Psychological intervention methods and cancer survival

The plan is for me to write a series of blogs about cancer. You will read this small paragraph every time you read one of these blogs because it is an explanation and a disclaimer. First of all, why should I do this and what qualifies me to do so? The answer to the second question is that I am a cancer immunologist with a PhD from the University of Pennsylvania and have 30-years experience in not only research, but also in the experiences of cancer patients. I have published numerous articles and a book about immunity to cancer and have two other books about my experiences with research and cancer patients as well as a fictional account of the final cure for the disease. However, none of this experience allows me to give advice or otherwise tell people what to do if they have cancer. I can be viewed as a participant/observer who will be relaying current and past observations about this world called “cancer”, which many people do not understand. That’s the answer to the first question, which is why I should do this. The first step in overcoming anything is to understand it first. With that being said, here they are:

Number 6 Psychological intervention methods and cancer survival

The earliest and most common form of psychological intervention used with helping cancer patients cope with their disease is Cognitive-Behavior Therapy. Even though there are several forms of this type of therapy, there are common themes associated with the practice of this form of psychotherapy. The initial goal of the therapy is to fully assess the patient’s emotional state. This entails recognizing maladaptive thoughts (inappropriate preconceptions), behaviors, feelings, and psychological reactions to related and non-related stimuli. For instance some cancer patients believe that a diagnosis of cancer is a death sentence and because of that belief loose the will to live. Friends and family can reinforce this type of maladaptive thinking by their treatment (catering to needs) of the patient. This type of situation often leads to a feeling of hopelessness, which often leads to depression. Cognitive therapy targets this maladaptive thinking by what is called cognitive restructuring, which allows the patient to replace the self-doubting negative thoughts. These thoughts were mentioned earlier and are often questions such as: “Why me?” “Why do I have bad luck?” and “I’m just waiting to die.” These thoughts are written out and beside them are written positive statements such as: “Anyone can get cancer”, “I’m not the only one”, and “It is not bad luck. It just happened to me”, as well as “I have plenty of time to do what I want in my life and I’m not giving-up.” The patient is instructed to construct this “two column” document, which allows the patient to view the maladaptive thoughts along side of the more rational statements thereby counteracting the depressive state. The “the two column” method is just one of the techniques used during the cognitive restructuring procedure.

Others include the “Didactic method” (promotion of healthy attitudes), the “Socratic method” (application of thought provoking questions), and “Self-statement Modification” (replacement of maladapted self-statements with adaptive ones). These methods along with positive imagery, hypnosis, stress management, and writing exercises allow the cancer patient to realign their thinking in such a way as to make the experience more like daily life instead of a nightmare they can’t wake-up from. Many of the techniques used in cognitive therapy are actually used to help the person not only mask the pain of cancer, but also to prolong life and increase health through imagery. As previously mentioned this psychological intervention has been show to not only increase the body’s ability to fight cancer, but also increase quality of life and cancer survival. However, cognitive therapist must us caution when using these technique to prolong life because it has been show that when they fail the patients enter a deep period of depression and possibly lapse into psychological/psychiatric morbidity. The techniques used in this type of cognitive therapy are intended to restructure the way the cancer patient thinks. Recently it was determined that there was a way to restructure the way the patient feels using a technique based on meditation.

This more recent and effective form of cognitive therapy used to treat cancer patients is called Mindfulness-Based Cognitive Therapy (MBCT). This type of therapy was developed to prevent relapse associated with major depression. Cancer patients often fall victim to depression so MBCT seemed like a good alternative to the standard cognitive behavioral therapy. The reason for this is that MBCT provides a way for patients to recognize the onset symptoms of depression (both mental and physical) and teaches an alternate way to respond to the symptoms, which allows preemption and prevention of the downward spiraling effects of depression. Standard cognitive therapy concentrates on modification of contents of erroneous thoughts and leads to their correction. The basis of MBCT is rooted in the technique of meditation and self-awareness. It has been show to not only reduce stress, but also chronic pain by letting the patient be aware of the thoughts and physical manifestations of the problem and accepting them. This acceptance leads to more control and more control invariably leads to a more positive attitude. Ultimately, patients treated with MBCT techniques accept aberrant thoughts and pain responses as passing mental and physical events and eventually abandon maladaptive thinking patterns.

MBCT use with cancer patients has met with significant success initially with breast cancer (BC) patients. Randomized controlled trails were performed on 84 BC survivors who were in various stages (0-III) of their disease, but were all within 2 years of surgery, radiation, and/or chemotherapy treatment. These patients were divided into two groups. One group received mindfulness-based stress reduction (MBSR) therapy and the other usual care. The six-week MBSR treatment resulted in significant improvements to the psychological wellbeing and quality of life in the participating patients when compared to the usual care control group. However the most interesting studies were the ones that are related to the reversal of stress-induced immune dysfunction, which was mentioned earlier. In that study, which was born out of the observation that stressed patients, had more leukemic relapses. Animals that were put under stress contained natural killer cells (NK cells) that were incapable of killing leukemic cells when compared to non-stressed animals with the same leukemia. In a recent study of patients with known autoimmune disorders there was a very similar observation concerning the reduction of stress through MBSR therapy. This group of patients had their blood drawn pre and post MBSR treatment and the samples were tested for NK cell cytolytic (killing) activity. Two weeks after the treatment the patients were assessed for anxiety and overall distress. In the patients that recorded improvement in overall mental well being there was a significant increase in NK cell cytolytic activity between pre- and post-MBSR blood samples. However, patients who reported no improvement in mental well being there was no difference in cytolytic activity between pre- and post-MBSR treatment. The most important study done in this area was done studying early stage breast cancer patients soon after diagnosis and prior to any treatment. As mentioned previously this group of patients are prone to a long series psychological distress symptoms. Patients in this study either volunteered for an 8-week MBSR program or did not (control group). Prior to the initiation of the program and before surgery and cancer therapy all of the women had reductions in NK cell activity (cytolysis) as well as diminished amounts of immune cancer fighting proteins (cytokines) when compared to similar non-cancer patients. Data collected four weeks post-MBSR treatment revealed that only the women who participated in the program showed increases (normal levels) of both NK cytolysis and cytokines, whereas the non-MBSR group continued to show depressed levels. In addition, there was a significant increase in the quality of life and ability to cope in the MBSR participants as compared to the non-MBSR group. It is clear that MBCT is a way for cancer patients, who are at various stages of their disease, to accept the changes (mental and physical) brought about by cancer. This acceptance fosters a lack of fear and allows the patient to gain control over a situation that was previously thought of as uncontrollable.