AP: Texas

11/17/2007

By MARINA PISANO  / Associated Press

In a cancer treatment center filled with high-tech machines and cold treatment rooms, Joel Marcus' office is an oasis of low lighting, comfortable furniture and soothing conversation.

No white coats or scrubs. What happens in there is treatment of a different kind.

Marcus, a clinical health psychologist, is also a psychosocial oncologist, one of only about 450 people in the nation trained in this relatively new subspecialty.

The patients he sees at the Cancer Therapy & Research Center in San Antonio are battling the physical onslaught of a relentless, life-threatening disease. But they are also struggling with emotional and psychological issues caused by the very fact they have cancer or by the grueling treatments or the layers of marital, family, social and work relationships impacted by their illness. Anxiety is common. About 20 percent to 30 percent are suffering from depression.

Ideally, Marcus likes to begin sessions with patients early in their treatment, and his approach usually includes psychosocial education and cognitive behavioral therapy to help a person develop different ways of thinking and coping skills to act more constructively. However, with some patients Marcus uses an intriguing and effective mind-body intervention: Clinical self-hypnosis.

Mike Downs learned about self-hypnosis his very first day of treatment at the center, in August, when he was so paralyzed by anxiety that he wasn't sure he could go on.

Downs, 54, who retired from a long career in radio in 1999, was diagnosed with advanced Stage IV colon cancer in 2003. Doctors in Fort Worth gave him just a few months to live. His tumor was shrunk with radiation therapy and then removed, but the cancer had spread to his liver, requiring course after course of chemotherapy.

While the chemotherapy worked on the cancer, his body began to react to the drugs. He was referred to a Phase I trial with an experimental drug at the Cancer Therapy & Research Center and began driving down with his wife, Kathy, from his home in Waco twice a week.

In Phase I trials, a drug is used for the first time in humans, and researchers evaluate how best to give the drug (by mouth or injection), the dosage and how often to give it. As Downs remarked, "These drugs don't have names. They have numbers. It's scary."

With Downs so fearful, the staff called on Marcus to work with him. The psychosocial oncologist explained the calming effect of self-hypnosis and gave him an instructional CD. After listening to it, the anxiety lifted and Downs was able to begin treatment.

"Years ago, I never would have been receptive to that sort of thing," Downs recalled one Tuesday afternoon as he sat in a recliner waiting for the seven blue capsules he takes. "But once you have this kind of change in your life, you're receptive to anything. I can't explain it. I don't know how it works. But that first day with this room as packed and noisy as an airport, I listened to the CD, and I was able to forget all that. I was able to focus, and it had a calming effect."

Of course, this isn't the Hollywood version of hypnosis, with a swinging pocket watch and the subject in a deep trance, powerless and doing the hypnotist's every bidding. Marcus described clinical hypnosis as a "state" or condition that occurs when certain appropriate suggestions elicit images, thoughts and feelings that take the person out of discomfort, pain or fear to a different place — a state of physical comfort, safety and calm.

He had to work very quickly with Downs, but more often it takes several sessions to guide the person into a state of deep relaxation, comforting mental imagery and focused attention.

"One of the primary components of hypnosis is a dissociative state. You relax. You go someplace else," Marcus said. "So first, I spend a lot of time talking to people to find out where they want to be, what would be peaceful for them. A beach? A meadow? Some write their own script. The idea is to teach self-hypnosis so they can do this on their own whenever they feel scared or stressed. They are in control. They go home and do it on their own."

That's important because for many, cancer has taken control of their lives.

Some are resistant to hypnosis. Marcus noted that it seems to work well with children only up to the age of 12 or 13 when their critical thinking kicks in.

Many of Marcus' patients have breast cancer — women who have had mastectomies or lost their hair with chemotherapy and have body-image concerns. For some, the change in appearance is devastating, and they begin to avoid crowds, withdraw and become isolated. Often marriages are affected.

But there are physical effects as well. When chemotherapy and hormonal treatments shut down ovaries and deplete women of estrogen, they are catapulted into menopause. They begin having hot flashes with sweating, flushing and palpitations. Symptoms can disrupt sleep and daily activities.

"With hot flashes, once one occurs, it creates that physiological response, and from then on you're on high alert," Marcus said. "You're vigilant. When is the next one going to come? Hypnosis helps calm you down."

It helped Annie Brandt. Diagnosed with advanced breast cancer in 2001, she was unable to have conventional chemotherapy because of a weakened immune system. Instead, she opted for an unconventional treatment that combines low-dose chemotherapy and insulin, and it has been effective on the cancer. Four years ago, she heard about Marcus' research with breast cancer patients and self-hypnosis and began a series of sessions in San Antonio.

As Brandt, 50, described it, "I didn't think I was receptive, but Joel proved me wrong. He sat me in a chair in his office for the first session. His voice is hypnotic, and he started helping me to relax. He was counting back 10 to one and saying that I was so relaxed, my left arm was floating up from the chair. I thought, yeah, right. But I looked and my arm was up off the chair."

Marcus suggested Brandt go somewhere in her mind, someplace safe and comforting. Using self-hypnosis, she felt herself floating down the cold waters of the Guadalupe River, looking up at the trees, listening to the wind. She had left a place of burning heat and felt cool and at peace.

"After four sessions with Joel, I didn't even have to stop and think about it," she said. "When I started to have a hot flash, my brain took over and, literally, within seconds, I felt cool and relaxed. After six months, I stopped getting hot flashes. It's just amazing to me — the power of the mind over the body."

In a paper published last year in the journal Psycho-Oncology, Marcus and colleagues reported that they found a 70 percent reduction in self-reported hot flash severity and frequency after hypnosis treatment.

There are wider uses for self-hypnosis. Brandt uses it for stress relief. Marcus finds it helps in pain management and in relaxing patients in end-of-life palliative care.

Meanwhile, life with cancer has become more stressful for Downs. In early October, a CT scan revealed the experimental drug wasn't working and the disease was progressing. More recently, he learned he could go on another Phase I drug trial at the cancer center.

He is feeling fatigued, physically and emotionally. "We have been on this roller coaster so many times in the past, where they told me something wasn't working. I am three years past my expiration date, and I don't know whether we're just getting tired of it. It doesn't have the same impact."

Kathy, who has been a strong support for her husband while keeping up with her job at Clear Channel Communications, was upbeat. "We'll just pull up our bootstraps. We're not giving up even though it gets you down emotionally."

Downs said he would like to see Marcus' instructional self-hypnosis recording accessible online, allowing cancer patients to download it directly.

As he concluded with characteristic humor, "It certainly helped me in the most unexpected way. All I have to do is slip on the headphones, and I can bring down the blood pressure. Now, if I could just bring down the waistline."