Breast Cancer Awareness Month: Mindfulness & Cancer

October is Breast Cancer Awareness Month

Written by Lauren Helm, M.A., B.C.B.

Cancer is incredibly common, and often leads to many difficult and frightening life changes. Studies have found that moderate to severe psychological distress occurs in 35-45% of all cancer patients (Carlson et al., 2004; Spiegel, 1996; Zabora, BrintzenhofeSzoc, Curbow, Hooker, & Piantadosi, 2001). Cancer is the most distressing diagnosis regardless of prognosis (Tacon & McComb, 2009), and anxiety can last even after treatment has been completed. Research has identified that cancer may lead to distress because of multiple factors, including the anticipation of suffering, and difficult treatment regimens (such as surgery, radiotherapy, chemotherapy, or hormone therapy). Some individuals experience great difficulty in coping with the life changes that cancer can bring about; in particular, the potential uncertainty and uncontrollability of illness is often formidable and distressing (Carlson, Ursuliak, Goodey, Angen, & Speca, 2001).  Additionally, when an individual is diagnosed with cancer, her quality of life may be profoundly impacted, and she may experience increases in stress, anxiety, depression, pain, fatigue, sleep problems, and nausea. The impact on one’s quality of life is not always easily “cured” by traditional Western medicine approaches. This is why some individuals with cancer also pursue supportive and complementary therapies, along with conventional medicine.

Some examples of supportive and complementary therapies for cancer patients include: support groups, interpersonal therapy, acupuncture, meditation, yoga, Tai Chi, hypnosis, massage, relaxation training, and mindfulness. When these therapies are used in conjunction with conventional medicine, studies have found that they may reduce stress, anxiety, depression, improve indicators of immune functioning, strengthen spirituality/religion, and improve coping skills, among other possible benefits.

Mindfulness is a potentially powerful tool that has been found to have a beneficial impact on the quality of life of individuals who are diagnosed with cancer. Mindfulness has been defined in many ways, but may be thought of as a “particular way of paying attention,” or “moment to moment” awareness where one adopts a non-judgmental, compassionate attitude towards one’s experience of the present moment. A mindful stance can be practiced by learning to accept, instead of resist or react to one’s thoughts, emotions, and physical sensations as they arise. It is all about changing the relationship to one’s thoughts and emotions so that a sense of equanimity is eventually achieved, even in the face of pain or distress (read more about mindfulness here).

Mindfulness has been embraced by patients and behavioral medicine practitioners alike (Baer, 2003; Bishop, 2002), in large part because of the positive physical and psychological changes that tend to result from the regular practice of mindfulness. A substantial body of empirical evidence supports the use of mindfulness with cancer patients (Carlson & Garland, 2005; Carlson, Speca, Patel, & Goodey, 2003; Carlson, Speca, Patel, & Goodey, 2004; Carlson et al., 2001; Speca, Carlson, Goodey, & Angen, 2000). Most of the literature supporting the use of mindfulness with cancer patients has examined Mindfulness Based Stress Reduction programs (a program developed by Dr. Jon-Kabat Zinn for those with chronic illness or pain that teaches patients how to practice mindfulness) since they are more frequently available in medical settings. Mindfulness has also been integrated into other psychological treatments , including Mindfulness-Based Cognitive Therapy (created by Zindel Segal, Mark Williams and John Teasdale to help prevent relapse for those with depression), Dialectical Behavior Therapy (created by Dr. Marsha Linehan in order to treat those with borderline personality disorder), and Acceptance and Commitment Therapy (developed by Dr. Steven Hayes and Dr. Kelly Wilson and is often used for those with anxiety – indeed, this evidence-based treatment is offered by therapists at CSAM!). Mindfulness is applicable for a wide range of problems.

Some of the benefits of mindfulness training may include:

• Improved general quality of life (Ledesma & Kumano, 2008)
• Improved markers of physical health (Ledesma & Kumano, 2008)
• Reduced anxiety and depression for patients, partners, and survivors (Ledesma & Kumano, 2008; Lengacher, Johnson-Mallard, Post-White, Moscoso, Jacobsen, Klein, Widen, Fitzgerald, Shelton, Barta, Goodman, Cox & Kip, 2009)
• Improved sleep (Carlson & Garland, 2005)
• Increased feelings of control, openness, personal growth, and spirituality and reduced feelings of isolation (Mackenzie, Carlson, Munoz, & Speca, 2007)
• Improved psychological health

Mackenzie, Carlson, Munoz, and Speca (2007) found that cancer patients who underwent mindfulness training through an MBSR program reported five major themes:

• Opening to change: Changes in how they think about and cope w/cancer and treatment
• Self-control:
  • An improved control of attention and behaviors, including a reduction of reactivity to stressors and learning when to take action vs. when to let go
  • An improved physical and mental self-regulation and self-discipline
  • Living better with cancer
• Shared experience:
  • Social support and camaraderie (sharing and listening; development of close and unique relationships; sense of community)
  • Reduced feelings of isolation, especially with cancer diagnosis
  • Instillation of hope (surrounded by other cancer survivors)
  • Improved coping skills (group problem solving, discovery of solutions together)
  • Meditation practice was reinforced
• Personal growth: 
  • Mindfulness provided comfort, meaning, and direction
  • Mindfulness increased willingness to learn from difficult life experiences, such as cancer
  • Shifting from negative to positive mindset; seeing cancer as a motivator to live a full life
  • “The way I look at cancer is that once you get through the awfulness it’s a very powerful motivator to live your life. I’m grateful I can come up here and be reminded of that.”
• Spirituality:
  • Exploration of spirituality (though a common theme that arose during interviews with study participants, though MBSR is secular)

In sum, the benefits of mindfulness are many, and can be potentially useful for those who suffer from cancer. If you or a loved one needs additional help in coping with the distress that cancer can bring, it may be worthwhile to learn more about additional resources that are available. Check out some of the resources below, or contact a qualified professional.

Breast Cancer Resources

Create an early detection plan: http://www.earlydetectionplan.org/

Beyond the Shock: http://www.nationalbreastcancer.org/nbcf-programs/beyond-the-shock

Anxiety and Breast Cancer: http://www.breastcancer.org/treatment/side_effects/anxiety

Tips on How to Combat Anxiety: http://www.breastcancercare.org.uk/news/vita-magazine/overcoming-anxiety#sthash.ku2X77DV.dpuf

If you'd like to speak with a professional at the Center for Stress and Anxiety Management for help with anxiety, please click here.

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Mindful Moods: Meditation, Yoga, and Your Brain

by Lucas Myers

If you haven't been hiding under a rock for ten years you're aware of the yoga phenomenon. Famously popular among health conscious men and women, yoga is more then just a fitness sensation. Everyone from NFL players to CEOs is practicing yoga to improve mental and physical well being. These are some extreme examples of how even those with the most demanding of lifestyles can benefit from changing their focus from the stress of competition to a more productive focus on self-mastery that is demanded by yoga. Although some may be attracted to yoga to cultivate greater strength and flexibility, many maintain their practice because yoga positively impacts the way they perceive and interact with the world.

Most yoga instruction begins with a call to reflect on the intention of the day's practice. It may focus on bodily sensations as muscles contract and release or on how breathing impacts performance. Though some may not even know it, these activities serve the important function of increasing mindfulness during practice. Mindfulness, an intentional way of paying attention that can help you cope with the challenges of everyday life, has been proven in study after study to have many benefits and applications. As the yoga student improves, mindfulness carries over into other aspects of life.

Yoga is an excellent form of self-maintenance and care. Its ancient traditions serve not only to tone and strengthen the body, but the mind as well. As a yoga student becomes more mindful, awareness of the relationships between thoughts, emotions, actions, and environment is enhanced. Negative patterns and influences tend to be abandoned in favor of habits and practices that improve health and well-being.

Research on yoga has demonstrated its ability to aid in lowering blood pressure, relieve back pain, and lower stress. In a study of prisoners in Illinois, researchers found that tests designed to measure impulsivity and attention were answered with greater accuracy by inmates after attending 10 weeks of yoga instruction. Researchers from UCLA found that meditation from yoga can help lower depression in caregivers and may even increase cognitive functioning. In fact, cellular aging was shown to be slowed in association with meditation because it reduced the release of destructive hormones which are triggered by stress. That's right, yoga and meditation are not just associated with better health, they may even keep you young.

Why does yoga work so powerfully on the brain? To borrow a cheesy neuroscience joke: “The neurons that fire together, wire together.” Research has demonstrated time and again that the brain has the ability to rewire itself in response to experiences, a concept known as neuroplasticity. This means the brain is changing with every moment of experience, adapting and altering the ways that we relate to our own minds, bodies, environments, and other people. This gives everyone the potential to harness our knowledge of the brain to force positive changes by choosing experiences that increase our capacity for learning, coping, and processing. Mindfulness, meditation, and yoga are like exercise for your brain that can make it faster, stronger, and happier.

Any medical doctor or licensed therapist will tell you that, along with diet and sleep, exercise is one of the best things that you can do for your health and happiness. So how does yoga fit in? To borrow a phrase from Swami Beyondananda “it feeds two birds with one scone.” The body and mind are both being exercised in a process that allows them to renew and reinvigorate themselves. This combination can yield powerful results. Exercise reinforces a strengthened and disciplined mind by triggering the release of hormones that reduce stress and increase feelings of happiness and wellbeing. According to Dr. Jill Stoddard, director of the Center for Stress and Anxiety Management, yoga can be a valuable adjunct to psychotherapy: “We know the mind-body connection is incredibly powerful when it comes to anxiety, stress, depression, and chronic illness. Through movement, breath, and mindfulness, yoga is one of the few practices that specifically targets this connection. I personally practice yoga and recommend it for our patients as a way to improve overall well being.”

References:

Axel, Gabriel. “Your Brain on Yoga: A Blueprint for Transformation”. U.S. News and World Report. September 4, 2013. Retreived from: http://health.usnews.com/health-news/blogs/eat-run/2013/09/04/your-brain-on-yoga-a-blueprint-for-transformation

Chan, Amanda. “Yoga For Carefivers: Meditation May Lower Depression, Improve Brain Functioning In Dementia Caregivers”. March 13, 2012. Retreived from: http://www.huffingtonpost.com/2012/03/13/yoga-caregivers-meditation-kirtan-kriya_n_1342389.html

Kawer, Stanton. “Yoga Made Me a Better CEO”. Forbes.com. March 25th, 2011. Retrieved from: http://www.forbes.com/2011/03/25/yoga-meditation-better-ceo-leadership-managing-kawer.html

Manchir, Michelle. “Yoga for prison inmates is no longer a stretch” Chicago Tribune. August 8, 2013. Retrieved from: http://articles.chicagotribune.com/2013-08-08/news/ct-met-prison-yoga-20130808_1_yoga-class-yoga-pants-nonprofit-yoga

Tags: anxiety, anxiety therapy san diego, anxiety therapy, therapy, San Diego, stress and anxiety in san diego, psychologist in san diego, psychotherapy, mental health tips, psychologist, San Diego Therapy, therapy in san diego, Mindfulness, chronic pain, Yoga, Meditation, Brain

Chronic Pain

By: Sarah Bond

From an evolutionary perspective, pain serves to warn us of potential injury to avoid subsequent danger.  Although acute pain affords a short-term advantage, its long-term persistence can lead to significant distress and suffering. According to the American Academy of Pain Medicine (2013), 100 million Americans are afflicted with chronic pain. Chronic pain can be defined as an uncomfortable feeling set off in the nervous system that persists for weeks, months, or even years. Although its onset may be attributed to injury, chronic pain can also occur without any predetermined indication.

The National Institutes of Health (NIH, 2006) found that the most common chronic pain complaints include: lower back (27 percent), head (15 percent), neck (15 percent), and facial (4 percent). Although the physical effects are evident, the psychological pain is equally burdensome for many. The implications of such physical pain can lead to emotional distress and discomfort.  In turn, emotional distress can also exacerbate the experience of physical pain.

Individuals may feel as though their pain prevents them from leading a ‘normal’ life. They feel as if they cannot partake in activities they found enjoyable in the past. This withdrawal may result when chronic pain is associated with a particular movement/activity (Dahl, Wilson, & Nilsson, 2004). In fact, lower back pain is the most common cause of disability among Americans under 45-years-old (The American Academy of Pain, 2013). When people refrain from participating in what gives them a purpose in life, it can have detrimental effects upon their psychological well-being.

Treatment for chronic pain patients can be challenging. Although 41 percent of those who take over the counter medications and 58 percent of those who take prescription medications reportedly express pain relief, there are many who do not benefit from pharmacological interventions (The American Academy of Pain, 2013). Thus, it is critical to consider other options when addressing chronic pain. 

Research suggests that psychotherapy is an effective method for treating chronic pain. Specifically, cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT)address the psychological factors that accompany physical pain (McCracken, Vowles, & Eccleston, 2005; Dahl et al., 2004). If the emotional factors are ignored, they can exacerbate the physical pain. Similarly, if the physical factors are ignored, they can exacerbate emotional pain. Therefore, it is important that both the psychological and physical factors are treated appropriately.

If you or someone you know suffers from chronic pain, professional support is available. If you are in the San Diego area and would like to speak to a professional at CSAM who specializes in CBT and ACT, please contact us. 

References

Dahl, J., Wilson, K.G., & Nilsson, A. (2004). Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-801.

Institute of Medicine. (2011). Report from the Committee on Advancing Pain Research, Care, and Education: Relieving pain in America, a blueprint for transforming prevention, care, education and research. The National Academies Press. Retrieved from http://books.nap.edu/openbook.php?record_id=13172&page=1.

McCracken, L.M., Vowles, K.E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43(10), 1335-1346.

National Centers for Health Statistics. (2006). Chart Book on Trends in the Health of Americans 2006, Special Feature: Pain. Retrieved from http://www.cdc.gov/nchs/data/hus/hus06.pdf.

The American Academy of Pain Medicine. (2013). Retrieved from http://www.painmed.org/patientcenter/facts_on_pain.aspx.

Tags: Cognitive Behavioral Therapy, pain, chronic pain, headache, back, ache, somatic