Tag Archives: cancer

Every Moment an Opportunity for an Epiphany

I am sure to grow old.
I cannot avoid aging.
I am sure to become sick.
I cannot avoid sickness.
I am sure to die.
I cannot avoid death.
All things dear and beloved to me
are subject to change and separation.
I am the owner of my actions;
I will become the heir of my actions.
— Anguttara Nikaya

Elana Rosenbaum

Elana Rosenbaum

Every now and then something happens that is pivotal in our lives by which we measure time, a marker event like 9/11, a marriage or divorce, a birth or death or a diagnosis such as cancer. I’ve divided time into pre cancer and post stem cell transplant for lymphoma.  The time is marked not by age but by changes in my world. Pre-cancer mortality was a given intellectually but post diagnosis I knew it in my heart, head and gut.   Death became a part of my awareness and I could no longer delude myself into believing that illness and loss happened to others but not to me. These last few weeks, with the earthquake ,tsunami, and radiation leaks in Japan  as well as war in Libya I am reminded of the universality of suffering and its pain.     I am inspired by the courage and cooperation of the Japanese people and horrified by the hatreds and violence of war. It feels like the whole world is trembling.  I ask myself daily, how am I living my life? What are my priorities? How am I putting mindfulness into action and what is possible to help others?

A favorite cartoon of mine is of two mice on an exercise wheel. One of the mice is shown peddling frantically and spinning around and around while the other is resting comfortably on the rim of his wheel with his legs dangling over it. The caption under him reads, “I’ve had an epiphany.”

Years ago my meditation teacher, Larry Rosenberg, talked about rolling over and over again and again in the mud.  I never quite understood what he meant until I began to notice certain thought patterns that refused to quit. I didn’t think in terms of greed, hatred and delusion I only knew that certain thoughts made me unhappy and created feelings, sensations and actions that perpetuated misery, mine and others.  I’ve been a psychotherapist since 1975. In working with my patients at a large HMO it seemed all too easy to slip into the morass of worry, fear and doubt. Identification with these states perpetuated misery by defining who we thought we were and what life held for us. This lead to immobility and more fear, anger and delusion.

Frustration and discouragement led me to the medical center and Jon’s (Kabat-Zinn) weekly yoga class and Larry’s (Rosenberg) meditation sessions. One short hour opened a window into possibilities. I would return to work energized and refreshed with greater clarity and patience to be with another. As my practice deepened compassion and understanding grew and real change became possible.

I’ve been very fortunate. I’ve been teaching MBSR since the early 80‘s with the support of a community dedicated to mindfulness and the eradication of suffering. Community is essential. Overcoming suffering and understanding its causes is often a painful process.  We need each other for support and inspiration. Discovering what helps and what harms takes effort, high ethical standards and steady attention. MBSR is not a technique or a smart career move. It’s goal is liberation and wise action. We are all inter-connected, the rebel in Libya and his antagonist, the tsunami victim and the rescue worker.  We are all responsible for our actions. Just as aging, illness, death and loss is part of life so is compassion, understanding and growth. May our work together bring greater peace for ourselves and our world.

Elana Rosenbaum is a longtime teacher of Mindfulness-Based Stress Reduction and author of a book on her experience of working mindfully with her own cancer diagnosis entitled Here For Now: Living Well With Cancer  Through Mindfulness . There is also a companion Audio CD for her book available, by the same name. To learn more about Elana and her work, download her free meditation audio files, or learn about upcoming events, visit her website at Mindfulliving.com .

Cheers! Here’s to Wonderful Old Wine in Amazing New Mindfulness-Based Bottles

By Steven Hickman, Psy.D.
Director, UCSD Center for Mindfulness

A colleague of mine emailed me yesterday to ask my advice. She had submitted a paper for publication in a respected scientific journal that looked at one particular aspect of Mindfulness-Based Stress Reduction (MBSR). One of the reviewers, apparently intending it as a significant criticism, asked if MBSR wasn’t just “old wine in new bottles”, noting that Carl Rogers and Gestalt therapists had been bringing mindfulness into psychotherapy years before anyone had heard of MBSR. She wanted to know how to respond to this rather stern criticism of her very thoughtful and innovative work.

I told her that she should agree with the reviewer.

Mindfulness is indeed, VERY old wine. Relatively speaking, MBSR and all the rest of the mindfulness-based interventions being devised and deployed in clinical practice these days are indeed quite new “bottles.” But nobody has suggested otherwise! From the beginning, Jon Kabat-Zinn (MBSR) , Marsha Linehan (Dialectical Behavior Therapy – DBT), Zindel Segal, Mark Williams and John Teasdale (Mindfulness-Based Cognitive Therapy – MBCT) and other treatment developers have openly and reverently acknowledged the very deep and ancient roots of mindfulness, mindfulness practice and the wisdom of drawing on these roots for the relief of suffering.

In his book Full Catastrophe Living, Jon Kabat-Zinn writes:

Although at this time mindfulness meditation is most commonly taught and practiced within the context of Buddhism, its essence is universal. Mindfulness is basically just a particular way of paying attention. It is a way of looking deeply into oneself in the spirit of self-inquiry and self-understanding. For this reason it can be learned and practiced, as we do in the stress clinic, without appealing to Oriental culture or Buddhist authority to enrich it or authenticate it. Mindfulness stands on its own as a powerful vehicle for self-understanding and healing. In fact, one of its major strengths is that it is not dependent on any belief system or ideology, so that its benefits are therefore accessible for anyone to test for himself or herself. Yet it is no accident that mindfulness comes out of Buddhism, which has as its overriding concerns the relief of suffering and the dispelling of illusions. (p. 12-13)

But where the analogy of old wine in new bottles falls apart, is that the “bottles” or the interventions themselves are an integral part of what makes these new programs effective and powerful. These are not meditation classes or silent retreats at remote monasteries, but fully thought out, carefully devised and thoroughly researched psychological interventions that honor the roots of their “wine” and skillfully bring it to suffering individuals in very systematic, deliberate and empirically-supported ways.

A plethora of studies have established MBSR as an effective intervention for addressing the suffering associated with chronic pain, cancer, sleep disturbance, anxiety, and ADHD, just to name a few (Grossman, 2004)(Hofmann, 2010). The 8-week program has been shown to not only reduce a variety of physical and psychological symptoms, but more recently has been shown to bring about structural, measurable changes in the brain itself. Constructed thoughtfully, MBSR has a relatively standardized protocol and logical progression that has consistently (for over 30 years) guided skeptical novices (facing the full spectrum of illness and symptoms, both medical and psychological) through a series of specific exercises and homework practices to a place of ease and equanimity that motivates them to want to continue various forms of mindfulness and meditation practice for years to come.

Focused on helping people alter their relationship with the experiences of their lives (whether those experiences are physical symptoms like pain, or mental phenomena like critical thoughts), mindfulness practice exposes options and flexibility that many never realized they had. One patient of mine with chronic neck and back pain (and significant depression as well) said it best when he noted, “I’ve been a tough guy all my life. I learned to play hurt in sports, to claw my way to the top of my field, and even to fight every day with this horrendous pain. What mindfulness allowed me to do was to see that I could dance with my pain.”

A recent randomized clinical trial reported in the Archives of General Psychiatry by Zindel Segal and his colleagues has established MBCT as an equally effective treatment to antidepressant medication in preventing relapse in previously depressed patients (Segal et al. 2010). Based upon the twin foundations of cognitive behavioral therapy and mindfulness, MBCT is being implemented with a wider and wider variety of diagnostic populations with repeated (if still somewhat preliminary) success. The heart of MBCT is encouraging the patient to simply notice the activity and patterns of the mind, adopting a “decentered” stance toward thinking in which thoughts are experienced as arising phenomena in awareness and not fact or imperative. The patient begins to become aware of the constructions of the mind, the “stories” if you will, that the mind constructs around the actuality of experience. The unreturned wave of a friend soon balloons into yet another indication that one is not worthy of friendship. The flutter of a heartbeat in a stressful situation soon billows into the anxious mushroom cloud of the specter of a heart attack.  And the patient learns to adopt an abiding presence that notices these processes and recognizes the option to not become entangled in them in the way in which they have in the past.

In his 1923 encyclopedia article “Psycho-Analysis,” Freud noted that “the attitude which the analytic physician could most advantageously adopt was . . . a state of evenly suspended attention, to avoid so far as possible reflection and the construction of conscious expectations.”

“Construction of conscious expectations” indeed! And with some perspective and “evenly suspended attention” one can encounter the frightful booming Wizard of Oz and also notice the presence of the pathetic little man behind the curtain. Thoughts are not facts. “Don’t believe everything you think,” says the bumper sticker.

It is my observation that mindfulness, at its essence, is not a treatment in and of itself. It is a very important component of all good treatment, whether explicitly named or not. It is the attitude that we embody when we work with clients and patients, the space we create with them in the therapy room, and healing force that works in them when they encounter what they have often encountered and respond in a healthy way rather than react in a habitual way. And it can also be utilized in a very specific, explicit and replicable way to address a variety of psychological disorders.

I happily and gratefully acknowledge the roots of the old wine in its “new bottles.” And raise my glass to toast those who have applied their considerable wisdom, experience and intelligence to finding ways to relieve suffering in thousands, if not millions of our fellow human beings.

Cheers!

NOTE: This article will be appearing in the upcoming edition of the newsletter of the California Psychological Association.
REFERENCES:
Kabat-Zinn, J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Delta. 1990

Grossman, Niemann, Schmidt and Walach Mindfulness-based stress reduction and health benefits: A meta-analysis Journal of Psychosomatic Research/Vol 57 (No. 1), July 2004

Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol./Vol 78 (No. 2), Apr 2010

Segal, Bieling, Young, MacQueen, Cooke, Martin, Bloch and Levitan Antidepressant Monotherapy vs Sequential Pharmacotherapy and Mindfulness-Based Cognitive Therapy, or Placebo, for Relapse Prophylaxis in Recurrent Depression Arch Gen Psychiatry/Vol 67 (No. 12), Dec 2010

Cancer: Listening for a Mindful Life

By Regina Huelsenbeck, PhD

I can remember that day. I was home from college for Thanksgiving break. I had picked up my best friend for lunch; we were going shopping, and then later, out for the evening. We had quite the day planned… Before CancerI just needed to stop by my pediatrician’s office for a quick checkup. I had a lump on the side of my neck; it had been there since spring of my freshman year. It was now fall of my sophomore year and it had gotten much larger, so I finally decided to tell someone. I didn’t think it was really anything. I was 19 years old and my world did not have the space for such notions. The doctor however, looked pretty worried, and sent us over to an ENT (ear, nose & throat) surgeon who immediately took a needle biopsy.

A few days later, we got the biopsy results. We had just gone to see the movie The Bodyguard (yes, Whitney Houston). I was riding in the back seat of our car, with that same friend when my mother got the call. She turned around from the front seat, phone to her ear, and announced, “Its Hodgkin’s, Regina”. … … “I have cancer?” It did not compute. The feeling I had is still so hard to describe. I wasn’t even in that car anymore. Cancer ShockI was physically sitting in the backseat looking out the window. But psychically, upon hearing those malignant words I had popped into another reality. I had left the world of the healthy-living-well people and was sinking down into what can only be described as an underworld.

Illness is the night side of life, a more onerous citizenship.  Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.  Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. ~Susan Sontag

With sickness comes isolation, sometimes vivid dreams, visitations in fever induced states and reflection; it is indeed another world. However, the lights of illness have a unique way of illuminating forgotten energies and disconnected pieces. In this respect, illness can and often does become an opportunity for reconnection, an anamnesis.

Through my journey into that underworld, I wondered how and why I got cancer. I have come to believe not only that I became ill for many reasons but that I was the only one who could uncover those reasons. No one else was qualified. No one could really tell me how I contracted cancer, exactly what I did or why I had it… I had lymphoma, and “they” really didn’t know and still don’t know what causes it. No one can truly provide a linear causal reason.

And that’s not the point anyway. The point is not necessarily what caused it; the point is really where this line of questioning took me, what this exile from the land of the fast movers and healthy shakers did for me.

Obviously, the journey was not all roses and inspirational change. It was hard and lonely and painfully self-reflective. I was also pretty pissed off. I was angry about missing out on what I considered to be the life I was “supposed to be living”. I was sick and I was tired. I was worried about the boy who no longer wanted to date me because I had cancer. I was worried that I had no hair and I was worried about being different from all my peers.

mindfully cutting veggiesThe angry part of me was not concerned with macrobiotics, death, meditation, mindfully cutting vegetables (something my macrobiotic instructor insisted upon- it wasn’t enough to simply prepare the dang recipes, everything had to be done a certain way: which I now understand, but then, not so much) or larger existential questions. A larger part of me, however, woke up because of my cancer experience. This part of me had questions and was ready to explore! This part of me truly blossomed after treatments were over and remission set in. This part of me did wonder about the benefits of slowly, mindfully cutting vegetables.

I became extremely interested in illness and the mind-body connection. I attended a conference on healing sponsored by the Institute of Noetic Sciences. My career and truly my life’s passion grew from the basic interconnected ideas discussed in this conference.  I was enlivened! I now had even more questions about the mind-body connection, healing and consciousness.

I returned to college and changed my major (fashion merchandising) to nutrition and minored in psychology. I found my true love studying the psyche and set out to become a clinical psychologist (FYI: a very long road). 745 years later, I completed my doctoral dissertation on the experience of living with cancer. I also penned a chapter for Newsweek journalist Jamie Reno’s book of lymphoma survivor tales: Hope Begins in the Dark. Much of this article was taken from that chapter. Today I work mindfully with others struggling to heal, understand and integrate the cancer experience. I am grateful for this work, the questions which continue to emerge and the answers that flow from the spirit of each client.

ListenSo the saying goes that a “gift” is contained within life’s tragic experiences.   Although if you’re in the midst of chemo and someone suggests that cancer is a gift, you may envision yourself punching them in the head (believe me I get it!) But maybe, just maybe, you might consider taking a walk on the inside, and beginning to listen for your message. Illness sometimes presents itself to offer a wake-up call for more conscious living, a new direction or a new perspective. Perhaps it’s simply an opportunity to slow down, but more likely, it has come for a reason. You are the only one who can uncover and then begin to live into those discoveries. Through the uncertainty of illness blooms a new order, a new understanding, a new consciousness, something is healed and perhaps a new enlivened path is revealed.

Take a Walk on the Inside:

1.      Regular Sitting Mindfulness Meditation practice (sign up for MBSR class here)

2.      Journaling: “Bones, Dying into Life” by Marion Woodman, “Writing for your Life” by Deana Metzger, “Rebirth” by Deborah Ludwig, or take course with Sharon Bray: “Writing through Cancer”. Next workshop begins Feb 28th (more information here)

3.      Yoga:  Stacy McCarthy The Soul of Yoga

4.      Mindful Psychotherapy (check out my web page here)

5.      Mindfully preparing food and cutting vegetables (I had to put that in for my macrobiotic teacher)

6.     cancer and mindfulness How to Book: Mindfulness-Based Cancer Recovery by Linda E. Carlson & Michael Speca.

Sources:

Myss, C.  (Speaker).  (1993).  Why people don’t heal. Institute of Noetic Sciences.  Boca Raton, FL.

Newman, M.  (1994).  Health as expanding consciousness.  New York, NY:  National League for Nursing Press.

Robbins, J.  (1998).  Reclaiming our health:  Exploding the medical myth and embracing the sources of true healing.  Tiburon, CA:  H J Kramer, Inc.

Sontag, S.  (1989).  Illness as metaphor and AIDS and its metaphors. New York, NY:  Picador U

Mindfulness-Based Cancer Recovery: How a Program (and a new book) Were Born

Psycho-oncology researchers and colleagues Linda Carlson and Michael Speca have been running mindfulness-based groups for cancer patients for over ten years now, and that experience has led to the development of a powerful program and now a very helpful new book from New Harbinger entitled Mindfulness-Based Cancer Recovery: A Step-by-step MBSR Approach to Help You Cope With Treatment and Reclaim Your Life. Read their individual accounts of the unfolding of this program below.

Michael: In 1995, I had been working as a newly minted psychologist for a couple of years and found myself working in a busy cancer treatment centre in Calgary, Alberta. On one particular day, two colleagues and I were sitting together having lunch in the hospital cafeteria and talking about our work, which consisted primarily of counseling and providing support to cancer patients and their families.

While discussing with some awe and not a little reverence the immensity of challenges many patients encounter and often overcome, we also spoke of our gratitude for the opportunity to do the work that we did.  Eventually we got around to acknowledging that this work was not without cost to us. Caring about the people with whom we work means sharing in their loss and grief as well as their triumphs. These experiences also heightened our own sense of vulnerability.

As our discussion deepened that day we discovered that we had something else in common. Each of us to varying degrees relied on meditation and yoga to cope with the stresses of our own lives. It occurred to us that some of our patients might benefit from these practices in a different way than what counseling could provide. We wondered if it would be possible for us to offer a program where we could share what we had learned through our own experience with meditation. How would it be accepted in the highly technical and institutional medical setting that was our workplace?

From that point on we set out to develop a program. We cobbled together bits and pieces of the yoga and meditation we had practiced and tied it into what we knew about stress and the mind-body perspective from our training as health professionals. From this we created a workbook for participants. There were about equal parts yoga, including yogic breathing practices, and a range of meditation techniques including mindfulness meditation. The first few times we ran the program we obtained written feedback from everyone at the end of what were then seven-week sessions and used that information to refine our approach. Word of mouth quickly spread and we had little difficulty filling our classes.

Linda: I joined the team first as a psychology intern in 1997, then as a postdoctoral fellow in 1998. Along the way we became more pointedly aware of Jon Kabat-Zinn and his MBSR approach. We developed a profound respect for the sensitivity and thoroughness with which he had described his work in his book Full Catastrophe Living: Using the wisdom of your mind and body to face stress, pain and illness and began to recommend it to all of our patients.

At about that time we began to conceive of our first formal study comparing the changes over time between patients randomized to either our mindfulness program or a wait-list control condition. We were pleased to find that our impressions of the value of these methods and the reports of benefit from patients were supported by the outcomes of that study, which was published in Psychosomatic Medicine in 2000 and has been cited almost 300 times since then!

We continued to write grants, run programs, train students and publish the results, which brought us to the 2008 when I was beginning my first maternity leave. Based on our body of work, I was approached by the publisher New Harbinger and asked if I wanted to write a mindfulness book for cancer patients. I thought it was a good idea and would give us a chance to write down a lot of what we had refined into our program over the years. Of course I asked Michael to be my co-author, given that we had been running groups together for the previous 10 years and it was his wisdom to originally develop the program, and the result, almost three years later, is Mindfulness-Based Cancer Recovery!

We are really pleased to see it in print and hope that it may, in some small ways, help those facing this journey. We wrote it with not only people who were diagnosed with cancer themselves in mind, but also their support network of professionals, friends and family. It might also be of interest to health-care professionals interested in applying mindfulness to their own work with people who have cancer and other chronic illnesses.