Studies Suggest Support Groups Are Good For You

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Studies Suggest Support Groups Are Good For You

by C.

Article Date: 4/25/2005

The evidence leaves no doubt. In study after study, researchers have

found that patients facing serious or traumatic illnesses typically

are able to cope better when they regularly take part in support

groups. The National Cancer Institute (NCI) advocates psychosocial

support as a powerful aspect of a patient's treatment plan. " Often,

support groups can help people affected by cancer feel less alone and

can improve their ability to deal with the uncertainties and

challenges that cancer brings, " reads an NCI patient education fact

sheet1.

Group Therapy Can Boost Coping Skills

No matter what the disease, the evidence of the benefits of patient

support groups is mounting. One study involved 125 women with

metastatic breast cancer (breast cancer that had spread elsewhere in

their body). They were assigned to either a group that offered

support group intervention and educational materials, or to

a " control " group in which only education was offered.

In medical trials, a " control " is a non-therapeutic intervention, or

lack of one altogether. The control then allows a comparison with

the therapeutic (use of drugs) intervention. Structuring a study

using control group(s) helps rule out anything that may influence

and/or affect the outcome.

In the breast cancer study, the researchers found that those women

who participated in the group therapy and received educational

materials " showed a significantly greater decline in traumatic stress

symptoms " compared to the women who received only educational

materials.

The conclusion? The researchers wrote, " Supportive expressive

therapy, with its emphasis on providing support and helping patients

face and deal with their disease-related stress, can help reduce

distress in patients with metastatic breast cancer2. "

The Positive Influence of Support Groups

In another study in which patients with non-malignant pain took part

in a series of support groups, researchers reported a significant

increase in functional ability and activity, and fewer visits to

their physician. The Malaysian researchers concluded that support

groups can offer benefits to patients that their doctors " are often

not appropriate or able to provide " 3

Other experts who have conducted research involving cancer and HIV

patients have also found positive results using group therapy. " What

we find is that people who participate in these groups are less

anxious and depressed, they have less pain, they manage their

emotions better. They are more open about their feelings about the

stresses they have, " said Spiegel, MD, Willson professor and

associate chair of psychiatry and behavioral sciences at Stanford

University. " And we have some data suggesting that breast cancer

patients also live longer if they participate in these groups. "

Helping the Chronically Ill Live Longer: Mixed Results

The findings about whether support groups extend a patient's survival

are actually mixed. One study released at a meeting of the European

Society of Medical Oncology in October found that support groups had

no effect on lifespan.

The researchers at the University of Exeter in England conducted a

comprehensive review of nearly a dozen studies involving some 1,500

patients who took part in psychologist-led support groups. The

researchers concluded that while these interventions do improve a

patient's quality of life, there is no evidence that they prolong

survival.(1)

By contrast, 129 patients in a 2001 study at UCLA were divided into

two groups; one that received group therapy, and a second group that

did not. The patients who underwent therapy received self-management

and coping strategies for depression, anxiety and anger;

cardiovascular health education; and physical relaxation techniques

with biofeedback training. Biofeedback is an approach in which a

person's positive mental state can positively influence his or her

physical condition. For example, a positive mental attitude might

help reduce pain. A control group in the study, meanwhile, received

no group therapy.

The researchers found an 86 percent reduction in the risk of

cardiovascular-related death for patients who took part in the group

therapy, and a 62 percent reduction in the risk of death for all

causes. In fact, they reported that six of seven cardiovascular

deaths in the control group were due to abnormal heart rhythms

(arrhythmias), but that the deaths in the therapy group were due to

stroke.(2)

The Consensus

While studies about how psychosocial support might reduce a patient's

chances of dying are inconsistent, there seems to be a consensus

about the benefits of group therapy in helping a patient cope better

with disease.

" We call the intervention supportive/expressive group therapy, "

explained Spiegel, MD, Willson professor and associate chair of

psychiatry and behavioral sciences at Stanford University, in a

telephone interview with Priority Healthcare. " We provide an

atmosphere of intense emotional support. We help [patients] form new

bonds. "

One of the reasons group therapy works so well, Spiegel says, is due

to its social aspect. " I think one of the things that is tremendously

helpful to these people is being among others who are coping with the

same problem, " he says. " It helps them gain a new perspective … They

feel better about themselves to the extent that they can give, as

well as receive help. They re-structure their priorities in life.

They deal directly with their fears of dying and death. "

The Mind/Body Link

Spiegel and his colleagues are currently investigating how group

support can affect a person's hormones related to how a disease

develops. " Hormones can affect tumor growth, and they're also

immunosuppressive [the ability to decrease the activity of your

immune system], " Spiegel explained.

He describes a very real mind/body link that exists, specifically

certain " host resistance factors " that affect tumor growth. These

factors include how the body's metabolism affects the amount of

nutrition a cancer tumor receives compared to the rest of the body,

as well as how the immune system attacks and kills some cells in the

tumor.

During tumor development, the balance shifts, and the tumor gets the

upper hand. For example, consistently high levels of cortisol, a

stress response hormone, can suppress your immune system and boost

the development of disease.

" Host resistance factors, which are influenced by our state of mind,

our arousal, and how we respond to stress, can be one factor in the

course of cancer, " said Spiegel.

The Benefits of Online Chat

Another evolving means of emotional support involves the piece of

equipment you are using right now: computer technology. It allows

people from various cultures to discuss personal issues with other

people around the globe. In fact, since the 1990's, people have been

discussing their distress and coping skills with others in anonymous

online chat rooms. These forms of group therapy can be attractive to

a new group of users who may have previously resisted face-to-face

group therapy because they fear divulging " family secrets " or other

embarrassing admissions.

Some topics discussed in online support groups may be culturally

taboo to discuss in face-to-face settings, such as family violence or

sexual assault. So, these venues allow people to discuss their

feelings and attitudes with other anonymous members in the chat room.

Positive Distractions for the Chronically Ill

Some experts believe it may be beneficial if patients with chronic

diseases have the opportunity to focus on positive distractions or to

develop a more positive perspective about their future by performing

certain activities that foster that a mindset. Using that hypothesis,

researchers in Philadelphia have launched a study that places cancer

patients in a non-conventional group therapy setting.

They are using a combination of art, meditation and other support

mechanisms to determine if their outlook about their diagnosis and/or

their overall quality of life improves.

The goal of the " Live Better With the Uncertainty of Cancer " study,

which is set to conclude in the summer of 2003, is to determine

whether psychological stress and the severity of medical symptoms can

be reduced through the use of these non-conventional interventions,

also known as Mindfulness-Based Art Therapy (MBAT).

" The therapy emphasizes creative expression and meditation as a means

to not only reduce stress for these patients, but to try to give them

a positive outlook on a life that may not seem so rosy at the

moment, " explains lead investigator Monti, MD, assistant

professor of psychiatry and human behavior at Jefferson

University, in an interview with Priority Healthcare. " In fact, some

of the participants who got the most benefit from the program felt

they had little or no artistic skills or talents prior to entering. "

Researchers plan to enroll 114 patients during the course of the

study. It is a follow-up to a smaller pilot study that reached

positive results, Monti said.

A Review of the Literature

" In the past year, there was a large study that was published in the

New England Journal of Medicine that did a comprehensive review of

the literature on this subject, showing that cancer patients do

better, " said Monti. " They report less symptoms of stress and

distress, oftentimes that leads to feeling better physically, and

their overall quality of life is better when they have this type of

supportive-expressive intervention. "

Monti says he and his colleagues have enhanced the supportive-

expressive intervention with meditation and " innovative mediums that

allow the patients to express themselves and all of the things that

they've gone through with the cancer experience. "

" Many patients are reporting having a different perspective of life,

and how they view themselves in relation to themselves, their

illnesses and the outside world, " Monti said.

Blending Art and Meditation

The study participants are being divided into two groups, one in

which mindful-based stress reduction training and art therapy are

introduced immediately, and a second group in which the MBAT therapy

is delayed for a period of eight weeks after the patients enter the

study. Both groups of patients undergo initial physiological and

psychological evaluations.

Each patient creates various art works through drawing and working

with clay. The idea is to help them focus on more positive aspects of

their lives, and give them a means of outwardly expressing the inner

turmoil that they are currently facing.

Researchers follow the prognosis of each patient for about two

months, and then both groups are evaluated and compared to understand

the differences.

The study is being funded with a $400,000 grant from the National

Institutes of Health (NIH) and the National Center for Complementary

and Alternative Medicine (NCCAM).

" Both of the components that this combined intervention is based upon

have done well in other illness populations, " Monti said. " …We will

probably apply this MBAT model to other illness groups once we're

done looking at cancer patients. "