Cancer as a Gateway | Multi-Dimensional Approach To Healing

NEWSWEEK MAGAZINE

September 27, 2004
Section: Cover Story: Health for Life: 'Mindfulness'
Edition: U.S. Edition
Page: 48

Buddha Lessons
A technique called 'mindfulness' teaches how to step back from pain and the worries of life
By Claudia Kalb

Newsweek - Jon Kabat-Zinn at 7-day mindfulness and stress reduction training, The Crossings, Austin, TX

For decades, Dalia Isicoff has suffered the agony of rheumatoid arthritis--joint pain, spinal fusion, multiple hip surgeries. Painkillers dull the aches, but it wasn't until she took a course at the University of Maryland's Center for Integrative Medicine that Isicoff discovered a powerful weapon inside her own body: her mind. Using a meditative practice called Mindfulness-Based Stress Reduction, or MBSR, Isicoff learned to acknowledge her pain, rather than fight it. Her negative and debilitating thought patterns--"This is getting worse," "I'm going to end up in a wheelchair"--began to dissipate, and she was able to cut back on her medication. The pain hasn't gone away, but "I view it is an ally now," she says. "Mindfulness is transformational." With its roots in ancient Buddhist traditions, mindfulness is now gaining ground as an antidote for everything from type-A stress to chronic pain, depression and even the side effects of cancer treatment. At the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School, where MBSR was developed by Jon Kabat-Zinn, a leader in the field, 15,000 people have taken an eight-week course in the practice; hundreds more have signed up at medical clinics across the country. Studies have shown that mindfulness can reduce pain and anxiety. Now researchers are using brain imaging and blood tests to study its biological effects, and early results are intriguing: this spring, the National Institutes of Health hosted its first conference on the topic. "People in the scientific community used to think that this was a lot of mystical mumbo jumbo," says psychologist Ruth Baer, of the University of Kentucky. "Now they're saying, 'Hey, we should start paying attention'."

Paying attention is the very essence of mindfulness. In 45-minute meditations, participants learn to observe the whirring thoughts of the mind and the physical sensations in the body. The guiding principle is to be present moment to moment, to be aware of what's happening, but without critique or judgment. It is not easy. Our "monkey mind," as Buddhists call the internal chaos, keeps us swinging from past regrets to future worries, leaving little time for the here and now. First attempts may provoke frustration ("I'll never be able to do this"), impatience ("When will this be over?") and even banal mental sparks ("What am I going to make for dinner?"). The goal, however, is not to reach nirvana, but to observe the cacophony in a compassionate way, to accept it as transient, "like bubbles forming in a pot of water or weather patterns in the sky," says Kabat-Zinn.

The keystone of mindfulness is daily meditation, but the practice is intended to become a way of life. At Stanford University, Philippe Goldin encourages patients battling social anxiety disorder to take "meaningful pauses" throughout the day as a way to monitor and take charge of their fears and self-doubts. "It breaks the circuit," says one participant. "I always thought that anxiety had me in its grip, but I realized it's the other way around. I have it in my grip. It's a matter of learning to let it go."

Inner control can be a potent tool in the fight against all sorts of chronic conditions. In a pilot study of 18 obese women, Jean Kristeller, director of the Center for the Study of Health, Religion and Spirituality at Indiana State University, found that mindfulness meditation, augmented with special eating meditations (slowly savoring the flavor of a piece of cheese, being aware of how much is enough), helped reduce binges from an average of four per week to one and a half. Now Kristeller is wrapping up a larger study that she says confirms her earlier findings. Mindfulness helped participant Chuck Cooley, 43, identify anxiety as a trigger for overeating--and cut back on the pizza buffets. "Before, I was on automatic pilot," he says. Now "I can take my time and enjoy a smaller portion."

Mindfulness takes you out of your same old patterns. You're no longer battling your mind in the boxer's ring--you're watching, with interest, from the stands. The detachment doesn't lead to passivity, but to new ways of thinking. This is especially helpful in depression, which plagues sufferers with relentless ruminations. At least half of all patients who have had one or two episodes of clinical depression will relapse into another; the more episodes, the higher the risk. University of Toronto psychiatry professor Zindel Segal combines mindfulness with conventional cognitive behavioral therapy, teaching patients to observe sadness or unhappiness without judgment. In a study of patients who had recovered from a depressive episode, Segal and colleagues found that 66 percent of those who learned mindfulness remained stable (no relapse) over a year, compared with 34 percent in a control group. Now Segal has a $2.1 million grant from the NIH to compare mindfulness against antidepressants as a maintenance therapy after relapse. Segal's patient Suzanne Simoni, 47, says she has learned to identify the early signs of an emotional hurricane--fatigue, irritability, hopelessness--before it hits. "I have the chance to catch it earlier," she says. And possibly steer it away altogether.

The biological impact of mindfulness--on the brain, the blood, the immune system--is the next frontier in scientific research. In an intriguing study published several years ago, Kabat-Zinn found that when patients with psoriasis listened to meditation tapes during ultraviolet-light therapy, they healed about four times faster than a control group. In an effort to understand how this kind of dramatic response is possible, scientists are hunting down mindfulness's biological footprints. Kabat-Zinn and neuroscientist Richard Davidson, of the University of Wisconsin, found that after eight weeks of MBSR, a group of biotech employees showed a greater increase in activity in the left prefrontal cortex--the region of the brain associated with a happier state of mind--than colleagues who received no meditation training. When the techies were given a flu vaccine, those with the greatest left-brain activation mounted the most vigorous antibody assault against the virus.

There's more in the pipeline. The University of Massachusetts' mindfulness center is studying the impact of mindfulness and diet on PSA levels in prostate cancer. Stanford's Goldin is taking brain images of social-anxiety patients to see if the practice affects emotional trigger points, like the amygdala, which processes fear. And at Maryland's Center for Integrative Medicine, director Dr. Brian Berman is tracking measures of inflammation, including gene expression, in patients with rheumatoid arthritis. For Dalia Isicoff, the payoff is already clear: "I'm at peace," she says. Her mind and her body, together.

HOW DO I BRING MORE MINDFULNESS INTO MY LIFE

By Jeff Brantley, MD

Background

Have you ever started eating an ice cream cone, taken a lick or two, then noticed all you had was a sticky napkin in your hand? Or been going somewhere and arrived at your destination only to realize you haven't noticed anything or anyone you met along the way? Of course you have, we all have! These are common examples of "mindlessness," or as some people put it, "going on automatic pilot."

We all fall into habits of mind and body, of attention and inattention, which result in our not being present for our own lives. The consequences of this inattention can be quite costly. They can result in our missing some really good things, and also in our ignoring really important information and messages about our life, our relationships, and even our own health.

Our reactions to the stressful events of our lives can become so habituated that they occur essentially out of our awareness, until, because of physical or emotional or psychological dysfunction, we cannot ignore them any longer. These reactions can include tensing the body, experiencing painful emotional states, even panic and depression, and being prisoners of habits of thinking and self-talk including obsessional list making, and intense, even toxic self-criticism.

An important antidote to this tendency to "tune-out," to go on "automatic pilot," is to practice mindfulness. To practice mindfulness means to pay more careful attention in a particular way. We all have the quality of mindfulness in us. It is the quality of bare awareness that knows what is here in the present moment. Mindfulness knows what is going on outside, and also, inside our own skin. However we experience life, through whichever sense gate life comes to us - eyes, ears, nose, tongue, body, even the mind itself - mindfulness is capable of knowing that seeing, or hearing, or smelling, or tasting, or feeling, or even thinking - is happening in this, the present moment.

So, we can practice mindfulness and become more present. All we have to do is to establish attention in the present moment, and to allow ourselves to be with what is here. To rest in the awareness of what is here. To pay attention without trying to change anything. To allow ourselves to become more deeply and completely aware of what it is we are sensing! And to be with what it is we are experiencing. To rest in this quality of being, of being aware, in each moment as our life unfolds.

And, to the extent we can practice "being" and become more present and more aware of our life and in our life, the "doing" we do about all of it, will be more informed, more responsive, and less driven by the habits of reaction and inattention.

Practicing Mindfulness

Make the effort! Whenever you think of it in your day or night, remember that you can be more mindful. See for yourself what it might be like to pay more careful attention and to allow yourself to experience directly what is here, especially including what is here in your own body, heart, and mind. When starting a new activity (beginning a meeting with 2 minutes of silence and attention on the breath, or taking a few mindful breaths before entering a patient's room, or a focus on the breath before starting your exercise routine, are some possibilities). In the middle of an on-going situation or process (bringing attention to the breath, or to the sensations arising while washing dishes, eating a meal, walking the dog, doing a job, etc.) Or when you are just waiting, in between the things on the schedule (gently bringing attention to the breath or the sounds or the sensations or the sights or even the thoughts while at a red light, in a line at the bus stop or grocery, or waiting for someone else to arrive).

In these situations, use the sensation of the breath as the "anchor" for awareness in the present moment. Establish mindfulness on the narrow focus of just the breath sensation. Allow yourself to feel the breath as it goes in, and goes out and the pause between in and out. Do not try to control the breath. Simply let it come and go. Bring as much attention, as completely and continuously as you can to the direct sensation of the breath.

After awhile, if you wish, when you have established awareness on the breath sensation, you could widen the focus to include all body sensations along with the breath sensation. Again, not trying to change anything at all! But, simply allowing yourself to feel, to be aware of the changing sensations in the body.

After awhile, again if you wish, you can further widen the focus to include all that is present. This means whatever you are hearing, seeing, tasting, smelling, touching, or even thinking. Just practice being with these different experiences as they unfold. Allowing yourself to feel your life in this moment. Resting in mindfulness, the open-hearted choiceless awareness of what is here in this moment.

Anytime you feel lost or confused or frustrated, gently narrow the focus and return awareness to the sensation of the breath. You may have to do this frequently. It is ok. Or you may wish to concentrate mainly on the breath, especially if you are new to meditation. That, too, is ok. The important thing is the quality of awareness you bring to the moment. One moment of mindfulness, one breath when we are truly present, can be quite profound. See for yourself!

You can practice mindfulness in this way throughout the day and night! Practice for a few breaths at a time, even for a few mindful moments. And, if you wish, you can make this a more "formal" meditation practice, by setting aside some time (from a few minutes to an hour or more, as you wish) free from other activity or distraction to devote full attention to simply being present, being mindful of what is present. Over time you may find that the "formal" practice supports and strengthens your ability to practice "informally" throughout the day and night in different situations.

Hints

Expect your mind to wander! Especially if you practice for even a few breaths or for a few minutes. Practice kindness and patience with yourself when this happens and gently return awareness to the breath sensation.

Notice any tendency to "be hard on yourself," or to feel frustrated or a failure. See this kind of judgment as just another kind of thinking, and gently return awareness to the breath.

Expect to feel some relaxation, especially if you practice for even a few breaths or for a few moments. This relaxed feeling is an ally. It helps us to be more present, more mindful. Relaxation alone is not what mindfulness is about, however! It is about being present with awareness.

Expect to become more mindful with practice! Expect to notice more things, including more painful things. This is actually progress! You are not doing anything wrong! Quite the opposite, you are increasing mindfulness for all things. When you begin to notice the painful things, see if you can hold yourself with compassion and kindness, and continue to bring open-hearted awareness to the experience that is unfolding. By practicing staying present, not turning away from the painful in our lives, we can learn to remain open to all the possibilities in each situation. This increases our chances for healing and transformation in meeting the pain we face. And it also gives us a way to be with those situations when there is nothing more we can do to "get away from the pain" but must find a way to be with it. We can discover that the quality of mindfulness is not destroyed or damaged by contact with pain, that it can know pain as completely and fully as it knows any other experience.

Finally, be careful not to try too hard when practicing mindfulness. Don't try to make anything happen, or to achieve any special states or any special effects! Simply relax and pay as much attention as you can to just what is here now. Whatever form that takes. Allow yourself to experience life directly as it unfolds, paying careful and open-hearted attention.

JOURNAL OF PSYCHOTHERAPY PRACTICE

Psychodynamic Psychotherapy for Cancer Patients

Norman Straker, M.D.

Received February 16, 1996; revised July 16, 1997; accepted July 25, 1997. From Memorial Sloan-Kettering Cancer Center and Cornell University College of Medicine, New York. Address correspondence to Dr. Straker, 850 Park Avenue, New York, NY 10021.

Psychosocial factors, as well as psychosocial interventions,have now become issues for study in relationship to cancer onset,quality of life, and length of survival. It is now documentedthat emotional expression,¹ social supports,² lower levels ofemotional distress,³, ⁴ and a fighting spirit^5–7 tend tobe associated with improved survival time in cancer patients.It would therefore be reasonable to expect that psychotherapeuticinterventions that address these issues might improve qualityof life, decrease level of stress, and improve survival timefor cancer patients.⁸ Hill et al.⁹ in a recent review showedthat in 12 of 17 controlled studies, the psychotherapeutic interventionswere efficacious in reducing psychological stress; only 2 studiesshowed no benefit.

Some studies have indicated a direct beneficial effect of socialsupport on survival time. The first and most publicized studyof Spiegel et al.¹⁰ showed that at 10-year follow-up there wasa statistically significant survival advantage for women withbreast cancer who had participated in group therapy treatment.They lived an average of 18 months longer than control subjects.Richardson et al.¹¹ reported the effects of home visits andeducational interventions on leukemia and lymphoma patients.The intervention group lived significantly longer, even whendifferences in medical treatment were controlled for. The conclusionwas that the psychosocial intervention was the significant variable.Finally, Fawzy et al.,¹² working with melanoma patients, documenteda survival advantage and lower rates of recurrence for 40 patientsrandomly assigned to 6 weeks of extensive group psychotherapy.There are as yet no controlled studies of the impact of individualpsychotherapy on recurrence or survival time; however, clinicalexperience is suggestive.

Cancer & Mindfulness

Cancer Patients Can Be Well Just as They Are
Jon Kabat-Zinn Shares Mindful Meditation at Cancer Center

People can be well even when they have cancer – “well” in the sense of having connectedness with themselves through meditation.

So says renowned author Jon Kabat-Zinn, Ph.D., founding director of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School.

The bestselling author of Wherever You Go, There You Are and Full Catastrophe Living, shared his thoughts Feb. 15 at the first community event in M. D. Anderson’s new Cancer Prevention Building. The presentation, which concluded with the signing of his new book, Coming to Our Senses, was the first in a Journey to Wellness series sponsored by M. D. Anderson’s Public Education Office.

“You can be unbelievably healthy no matter what is wrong with you,” Kabat-Zinn told the crowd of 350 people. “It’s not like you have cancer and have to be done with that before you can be well. And one way of being well is through meditation.”

Demystifying the meditative practice

A leading expert in meditation, Kabat-Zinn set about to demystify the practice by guiding the crowd through a short exercise. He asked people to be aware of their thoughts and their breath as it rose and fell. It did not matter if their eyes were open. It did not matter what they were thinking. Meditation does not require that people “empty” their minds. It does not require a Gandhi-like trance.

“Meditation is about knowing what’s on your mind,” he told the group. “The real meditation is how you live your life, not how you sit in a chair. It is about how intimate you are with yourself in the moment.”

The practice of meditation also can help a cancer patient be in tune with his or her body. “No matter how many people are working on your body, you know your body better than anybody, or you could know your body better than anybody (through meditation),” said Kabat-Zinn, who holds a Ph.D. in biochemistry from the Massachusetts Institute of Technology (MIT).

Mindfulness makes a difference

Kabat-Zinn was invited to M. D. Anderson because his work relates to ongoing research conducted at the institution and at The University of Texas School of Nursing, the event co-host.

The School of Nursing has received a National Institutes of Health grant to study mindfulness meditation as a treatment in addictions. M. D. Anderson’s Department of Behavioral Sciences received a grant involving similar therapy for smoking cessation. Kabat-Zinn also has strongly influenced an M. D. Anderson study involving a mindfulness-based relaxation program with chemotherapy.

Lorenzo Cohen Ph.D., director of M. D. Anderson’s Integrative Medicine Program, explains the connection between the author’s work and the institution’s growing Integrative Medicine Program.

“Dr. Kabat-Zinn’s research is pioneering work that shows the mind can influence physiology and can have an impact on clinical outcomes of chronic illnesses,” Cohen says.

Research includes complementary therapies

Kabat-Zinn’s early research strongly influenced Cohen’s own research focus. Today, under Cohen’s leadership, the Integrative Medicine Program is organized into three major areas that reflect some of that influence:

Studying the biobehavioral effects of mind/body-based interventions on cancer patients, including stress management, yoga, support groups, music therapy, meditation (including Tibetan meditation), expressive writing and other behavioral approaches.

Examining the anti-cancer potential of natural compounds such as dietary supplements, vitamins and herbal remedies. Products being studied include green tea, turmeric, oleander, melatonin, shark cartilage, fish oil and mushrooms.

Using acupuncture to treat common cancer treatment-related side effects including nausea, postoperative ileus (partial or complete blockage of the small or large intestine) and mucositis (inflammation of the lining of the mouth, throat and gastrointestinal tract).

Cancer center wellness programs

In addition, M. D. Anderson’s Place…of wellness offers more than 40 complementary therapy programs to patients, family members and caregivers. The Integrative Medicine Program’s Complementary/Integrative Medicine Education Resources website also provides current information about dietary supplements.

The growth of such complementary therapies in mainstream medicine throughout the country is a trend that has continued to advance since Kabat-Zinn started the Stress Reduction Clinic. Today, there are satellite clinics all over the world.

Despite the growth, the core philosophy the clinic staff shares with patients remains the same: “No matter what it is, when patients meet with us, we tell them, ‘there is more right with you than wrong with you,’ “ he says. At last month’s event, Kabat-Zinn encouraged the audience to explore a more mindful existence, leaving them with this thought: “Live your life as if it really mattered