A good friend of mine sent this to me this morning, and I thought I would pass it along. I completely agree, and it’s well worth remembering for those of you that feel guilty when indulging in time with your girlfriends. Which, by the way, I never do! Thanks to all my girlfriends, all over the world, for all the laughs and good times we’ve shared.
“I just finished taking an evening class at Stanford. The last lecture was on the mind-body connection – the relationship between stress and disease. The speaker (head of psychiatry at Stanford) said, among other things, that one of the best things that a man could do for his health is to be married to a woman whereas for a woman, one of the best things she could do for her health was to nurture her relationships with her girlfriends. At first everyone laughed, but he was serious.
Women connect with each other differently and provide support systems that help each other to deal with stress and difficult life experiences. Physically this quality “girlfriend time” helps us to create more serotonin – a neurotransmitter that helps combat depression and can create a general feeling of well being. Women share feelings whereas men often form relationships around activities. They rarely sit down with a buddy and talk about how they feel about certain things or how their personal lives are going. Jobs? Yes. Sports? Yes. Cars? Yes. Fishing, hunting, golf? Yes. But their feelings? Rarely.
Women do it all of the time. …”
David Spiegel, MD
Co-chair, Department of Psychiatry and Behavioral Sciences
Stanford University Medical Center
Stress does have its positive side: The fight or flight response can help us rise to an challenge or provide the surge of energy needed to deal with a threat. But there’s an important difference between the short-term stress that stimulates the resources to hurdle obstacles, and chronic stress, which wears down the ability to adapt and cope.
The paradox of stress is that what can protect can also damage, leading to a condition called allostatic load-the cumulative effect of stressors over the long term. Chronic stress disrupts the body’s internal balance by overworking its biological pathways.
A diagnosis of breast cancer is one of life’s ultimate stressors. Not only is the disease a physical, emotional and psychological trauma, its treatment can often be as harsh as the disease itself, and many women must learn to deal with graphic reminders of their experience.
While conventional cancer therapy is increasingly effective at eradicating cancer, interventions such as surgery, chemotherapy and radiation therapy can cause additional distress. For many women, after the initial jolt, the most stressful period of dealing with breast cancer is when the treatment ends.
“That is one of the most difficult moments because you are suddenly not doing anything active,” said David Spiegel, MD, co-chair of Stanford’s Department of Psychiatry and Behavioral Sciences and director of the Center for Stress and Health, who discussed his work on the relationship between mental and physical health at a presentation sponsored by Women’s Health @ Stanford. “You are back in the normal world even though you are not feeling normal, a difference made worse by the dogma of having to put on a happy face-what I call the ‘prison of positive thinking.’ This is an especially important time to explore your feelings and figure out ways to deal with them.”
The Mind-Body Connection
Spiegel’s expertise is in the relationship between the mind and body, a field known as integrative medicine. Integrative medicine emphasizes the combination of both conventional and alternative approaches to address the biological, psychological, social and spiritual aspects of health and illness. Spiegel’s 30 years of working with breast cancer patients has shown that mind-body interventions can improve mood, quality of life and coping skills, as well as alleviate symptoms.
>Spiegel discussed the relationship between depression and health, and explained that dealing with chronic stress can elevate the chance of developing breast cancer in the first place and can affect mortality by placing constant demands on the body’s endocrine and immune systems. Depression, a form of chronic stress, makes the prognosis for cancer worse, he said. One study showed that long-term depression predicted mortality and that depressed cancer patients showed significantly higher mortality than non-depressed cancer patients.
“These studies underscore the importance of treating people’s psychosocial needs, not just their biological ones,” Spiegel said. “Integrative medicine needs to be an integral part of cancer care.”
Benefits of Therapy
Proven techniques for improving outlook include individual sessions, peer counseling and cognitive behavioral therapy. Spiegel described the benefits of supportive expressive psychotherapy, which helps patients by:
Building bonds-creating social glue to help women share their reactions to breast cancer and help them find meaning in their experience.
Expressing emotions-processing feelings and sharing them to build closeness and to learn ways of coping better. “It’s healthy to feel anger or sadness,” said Spiegel. “Women who check out by trying to constantly control their emotions are under more stress.”
Detoxifying dying-facing the reality of death can make it familiar and less frightening; the goal is to restructure fear into a series of smaller problems to develop active coping strategies.
Reordering life priorities-taking on new projects or tasks for pleasure, such as artwork or writing, or making time for others. “I’ve found it helps, not harms, people to face death,” Spiegel said. “It can make them think, ‘If there’s not enough time, how do I want to live it?’”
>Fortifying families -clarifying problems brought on by having cancer can help to cultivate better social support, as can recognition that the family is equally stressed – just in different ways.
Clarifying communications-encouraging clear communication with physicians because taking control of treatment decisions improves patient outcomes.
Managing symptoms-learning techniques to control pain and psychological outlook; tactics like hypnosis and mental imaging can alter perceptions of pain.
“Research has shown that women with advanced breast cancer involved in psychotherapy were less depressed and felt better about facing the possibility of death,” said Spiegel. “It can help convert someone who is severely damaged into someone who can deal.”
>Promising Investigations
Spiegel discussed his landmark study that found that women with advanced metastatic breast cancer involved in a support group, along with traditional medical care, not only experienced reduced anxiety, depression and pain, but survived an average of 18 months longer than women who did not take part in a support group. More recent studies have found similar findings or no change in survival rates, even though medical treatments have become more effective over the years.
“How can psychosocial interventions improve not just quality of life but quantity of life as well?” he asked. “The answer goes back to the cumulative effect of stressors on the body.”
Spiegel is involved in several studies looking at the role of cortisol, a hormone secreted by the adrenal glands that is part of the body’s “fight or flight” response to stress as well as immune function and inflammatory response. One of his projects involves studying circadian rhythms and sleep patterns to track cortisol levels in cancer development. Normally, cortisol is present in the body at higher levels in the morning and at its lowest at night: in patients with chronic depression, the levels stay stable, which point to a link between stress and cancer development. Those with these abnormal cortisol patterns throughout the day have a poorer prognosis, demonstrating a link between stress hormones and cancer progression.
To keep cortisol levels under control, the body needs to relax after a stress response. Spiegel oversees the Cancer Supportive Care Program, which coordinates a variety of programs and classes for cancer patients, including massage, exercise, guided imagery and ongoing support groups, and he directs the Center on Stress and Health, which conducts research in mind-body connections.
About the Speaker
Dr. Spiegel, the Jack, Samuel and Lulu Willson Professor of Medicine and associate chair of the Department of Psychiatry and Behavioral Sciences, is internationally known for his work in gauging the effects of the mind on physical health. As director of Stanford’s Center on Stress and Health, he oversees a wide variety of research on how stress and support affect the brain and body. He is also the Medical Director of the Center for Integrative Medicine at Stanford, which provides alternative and complementary services, such as acupuncture, meditation, hypnosis and massage, to help patients cope with cancer and other diseases. Spiegel has authored more than 475 research papers and chapters in scientific journals and ten books; he was featured on Bill Moyer’s ground-breaking PBS series Healing and the Mind and appeared recently on Good Morning America.