The Healing Journey

The Healing Journey: Incorporating psychological and spiritual

dimensions into the care of cancer patients

Alastair CunninghamOntario Cancer Institute

www.healingjourney.ca

Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.

http://current-oncology.com/

http://multimed.current-oncology.com/

http://www.multi-med.com/


Why we suffer• Suffering is a mental reaction to events seen

as unwanted.• Our suffering comes from the diagnosis,

and what we think it implies, rather than directly from the cancer– Cancer is an existential crisis, not simply a

physical one• There are two main ways to relieve

suffering: remove the “event” or change the mental reaction.





Healing: the relief of suffering.Approaches:

• Medical: repair of physical disability• Psychological (and social): relief of

suffering• Spiritual: a return to “oneness”, unity with

the Divine Ground

• In the hierarchy “spirit – mind – body”, each level encompasses those below it.

• “Wellness” can be pursued at all levels.– The “higher” 2 depend on active participation

by the healee





Healing (relieving suffering) through therapy at the level of mind

• There is much more we can do to relieve suffering – Is it therefore unethical not to do it?

• The extra avenue for healing is the patient’s mind (this is how human medicine differs from veterinary medicine).

• Patients can be helped to adapt much more skillfully to life-threatening disease

• Quality of life, and of dying can be enhanced; life may be prolonged.

• Psychological and spiritual assistance need to integrated into the treatment protocol





Healing from within, or self-healing, is something we can learn

• A progressive educational process (like learning a language)

• We learn how we “create” our experience, including our distress, with our thinking.

• This provides the opportunity to change our adaptation to events (such as a cancer diagnosis); to live more “skillfully”. =“Wellness” training.

• Active participation and practice is required.• A teacher is needed: this is a major function of

professionals operating at psychological and spiritual levels




Understanding and changing thoughts (judgment, guilt)

Do nothing

Support: comforting; emotional expression, problem solving

Healthy lifestyle: diet, exercise, basic coping skills, (relaxation, imagery, thought monitoring, goal setting)

Spiritual search: discovering the Self

Self healing: a progressive, educational process






Who should be offered psychological therapy for relief of suffering? Everyone?

Usual: • referral of obviously distressed patients• Patient request(Means that only a tiny minority receive much psychological help

at present in most settings)

Preferable:• where expert sees possibility of benefit to patient (as in general

medicine). – “Could this patient be helped to cope even better?”– “What modes of help would be most beneficial?”

Patient potential: cancer patients are usually psychologically “normal”: don’t use models from psychopathology.





Is it too expensive?

• Costs are small in comparison to much high-tech medical care:

• Example ; “What can be done with $150,000?– 1 Bone Marrow transplant– Basic psychosocial help for 1,000 patients





How professionals often disempower patients

• Too much negative information/prediction• Undervaluing psychological therapy, or

restricting it to “support”• Dismissing the possibility of self help

– Unawareness of the great potential people have to help themselves.

– “Go home and forget about it”– Being afraid people will blame themselves if

they try self help and “fail”





Modes of psychological intervention for cancer patientsNature of intervention Activity required Benefits

Information (re disease, treatment)

Listening; internet searching Greater sense of control. Sometimes more anxiety

Support Sharing feelings Comfort; QoL improved. No effect on average lifespan

Learning coping skills (HJ I + II)

Active cognitive and behavioural change, e.g. relaxation, meditation, exercise

Greater improvement in QoL than with support alone (anxiety, depression, physical symptoms).

Adjunctive psychological therapy (HJ III + IV)

Examining and changing habits of thought; introduction to spiritual work.

Less judgment, guilt, projection. Peace of mindPoss prolongation of life.

Spiritual search(HJ IV + V)

Study spiritual texts. Meditation, prayer, discussion. Dropping preconceptions about reality.

Discovering meaning, “Self”. Peace, acceptance.Poss further prolongation of life?




The Healing Journey:(25 years in Toronto)

Alastair Cunningham Claire Edmonds

Jan Ferguson (coordinator)

Cathy PhillipsJudy GouldKim Watson

Joanne Stephen

Wellspring team

www.healingjourney.ca


http://www.healingjourney.ca/




The Healing Journey ProgramPMH and WellspringStage

“Coping with Cancer Stress” (4 weekly sessions)Large groups – lecture style

“Skills for healing” (8 weekly sessions)Mixture of didactic sessions and support groups

“Steps to spiritual healing” (8 weekly sessions)Mixture of didactic sessions and written home assignments

I

II

III

IV

V “Spiritual aspects of healing” Group study of “A Course in Miracles” (ACIM)

“Recovering Authenticity”Small group work, or home study

“Graduate discussion group”(no time limit)

CORE

Graduate discussion group (ACIM)Published by Current Oncology and the Cancer Knowledge Network © 2011

Multimed Inc.





HJ level Ilarge groups: 4 weekly sessions, lecture style.

(if small groups: conventional discussion in circle)

• 1. Intro to theory of self-help and healing– Progressive muscle relaxation

• Imagining relaxing at the beach• Stress management

• 2. Watching and managing thoughts– Self-hypnotic (“deep inner”) relaxation

• 3. Mental imagery– Imagining body controlling the cancer

• 4. Clarifying goals– Imagining an ideal day in the future





HJ level IIlarge groups: didactic work, followed by:

small groups: discussion of techniques and feelings1. Mind watching and journalling2. Meditation; 3. Imagery: “dialogue” with the cancer4. “Inner Healer”5. Goals: “One week to live”6. “Letting go of resentments”7. The spiritual journey (introduction) -“mindfulness” meditation

8. Review





Quote on effects of relaxation

During relaxation/meditation, I feel a quieting effect. My mind tends to focus on fewer things and sometimes only on one. My body feels more relaxed and tends to slow down. If I have pain, I can often breathe into the pain and relieve it for the time being.





Thought management

• Monitoring (awareness)• Journalling• Changing thoughts; affirmations• Goal setting• Writing a life story• Meditation techniques

– Mindfulness/awareness– Focus/mantra




“Nothing happens next. This is it”






Mental imagery• Mental representation of experience• A powerful “language” for internal

communication (to mind and body)– Imagining return to health/defenses

opposing disease– Overcoming resentments– Consulting an inner source of wisdom

(“Inner Healer”– Connecting with spiritual figure(s)





Spirituality: the search for ultimate meaning

• The individual’s search for the transcendent or sacred (contrast religion: social institutions supporting this search)

• Many ways exist to think of this dimension (God; the Way, the Void, Ultimate Order, the One….)

• Experts: the mystics – lives successfully devoted to this search – Jesus, Buddha, Mohammed, Laotze, Ramana…. [teachings available to us]

• Role of the health professional: to experience this for him/herself and interpret it to patients





Importance of the spiritual/existential dimension to many cancer patients

- Life is under threat- Is this the end?- Does this suffering, and my life, have any meaning?

- Spiritual work may:- Enhance quality of life, peace, diminish suffering- Provide a sense, that all will be well, that one is loved- Help in acceptance of dying- Prolong life?

- Spirituality can be treated in a non-sectarian way





Introducing spirituality to patients through a program teaching self healing.

• Spiritual experience is about seeing the world, and oneself, in a different way

• Therefore, it needs to be preceded by basic instruction in psychological self help; especially awareness of patterns of thought

• Essential that the teacher/therapist have own practice and experience





Introducing spirituality to patients through a program teaching self healing (contd)

• Begin with basic psychological self-help techniques (relaxation, mental imaging, thought management, meditation…. ) [HJ levels 1 and 2]

• Progress to examination of harmful habits of thought that obstruct spiritual experience: judgment, guilt, projection …[HJ level 3]

• Exercises to consolidate, based on study of remarkable survivors [HJ level 4]

• Study the writings of spiritual masters [HJ level 5]– Non-sectarian, patient ultimately chooses own path.





HJ Level III: Diminishing obstacles to spiritual experience

• 8 weekly sessions: written work done at home, read by leader, comments offered at next session.

• Content:– 1. Different ways of thinking about “the Divine”– 2. Judgment of others; – 3. forgiveness;– 4. projection; – 5. Self-judgment (guilt); defensiveness;– 6. unconditional love vs worldly love– 7. Self importance and self will. – 8. Review

• Regular practices: meditation (5 methods taught), prayer, thought monitoring and keeping a journal.

• Continuing weekly meetings for interested patients: reading the mystics, discussion





Background to Level IV: research on “remarkable survivors

• Interview study: 10 people with medically incurable cancers from our program who lived 4 – 14 years beyond predictions

• Medical status and prognoses: (by panel of oncologists): usually approx 1 year.

• Survival: 4-14 years beyond predictions • Analysis: qualitative analysis of interviews• Comparison groups:

– 6 cancer patients recently beginning in HJ program– Historical data from patients who did not outlive

predictions.– (ref: Cunningham and Watson, 2004 – see

www.healingjourney.ca)





Results of interview study:Properties of good “self-healers”

• Authenticity: awareness of our true needs and values • Autonomy: exercising free choice in our actions (living as we feel

we are meant to live).

• Acceptance: much less judgment and criticism of oneself, other people, and events around us.

……………………………………………………..• Sense of meaning, purpose in life, identity.• Strong spiritual connectedness; peace of mind, calm, joy, love.

Living in the present.• Motivation to help others.• Cancer becomes less important





Level IV of the Healing Journey

• Exercises to develop authenticity, autonomy and acceptance (based on study of long survivors)– Mind watching and control– Defining what is important and what isn’t– Dropping grievances– Listening to an “inner voice”– Defining what I really want– Operating from the “Higher Self”– Accepting guidance– Locating oneself in the “territory of the mind”– Living in an accepting way– Writing a life story.





Selecting a spiritual system suitable for use in level V, and in health psychology generally.

• Focus on personal understanding and experience, not ritual or unquestioning belief

• Promotion of love, harmony, as opposed to judgment, self-criticism, “sin”

• Openness to ideas from the major religions of all cultures (inclusive, not exclusive: non-sectarian). – Convergence of main ideas with those of other major

spiritual systems• Use of material close to a source of “revelation”,

rather than “scriptures” written by ordinary people.

• Providing an explication of the nature of “reality”





Level V of the Healing Journey

• Introduction to study of “A Course in Miracles” (other texts could be used)– 8 – 10 weekly sessions– Preparatory reading at home suggested;

questions to answer from the text– Read together in the class; discuss

• Continuing practice of meditation and coping skills advocated





Research on psychological help for improving quality of life, and

possibly length of life, in cancer patients:

Results with the Healing Journey





Clinical trials (verification) approach – main limitations

• Results allow the conclusion that low-intensity group psychological interventions do not significantly increase the mean survival time of the populations tested.

• Comparison of group means ignores the great variability between subjects– Would miss effects on a minority of highly motivated

subjects– In effect, the independent variable is not being in the

intervention arm, but what participants do with it.• Interventions have not been designed to induce

change• “Contamination” of controls (who find other help)




“Allostatic load”(strain on all systems)

Predisposition to disease

Disease develops Recovery of health

Diminished allostaticload

No change:Illness progresses

Childhood:Distorted adaptation, e.g.

defensive, repressed.(“inauthentic self”)

Healthier adaptation(authenticity, autonomy,

Acceptance)

Psychologicalchange


Additional Survival Observed

Predicted Survival



Research currently needed on impact of psychotherapy on survival

• Main aim: defining psychological qualities associated with prolonged survival

• Designs: more exploratory, not RCTs at present, but prospective, longitudinal, correlative.– Interview style data collection, not psychometric– Qual/quant analysis and rating (explore variety)

• Therapies– Test various kinds– Test more intensive therapies (e.g. long-term residential)

• Patient populations: test those with lower tumour burden (e.g. stages I - III)

• Controlled trials – a final step, to check efficacy





Why is healing through the mind undervalued?• Not widely understood that our mind creates our experience

of life (how much we “project”)• However, obvious to almost everyone that mental state

affects physical– Behaviours – “external loop”– Attitudes – “internal loop”

• Why not part of treatment protocols?– The materialism of medicine and culture generally– Psychological therapy takes time, and active participation

by healer and healee. – Little general understanding of the potentials of mind– Even less understanding of spirituality – Little research evidence as yet





Summary• Support: Now clear that support helps many cancer

patients – almost all, if they are encouraged to attend meetings.– Criterion for advocacy: not “does she ‘want’ this”,

but “would it help her?”• Next step: adding training in active coping skills, such

as relaxation, mental imaging, thought management. These are within the reach of most, if advocated and encouraged.

• More advanced work: – changing dysfunctional habits of thought and self-concept. Not suited to all patients





Summary (contd)• Conclusions on “mind-body”:

– Benefits of basic psychological help on quality of life are obvious

– Therefore, this kind of help should become a regular part of the treatment protocol for cancer patients;

– Benefits on length of life are highly probable, but need more research.

• “Cutting edge”: incorporating the spiritual search into management of cancer patients, testing efficacy, and developing theories on mode of effect on the health of the body.




The Healing Journey

Health & Medicine

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