Fighting for Life: A Qualitative Analysis of the Process of Psychotherapy-Assisted Self-Help in Patients With Metastatic Cancer

Abstract

This exploratory study is an attempt to define psychological attributes related to longer survival in patients with metastatic cancers. Previous published analyses have been limited in two ways. First, they have almost always been carried out on patients not receiving therapy; we have followed people receiving a year of group therapy, on the assumption that if mental qualities are to affect cancer progression, substantial mental change would be needed to alter the established balance between the cancer cells and host regulatory mechanisms. Second, the methods typically used to characterize patients' psychology have been self-report inventories, and many decades of research with such methods have largely failed to produce a consensus on what mental qualities, if any, promote survival. By contrast, we have used qualitative methods, allowing a much more in-depth analysis of the patients, without preliminary assumptions as to what would be important. The present report describes the results of a detailed qualitative analysis of data collected from 22 participants over a year of weekly group therapy. Using grounded methods, categories were derived from the extensive verbal data (comprising patients' written homework and therapists' notes), and linked in a model of change. By applying ratings to some of these categories, and combining these ratings, we derived a quantitative estimate of patients' "involvement in self-help." Rankings on degree of involvement corresponded quite closely with the quality of patients' experience and with their survival duration. There was a great range in degree of involvement, and various subgroupings could be discerned. Nine of the participants were classed as "highly involved," meaning that they devoted regular daily time, often several hours, to such self-help strategies as relaxation, mental imaging, meditation, cognitive monitoring and journalling. All but 1 of these patients enjoyed a good quality of life and lived at least 2 years. Two of them have remained in complete remission for 7 years. At the other end of the scale, 8 patients showed little application to the work, being either unconvinced that it would help them or hampered by psychological problems such as low self-esteem. None of these was rated as having a good quality of life, and only 1 lived more than 2 years, although, as a group, their medical prognoses were no more unfavorable at the onset of therapy than for the "high involvement" group. The different subgroups and aspects of the model are illustrated by representative quotations.

Personal Resiliency: Serious Diagnosis and Prognosis With Unexpected Quality Outcomes

“…Some variables have been explored in epidemiological literature (e.g., social status, income levels; see Eames & Ben-Shlomo, 1993;House & Landis, 1988), others in health psychology (e.g., coping and stress appraisal, self efficacy, social support; see Antonovsky, 1987;Bandura, 1982;Lazarus, 1990;Pennebaker, 1990), and others in the field of psychoneuroimmunology (e.g., psychosocial support and self regulation; see Spiegel & Giese-Davis, 2003;Temoshok, 1987). One study that compared outcomes of participants in group therapy in relation to participation identified a series of variables that might have explanatory value (Cunningham, Phillips, Stephen, & Edmonds, 2002). Health psychology texts attempt to gather these studies into a coherent whole (Sutton, Baum, & Johnston, 2004), with limited success.…”

Cancer, the Mind, and the Problem of Self-blame

“…Alastair Cunningham, in an earlier article in this journal, described a group of patients who were highly involved in a psychotherapy-assisted group self-help study, to the extent of doing daily journaling, mental imaging, meditation, cognitive monitoring, or relaxation, sometimes for hours each day. 9 These patients had longer survival and better quality of life than patients who attended the program but had little or no involvement. There may be ways to structure psychooncology programs that engage patients more thoroughly while helping them to mobilize their physical and psychological resources more effectively.…”

Do Future Limitation Perspective in Cancer Patients Predict Fear of Cancer Recurrence, Mental Distress, and the Ventromedial Prefrontal Cortex Activity?

“…When one’s lifetime is perceived as running out, the individual is defined as possessing a future limitation perspective (FLP); in contrast, when their lifetime is perceived as open-ended (expansive), they are considered to have a future opportunities perspective (FOP). Therefore, cancer patients’ forming of their FTP is based on their disease state and treatment effects ( Cunningham et al, 2002 ). Having greater health constraints and lower subjective health is associated with a stronger FLP ( Grühn et al, 2015 ).…”