When most people are asked to think about a hospital, their minds naturally draw connections to safety, physical health, and recovery. However, for the millions of people who live with cancer in the U.S., their minds might wander to feelings of depression, anxiety, or loneliness. You will find a similar reaction in many of the 2 million amputees living in the United States, as well as with the millions of other patients every year that spend long amounts of time in U.S. hospitals. According to a study conducted in 2015, 24.6 million people have visited “physician offices with cancer as the primary diagnosis”, and nearly all of those patients returned to the same doctor for at least one follow-up (Rui). Many of those patients go on to spend months – or even years – staying in or paying frequent visits to hospitals, and it has been proven that their mental health suffers because of it. Many studies have been conducted in the last ten years on the relationship between depression, anxiety, and having a long-term illness, and the results have all been conclusive – patients, especially those with cancer, “experience clinically significant anxiety and depression and traumatic stress symptoms” (Classen). In fact, the Center for Disease Control has stated that “cancer survivors in the United States take medicine for anxiety or depression at about twice the rate of people without a history of cancer” – that’s approximately 2.5 million people (Hawkins).
This is a massive number, and one that has not gone unnoticed by both physical and mental health professionals. In the 1990s, a group of health professionals from Stanford University came together to observe the effects of therapy on women with metastatic breast cancer; they had 125 women partake in the study, split into two groups. 64 of the women with breast cancer were assigned to the “intervention”, and 61 were assigned to the control group. All of the women were given educational materials on the subject of coping with breast cancer, while the women in the intervention group also attended weekly group therapy. The study described the group therapy as “[involving] the creation of a supportive environment in which participants were encouraged to confront their problems, strengthen their relationships, and find enhanced meaning in their lives. The intervention was unstructured, with therapists trained to facilitate discussion of . . . themes in an emotionally expressive rather than a didactic format” (Classen). Data was collected every four months in the first year and every six months in the years that followed. Participants were interviewed and given surveys to monitor their mental health, happiness, and general well-being, as well as their mindset on having cancer. Looking at the data, the researchers were easily able to see that “participants in the treatment condition showed a significantly greater decline in traumatic stress symptoms . . . compared with the control condition” (Classen). Group therapy – and addressing mental health within that setting – was proven to help people with life-threatening illnesses and some of the highest rates of depression in the nation.
If this topic and study spark interest for you, you can read the whole study here.
POSITIVE PSYCHOLOGY AND PHYSICAL HEALTH
However, this isn’t the only research that has been done on the topic. A study in 2010 conducted by a university in Italy found links between optimism and both mental and physical health, including how it helped patients with cancer, AIDS, and people at risk of heart problems. In their research, they found that, in patients with neck or head cancer, those that were optimists and actively practiced optimism “manifested significantly greater survival” one year after being diagnosed when compared to those that identified as pessimists and / or did not actively practice optimism. They also discovered that “dispositional optimism, less avoidant coping strategies and lower level of depression positively [influenced] progression of the illness in patients suffering from AIDS” (Conversano). While being a pessimist does not mean that one will have a lower chance of survival, we do know that optimists often see improvement in their conditions and feel better prepared to emotionally deal with the effects of having a long-term, life-threatening disease. Practicing optimism helps your brain build pathways between happy thoughts and happy memories, meaning that it becomes easier to think with a positive mindset; optimism also helps moderate your brain’s reaction to stress, meaning that one becomes more capable of handling their anxiety when the brain picks up on a stressor or triggering thought (Conversano).
Optimism is an integral part of positive psychology and plays a heavy role in one of the most prevalent and powerful theories within the field: the Broaden-and-Build Theory. The Broaden-and-Build Theory seeks to use the daily practice of optimism and reflecting on your emotions to develop an upward spiral in one’s mental health and make it easier for the brain to connect to positive feelings. The “Broaden” part of the theory comes from the realization that positive emotions create non-specific, broad, cognitive changes that can lead to both behavioral and lifestyle changes through something called action-thought tendencies. Action-thought tendencies are suggestions that our brain gives us about our attention, creative problem-solving, and flexibility, which help the brain grow and different cortexes connect. One resource on the theory describes this aspect of the theory as “positive emotions . . . broaden[ing] and expand our attention, fueling novel approaches to thought and action” (Conway). By fostering these connections and focusing on positive emotions, one can begin to create growth and adaptation in the brain, which ultimately leads to life-long effects on one’s mental health, risks of depression and anxiety, and overall sense of well-being (Conway).
HOW DO WE CREATE CHANGE?
So, knowing this, how can we take the steps and connect these proven psychological practices to one of the groups with the highest rates of anxiety and depression – patients in hospitals? For a start, many hospitals around the country already have solid systems in place for supporting their patients’ mental health, whether those patients are there for an hour or for a year. Here is an interview I conducted with Dr. Stephen “PB” Tilghman – who works in the ER at Swedish Hospital in Seattle – in which we discuss what a typical day for him looks like and how mental health and grief are handled by healthcare professionals in the United States.
He gave me an insider look into how doctors can learn to help patients with mental problems as well as physical ones – while they should not be trusted as a therapist or mental health professional, they still need to be able to instill in patients a sense of safety, security, and calm. While many hospitals and doctors are beginning to realize this in recent years, that’s still far from the ideal scenario. So how do we begin to bring positive psychology into a hospital setting? My answer is simple and refers to an earlier portion of my findings – we use supportive group therapy.
Now, you might be wondering: why group therapy? For starters, “support groups have the potential to be a potent and cost-effective form of psychosocial treatment for patients with cancer” (Classen). Not only can you affect multiple patients at the same time, there’s also a proven psychological effect to discussing your problems and worries with people who have undergone the same experiences. Studies have shown that humans are drawn to small groups and find safety and well-being in being in groups that share a common factor with them, even if the conditions they’re sharing are grim and life-threatening. For example, in World War II London during the Blitz, “psychiatric hospitals around the country saw admissions go down” (Junger), as did suicide rates. This was due to the connection that all Londoners felt with one another – they were undergoing an incredibly difficult time in their lives, but they had a whole city of people who felt the same way. An Irish psychologist who monitored this phenomenon during the riots of 1969 and 1970 concluded that, “‘When people are actively engaged in a cause their lives have more purpose with a resulting improvement in mental health’” (Junger 49). He also noted that “‘people will feel better psychologically if they have more involvement in their community’” (Junger 49), a finding that has been mirrored by many other psychological studies – including by Mass Observation – conducted on people during wartime and natural disasters.
Group therapy allows people to foster well-being both through the sense of connection and community as well as by practicing positive psychology techniques. One specific technique that I’ve mentioned has been the Broaden-and-Build theory, which helps to foster positive emotions and optimism, two aspects of positive psychology that have been proven to affect mental health and well-being. Through group therapy, licensed therapists and medical social workers could guide patients through activities that are rooted in the Broaden-and-Build theory, taking the feelings and worries patients have and using aspects of positive psychology to ease them and build a stronger positive foundation. This would allow long-term patients can decrease their risk of depression and anxiety as well as lower the effect it has on them when they begin the therapy program; by lowering rates of depression and anxiety, well-being in hospitals would drastically increase. While crafting a therapy program is difficult due to the different nature of patients and their conditions, there are 5 main things that should be kept consistent. Those 5 things are:
- Let the patients present their needs and craft the program to meet them. You cannot successfully help people if you are not addressing the needs that they feel are most prevalent in their lives.
- Encourage daily practice of positive psychology concepts such as optimism and gratitude. While practicing weekly when you meet as a group is still effectual, studies have shown the more often you practice, the faster you get results. You will not begin to see true change unless you put in the time and the effort into the concepts.
- Don’t bulldoze over the patients. By giving the patients time to talk on their own and relate to one another about the struggles they are facing, you are fostering connections. Connections through shared experiences are, as I’ve mentioned, incredibly beneficial to mental health. Don’t let them talk the whole time you meet but give them a fair chance to interact with one another and form supportive relationships.
- Encourage family members to practice, too. It’s hard to get through a new goal or practice alone – that’s why most people give up their New Years Resolutions so early. By having family or friends practice positive psychology alongside the patient they are being provided with more motivation to actually practice and observe the concepts.
- Remind them that results take time. They will not see immediate change within a week, and most likely not within a month. There are certain exercises, such as gratitude letters, that can make one feel better in the moment, but that change will not be lasting. However, just because something doesn’t feel like it’s working doesn’t mean that it’s not – changing your brain takes time.
For the millions of people in the United States that live with cancer or another long-term disease, mental health is a rising and very troublesome issue. They are more at risk to develop anxiety or depression and have some of the lowest rates of happiness and well-being in the nation. However, we can fix that! By instituting better mental health practices into hospitals that use positive psychology, we can help to improve the mental health and sense of well-being in these patients, which will ultimately lead to a happier life. Through group therapy centering around optimism and the Broaden-and-Build Theory, patients can work to change their brain and create lasting connections that all work to improve their mental health. It takes time and systemic change, but it is something that needs to be done. Mental health in our nation’s healthcare state, is a drastic, over-looked issue, and one that needs to be fixed; everyone has a right to physical and mental well-being – why must we only focus on the physical?
Here I’ve attached a Flipgrid, which is a site where you can post thoughts in video form and interact with other people’s videos! My questions for you are: How do you think the healthcare system could improve? How else could mental health and well-being be improved in hospitals? Were you surprised by anything you learned here? What stuck out to you the most? What would you want to learn more about?
Classen C, Butler LD, Koopman C, et al. Supportive-Expressive Group Therapy and Distress in Patients With Metastatic Breast Cancer: A Randomized Clinical Intervention Trial. Arch Gen Psychiatry. 2001;58(5):494–501. doi:10.1001/archpsyc.58.5.494
Conversano, Ciro et al. “Optimism and its impact on mental and physical well-being.” Clinical practice and epidemiology in mental health : CP & EMH vol. 6 25-9. 14 May. 2010, doi:10.2174/1745017901006010025
Conway, Anne M. “The Broaden and Build Theory of Positive Emotions: Form, Function, and Mechanisms.” The Oxford Handbook of Happiness, by Susan A. David et al., Oxford, Oxford UP, 2013, pp. 17-34.
Hawkins NA, Soman A, Buchanan Lunsford N, Leadbetter S, Rodriguez JL. Journal of Clinical Oncology 2016. External Journal of Clinical Oncology 2016.
Junger, Sebastian. Tribe. London, Fourth Estate, 2016.
Rui P, Okeyode T. National Ambulatory Medical Care Survey: 2015 State and National Summary Tables. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2015_namcs_web_tables.pdf.