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Psychotherapy Helps -- Even When It's Not All in Your Head

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WebMD Health News
Reviewed by Daniel J. DeNoon

Aug. 28, 2001 (San Francisco) -- When combined with effective medicine, psychotherapy has a role in treating headache, obesity, cigarette addiction, and even heart disease, according to new research presented here at the annual meeting of the American Psychological Association. Even more impressive are findings that group therapy can ease the burden of terminal cancer and may increase the odds of survival.

"These problems are right at the top of our national list of killers," says Stanford University researcher W. Steward Agras, MD.

Psychotherapy is the treatment of distress through talking with a specially trained therapist and learning new ways to cope rather than merely using medicines to alleviate the distress. For example, Stanford University psychiatrist David Spiegel, MD, works with patients who have breast cancer and other chronic illnesses. He finds that teaching them self-hypnosis techniques lessens their need for pain drugs. And he finds that group psychotherapy helps patients deal with emotions and stress that literally may be shortening their lives.

"We think it is possible that the way people respond to stress may affect [how] their immune [system fights disease]," he says. "In group therapy we are reducing patients' tendency to suppress emotion. To the extent they learn to stop suppressing their emotional reaction to the disease, they are less distressed."

Half of people told they have cancer will not die of the disease -- but all of them think that they will, Spiegel says. People who experience the trauma of a violent crime or a serious accident often have long-lasting stress -- known to psychologists as post-traumatic stress disorder, or PTSD.

"We are finding that the [ways of understanding] PTSD apply as well for patents with chronic illness," Spiegel says. "The nightmares and flashbacks are comparable to those experienced by rape victims and accident victims."

Another example of distress due to chronic illness is depression. Spiegel notes that clinical depression is seen in 3% of the general population, 20% of terminally ill patients, and 60% of people requesting assisted suicide.

Both depression and PTSD can be treated with psychotherapy.

"So there is a lot we can be doing for these people," Spiegel says. He points to data from an ongoing study of terminal cancer patients receiving group therapy. "After a year of supportive group therapy, have reduced their level of distress," he says

More than a decade ago, Spiegel published a small study showing that cancer patients who participated in group psychotherapy survived longer than those who did not. Most studies since then support these findings, although some do not. Spiegel is now completing a larger study.

Other conference presentations showed that even when there are effective drug treatments for an illness, adding psychological treatments can give better results.

  • Severe tension headache. A study led by Lehigh University researcher Kenneth A. Holroyd, PhD, shows that therapy to improve stress management works as well as taking antidepressant medicine to relieve severe headache. Combining psychological treatment with drug treatment was more effective than either treatment by itself.
  • Obesity. A study by Brown University researcher Suzanne Phelan, PhD, shows that people getting therapy to help them modify eating behavior plus taking an appetite-suppressing drug lose more weight than those getting either treatment by itself.
  • Quitting smoking. Brown University researcher Raymond Niaura, PhD, analyzed a number of studies of behavioral therapies aimed at helping people quit smoking. These treatments -- when used in combination with nicotine patches or nicotine gum -- were twice as effective as nicotine replacement alone.

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