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Biomedical subjects

Alastair J Cunningham

Publications and source records attributed to Alastair J Cunningham.

8 recordsLinked to original sources
PubMed2005

Integrating spirituality into a group psychological therapy program for cancer patients.

PURPOSE: Although the importance of spiritual issues to people with cancer is by now widely acknowledged, there has been almost no research on the value of interventions specifically designed to enhance the spiritual experience of these patients. The present report describes an exploratory study on the effects of a brief psychoeducational course emphasizing spiritual aspects of coping and healing. METHODS: Ninety-seven patients with various types and stages of cancer took part in the 8-session course as the third stage in a progressive, stepwise program of support and psychological education. Standard psychometric tests were administered at entry, 8 weeks, and 6 months. Written home assignments, returned by participants, provided an insight into their experience. RESULTS: Significant improvements in scores were found immediately following the intervention; by 6 months, however, these improvements above entry level had declined to about half the 8-week value. In their written homework, patients grappled with such issues as doubts about the existence of a god, judgment and forgiveness, guilt, projection, self-importance, and the meaning of love. As the course progressed, many claimed to be better able to accept their condition and to experience an enhanced sense of meaning in their lives, coupled with a heightened appreciation for the events of everyday life and less tendency to conflict with others. CONCLUSIONS: These preliminary findings indicate that further, more rigorous investigation would be worthwhile and support the growing view that addressing spiritual issues within the framework of group therapy can be of great benefit to people with cancer.

Adaptation, Psychological↗
PubMed2004

How psychological therapy may prolong survival in cancer patients: new evidence and a simple theory.

This article presents new data and attempts to draw together converging lines of evidence on the mental attributes that may favor prolonged survival in the face of metastatic cancer. The authors interviewed 10 individuals with medically incurable cancers who had outlived their prognoses by from 2.2 to 12.5 years (and have all survived, a further 2 more years in most cases, between interview and publication). The authors derived, by qualitative analysis, a number of themes common to most or all of them. Three major qualities emerged: "authenticity," or a clear understanding of what was important in one's life; "autonomy," the perceived freedom to shape life around what was valued; and "acceptance," a perceived change in mental state to enhanced self-esteem, greater tolerance for and emotional closeness to others, and an affective experience described as more peaceful and joyous. Previous descriptions of "remarkable survivors" have suffered from a serious limitation: the research to date has not clarified to what extent they differed psychologically from their many peers who did not survive. The authors attempted to address this question in 2 ways. Six of the subjects were part of a protocol (the Healing Journey study) in which patients belonged to a larger group, all of whom were medically assessed prospectively, by an expert panel. A prediction of the likely duration of survival was made for each of the patients in this study, and it could be shown that those who subsequently survived were not a random sample of the whole but displayed a much higher degree of early involvement in their psychological self-help than did most of their nonsurviving peers. They also compared long survivors with 2 other groups: 6 individuals with similar diseases who had not yet received psychological help and 6 individuals from the Healing Journey study whose survival duration was at the lower end of the whole group. The patients in these comparison groups also lacked many of the most salient qualities identified among the long survivors. Many of the attributes found in the long survivors were, however, also noted in the earlier reports of remarkable survivors in the literature, which suggests that the observations may be generalizable. Putting these joint findings together with the early work of Temoshok on "type C" adaptation as a risk factor for cancer, one can see that there is a mirrored symmetry between the psychological patterns possibly promoting disease and the changed adaptations that may lead to longer survival in some cases. The authors arrive at a commonsense hypothesis: to the extent that the progression of cancer, or other chronic disease, is favored by a distorted psychological adaptation such as type C, healing may be assisted by a reversal of that adaptation--in the case of cancer, toward greater authenticity of thought and action.

Adaptation, Psychological↗
PubMed2002

Group psychological therapy: an integral part of care for cancer patients.

Adjuvant psychological therapy can help cancer patients in 2 main ways. It has, first, a well-documented capacity to alleviate distress and thus improve quality of life. However, if this kind of assistance is to be made available to the majority of cancer patients, a number of problems need to be solved: administrators need to become aware of the evidence for efficacy of psychosocial care for cancer patients; the treatment needs to be advocated in a manner that would benefit patients rather than being left to the patient to request it; and, for reasons of economy, large, classroom-style, psychoeducational classes may need to be offered in place of small support groups. Furthermore, to allow for individual differences in preferences and abilities, a variety of modes of help should ideally be made available. The author discusses how the provision of coping strategies can be organized in a progressive way to encourage development of greater coping skills. An example of such a stepwise program is given, all aspects of which have been researched and made available in manuals over some 20 years. The possibility of prolonging life with this kind of therapy is still controversial. While randomized controlled trials have become the method of choice to investigate this question, reasons are given for strongly preferring more exploratory modes of research at the present early stage of knowledge. The central task is seen as understanding the states of mind that promote healing or longer life, something that cross-sectional, psychometric research has not been able to accomplish. As an alternative, prospective, longitudinal designs are needed, with detailed interview-style analyses of patients' mental attributes. An example is given of one such study. Furthermore, it is suggested that we consider much more intensive therapies of this kind, since the impact of mind on body will logically be related to the extent of psychological change experienced.

Humans↗
PubMed2002

Fighting for life: a qualitative analysis of the process of psychotherapy-assisted self-help in patients with metastatic cancer.

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.

Adult↗