By Charlene Thurston, ANP, Program Director – from Currents spring 2017

This winter, our Palliative Care Counselor, Bonnie Fitz-Gibbon, Ph.D., LMHC and I spent many hours participating in conferences which enabled us to bring new treatment strategies back to our patients.

Bonnie attended “Transforming Trauma” with Dr. James Gordon of the Center for Mind Body Medicine, and I attended a CDC funded program at City of Hope Medical Center, entitled “Cognitive Behavioral and Related Interventions in Cancer Care.” Both conferences added many tools to our treatment toolkits, and I thought I’d share some information we acquired with our readers.

Both conferences strongly emphasized the value of relaxation/meditation skills as the backbone to improvement for both emotional and physical symptoms. In Dr. Gordon’s conference which dealt specifically with trauma, he stated that meditation served as an antidote to trauma. His program, which is a mindfulness-based stress reduction program, has helped traumatized victims in war torn areas around the world and has had amazing results restoring both children and adults to more functional lives.

City of Hope’s conference for treating cancer-related symptoms focused on the use of relaxation/meditation and other cognitive behavioral interventions for symptoms like fatigue, anxiety, depression, insomnia, and pain. Cognitive behavioral interventions focus on how we think, behave, and feel, and have been validated in study after study to show their effectiveness. Using these techniques to alleviate these cancer-related symptoms is exciting for several reasons.

First, they’re effective; second, they’re not medications, which often have side effects; and third, they are skills that patients can be taught so that they can become more empowered to take back control of their own well-being, a feeling that is often lost when facing an illness like cancer. More-over, although the emphasis of this particular conference was on cancer care, these same skills can be learned and utilized by anyone.

The use of cognitive behavioral strategies for depression has been shown in research to be as effective as medication for the treatment of mild to moderate depression and its effects can be long-lasting. Teaching patients to look at and correct how their thinking might be distorted (e.g., jumping to conclusions, catastrophizing, etc.) helps them decrease their distress. Also, oftentimes, changing behavior alone can be effective, even when not analyzing thoughts. In other words, getting out of bed, engaging in various activities, etc., despite feeling sad, can often decrease feelings of sadness and break the pattern of depression. Lastly, during research on the use of a lightbox to improve cancer-related fatigue, they found that patients also showed a decrease in depression. Further details about this appear later in this article.

Education and behavior changes have also been very effective for patients with insomnia. Dr. Ancoli-Israel from UCSD, an award-winning expert in sleep disorders, discussed how teaching people with insomnia about the sleep-wake cycle and circadian rhythms and helping them develop a plan to change their behavior by regulating their time in bed, napping, and arising has been very effective in treating insomnia.

Fatigue is one of the most frequently reported and distressing symptoms that patients with cancer face, and there have been few medications or treatments that help effectively. Therefore, to me, one of the most novel and promising presentations of the conference was on research that is being conducted on the use of a lightbox for patients with fatigue, depression, or insomnia.

People are probably familiar with the idea of using a lightbox for Seasonal Affective Disorder. Now Dr. William Redd of the Icahn School of Medicine of Mount Sinai in New York, has had remarkable results in using it for several other symptoms. In his research, patients have been using a lightbox that emits 10,000 lux of bright white light for 30 minutes/day, preferably early in the morning. The lightbox is placed on a table and positioned about arm’s length away from the face at about a 45 degree angle. (Do not look directly into the light.) That’s all there is to it.

The patient can be checking emails, reading, sitting, whatever. Eyeglasses don’t interfere, but sunglasses should not be worn during that time. Patients with mania of bipolar disease and patients with eye disorders like glaucoma, cataracts, diabetic eye damage, etc. shouldn’t use it without prior approval by their doctors, but, thus far, there have apparently been few other problems identified.

I do emphasize that this treatment is still being researched, but, so far, it is a simple intervention using an easily available and affordable lightbox and has been showing remarkable results. (There are many lightboxes on the market. The one that was used in the research discussed was the Litebook Edge.)

These have been exciting conferences offering several novel approaches to some of our patients’ most distressing symptoms. We look forward to incorporating our new learning into our practices over the coming months, and hope that, by doing so, our patients find great benefit.

If you’re interested in learning more, don’t hesitate to call on us. Also, if you’re interested in reading more about cognitive behavioral therapy overall, you might like The Feeling Good Handbook, by Dr. David Burns. For Dr. James Gordon’s work, see
Unstuck: Your Guide to the Seven Stage Journey out of Depression.

Finally, if you just google meditation, you’ll find numerous articles, audios, and you tube videos available for free to lead you through various techniques.

Funded by the Palliative & Supportive Care of Nantucket Foundation, the Palliative & Supportive Care Program is operated as a department of the Nantucket Cottage Hospital, which is an affiliate of Massachusetts General Hospital, and a member of Partners HealthCare. Palliative & Supportive Care of Nantucket is a specialized health care program dedicated to providing excellent physical, psychological, social, and spiritual care to persons with life-threatening illness and their families.

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