I had seen Asha off and on for psychotherapy, and she sat in my office again after an absence of a few months. She said “I watched your TEDx talk on the link between childhood trauma and cancer.” (click here to watch, here and here to learn more). I nodded, recalling that she had multiple Adverse Childhood Experiences. Her parents had split up when she was in preschool, the result of their heavy drinking and violence to each other. Her Dad remarried, and Asha’s step-mother had a complete loser of a brother. He sexually abused her for months, and when she disclosed, she was told to stop lying.[i] When she entered therapy with me, she was depressed from her deep shame. She believed that she was a failure and had to push herself relentlessly. Asha continued “I totally believe that what I went through as a kid is affecting me.” Her eyes filled with tears. “I don’t want to die early. What do I do?”
Her fear-filled words vibrated in my brain, and I took a breath. Thankfully, there was an answer to her anguished question. One of the pathways from psychological injuries in childhood to cancer in adulthood was through the process of inflammation. I discussed this in my previous post (here). We saw that when a person is injured the body goes into inflammation, releasing messenger proteins called cytokines that dilate blood vessels, activate the immune system, encourage proliferation of cells to rebuild the damaged area, and have blood vessels grow. However, if inflammation is chronic due to the person having multiple Adverse Childhood Experiences, then the same process can accelerate a cancer cell’s growth and proliferation.[ii]
But inflammation is not permanent. It winds down when the physical injury is healed. In a fascinating parallel, the evidence is accumulating that when the psychological injuries are healed, that inflammation decreases as well. There are now dozens of studies, looking at the impact of psychotherapy on the immune system, and markers of inflammation.[iii] [iv] The data is clear, that therapy was associated with a 14.7% improvement in beneficial immune system function. Therapy also led to a 18.0% decrease in harmful immune system function over time. You may be a bit puzzled by this last sentence, wondering how the immune system can be harmful. This is where the cytokines (Interleukin-6 and Tumor Necrosis Factor) come in, because they signal the body to go into inflammation. Since therapy reduces these cytokines, there is less inflammation.
Drilling a bit deeper, there were a couple types of therapy that were more effective than the others. Combined interventions and Cognitive Behavioral Therapy (CBT) were more helpful than other therapies. CBT therapy was associated with a 14.8% improvement in beneficial immune system function, and a 33.8% decrease in harmful immune system function over time. Combined interventions were even more effective, or interventions that included a group, rather than just one on one sessions with a therapist.
You may be wondering how this stacks up against medications for inflammation. Actually, quite well. To begin, there are no negative side effects to psychotherapy. When I worked with Asha, we looked at her deeply held belief that she was worthless. We closely examined where it came from and took a variety of steps to change it. She started to recognize that she had genuine worth as a person. There is no way that changing her beliefs would cause heart failure, or low levels of white blood cells, or liver problems. Yet these are some of the side effects of infliximab, which is a high powered medication to reduce inflammation in persons with an autoimmune disorder.
CBT also is just as effective as infliximab at reducing proinflammatory markers, even when the drug is given at the maximum dose and frequency. Cost is another major issue. CBT costs about $2000 for ten sessions, while the drug costs approximately $25000 per patient per year.[v] Finally, therapy is longer lasting. The positive effects are seen in the immune system 6 months or more after therapy ends. Once people have shifted their beliefs, learned how to navigate their emotions, and taken up new patterns of behavior, these become part of them. However, a pill or injection fades with time.
It was fascinating to listen to Asha as she spoke in our therapy sessions. Early on, when she said “I screwed up, I hate myself so much” I winced a bit. I knew the shame and anger at herself was also inflaming her body, potentially causing any cancer cells to proliferate. As months passed, her self-talk shifted. She would say “I made a mistake. I am not happy about it, but I am trying really hard and learning each time from a setback. I am growing all the time.” Her words not only soothed herself, but they dialed down the inflammation. Mind and body are so inter-connected, that as her shame diminished, her immune system settled into calmness.
You may have the same fear that Asha had, that because of your psychological injuries, that cancer can take root. There is good news. Psychological healing through good psychotherapy can change your path. Psychotherapy is just as effective as advanced medications in reducing inflammation, and it is one tenth the price. It has no negative side-effects, and it is longer lasting. Not only are these powerful advantages, you can access them right away. You can seek out a psychotherapist, preferably one that measures in session. Together, you can start the process of healing your psychological injuries, and de-escalating your inflammation.
Dr. Eric Kuelker
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