The Healing Journey:   Incorporating psychological and spiritual dimensions into the care of cancer patients   Alastair Cu...
Why we suffer <ul><li>Suffering is a mental reaction to events seen as unwanted. </li></ul><ul><li>Our suffering comes fro...
Healing: the relief of suffering. Approaches: <ul><li>Medical: repair of physical disability </li></ul><ul><li>Psychologic...
Healing (relieving suffering) through therapy at the level of mind <ul><li>There is much more we can do to relieve sufferi...
Healing from within, or self-healing, is something we can  learn <ul><li>A progressive educational process (like  learning...
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Understanding and changing thoughts  (judgment, guilt) Do nothing Support:  comforting; emotional expression, problem solv...
Who should be offered psychological therapy for relief of suffering?  Everyone? <ul><li>Usual :   </li></ul><ul><li>referr...
Is it too expensive?  <ul><li>Costs are small in comparison to much high-tech medical care: </li></ul><ul><li>Example ; “W...
How professionals often disempower patients <ul><li>Too much negative information/prediction </li></ul><ul><li>Undervaluin...
Modes of psychological intervention for cancer patients Nature of intervention Activity required Benefits Information (re ...
The Healing Journey: (25 years in Toronto) Alastair  Cunningham  Claire Edmonds Jan Ferguson (coordinator) Cathy Phillips ...
The Healing Journey Program PMH and Wellspring Stage “ Coping with Cancer Stress”  (4 weekly sessions) Large groups – lect...
HJ  level I large groups : 4 weekly sessions, lecture style. (if  small groups : conventional discussion in circle) <ul><l...
HJ  level II large groups: didactic work, followed by: small groups: discussion of techniques and feelings <ul><ul><li>Min...
Quote on effects of relaxation <ul><li>During relaxation/meditation, I feel a quieting effect.  My mind tends to focus on ...
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Thought management <ul><li>Monitoring (awareness) </li></ul><ul><li>Journalling </li></ul><ul><li>Changing thoughts; affir...
“ Nothing happens next.  This is it ” Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed ...
Mental imagery <ul><li>Mental representation of experience </li></ul><ul><li>A powerful “language” for internal communicat...
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Spirituality: the search for ultimate meaning <ul><li>The individual’s search for the transcendent or sacred (contrast rel...
Importance of the spiritual/existential dimension to many cancer patients <ul><li>-  Life is under threat </li></ul><ul><u...
Introducing spirituality to patients through a program teaching self healing. <ul><li>Spiritual experience is about seeing...
Introducing spirituality to patients through a program teaching self healing (contd) <ul><li>Begin with basic psychologica...
HJ  Level III:  Diminishing obstacles to spiritual experience <ul><li>8 weekly sessions: written work done at home, read b...
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Background to Level IV: research on “remarkable survivors <ul><li>Interview study:  10 people with medically incurable can...
Results of interview study: Properties of good “self-healers ” <ul><li>Authenticity:  awareness of our true needs and valu...
Level IV of the Healing Journey <ul><li>Exercises to develop authenticity, autonomy and acceptance (based on study of long...
Selecting a spiritual system suitable for use in level V, and in health psychology generally. <ul><li>Focus on personal un...
Level V of the Healing Journey <ul><li>Introduction to study of “A Course in Miracles” (other texts could be used) </li></...
Research on psychological help for improving quality of life, and possibly length of life, in cancer patients: Results wit...
Clinical trials (verification) approach – main limitations <ul><li>Results allow the conclusion that  low-intensity group ...
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
Published by  Current Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc .
“ Allostatic load” (strain on all systems) Predisposition to disease  Disease develops Recovery of health Diminished allos...
Published by  C urrent Oncology  and the  Cancer Knowledge Network  © 2011  Multimed Inc . Additional Survival Observed Pr...
Research currently needed on impact of psychotherapy on survival <ul><li>Main aim: defining psychological qualities associ...
Why is healing through the mind undervalued? <ul><li>Not widely understood that our mind creates our experience of life (h...
Summary <ul><li>Support:  Now clear that support helps many cancer patients – almost all, if they are encouraged to attend...
Summary (contd) <ul><li>Conclusions on “mind-body”:   </li></ul><ul><ul><li>Benefits of basic psychological help on qualit...
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The Healing Journey

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By: Alastair Cunningham, Ontario Cancer Institute

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  • Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc.
  • The Healing Journey

    1. 1. The Healing Journey: Incorporating psychological and spiritual dimensions into the care of cancer patients Alastair Cunningham Ontario Cancer Institute www.healingjourney.ca Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    2. 2. Why we suffer <ul><li>Suffering is a mental reaction to events seen as unwanted. </li></ul><ul><li>Our suffering comes from the diagnosis, and what we think it implies, rather than directly from the cancer </li></ul><ul><ul><li>Cancer is an existential crisis, not simply a physical one </li></ul></ul><ul><li>There are two main ways to relieve suffering: remove the “event” or change the mental reaction. </li></ul>
    3. 3. Healing: the relief of suffering. Approaches: <ul><li>Medical: repair of physical disability </li></ul><ul><li>Psychological (and social): relief of suffering </li></ul><ul><li>Spiritual: a return to “oneness”, unity with the Divine Ground </li></ul><ul><li>In the hierarchy “spirit – mind – body”, each level encompasses those below it. </li></ul><ul><li>“ Wellness” can be pursued at all levels. </li></ul><ul><ul><li>The “higher” 2 depend on active participation by the healee </li></ul></ul>
    4. 4. Healing (relieving suffering) through therapy at the level of mind <ul><li>There is much more we can do to relieve suffering </li></ul><ul><ul><li>Is it therefore unethical not to do it? </li></ul></ul><ul><li>The extra avenue for healing is the patient’s mind (this is how human medicine differs from veterinary medicine). </li></ul><ul><li>Patients can be helped to adapt much more skillfully to life-threatening disease </li></ul><ul><li>Quality of life, and of dying can be enhanced; life may be prolonged. </li></ul><ul><li>Psychological and spiritual assistance need to integrated into the treatment protocol </li></ul>
    5. 5. Healing from within, or self-healing, is something we can learn <ul><li>A progressive educational process (like learning a language ) </li></ul><ul><li>We learn how we “create” our experience, including our distress, with our thinking. </li></ul><ul><li>This provides the opportunity to change our adaptation to events (such as a cancer diagnosis); to live more “skillfully”. =“Wellness” training. </li></ul><ul><li>Active participation and practice is required. </li></ul><ul><li>A teacher is needed: this is a major function of professionals operating at psychological and spiritual levels </li></ul>
    6. 6. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    7. 7. 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 Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    8. 8. Who should be offered psychological therapy for relief of suffering? Everyone? <ul><li>Usual : </li></ul><ul><li>referral of obviously distressed patients </li></ul><ul><li>Patient request </li></ul><ul><li>(Means that only a tiny minority receive much psychological help at present in most settings) </li></ul><ul><li>Preferable: </li></ul><ul><li>where expert sees possibility of benefit to patient (as in general medicine). </li></ul><ul><ul><li>“ Could this patient be helped to cope even better?” </li></ul></ul><ul><ul><li>“ What modes of help would be most beneficial?” </li></ul></ul><ul><li>Patient potential : cancer patients are usually psychologically “normal”: don’t use models from psychopathology. </li></ul>
    9. 9. Is it too expensive? <ul><li>Costs are small in comparison to much high-tech medical care: </li></ul><ul><li>Example ; “What can be done with $150,000? </li></ul><ul><ul><li>1 Bone Marrow transplant </li></ul></ul><ul><ul><li>Basic psychosocial help for 1,000 patients </li></ul></ul>
    10. 10. How professionals often disempower patients <ul><li>Too much negative information/prediction </li></ul><ul><li>Undervaluing psychological therapy, or restricting it to “support” </li></ul><ul><li>Dismissing the possibility of self help </li></ul><ul><ul><li>Unawareness of the great potential people have to help themselves. </li></ul></ul><ul><ul><li>“ Go home and forget about it” </li></ul></ul><ul><ul><li>Being afraid people will blame themselves if they try self help and “fail” </li></ul></ul>
    11. 11. Modes of psychological intervention for cancer patients Nature 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 mind Poss 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?
    12. 12. The Healing Journey: (25 years in Toronto) Alastair Cunningham Claire Edmonds Jan Ferguson (coordinator) Cathy Phillips Judy Gould Kim Watson Joanne Stephen Wellspring team www.healingjourney.ca Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    13. 13. The Healing Journey Program PMH and Wellspring Stage “ 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 “ Recovering Authenticity” Small group work, or home study “ Graduate discussion group” (no time limit) C O R E Graduate discussion group (ACIM) Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc . “ Spiritual aspects of healing” Group study of “A Course in Miracles” (ACIM)
    14. 14. HJ level I large groups : 4 weekly sessions, lecture style. (if small groups : conventional discussion in circle) <ul><li>1. Intro to theory of self-help and healing </li></ul><ul><ul><li>Progressive muscle relaxation </li></ul></ul><ul><ul><ul><li>Imagining relaxing at the beach </li></ul></ul></ul><ul><ul><ul><li>Stress management </li></ul></ul></ul><ul><li>2. Watching and managing thoughts </li></ul><ul><ul><li>Self-hypnotic (“deep inner”) relaxation </li></ul></ul><ul><li>3. Mental imagery </li></ul><ul><ul><li>Imagining body controlling the cancer </li></ul></ul><ul><li>4. Clarifying goals </li></ul><ul><ul><li>Imagining an ideal day in the future </li></ul></ul>
    15. 15. HJ level II large groups: didactic work, followed by: small groups: discussion of techniques and feelings <ul><ul><li>Mind watching and journalling </li></ul></ul><ul><ul><li>Meditation; </li></ul></ul><ul><ul><li>Imagery: “dialogue” with the cancer </li></ul></ul><ul><ul><li>“ Inner Healer” </li></ul></ul><ul><ul><li>Goals: “One week to live” </li></ul></ul><ul><ul><li>“ Letting go of resentments” </li></ul></ul><ul><ul><li>The spiritual journey (introduction) </li></ul></ul><ul><ul><li>-“mindfulness” meditation </li></ul></ul><ul><ul><li>8. Review </li></ul></ul>
    16. 16. Quote on effects of relaxation <ul><li>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. </li></ul>
    17. 17. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    18. 18. Thought management <ul><li>Monitoring (awareness) </li></ul><ul><li>Journalling </li></ul><ul><li>Changing thoughts; affirmations </li></ul><ul><li>Goal setting </li></ul><ul><li>Writing a life story </li></ul><ul><li>Meditation techniques </li></ul><ul><ul><li>Mindfulness/awareness </li></ul></ul><ul><ul><li>Focus/mantra </li></ul></ul>
    19. 19. “ Nothing happens next. This is it ” Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    20. 20. Mental imagery <ul><li>Mental representation of experience </li></ul><ul><li>A powerful “language” for internal communication (to mind and body) </li></ul><ul><ul><li>Imagining return to health/defenses opposing disease </li></ul></ul><ul><ul><li>Overcoming resentments </li></ul></ul><ul><ul><li>Consulting an inner source of wisdom (“Inner Healer” </li></ul></ul><ul><ul><li>Connecting with spiritual figure(s) </li></ul></ul>
    21. 21. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    22. 22. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    23. 23. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    24. 24. Spirituality: the search for ultimate meaning <ul><li>The individual’s search for the transcendent or sacred (contrast religion: social institutions supporting this search) </li></ul><ul><li>Many ways exist to think of this dimension (God; the Way, the Void, Ultimate Order, the One….) </li></ul><ul><li>Experts: the mystics – lives successfully devoted to this search – Jesus, Buddha, Mohammed, Laotze, Ramana…. [teachings available to us] </li></ul><ul><li>Role of the health professional: to experience this for him/herself and interpret it to patients </li></ul>
    25. 25. Importance of the spiritual/existential dimension to many cancer patients <ul><li>- Life is under threat </li></ul><ul><ul><li>Is this the end? </li></ul></ul><ul><ul><li>Does this suffering, and my life, have any meaning? </li></ul></ul><ul><li>Spiritual work may: </li></ul><ul><ul><li>Enhance quality of life, peace, diminish suffering </li></ul></ul><ul><ul><li>Provide a sense, that all will be well, that one is loved </li></ul></ul><ul><ul><li>Help in acceptance of dying </li></ul></ul><ul><ul><li>Prolong life? </li></ul></ul><ul><li>Spirituality can be treated in a non-sectarian way </li></ul>
    26. 26. Introducing spirituality to patients through a program teaching self healing. <ul><li>Spiritual experience is about seeing the world, and oneself, in a different way </li></ul><ul><li>Therefore, it needs to be preceded by basic instruction in psychological self help; especially awareness of patterns of thought </li></ul><ul><li>Essential that the teacher/therapist have own practice and experience </li></ul>
    27. 27. Introducing spirituality to patients through a program teaching self healing (contd) <ul><li>Begin with basic psychological self-help techniques (relaxation, mental imaging, thought management, meditation…. ) [HJ levels 1 and 2] </li></ul><ul><li>Progress to examination of harmful habits of thought that obstruct spiritual experience: judgment, guilt, projection …[HJ level 3] </li></ul><ul><li>Exercises to consolidate, based on study of remarkable survivors [HJ level 4] </li></ul><ul><li>Study the writings of spiritual masters [HJ level 5] </li></ul><ul><ul><li>Non-sectarian, patient ultimately chooses own path. </li></ul></ul>
    28. 28. HJ Level III: Diminishing obstacles to spiritual experience <ul><li>8 weekly sessions: written work done at home, read by leader, comments offered at next session. </li></ul><ul><li>Content: </li></ul><ul><ul><li>1. Different ways of thinking about “the Divine” </li></ul></ul><ul><ul><li>2. Judgment of others; </li></ul></ul><ul><ul><li>3. forgiveness; </li></ul></ul><ul><ul><li>4. projection; </li></ul></ul><ul><ul><li>5. Self-judgment (guilt); defensiveness; </li></ul></ul><ul><ul><li>6. unconditional love vs worldly love </li></ul></ul><ul><ul><li>7. Self importance and self will. </li></ul></ul><ul><ul><li>8. Review </li></ul></ul><ul><li>Regular practices: meditation (5 methods taught), prayer, thought monitoring and keeping a journal. </li></ul><ul><li>Continuing weekly meetings for interested patients: reading the mystics, discussion </li></ul>
    29. 29. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    30. 30. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    31. 31. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    32. 32. Background to Level IV: research on “remarkable survivors <ul><li>Interview study: 10 people with medically incurable cancers from our program who lived 4 – 14 years beyond predictions </li></ul><ul><li>Medical status and prognoses: (by panel of oncologists): usually approx 1 year. </li></ul><ul><li>Survival: 4-14 years beyond predictions </li></ul><ul><li>Analysis: qualitative analysis of interviews </li></ul><ul><li>Comparison groups: </li></ul><ul><ul><li>6 cancer patients recently beginning in HJ program </li></ul></ul><ul><ul><li>Historical data from patients who did not outlive predictions. </li></ul></ul><ul><ul><li>(ref: Cunningham and Watson, 2004 – see www.healingjourney.ca) </li></ul></ul>
    33. 33. Results of interview study: Properties of good “self-healers ” <ul><li>Authenticity: awareness of our true needs and values </li></ul><ul><li>Autonomy : exercising free choice in our actions (living as we feel we are meant to live). </li></ul><ul><li>Acceptance : much less judgment and criticism of oneself, other people, and events around us. </li></ul><ul><li>…………………………………………………… .. </li></ul><ul><li>Sense of meaning , purpose in life, identity. </li></ul><ul><li>Strong spiritual connectedness ; peace of mind, calm, joy, love. Living in the present. </li></ul><ul><li>Motivation to help others . </li></ul><ul><li>Cancer becomes less important </li></ul>
    34. 34. Level IV of the Healing Journey <ul><li>Exercises to develop authenticity, autonomy and acceptance (based on study of long survivors) </li></ul><ul><ul><li>Mind watching and control </li></ul></ul><ul><ul><li>Defining what is important and what isn’t </li></ul></ul><ul><ul><li>Dropping grievances </li></ul></ul><ul><ul><li>Listening to an “inner voice” </li></ul></ul><ul><ul><li>Defining what I really want </li></ul></ul><ul><ul><li>Operating from the “Higher Self” </li></ul></ul><ul><ul><li>Accepting guidance </li></ul></ul><ul><ul><li>Locating oneself in the “territory of the mind” </li></ul></ul><ul><ul><li>Living in an accepting way </li></ul></ul><ul><ul><li>Writing a life story. </li></ul></ul>
    35. 35. Selecting a spiritual system suitable for use in level V, and in health psychology generally. <ul><li>Focus on personal understanding and experience, not ritual or unquestioning belief </li></ul><ul><li>Promotion of love, harmony, as opposed to judgment, self-criticism, “sin” </li></ul><ul><li>Openness to ideas from the major religions of all cultures (inclusive, not exclusive: non-sectarian). </li></ul><ul><ul><li>Convergence of main ideas with those of other major spiritual systems </li></ul></ul><ul><li>Use of material close to a source of “revelation”, rather than “scriptures” written by ordinary people. </li></ul><ul><li>Providing an explication of the nature of “reality” </li></ul>
    36. 36. Level V of the Healing Journey <ul><li>Introduction to study of “A Course in Miracles” (other texts could be used) </li></ul><ul><ul><li>8 – 10 weekly sessions </li></ul></ul><ul><ul><li>Preparatory reading at home suggested; questions to answer from the text </li></ul></ul><ul><ul><li>Read together in the class; discuss </li></ul></ul><ul><li>Continuing practice of meditation and coping skills advocated </li></ul>
    37. 37. Research on psychological help for improving quality of life, and possibly length of life, in cancer patients: Results with the Healing Journey
    38. 38. Clinical trials (verification) approach – main limitations <ul><li>Results allow the conclusion that low-intensity group psychological interventions do not significantly increase the mean survival time of the populations tested. </li></ul><ul><li>Comparison of group means ignores the great variability between subjects </li></ul><ul><ul><li>Would miss effects on a minority of highly motivated subjects </li></ul></ul><ul><ul><li>In effect, the independent variable is not being in the intervention arm, but what participants do with it . </li></ul></ul><ul><li>Interventions have not been designed to induce change </li></ul><ul><li>“ Contamination” of controls (who find other help) </li></ul>
    39. 39. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    40. 40. Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    41. 41. “ Allostatic load” (strain on all systems) Predisposition to disease Disease develops Recovery of health Diminished allostatic load No change: Illness progresses Childhood: Distorted adaptation, e.g. defensive, repressed. (“inauthentic self”) Healthier adaptation (authenticity, autonomy, Acceptance) Psychological change Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc .
    42. 42. Published by C urrent Oncology and the Cancer Knowledge Network © 2011 Multimed Inc . Additional Survival Observed Predicted Survival
    43. 43. Research currently needed on impact of psychotherapy on survival <ul><li>Main aim: defining psychological qualities associated with prolonged survival </li></ul><ul><li>Designs: more exploratory, not RCTs at present, but prospective, longitudinal, correlative. </li></ul><ul><ul><li>Interview style data collection, not psychometric </li></ul></ul><ul><ul><li>Qual/quant analysis and rating (explore variety) </li></ul></ul><ul><li>Therapies </li></ul><ul><ul><li>Test various kinds </li></ul></ul><ul><ul><li>Test more intensive therapies (e.g. long-term residential) </li></ul></ul><ul><li>Patient populations: test those with lower tumour burden (e.g. stages I - III) </li></ul><ul><li>Controlled trials – a final step, to check efficacy </li></ul>
    44. 44. Why is healing through the mind undervalued? <ul><li>Not widely understood that our mind creates our experience of life (how much we “project”) </li></ul><ul><li>However, obvious to almost everyone that mental state affects physical </li></ul><ul><ul><li>Behaviours – “external loop” </li></ul></ul><ul><ul><li>Attitudes – “internal loop” </li></ul></ul><ul><li>Why not part of treatment protocols? </li></ul><ul><ul><li>The materialism of medicine and culture generally </li></ul></ul><ul><ul><li>Psychological therapy takes time, and active participation by healer and healee. </li></ul></ul><ul><ul><li>Little general understanding of the potentials of mind </li></ul></ul><ul><ul><li>Even less understanding of spirituality </li></ul></ul><ul><ul><li>Little research evidence as yet </li></ul></ul>
    45. 45. Summary <ul><li>Support: Now clear that support helps many cancer patients – almost all, if they are encouraged to attend meetings. </li></ul><ul><ul><li>Criterion for advocacy: not “does she ‘want’ this”, but “would it help her?” </li></ul></ul><ul><li>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. </li></ul><ul><li>More advanced work: – changing dysfunctional habits of thought and self-concept. Not suited to all patients </li></ul>
    46. 46. Summary (contd) <ul><li>Conclusions on “mind-body”: </li></ul><ul><ul><li>Benefits of basic psychological help on quality of life are obvious </li></ul></ul><ul><ul><li>Therefore, this kind of help should become a regular part of the treatment protocol for cancer patients; </li></ul></ul><ul><ul><li>Benefits on length of life are highly probable, but need more research. </li></ul></ul><ul><li>“ 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. </li></ul>

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