Download Positive psychology in cancer care: safe territory or a bridge too far?

Psycho-oncology meeting, Christchurch 24 Sept 2012
Positive psychology
in cancer care: safe
territory or a bridge
too far?
Associate Professor Lois Surgenor
Outline
What is positive psychology?
How is it applied in cancer?
What is the evidence?
Implications?
Not to be reproduced without
permission
History of positive psychology
Seligman and Csikszentmihalyi (2000) take
credit for the revolution, and coining term
“Positive Psychology”
Though part of a wider movement, including
the increased demand from people who are
not severely psychologically unwell but want to
increase their well-being.
Not to be reproduced without
permission
History of positive psychology
• Criticisms of conventional psychology as
“negative psychology”
(focusing on psychopathology)
• Focus on mental health has “developed a
distorted view of what normal- and exceptionalhuman experience is like”
• “It is not enough to help those who suffer”
Not to be reproduced without
permission
History of positive psychology
History goes back much further:
e.g., James “healthy mindedness” (1902)
Maslow “hierarchy of needs” (1950s)
Rogers “person-centred therapy” (1960s)
Not to be reproduced without
permission
What is positive psychology?
Psychology traits that contribute:
•
•
•
•
Subjective well-being
Hope and Optimism
Happiness and contentment
Self-determination
Not to be reproduced without
permission
What is positive psychology?
Positive personality traits at an individual level:
•
•
•
•
•
•
•
•
•
•
•
capacity for love and vocation
courage
interpersonal skill
aesthetic sensibility
perseverance
forgiveness
originality
future mindedness
spirituality
high talent
wisdom
Not to be reproduced without
permission
Fighting Spirit
Cancer is a challenge, be optimistic, the
cancer is controllable, take an active role in
recovery, and attempt to live life as normal
as possible.
Not to be reproduced without
permission
Post-traumatic growth
Experiencing improved relationships,
increased inner strength, deepening
spirituality from having undergone a
traumatic or life-threatening experience.
People overly link (attribute) change to a
traumatic experience
Not to be reproduced without
permission
Optimism – the generalised expectancies for
desirable future outcomes
Carver et al., 2010
Not to be reproduced without
permission
Benefit-finding
Exactly what this is has not been clearly
spelt out in the literature
? positive illusory process (bias, selective
recall)
? positive self-narratives
Benefit-finding researchers has not been
able to consistency show that this is linked
to adjustment
Not to be reproduced without
permission
Self-help books: the popular
(commercial) arm of positive
psychology
Not to be reproduced without
permission
“Can the Mind Cure Cancer?
Several studies we have examined show that there is a definite
correlation between emotional stress and the development of
disease, including cancer. Likewise, we can conclude that a positive
outlook, lowered anxiety and depression, a sense of control, and
improved mood increase the survival times of cancer patients. There
is solid evidence that stress and mood negatively affect the status of
the immune system”
http://curezone.com/diseases/cancer/psychology.asp
(downloaded 13.09.12)
Not to be reproduced without
permission
The lay expectation is that a diagnosis of cancer (and living with
cancer) is distressing….and something should be done to
ameliorate this distress.
Not to be reproduced without
permission
“Received wisdom is what we know to be true,
because it is said often enough (with enough
gravitas by such senior people) that it would
seem like heresy to think otherwise”
Waller, 2011
Not to be reproduced without
permission
Social pressure and a desire to find answers
“If it is not true, it ought to be”
Coyne, 2010
Not to be reproduced without
permission
Reality checks
Studies claiming that psychological
interventions improve immune functioning
have been found to be seriously flawed in
their conclusions
(See Coyne et al., 2010)
Not to be reproduced without
permission
Reality checks
It has not been demonstrated that
psychotherapy promotes survival in people
with cancer.
(the view that it does mainly rests on 2
studies [Fawzy et al., 1993; Spiegel et al, 1989] that have
been found to be seriously flawed)
Not to be reproduced without
permission
Reality checks
How so?
Fawsy et al (1993) and follow-up (2003)
Never intended to study survival…only decided to look at this later
Statistically under-powered for survival analysis
No intent to treat analysis
Problems with data analysis
See Coyne et al., 2007
Not to be reproduced without
permission
Time to air our dirty laundry in public:
A famous historical example
Eysenck co-published a study ‘demonstrating’
that personality was related to smoking, and
personality was related to lung cancer, and thus
any direct relationship between smoking and
lung cancer was illusionary.
When do you think this study was published?
1988
Eysenck received £ 800,000 from American tobacco companies
Not to be reproduced without
permission
Reality checks
Straw man argument used:
Positive psychology falsely depicts clinical
psychology as not taking into account the
positives (in assessment and interventions)
Clinical work is routinely assessing
protective factors
Not to be reproduced without
permission
Reality checks
Much has been learned about the study of
happiness through the study of depression
Not to be reproduced without
permission
Reality checks
The benefits of any emotional/psychological
coping style are not linear.
No emotion is uniformly positive or negative
Not to be reproduced without
permission
Reality checks
Context is important: studies show that
psychological traits such as forgiveness,
optimism, hope etc can be beneficial or
harmful depending on the context.
‘Negative emotions’ can be helpful: Anger
can help avoid depression in some contexts
Not to be reproduced without
permission
Reality checks
Context is important: studies show that
psychological traits such as forgiveness,
optimism, hope etc can be beneficial or
harmful depending on the context.
(optimism in a gambler is problematic;
forgiveness in a victim of domestic violence
may be dangerous)
Not to be reproduced without
permission
Reality checks
Context is important: studies show that
psychological traits such as forgiveness,
optimism, hope etc can be beneficial or
harmful depending on the context.
Optimists are less likely to disengage from
an unwinnable task and are more likely to
overspread their resources (Norem &
Chang, 2002)
Not to be reproduced without
permission
Criticisms
• “Saccharine terrorism”
Not to be reproduced without
permission
Criticisms
Distracts practitioners and public from what
the hard science offers (and this has
resultant implications for service provision
decisions).
Not to be reproduced without
permission
Criticisms
Over-promise (of the effect of ineffectual
approaches) risks public backlash
generalising to other branches of
psychology where there are well-validated
interventions.
Not to be reproduced without
permission
Challenges
• How do we, as health workers, make the
buyer beware?
• How do we utilise the coping mechanisms
that patients bring but not collude with
beliefs that are ill-founded?
Why is this such an uphill battle? Social
psychology theory helps us out…
Not to be reproduced without
permission
The goal has to be…
- applying specific psychological
technologies for conditions where there is
evidence that these technologies are
effective
- early detection of clinically significant
psychological problems and conditions
- avoiding a ‘waiting list’ situation for those
who deemed to require treatment.
Not to be reproduced without
permission
Health science should not be a social movement,
marketing, or a political manifesto
Not to be reproduced without
permission
Conclusion
A bridge too far, although the
promises are tempting
Not to be reproduced without
permission
Thank you for your attention
Dr Lois Surgenor
Associate Professor in Psychological Medicine
Associate Dean (Postgraduate Studies)
University of Otago at Christchurch, PO Box 4345 Christchurch 8140
New Zealand
Tel 64 3 3720400 Fax 64 3 3720407