cognitive Therapy for Cancer: Gently
Turning Towards. Oxford: Wiley Blackwell
Speca, M., Carlson, L.E., Goodey, E., & Angen, M., (2000) A randomised, waitlist controlled clinical trial: The effect of a mindfulness meditation-based
stress reduction program on mood and symptoms of stress in cancer
outpatients. Psychosomatic Medicine, 62, 613-622.
CMRP 2 day retreat workshop on 2-4th November 2011 in North Wales.
‘Mindfulness Based Cancer Therapy for Cancer’ led by Trish Bartley