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Ernest H. Rosenbaum, MD

Cognitive Therapy

This Is An Interesting Process--How Depression Arises And How It Will Affect One's Entire Life.

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People who are happy have a better health situation as they are willing to fight for their life and a stronger will to live. Those with depression will give up earlier, feel a diagnosis of heart disease or cancer etc is a death sentence and unless they have support often can will themselves to death and just give up. Thus a depressed person is more negative, may lose their supportive family and friends and all these and others (pain, suffering etc) will hurt their will to live and may even lead to severe mental problems or suicide.

News Release

STANFORD, Calif. A good night's sleep may be one weapon in the fight against cancer, according to researchers at Stanford University Medical Center. Their work is among the first to piece together the link between mental well-being and cancer recovery.

Previous studies have found people with cancer who go through group therapy or have a strong social network fare better than those with weaker social support. The question has been how psychosocial factors exert their influence on cancer cells. David Spiegel, MD, the Jack, Lulu and Sam Willson Professor in the School of Medicine, and Sandra Sephton, PhD, Spiegel's former postdoctoral fellow now at the University of Louisville School of Medicine, suggest that a person's sleep/wake cycle might be the connection. Their work will be published in the October issue of Brain, Behavior, and Immunity.

"Psychosocial factors affect your behavior patterns, such as exercise, what you eat and drink, and your sleep," Spiegel said. Of these factors, how well you sleep can seriously alter the balance of hormones in your body. This makes the sleep/wake cycle, also called the circadian rhythm, a good candidate for linking a person's social network to his or her cancer prognosis.

Spiegel suggested two possible ways in which the circadian rhythm may influence cancer progression. The first involves a hormone called melatonin, which the brain churns out during sleep. Melatonin belongs to a class of compounds called anti-oxidants that mop up damaging free-radical compounds. With a disrupted circadian rhythm, the body produces less melatonin and the cell's DNA may be more prone to cancer-causing mutations.

Melatonin also slows the ovaries' production of estrogen. For many ovarian and breast tumors, estrogen spurs the cancerous cells to continue dividing. Shift workers who work through the night and produce less melatonin may therefore produce more cancer-activating estrogen, the researchers said.

The second link lies with a hormone called cortisol, which normally reaches peak levels at dawn then declines throughout the day. Cortisol is one of many hormones that help regulate immune system activity, including the activity of a group of immune cells called natural-killer cells that help the body battle cancer.

One study found that people who are at high risk for breast cancer have a shifted cortisol rhythm, suggesting that people whose cortisol cycle is thrown off by troubled sleep may also be more cancer-prone. In past work, Spiegel and his coworkers have found that women with breast cancer whose normal cortisol cycle is disrupted - with peak levels in the afternoon rather than at dawn - die earlier from the disease. Those women whose cortisol cycle was shifted also tended to sleep poorly, had lost a spouse or partner and had cancer-fighting branches of the immune system suppressed.

Other studies back up this theorized connection. Spiegel cited the recent finding that night-shift workers have a higher rate of breast cancer than women who sleep normal hours. What's more, mice whose circadian rhythm has been interrupted show much more rapid tumor growth than normal mice. Together, these studies led Spiegel to suspect that a poor night's sleep may be one link between a weak social network and a poorer cancer prognosis.

Spiegel said that although much remains to be learned about how the stress response system affects tumor growth, the current research draws a connection that doctors should heed. "I'd like people to reconceptualize cancer as a biological event that triggers stress responses affecting how the disease progresses," he said. "Managing those stress responses by adopting healthy eating and exercise habits, getting a good night's sleep, and finding good emotional and social support, should be regarded as much a part of cancer treatment as chemotherapy or radiation", he said.

Doctors should not just be fighting the tumor but helping the people with the disease to live with it, he said.

Stanford has a Cancer Supportive Care Program, directed by Spiegel, UC-San Francisco oncologist Ernest Rosenbaum, MD, and nurse Holly Gautier, that offers yoga, counseling, energy healing and other stress reduction classes for people with cancer. Spiegel said these types of services can help people with cancer maintain their emotional well- being, which could in turn help them sleep well and perhaps help their bodies better resist cancer growth.

Although having cancer might be something to lose sleep over, Spiegel noted, We'd rather help people regain the sleep and lose the cancer.

2,000 years ago Galen and Hippocrates were speculating the role of mind and body. People who are happy have a better health situation as they are willing to fight for their life and a stronger will to live. see our chapter in the book (Everyone's Guide for Cancer Therapy 4th Edition) on will to live. Those with depression will give up earlier, feel a diagnosis of heart disease or cancer etc. is a death sentence. Unless they have support often they can will themselves to death-just give up. Thus a depressed person is more negative and may lose suppportive family and friends. All these reasons and others (pain, suffering, etc) will hurt the will to live and may even lead to severe mental problems or suicide.

People feel they are losers, lonely, have no friends and they don't think of going to parties or socializing; I won't have any fun As these feelings are running through their minds, they become pessimistic, and they become realistic in that their world is indeed gloomy and devoid of hope.

Cognitive Therapy
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1. patients are encouraged to see that their self-deprecating thoughts have an immediate effect on their mood, actually creating a state of depression.
2. they are helped to see They are helped to see that these thoughts are ingrained--have become automatic so they occur without people being fully aware of them; they only become aware of the depressed mood that follows the thoughts.

Patients are taught to identify such thoughts when they occur, articulate them and then ask themselves if these thoughts are warranted based on the evidence. They should try to replace these thoughts which are negative with positive thoughts and try to better their life circumstances. Cognitive Therapy helps them become more aware and leads them to change their circumstances. Weekly sessions over several months may help people become more optimistic. The goal is to change a pessimistic thought process to optimism.

This Is An Interesting Process--How Depression Arises And How It Will Affect One's Entire Life.
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Everyone has depressive moments but it is only when they overwhelm you and control your life that they make a big difference. Being homeless or having cancer or heart disease can be depressing; how do you handle the problem and can you do it without help and medication.

To me a lot depends on your upbringing, your social values, your will to live. Can you fight for your life and survive the crises or problems? Is there the support structure of family, friends or medical team? Are you willing to try? Those who are copers and who have survived many crises and have learned family values as they grew up and have had successes in life can cope better with a depression or an illness. Those who have been a part of a nonfunctional family, had few support systems and could not cope in school or with life or family and friends will obviously be more negative and give up faster. Those who can struggle through their crises and problems have a better chance especially if they are willing to have and accept help.

Go back to the David Spiegel paper on lack of sleep and the role of the brain and mind and his work on cortisol levels. Depression is also a chemical reaction which is lacking something or is altered and this is where the drugs can help but it is a shame that some many people are depressed

There is an interesting book Mind Body Medicine how to use your mind for better health from Consumer Reports Books 1993 ISBN 0-89043-580-4.
p88-89 Modern folklore has it that depression makes you especially vulnerable to cancer. However, careful studies have shown no link between depression and cancer. There was a study of 6,400 people with major depression and in a 10 year follow up on death rates of those who died there was no increase in the cancer death rate for those with depression 10 years earlier. p362 - The role of attitude is least important in the beginning and the end of an illness to make an effect but it appears that personality and attitudinal factors had no influence on whether a research participant fell ill. So optimism may not help keep you healthy and is unlikely to rescue you from a terminal illness. In advanced cancer personality and attitudinal differences showed no relationship to survival time although hope, optimism and control do play a role.

Using Cognitive Therapy Aaron Beck at the University of Pennsylvania studied the treatment of depression and showed that Cognitive Therapy can be as effective as an antidepressnt medication although some depressed people still require drug therapy. Cognitive therapy can help some people become more optimistic.

Beck felt that many people are depressed because they think in overly, negative ways. Negativity has long been recognized as a sign of depression but Beck believes it can actually be the cause. Beck believes that people maintain their negative views because they think in irrational ways that keep them from changing their distorted perspective.

Bernard Fox, noted epidemiologist on the psychosocial aspects of cancer concluded in an editorial in JAMA 1989-data overall do not suggest an association between depression symptoms and cancer. Some scientists, based on animal data, still believe there is an association.

Patients with many diseases including cancer suffer from depression. The entire experience from diagnosis through therapy is depressing. It is of interest that the majority of cancer patients are not depressed - they can be scared, or fearful rather than depressed. Depression occurs when there are often prior or other psychological probes or due to chemical and biological causes which are treatable.

Fear of death or the end of life is often a trigger to depressive thoughts. Cancer is a total body experience as well as a personal experience as it affects one's life and requires many compromises. For younger people there is a threat that they will not complete their lives. Their future is uncertain, while those who are older often feel that they have completed their lives. 

Cancer evokes sadness rather than depression - a feeling of vulnerability. The sorrow can lead to depression depending on the response to treatment and the general philosophy of the person and how they have coped in the past. Often the threat that life may be over, and its aspirations and goals can place a family's future in jeopardy.

The biological causes from the hormone changes, cortisone changes and the effects of chemotherapy drugs can promote body chemical changes. These can lead to depression such as in women going through menopause or when on hormonal therapy - tamoxifen, for example. Using supportive care treatments such as nutrition, exercise, yoga, qigong, healing imagery, acupuncture, pain control can help. Exercise helps by increasing your endorphines (your own morphines) which help via chemical support.

For those with a past history of depression, this is the time to take action early rather than waiting for a depressive crisis to occur. Try to figure what you are depressed about and try to analyze your depressive thoughts-are they rational.

To reduce your doubts, work out ways to feel good about yourself. Use music, see shows which are funny, rely on your religious thought and confide in your church, mosque, synagogue and minister or clergy to help you. Accept help-especially since you are in need with group therapy or a psychologist or psychiatrist as needed.

The role of psychotherapy and antidepressant medicine are important. Brain chemicals such as serotonin-a neurotransmitter when serotonin is released at the end of the nerve. When insufficient amounts of serotonin to help in nerve conduction, can lead to depression. The antidepressants SSRIs (selective serotonin re-uptake inhibitors) help to block serotonin reabsorption and thus help to relieve the symptoms of depression by making serotonin more available. This is like putting on bandaids which really can help but does not solve the causes of what initiates the process of depression. Thus Emotional Support + drugs may go a long way to help relieve the symptoms and control depression.

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