Guide 2 Mind Body and Healing
Illness Representations The Mind/Body Connection Matures
My wife and I began our work in 1985, just months after I was told by my surgeon, “I’d give you about thirty days to live.” At that time a book called Love, Medicine and Miracles by Bernie Siegel, M.D., was just making its debut. The book’s release was widely embraced by the media. Soon I found a copy and began to devour it.
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- Dr. Siegel’s experience as a surgeon led him to become aware that those patients, especially cancer patients, who held expectations of a positive outcome often did better than those patients who simply gave up. This led him and his wife, Bobbi, to form a group he called ECaP (Exceptional Cancer Patients).
- They held support group meetings, and central to the experience was the practice of mind/body techniques. Many different meditative disciplines were taught at ECaP, as well as the concept that mind and body work together to positively impact health.
Read And Learn More: Cancer Essential Things To Do A Road Map For All Cancer Patients Treatment Diagnosis
- “Bernie,” as he preferred to be called, through his books and public appearances, did much to popularize the mind/body movement as it applied to cancer and healing.
- Others came before Bernie, including Herbert Benson, M.D., and Lawrence LeShan, Ph.D. Both made significant and lasting contributions to our understanding of the mind/body connection. But the foremost pioneer in modern-day psychosocial oncology was O. Carl Simonton, M.D. (1942-2009).
- Trained as a physician at the University of Oregon Medical School, Simonton completed a three-year residency in radiation oncology. It was during this time that he developed a model of emotional support for the treatment of cancer patients.
As Chief of Radiation Oncology at Travis Air Force Base, Simonton first implemented the model. Dr. Simonton’s work was the first systematic emotional intervention used in the treatment of cancer.
- His program was actually approved by the Surgeon General’s Office in 1973. Simonton was the pioneer who introduced and applied the concept that one’s state of mind could influence one’s ability to survive cancer.
- This idea was revolutionary. Enthusiastically received by cancer patients, Simonton’s work was widely condemned by the medical community. Oncologists derided the idea that the mind and emotions had a role in either the onset of cancer or in the recovery from it.
- The American Cancer Society put Simonton’s model on their so-called blacklist of dangerous unproven methods, an unfortunate derogatory characterization that would remain with Simonton through the 1990s.
The groundbreaking Simonton Cancer Program was founded on ten major tenets. Dr. Simonton postulated:
- Our emotions significantly influence health and recovery from disease (including cancer). Emotions are a strong driving force in the immune system and other healing systems.
- Our beliefs and attitudes influence our emotions, thereby affecting our health and healing systems.
- We can significantly influence our beliefs and attitudes.
As a result, we shape our emotions, and therefore, significantly influence our health. - Ways of influencing beliefs, attitudes, and emotions can be readily taught and learned by using a variety of accessible methods that are presented in this (Simonton) program.
- All of us function as physical, mental, social, and spiritual/ philosophical beings. These aspects need to be addressed in the broad context of healing, with a focus on the particular needs of a person who is ill, and that person’s family, community, and culture.
- Harmony is central to health—balance among the physical, mental, and spiritual/philosophical aspects of being. This extends to relationships with self, family, friends, community, planet, and universe.
- We have inherent (genetic, instinctual) tendencies and abilities that aid us in moving in the direction of health and harmony (physical, mental, spiritual/philosophical and social).
- These abilities can be developed and implemented in meaningful ways through existing techniques and methods that are presented in this program.
- As these abilities are developed, proficiency evolves, as when learning other skills. The result is greater harmony and improved quality of life, which significantly impacts one’s state of health.
- These skills and insights also change our relationship with death by lessening our fear and pain and freeing more energy for getting well and living life more fully today.
A New Era in Mind/Body Approaches
Many pioneering medical efforts prove to be less than complete, even dangerous. Not so with Simonton’s. His work has stood the test and is now being confirmed in the new and burgeoning field of health psychology called illness representations. These new insights and understandings are creating a revolution in mind/body medicine.
- Illness representations are a patient’s beliefs and expectations about a symptom or illness and how those beliefs and expectations actually impact the experience and outcome of the symptom or illness. An example may best explain this construct.
- Assume a healthy person starts to feel slightly achy and begins to experience a runny nose. The individual identifies and then “labels” the symptoms as most likely the beginning of the common cold.
- Since this person believes a cold to be a temporary phenomenon lasting perhaps a week to ten days, a “timeline” is now added to the initial label.
- The initial label of a common cold instills a belief that the symptoms, and any resulting illness, present a minor threat. Thus the “consequences” of a cold are not believed to be serious.
- This individual may also think, I know where I got this. Harry at work was sneezing and coughing for a couple of days. That’s it. Thus a “cause” is assigned. This leads to the individual’s beliefs about colds and how they are best managed. Okay, he thinks.
- I need to drink lots of fluids, get extra rest, and have chicken soup a couple of times a day. This reflects the individual’s beliefs about a “cure” for the common cold.
- There are parallel emotional reactions to each of these cognitive processes. And even though in the case of the common cold the emotions will tend to be subtle or muted, the feelings are nonetheless present.
- For many people the emotional reaction to a cold will be an annoyance, Oh no, I’ll probably have to miss work and this will put an extra burden on my co-workers to meet the project deadline.
The emotional impact could be concern about the cold being a precursor to a more severe health problem. The emotional response to the individual’s beliefs is called “illness coherence.”
- Cancer typically triggers a completely different set of beliefs and emotional responses. As an illustration, let’s assume a woman detects an unusual lump in her breast. For millions of women, the first thought (label) that comes to mind is breast cancer.
- This sus- suspicious-lump-equals-breast-cancer belief runs deep and often sets in motion a complex combination of personal and cultural beliefs.
- The cluster of thoughts that tend to be fused together with very intense emotions include breast cancer runs in my family (cause), this is going to mean surgery and the dreaded chemotherapy (cure), breast cancer is serious, even life-threatening (consequences), this will mean a year or two of treatment and uncertainty (timeline), and I may die (illness coherence). It’s easy to see why cancer is called a “hot cognition.”
- Several researchers are now dedicated to understanding illness representations more fully. But the pioneer is clearly Howard Leventhal, Ph.D., Director of the Rutgers Center for the Study of Health Beliefs and Behaviors, Institute of Health, Department of Psychology at Rutgers University in New Jersey.
- Leventhal and his colleagues have broken new ground in the understanding of the mind’s role in health and healing. Consistent with Simon-Ton, the central point of understanding is that our emotions greatly impact our health and prospects for recovery from illness.
- One of the Leventhal team’s most basic discoveries is that patients are only partially aware of how they create and maintain personal views of disease and treatment. In the case of cancer, the typical beliefs are detrimental to recovery, healing, and maintenance of health.
- In our work, we have found the belief that cancer equates with death to be very widely held. Countless times I have listened as patients maintain their views and defend their beliefs, even if those beliefs are harmful. For tens of thousands of cancer patients, the mindset is, “Yes, I will fight. I’ll do anything to survive. But in the end, my cancer is probably going to kill me.”
- About three years ago, a gentleman going through prostate cancer was in my office. His surgery followed by hormone therapy was successful in controlling the cancer. And even though he suffered from incontinence and impotence following treatment, his follow-up tests showed no signs of cancer.
In an effort to instill a more upward look, I proclaimed, “Celebrate with me, Omar. You are a survivor!” His answer foreshadowed a different outcome.
- He said, “You know, Greg, I’m doing well now, but this kind of cancer always gets you.” We examined his belief but to limited avail. I spoke at his funeral service about four years following his initial diagnosis.
- As stated in the “50 Essential Things to Do” section on beliefs, cancer absolutely does not equate with death. This is a very harmful toxic illness representation. For patients who want to get well and stay well, illness representations that equate to cancer and death must be changed.
- Simonton was one of the first to ask patients to illustrate their cancer and their treatment. He gave them a small box of crayons and one sheet of paper and said, “Draw your cancer and your treatment.” The objective was to help the patient gain a greater understanding of the beliefs they brought to the recovery process.
- For example, a person who illustrated their illness as a mountainous rock formation and their treatment as a mere hand shovel was led to explore the beliefs behind those images. In the end, one hoped the power of the pictures of treatment would match the power of the images of the illness. We continue to implement variations of this exercise in our work today.
- Traditional mind/body techniques have their place. Transcendental Meditation, and its less-religious offspring the relaxation response, can clearly help counter stress. They also assist in lowering blood pressure and changing other vital bodily functions that are normally unconscious.
- Biofeedback and mindfulness meditation yield similar results. But none demonstrate the physiological outcomes like illness representations—the new frontier in mind/body understanding.
The Power of Awareness
- There is a great deal to be gained when cancer patients better understand the way in which they are processing their experience.
- We are now aware that illness representations have predictive validity that can significantly assist patients in examining their beliefs and attitudes toward a cancer diagnosis.
- New tools to assess illness representation are being developed around the globe. I would like to add to these efforts.
- I wish to acknowledge the work of Dr. Elizabeth Broadbent at the University of Auckland’s School of Medicine for allowing me to borrow from her work in developing this tool specifically for cancer patients.
The Cancer Representation Questionnaire (Short Form)
For the following questions, please circle the number that best corresponds to your view:
1. Once your symptoms were diagnosed (labeled) as “cancer”, how much impact has the diagnosis had on your life?
0 1 2 3 4 5 6 7 8 9 10
Severe impact No impact
2. How long do you think your cancer will be active (timeline)?
0 1 2 3 4 5 6 7 8 9 10
As long as I live A very short time
3. How much personal control do you feel you have over your illness (control)?
0 1 2 3 4 5 6 7 8 9 10
Absolutely no control Significant control
4. How much do you think your treatment can help your illness (cure)?
0 1 2 3 4 5 6 7 8 9 10
Not at all Very helpful
5. How much do you experience symptoms from your illness (consequences)?
0 1 2 3 4 5 6 7 8 9 10
Many severe symptoms No symptoms at all
6. How much do you experience symptoms from your cancer treatment (consequences)?
0 1 2 3 4 5 6 7 8 9 10
Many severe symptoms No symptoms at all
7. How concerned are you about your illness (consequences)?
0 1 2 3 4 5 6 7 8 9 10
Extremely concerned No cancer at all
8. How well do you understand the clinical aspects of your diagnosis (control)?
0 1 2 3 4 5 6 7 8 9 10
Do not understand Very clear understanding
9. How much does your diagnosis and treatment affect you emotionally? For example, does it make you angry, depressed, frightened, or upset (coherence)?
0 1 2 3 4 5 6 7 8 9 10
Extremely emotionally impacted No emotional change
10. How much do you believe you personally contributed to your cancer diagnosis (cause)?
0 1 2 3 4 5 6 7 8 9 10
Absolutely no contribution I greatly contributed
Please total your scores from questions 1 through 10. Record total here_________
Please list in order of priority the three most important factors that you believe caused your illness:
A.___________
B.___________
C.____________
- The interpretation and predictive value of illness perceptions and responses are as much art as science.
- But generally, either a low score (0-15) or a high score (85-100) indicates extreme responses to a cancer diagnosis. Neither is preferred. Midrange scores indicate a balanced response, which is preferred.
- The scores are indicative of the “intensity of beliefs” regarding a cancer diagnosis and subsequent treatment.
- But it is neither the score nor the beliefs that matter. It is the emotions generated by the beliefs and simply indicated by the score. The good news is that we can change our beliefs and thus our emotions. Awareness of our beliefs is the starting point.
Is the Glass Half Full or Half Empty?
The subject of illness representation quickly leads to the question of positive thinking—a state of mind that is deeply embedded in the beliefs we hold. Over the past quarter-century, my work has been the leading voice of the positive thinking school in the cancer field.
- Through our work, we have encouraged literally millions of cancer patients to change their negative beliefs into positive expectations. Unapologetically, I want people to embrace hope and the possibility for healing.
- This message is not universally appealing. Many patients have made it clear that in their eyes I am naive, uninformed, and even cruel.
- “Positive thinking? Is that all it takes to cure my lung cancer?” wrote a patient. “You’ve got to be kidding. Are you sure you had lung cancer?” Another e-mailed, “You can talk about hope all day long. But there are days I just need to cry.”
- Jerome Groopman, M.D., is an oncologist and author of the book The Anatomy of Hope. The book chronicles patients whom he considers were helped by positive hopeful thinking and some whose demise he attributes, in large part, to lack of hope.
- Groop-man’s studies show that positive beliefs and expectations—the essential contents of hope—impact the body on a physiological level. Pain management, respiration, circulation, and even motor function are demonstrated to be enhanced with a positive outlook.
- I have never represented the view that all it takes to cure cancer is positive thinking. But I have long advocated that a person with cancer is best served by beliefs and attitudes that project an upward look.
- Evidence has existed for decades that immunoglobulin levels, a precursor and one measurement of immune function, increase with a more hopeful stance.
- Yet as soon as I put forward this evidence and make the positive outlook assertion, there is a small but vocal group of patients who respond, “Stop laying a guilt trip on me. You’re saying, at some level, I caused my cancer.” Not so.
- The hopeful outlook bolsters health—emotionally and physically. It produces a sense of guilt only if that is how it is received.
- Today we can note that further evidence from the field of illness representation leads to a profound conclusion belief and hope are very real and very powerful forces in health and healing. And there is a biology connected to positive thinking.
Of course, this is interpreted as “false hope” by many people. But once again, I firmly believe there is no such thing as false hope.
- I believe there is only real hope—for a cure, for a peaceful death, for a better tomorrow no matter how long we may have to live.
- Unfortunately, there is a very real and toxic force called “false no-hope.” This is typically when the doctor finds it necessary to /five patients the “get your affairs in order” speech. It is a devastating experience.
- I can still clearly recall how despondent I became after my surgeon gave me thirty days to live. Every week wc counsel frightened and depressed patients who have been given a terminal diagnosis.
- Our guidance to these patients has changed over the decades. I used to encourage everyone who received the “terminal” news to actively and forcefully challenge the doctor.
- My advice was helpful to only a few and probably created what some called a positive thinking prison for some patients.
- Today we encourage cancer patients to experience all their feelings and help them understand that fear and despair are normal natural responses to a life-threatening illness.
- Face it, some days following chemotherapy are lousy. The bone-deep fatigue that often comes with radiation therapy generates understandable thoughts of hopelessness. One patient remarked, “If I started to feel bad, I began to think there was something wrong with me.”
- Now we teach, “Feel the feelings—the positive as well as the negative. But do not get into the habit of replaying the negatives ones.”
Repeatedly rehearsing our ills is a trap even more deadly than denial. We remind patients that all our emotions are rooted in our beliefs—and beliefs are things we have the absolute power to change.
Positive thinking? Yes. Optimism? Of course. As long as they lead to feelings of hope. Positive thinking and optimism are cognitive behaviors—decisions. Hope is an emotion, a feeling that differentiates this force from merely choosing an upward look.
Our emotions make the difference. And it is the hopeful emotional response that serves us best in our illness representations. Welcome to the new era of mind/body medicine.
Meditation and Visualization Exercises
- You may decide to choose a mind/body exercise to integrate into your healing program. There is excellent evidence that many mind/body/spirit approaches can play an important role in the healing process.
- Meditation produces demonstrable effects on brain and immune function. Some of the side effects of conventional cancer treatments may be lessened with the integration of simple meditative exercises.
- Meditation includes a wide range of approaches. The exercises described below are those that have been helpful to thousands of cancer patients around the world.
Meditation
- For many of us, our minds are so busy with thoughts that we rarely create the opportunity to simply be at peace, relaxing into the present moment, quieting our minds, and being more aware of the sensations in our bodies.
- By practicing meditation, which is simply learning to relax and be at peace, we can become more open and attentive to our deeper, intuitive wisdom and the healing potential that lies within us.
- By invoking this relaxation response, our body moves into the parasympathetic “healing” mode in which physical healing is optimized.
- Meditation is a way of cultivating moment-to-moment awareness and supports becoming more present to our own experience.
- To do this requires that we become aware of the constant stream of thoughts and reactions to our inner and outer experiences in which we are all normally caught up. During meditation or contemplation, we discover that we are constantly generating thoughts and reactions.
- By simply becoming aware of our breath instead of the stream of thoughts, we become more aware of our body experience, allowing us to release pent-up anxieties and emotions. With practice, we can move toward acceptance and release of stress, and even change our limiting beliefs.
- Meditation is a valuable way of reestablishing inner calmness and balance in the face of emotional upset or when you “have a lot on your mind.”
- When life becomes stressful and out of balance, we have all experienced how relaxing it can be to be alone for a few minutes and just breathe, in and out, deeply and quietly.
- Research has shown that meditation can alleviate the psychological and physical suffering of persons living with cancer.
Visualization
- Guided imagery, also known as visualization, is an extension of meditation. A leader or a recorded script is often employed to assist the participant in visualizing health and healing.
- Guided imagery has been credited with reducing side effects, pain, and stress. It can also aid in emotional coping with cancer and assist in preparing for anticipated situations such as surgery or chemotherapy.
- The imagery process can also be helpful in decision-making and can be employed to improve mental health and control.
- Finally, guided imagery can reduce the need for pain medication. Research shows increases in natural killer cell activity as a result.
- Both meditation and guided imagery are less about method and more about calming your mind and spirit and living in the present moment.
- By cultivating clarity and peace in meditation, by imagining health and healing, we become more accepting, less judgmental, and happier. What follows are some suggested scripts for your consideration:
Meditation Exercise Relaxation
Please try this simple exercise to help you fully relax your body:
- Close your eyes, remove glasses, loosen tight clothing, and take your shoes off.
- Start by adjusting your position so that you are sitting comfortably. Don’t cross your legs, ankles or feet, or hands. Sit with your back supported. If your legs are too short to reach the floor comfortably, then put a book or bag on the floor on which to rest your feet. Lie on the floor if you wish.
- There may be sounds in the room or outside. Try to ignore them. Remember that life goes on and that we can become relaxed despite the noises around us.
- Raise your shoulders up to your ears and let them fall down gently.
- Open your mouth as if yawning, close it a little, and rock your lower jaw left and right.
- Close your mouth and push your tongue hard up to the roof of your mouth. Let the tongue spring back. Loosen your jaw more.
- Once again raise your shoulders to your ears, then release them gently.
- Now just breathe normally and softly.
- Allow your inward breath to become a little deeper.
- As you breathe, just notice the breath and bring your attention to the sensation of the breath flowing at the tip of your nostrils.
- Now notice the natural gentle movement of your chest as you breathe in and breathe out.
- Take a deep breath without straining.
- Allow the breath to come and go effortlessly.
- Just continue for a moment or two longer.
- Allow the natural rise and fall of your breath to help you to soften and relax and remove any tiredness or tension.
- As you breathe in, bring in softness and relaxation.
- As you exhale, take away any tiredness or tension.
- Inward breath bringing softness and relaxation.
- Outward breath taking away tension.
- Continue to breathe slowly and peacefully.
- Check around your body. Is there any remaining tension or tiredness? If so, take your breath there to soften and renew.
Visualization Exercise Guided Imagery for Healing
Please try this simple exercise to help you support your immune function:
- Find a comfortable place to sit, with your back straight and your feet firmly on the ground. Ensure that you will not be disturbed during your meditation by muting your cell phone or taking your phone off the hook and allowing the answering machine to handle incoming calls.
- Take about five minutes to relax your body completely, working through from the feet up to the head. Imagine that you can just let go of all the muscles; feel them soften and release, allowing the tension to flow out of your whole being.
- Focus particularly on the shoulders, the neck, and the jaw, as these are areas where we often, without realizing it, hold a great deal of tension.
- When your body feels totally relaxed, bring your attention to your breathing. Don’t change it. Just be aware of the breath moving in and out of your body.
- Notice as much as you can about your breathing. How it feels as the breath moves in and out of the nostrils? Where do you take the breath to in your body? Stay with this for another five minutes or so.
- Now imagine that you are outside in the sunshine. Get a sense of the light of the sun, warm but not too hot, and shining down on you. You might like to imagine that you are lying on a quiet beach soaking up the sunlight.
- Imagine that you can breathe in the light of the sun, taking it into your body. Let the light fill up every cell of your body. When you feel glowing and full of light, let that light move anywhere in your body where you feel that you are in need of healing. Feel your cells transforming, becoming energized as the radiance heals and restores you.
- Now let the light expand out of you. Radiate the light around your body, so that you are imagining yourself glowing with light and health. Stay with this part of the meditation for about ten minutes.
- Now bring your attention back to the breath. Every time you breathe in, silently say, “I am breathing in health.” And on each out-breath say to yourself, “I am happy and whole.” As you do this, feel the truth of what you are saying. Believe it so that it becomes a reality for you.
- Now let it all go and bring yourself back to the room, slowly and gently. Feel the ground beneath your feet and become aware once more of your surroundings.
You may wish to expand your meditation and visualization experiences. Many communities offer classes that can assist you in perfecting these skills. There are also many recorded meditations that can help assist your efforts.
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