Emotional Healing: Support Groups and Counseling -- Ann Webster, PhD.

Last Editorial Review: 10/23/2003

By Ann Webster
WebMD Live Events Transcript

Getting proper emotional support and sharing your treatment journey with others is as vital to survival as any medical intervention. Studies show that support groups and counseling add years to the lives of women with breast cancer. Psychologist Ann Webster, PhD, director of the mind-body cancer program at Boston's Beth Israel Deaconess Medical Center, joined us to talk about support issues.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD University. Our guest today is Ann Webster, PhD, director of the mind-body cancer program at Boston's Beth Israel Deaconess Medical Center. Let's start by asking you to explain mind-body medicine.

Webster: Mind-body medicine looks at the interactions between what goes on in the mind and what goes on in the body. The techniques that we offer to patients are self-care techniques such as the relaxation response, nutrition, exercise, social support, cognitive therapy, and spirituality -- anything that the patient can do for her- or himself. This is not considered an alternative to traditional medicine; we think of it as a complement or an adjunct to regular medicine.

Moderator: How do you determine what will work for a particular woman?

Webster: The program I offer is in a group format; approximately 15 people with breast cancer in a group at a time for 10 weeks. Every week I am teaching another component of mind-body medicine. So each woman learns an abundance of self-care techniques and she can decide which ones really work for her. Hopefully, all of them work. So I don't actually make a decision as to which one will work. I offer many choices.

Moderator: I have not heard of this type of work being done in this way before. How did your program develop?

Webster: This program has been in existence at Harvard for 30 years. It was developed by Dr. Herbert Benson, a very well-known cardiologist at Harvard. I have been the director of the Mind-body Cancer Program for 17 years. I also do the same type of interventions for individual cancer patients, not just in a group. There has also been a fair amount of research looking at the health benefits of mind-body groups for cancer patients.

Moderator: Does the group aspect enhance the results of the individual types of intervention? Is there a synergy?

Webster: Yes. The group experience is extremely powerful. Women with breast cancer are together and discover they are not alone in this experience. They have many common threads. The group is the only place where everyone understands each other. This is extremely comforting.

Member: Tell us something concrete about your program.

Webster: One of the techniques that we offer in mind-body medicine is a relaxation technique. It's approximately 15 minutes long. People learn to quiet their bodies and minds. Everyone who has cancer is extremely anxious and worried, so this is the first step toward dealing with that emotional upset. Everyone receives a copy of my audiotape and they are asked to listen to it once a day. It teaches breathing techniques, muscle relaxation, and focusing the mind.

We also teach "minis," which are little relaxation techniques that simply focus upon breathing and counting or breathing and a word, such as "peace," or breathing and repeating a phrase or prayer on the out breath such as "God be with me." So the first thing we offer is a way to calm the mind and the body.

Moderator: How can someone get a copy of your relaxation tape?

Webster: They can write to me at:

Anne Webster, PhD
Mind-Body Medical Institute
824 Boylston Street
Chestnut Hill, MA 02467

The tape is $10 with a dollar for shipping and handling, total of $11.

Member: Should checks for the tape be made out to the doctor or the institute?

Webster: It should be made out to me, Anne Webster, PhD. I also have a CD called Healing Imagery that is specifically for people with cancer.

The CD is $18, which includes shipping and handling.

Member: Does your clinic support patients who only opt for the complementary [treatment], or must they be using it in conjunction with conventional medicine?

Webster: Our clinic supports anyone who is going through cancer, no matter what kind, no matter what treatment. Everyone is welcome.

Member: Can group therapy work if there isn't support at home?

Webster: Sure. Absolutely. That's part of the magic of group support because often there is not support at home. People at home often do not understand what the person with cancer is going through, and often one does not feel comfortable talking about the experience of cancer with family or friends. So that is part of the magic of a group.

I want to add one qualifying statement: The type of support group that one attends is very important. If the group is composed of people who are there simply to complain, that is not going to be good for your health. You need to find a group where you learn self-care techniques, where there is optimism and hope, because having a positive attitude and fighting spirit is extremely important in trying to deal with cancer. A depressing group experience is not going to be a benefit.

Moderator: Can you explain the nutrition work you do in group?

Webster: What we put into our bodies is extremely important. I want my patients to understand what a healthy diet is, because most people in America seem to have forgotten. Anyone with cancer needs to be eating fruits and vegetables that are very strongly colored, such as broccoli, kale, beets, red grapes, etc. Because these fruits and vegetables contain cancer-fighting nutrients called flavonoids and phytochemicals.

Also, people need to understand which are the good fats and which are the bad fats. Anyone with cancer needs to know how to interpret food labels and get all of the additives and chemicals that we are putting into foods out of their diet.

Also, in terms of nutrition, it is not only what we eat; it is also how we eat. People need to prepare their own food, sit down, take time to eat, savor the tastes and textures, be grateful for their food, and share the dining experience with others, which can be a spiritual experience.

Member: Can you discuss how trans fat fits into that?

Webster: Trans-fatty acids are bad things, and everyone in America should get all of these fats out of their diets. They are bad for every system of the body.

Member: What if you are too tired to fix food? I enjoy having dinner with friends but I'm too tired to cook and too tired to entertain.

Webster: Many of my patients asks friends to make food for them. People love to cook for others. Put a big red cooler on your front porch or your back deck or wherever, ask one friend each day to put a casserole, a salad, a yummy desert, whatever into your cooler. Now you can be tired and food will be there.

Moderator: You seem to emphasize not only the nutritional aspect of food, but also the communal nature of dining rather than eating, the spiritual aspect of completely nourishing yourself.

Webster: Yes I do. I think food is very healing and nurturing and too many people are standing in their kitchens, watching TV, or talking on their cell phones and eating their dinner out of a cardboard or plastic container. What is wonderful about that? Food is spiritual thing and we need to get that back into our lives again.

Member: What should someone look for in choosing a breast cancer support group? Where do you begin your search for help?

Webster: Call you local chapter of the American Cancer Society or ask other people who are going through the cancer experience, because many of these groups operate by word-of-mouth. Check with a social worker or ask your nurse. If nothing exists in your area, start your own group.

Moderator: Is it important to have a trained moderator?

Webster: I believe it is important for a group leader, provider, moderator to have experience in group process -- preferably a psychologist, social worker, nurse, psychiatrist, or pastoral counselor. Most of these people have had training in group therapy of some type.

Member: How do you start your own group?

Webster: The most important thing is to advertise so that you have a collection of people. Find someone who has training to work with groups, get that person to join you, find a location, you're good to go.

Moderator: Check with the local church, synagogue, hospital, nonprofit organization, school, etc. for a meeting place.

Member: Is online support as effective as face-to-face?

Webster: Yes, it is. Online support is very powerful. There is an organization in New York City called Cancer Care. I was just there last week, talking, and they do a lot of online support. So I suggest people contact them.

Member: Is this kind of mind-body treatment available all over the country?

Webster: Unfortunately, mind-body medicine is not available everywhere.

We have 12 affiliates across the country, one is in Tacoma, one in Houston, one in South Bend, Ind., and about nine other sites, and they offer mind-body medicine.

Moderator: For the woman who opts for individual counseling, what do you recommend?

Webster: I would suggest finding a psychologist or social worker that has experience working with people who have cancer, or a pastoral counselor. And this type of therapy can be very effective.

Moderator: If want to bring your family into the therapy process, how do you do that?

Webster: Well, you invite them and find a therapist or counselor who is trained in family therapy. I think this is a very good idea because family members are very much affected by the cancer experience, yet there are very few services for family members. And family members also feel like they have no right to their feelings. A therapy session allows everyone in the family to have a voice.

Women with breast cancer need to ask for help. I find that so many of my patients are afraid to ask family members, spouses, and friends for help. They feel as if they will be a burden or a source of trouble. But spouses and family members and friends often want to help, they want to do things, but the person has to let them know what they want. If you want your partner to rub your back, say so. If you want your spouse to do the dishes or come with you to chemotherapy or do some cooking or make phone calls to friends and family or whatever, you have to ask.

Member: I am continually putting others (family included) at a distance. Is this a common reaction?

Webster: My question to you would be, putting them at a distance for what reason? This is not necessarily common. If it is because you don't want help from them or they don't understand, I think you need to find support from others because you cannot go through a cancer experience alone.

Member: I hate to bother them. I don't want them to feel that I'm whining.

Webster: I think you need to let your family members in on what you are experiencing. Asking for help does not equal whining; it's simply making a statement for what you need. Should you get no response or help from family members, speak up. If you still receive no support, then seek out help in other directions.

Member: How do you get over the fear of having cancer again?

Webster: I think that one never really gets over a fear of recurrence.

It's a very valid fear. However, in our mind-body programs we teach something called cognitive restructuring. When you feel upset or worried you write down those negative thoughts. When you are having those thoughts you also write down how you feel so that you can see that your negative thoughts are creating your anxiety and worry. Many of the thoughts are not true or they are exaggerated or they are not helping you. Then we challenge those negative thoughts and replace them with more rational ways of thinking. When one is worried about the future you are missing the moment. So we try to shift people from worrying about the future, all those "what-if" questions, and return their focus to what they're doing at that very moment so that each day is rich and full, not filled with worries about six months from now, a year from now, etc.

Moderator: Do you have any advice about support groups for women experiencing recurrence or metastatic breast cancer? Should they seek out a group focused more specifically on their issues?

Webster: In my groups it's a big mix. I do not separate newly diagnosed from recurrences. People with recurrences are often filled with much wisdom. They are the survivors. So women who are newly diagnosed can often learn from women who have been coping with cancer for a while. So I don't see the merit of separating recurrences from newly diagnosed people. Again, this gets back to the type of support group that one is participating in. If it's just a group where people sit and complain, it's not going to help anyone.

You know what I often say to my patients? Become the Lance Armstrong of your neighborhood. He is the role model for anybody living with cancer.

Moderator: Attitude makes such a difference -- do you use humor in your groups?

Webster: Humor is a perfect antidote to depression, anxiety, and anger.

There have also been studies by Lee Burke at Loma Linda Hospital in California looking at the health benefits of laughter. A good laugh boosts immune functioning and decreases stress hormones and releases beta-endorphins in the brain, which are your own natural painkillers. In my mind-body group there is a tremendous amount of laughter, humor, props, such as tiaras, clown noses, all different kinds of wigs and hats. We have a wonderful time.

Moderator: Ann, we are almost out of time. Do you have any final comments for us today?

Webster: I encourage anyone living with cancer to explore all sorts of self-care techniques -- anything that you can do to maximize your health and healing and find people in your life with whom you can share this experience and also add a spiritual component to your lifestyle. Give this your best shot. Spiritual does not necessarily mean religion. Spirituality is having purpose and meaning in your life and also feeling profoundly connected to yourself and others, and much research has shown that having a spiritual dimension to your life is very good for your health. Blessings to everyone.

Moderator: We are out of time. Thanks to Ann Webster, PhD, for joining us today. To learn more about breast cancer, be sure to explore all the breast cancer info here at WebMD, including our message boards and live chats.

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