Month: April 2022

Patients  diagnosed with some type of cancer face an anxious time.  They may be fearful about their own survival or worry the the impact that their death could have on their family members.  They may have concerns about their treatment including their ability to deal with pain, nausea or surgery; or relating to the impact on their appearance, on their body,  on their career, on their finances, on their relationships or on their family.  They may feel overwhelmed or unable to control their emotions; and they may feel anxious as they await tests or scans to clarify their situation. It’s quite a list.  And most all of the 3650,000 people diagnosed with cancer in the UK every year will have most of these worries.  And so too will their loved ones.

Besides anxiety, as they await medical professionals to make perhaps life changing decisions, patients may feel helplessness or have low mood.  Some may fear the worst or start to anticipate a poor outcome.  In fact those admitted as in-patients are nearly twice as prone to depression related to their cancer in comparison with those who are treated as out-patients.

Now,  there are many studies that show just how effective Mindfulness Based Cognitive Therapy (MBCT) is in reducing depression and anxiety within cancer patents.  I have posted before about a study involving 245 cancer patients: “Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial” (2019 published in Journal of Clinical Oncology).  Each of the cancer patients taking part in the study was categorised as experiencing “psychological distress” — i.e. demonstrating a score ≥ 11 on the Hospital Anxiety and Depression Scale (HADS).  The study compared patients treated with the usual psychological support  with those receiving an eight week course in either “therapist lead” MBCT or self-help (internet based) eMBCT. The results demonstrated that both face-to-face and internet-based self-help mindfulness based cognitive therapy significantly reduced psychological distress in patients with cancer – reducing fear of cancer recurrence and improving mental health–related quality of life. See here

The results showed:

• “Usual treatment” produced a small change in mean HADS score from 17.04 at baseline to 16.37 at post-intervention
• Yet “Face to face MBCT” achieved a change from 18.81 to 13.25
• and the “eMBCT group” achieved a change from 17.24 to 11.87 – almost eliminating  “psychosocial distress”

So, both MBCT and eMBCT significantly reduced fear of cancer recurrence and rumination; thereby increasing mental health–related quality of life, mindfulness skills, and more positive mental health compared with usual treatment. The investigators concluded, “Compared with treatment as usual, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.”

As you may be aware we are currently working on a version of our Rezl app to provide information, advice and support to those diagnosed with cancer and those close to them.

As part of building the justification-case for the use of MBCT within cancer clinics I spotted this paper from the Netherlands:  “Cost‐utility of individual internet‐based and face‐to‐face Mindfulness‐Based Cognitive Therapy compared with treatment as usual in reducing psychological distress in cancer patients” (April 2019 by  Compen et al).

The study was an random controlled trial tracking three groups of patients: one given MBCT; one given access to an online MBCT programme (eMBCT); and a control group given treatment as usual (TAU). The paper investigated the “societal costs” (loss of employment earnings, cost of psychological treatment and “quality of life” measures)  through-out treatment and through to nine months post-treatment.

The results showed:

• The MBCT and eMBCT patients both demonstrated a  40% reduction in  the cost of the psychiatric/psychological care required in comparison with the TAU group;
• The MBCT and eMBCT patients both demonstrated a 70% reduction the earnings lost in comparison with the TAU group;
• The MBCT and eMBCT patients both reported significantly higher quality of life than the TAU group

The researchers concluded that “Results indicate that eMBCT and MBCT are cost‐saving treatments whilst simultaneously improving quality of life for distressed cancer patients.”

It seems to me that that healthcare insurers would benefit from the reduced treatment costs;  and disability income or income protection scheme providers would see reduced claims – maybe they should consider the provision of MBCT/eMBCT to reduce their costs (and their premiums) and to increase the “quality of life” of their customers.

So how do the brains of men and women differ?

In the words of the late Caroline Aherne’s Mrs Merton character: “Let’s have a heated debate.”

Twenty five years ago  John Gray’s book told us how  “Men are from Mars, Women from Venus” – well not literally, but the concept was that by understanding each other’s thinking and likely reactions to events then we could all be more understanding of each other.

As a guy, I have often surprised myself that I can focus on work or even on watching soccer at a time when other parts of my life present real challenges… and I notice how my girlfriend can find it difficult to focus on anything other than whatever is troubling her.  John Grey’s book taught me to stop trying to respond to her problems by trying to fix them;  but to just be empathetic and supportive. Thanks John.

So, while sitting in my “man cave”  (and in joke for those who read the book) I started to wonder about how good or bad men and women are at compartmentalisation.

Compartmentalization is a defence mechanism in which people mentally separate conflicting thoughts, emotions, or experiences

I found a great blog post on thrivinglivescounseling.com/by Jennifer Crumb Perez   here.   It explains how women may see men as “distant” because men are often focusing elsewhere or avoid serious issues of the here and now.

“Men tend to compartmentalize their feelings and thoughts about, well, pretty much everything. If you were to look inside a woman’s brain, you might find a comfy quilt made from her thoughts and feelings, all stitched together. Women naturally process thoughts and feelings and integrate them into one cohesive ‘thing’.”

It turns out that back when we were all living in hunter gather communities, men and women played different roles. Women were responsible for raising healthy and functioning members of society; so they needed to be able to think and feel at the exact same time – to multi-task and to avoid neglecting any current “family raising issues”.   While Men were tasked with hunting and fighting; so to keep focused they needed to avoid any distracting emotions or “issues”. It would not have been helpful to think and feel at the same time.   The guys needed to focus to stay alive and to complete their current tasks. So, compartmentalization of thoughts and feelings would be very helpful for the men… yet unhelpful for the women.

Today, being compartmentalised may not be so important (how much focus do you need int the  store?); and it can apparently be a barrier in relationships – unless your partner has read John Gray’s book.  The advice to men is to begin to integrate their thoughts and feelings. As a start, Crumb Perez suggests, men should admit they have them!

A piece on WebMD.com “The Mind of a Man” highlights how strange women may find guys’ apparent inattentiveness to important issues or their distractednesss (code for not listening).  The piece quotes Michael Gurian, author of the book “What Could He Be Thinking?” who explains how our hormones have caused our brains to develop differently.  This difference can be seen on MRI scans:
“If you line up PET scans of 50 male brains and 50 female brains, you’ll see more colors lighting up in the female brain because there’s about 15% more blood flow, on average, in the female brain. If you show those 100 men and women a picture of someone looking sad, you’ll notice that less of the male brain lights up as the men try to figure out the emotion involved. There’s less involvement of the emotive centers and less going on in the hippocampus, where memory storage is.” Says Gurian.  So women are more sensitive to emotions.

Yet if the men and women were asked to do a math or science problem, the PET scan would show, on average, that women used more of their brain to get the answer than the men did. “The male brain tends to be more efficient to lateralize and compartmentalize, which has the advantage of making him more task-focused. The female brain has more [nerve] connections and constantly cross-signals and takes in more, so it tends to see and feel more than the male brain,” Gurian says.

Are these pictures showing compartmentalisation in actions? I think so.

So, there we have it – men’s brains are different from women’s brains… including by being more “compartmentalised” – which is helpful in some aspects of life but  not in others.  We can break to break free of these limitations by women becoming more compartmentalised  in their thinking or men becoming more focused on their emotions and feelings.

Or we can just understand each other… and cut each other some slack, maybe.