Researchers seek ways to ease anxiety in cancer patients

At top, the amygdala "lit up" after the patient listened to a recording about a traumatic event. Below, repeating the test after therapy, the amygdala shows normal activity.
At top, the amygdala "lit up" after the patient listened to a recording about a traumatic event. Below, repeating the test after therapy, the amygdala shows normal activity.
Posted: July 14, 2014

The surgeon delivered the bad news on Elizabeth Koniz's lumpectomy: "We didn't get clean margins."

Stunned, she couldn't think of anything else.

"The words rang in my head," said Koniz, a 48-year-old admissions coordinator at Temple University School of Medicine. "I had terrible anxiety. I was nervous at medical appointments. I had tremendous trouble sleeping and cried for weeks after the diagnosis."

About a third of cancer patients experience high levels of anxiety - intense distress, although not typically to the level of post-traumatic stress disorder - after getting the diagnosis or during a difficult moment in treatment.

To address it, integrative medicine clinicians at Thomas Jefferson University Hospital are testing an innovative treatment that combines Chinese medicine with a type of psychotherapy known as cognitive-behavioral therapy, along with a "muscle test" that helps patients understand the level of stress that can be triggered by experiences long before they got sick.

Early results - far too early to publish - with what is called neuro-emotional technique (NET) are positive, said Anna Tobia, a clinical psychologist at Jefferson's Myrna Brind Center of Integrative Medicine. After three sessions, she said, patients see that "their mood changes, their energy is up, and their distress levels are lowered."

"NET treatment requires patients to examine their emotions around the traumatic moment sparked by their cancer - fear, impending doom, feeling lost, sadness," Tobia said. "We then go back through their lives to find other times when they've felt similar emotions around unresolved traumatic experiences."

The point is to connect the traumatic responses from different times.

"We're interested in examining how trauma gets locked into the body," Tobia said.

To release the tension, Tobia employs a technique from Chinese medicine based on meridians, or energy systems that run throughout the body. According to this theory, when meridians are blocked, they create dysfunction in the body or brain. During NET treatment, Tobia stimulates pulse points on the body to help "release those primal traumas that are holding the body back from healing."

She also uses a muscle test as an indicator of stress in the body. As patients concentrate on a moment of traumatic memory, Tobia grasps their wrists to show how their muscles "go weak" in response to the old event.

"NET cuts through psychological defenses: people see directly and immediately that their muscle strength changes," she said. "I may not think something bothers me, but I can see it bothers my body. It makes it real in a way that talk therapy can't access."

Tobia is leading an ongoing study of the technique - the first, she said, to examine the effects on volunteers with cancer-related anxiety using functional-MRI, which measures brain activity in real time.

The study has tested 24 participants so far, and will eventually enroll 30 to 40. Participants initially are divided at random into two groups - one receives the treatment and one does not - but all volunteers are eligible to eventually receive the full three to five treatment sessions of the therapy for free.

An earlier pilot study of seven volunteers, also conducted at Jefferson, showed statistically significant positive results when cancer survivors with anxiety were treated in three sessions.

In the current research project, all patients rate their anxiety levels on a scale of 1 to 10 before beginning treatment, and then undergo a functional-MRI to get a baseline reading. The f-MRI tracks electrical impulses in the brain while volunteers listen to a description of a neutral experience ("You are at your kitchen counter chopping lettuce") followed by a traumatic moment ("The doctor walks in. He doesn't meet your eyes. You know the news is bad.")

After the final treatment, participants undergo a similar exercise; the technology measures differences in the brain.

Preliminary results show that all of those study participants who reported a high level of anxiety during the initial f-MRI reported a "normal" range of anxiety after treatment.

More important, the imaging actually showed that the amygdala, a center for memory and emotion in the brain, lit up the first time but returned to a normal non-reaction state at the end.

"Simplistically speaking, we see a brain that normalizes itself," said Andrew Newberg, director of research at the integrative medicine center, who described the results as "impressive."

"After the NET treatment, not only do participants show less of a response clinically, but when the amygdala listens to the traumatic story, it acts as though it's listening to any other story. It doesn't listen to the traumatizing moment as an incredibly traumatic event," Newberg said.

"It's great to have an option that's not a drug that has a pretty dramatic effect on people."

That was Koniz's experience.

Following her lumpectomy, she went on to undergo a double mastectomy. But she said the NET treatment helped her "acknowledge my emotions and not to try to suppress them."

"It sounds corny," she said. "But the treatment left me feeling lighter and more at peace. I'm more able to handle what might come in the future, and I don't worry about what will come in the future."


Men and women are still being sought.

Participants must be over 18; diagnosed with any cancer but not in the terminal stage and not currently getting chemotherapy or radiation; and have severe anxiety related to the illness. All volunteers will get the treatment eventually.

For details,click here or call Dr. Andrew Newberg at 215-503-3422.


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