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Annals of Behavioral Medicine
Published in: Annals of Behavioral Medicine 1/2010

Open Access 01-02-2010 | Original Article

Positive Psychology in Cancer Care: Bad Science, Exaggerated Claims, and Unproven Medicine

Authors: James C. Coyne, Ph.D., Howard Tennen, Ph.D.

Published in: Annals of Behavioral Medicine | Issue 1/2010

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Abstract

Background

Claims of positive psychology about people with cancer enjoy great popularity because they seem to offer scientific confirmation of strongly held cultural beliefs and values.

Purpose

Our goal is to examine critically four widely accepted claims in the positive psychology literature regarding adaptational outcomes among individuals living with cancer.

Methods

We examine: (1) the role of positive factors, such as a “fighting spirit” in extending the life of persons with cancer; (2) effects of interventions cultivating positive psychological states on immune functioning and cancer progression and mortality; and evidence concerning (3) benefit finding and (4) post-traumatic growth following serious illness such as cancer and other highly threatening experiences.

Results

Claims about these areas of research routinely made in the positive psychology literature do not fit with available evidence. We note in particular the incoherence of claims about the adaptational value of benefit finding and post-traumatic growth among cancer patients, and the implausibility of claims that interventions that enhance benefit finding improve the prognosis of cancer patients by strengthening the immune system.

Conclusion

We urge positive psychologists to rededicate themselves to a positive psychology based on scientific evidence rather than wishful thinking.
Footnotes
1
Our discussion of post-traumatic growth is based in part on Tennen and Affleck (2008).
 
Literature
1.
Peterson C. Forward. In: Lopez S, Snyder CR, eds. Oxford handbook of positive psychology. New York: Oxford University Press; 2009:xxiii-xxiv.
2.
Seligman M, Csikszentmhhalyi M. Positive psychology: An introduction. Am Psychol. 2000; 55: 5–14.CrossRefPubMed
3.
Peterson C, Steen TA. Optimistic explanatory style. In: Snyder CR, Lopez SJ, eds. Handbook of positive psychology. New York: Oxford University Press; 2002: 244–256.
4.
Antoni MH, Lutgendorf S. Psychosocial factors and disease progression in cancer. Curr Dir Psychol Sci. 2007; 16: 42–46.CrossRef
5.
Lutgendorf S, Seigal S, Costanzo E. Psychosocial influences in oncology: An expanded model of biobehavioral mechanisms. In: Ader R, Cohen N, Felten D, eds. Psychoneuroimmunology IV. San Diego: Elsevies; 2007: 869–896.CrossRef
6.
Fredrickson BL. The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. Am Psychol. 2001; 56: 218–226.CrossRefPubMed
7.
Bonanno G. Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely adverse events? Am Psychol. 2004; 59: 20–28.CrossRefPubMed
8.
Zautra AJ, Johnson LM, Davis MC. Positive affect as a source of resilience for women in chronic pain. J Consult Clin Psych. 2005; 73(2): 212–220.CrossRef
9.
Patterson JT. The dread disease: Cancer and the modern American culture. Cambridge: Harvard University Press; 1987.
10.
Aspinwall LG, MacNamara A. Taking positive changes seriously—toward a positive psychology of cancer survivorship and resilience. Cancer. 2005; 104(11): 2549–2556.CrossRefPubMed
11.
Greer S, Morris T, Pettingale KW. Psychological response to breast-cancer—effect on outcome. Lancet. 1979; 2(8146): 785–787.CrossRefPubMed
12.
Watson M, Haviland JS, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: A population-based cohort study. Lancet. 1999; 354(9187): 1331–1336.CrossRefPubMed
13.
Petticrew M, Bell R, Hunter D. Influence of psychological coping on survival and recurrence in people with cancer: Systematic review. Brit Med J. 2002; 325(7372): 1066–1069.CrossRefPubMed
14.
Watson M, Homewood J, Haviland J, Bliss JM. Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort. Eur J Cancer. 2005; 41(12): 1710–1714.CrossRefPubMed
15.
Phillips KA, Osborne RH, Giles GG, et al. Psychosocial factors and survival of young women with breast cancer: A population-based prospective cohort study. J Clin Oncol. 2008; 26(28): 4666–4671.CrossRefPubMed
16.
Kleefstra N, Landman GW, Houweling ST, et al. Prediction of mortality in type 2 diabetes from health-related quality of life (ZODIAC-4). Diabetes Care. 2008; 31(5): 932–933.CrossRefPubMed
17.
18.
Chida Y, Steptoe A. Positive psychological well-being and mortality: A quantitative review of prospective observational studies. Psychosom Med. 2008; 70(7): 741–756.CrossRefPubMed
19.
Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Prac Oncol. 2008; 5(8): 466–475.CrossRef
20.
Andersen BL, Yang HC, Farrar WB, et al. Psychologic intervention improves survival for breast cancer patients a randomized clinical trial. Cancer. 2008; 113(12): 3450–3458.CrossRefPubMed
21.
Rensing L, Rippe V. Is psychological stress a risk factor for the induction and development of tumors? Onkologe. 2009; 15(8): 784–791.CrossRef
22.
Glass GV, McGaw B, Smith ML. Meta-analysis in social research. Beverly Hills: Sage; 1981.
23.
Rosenthal R, Rubin DB. Meta-analytic procedures for combining studies with multiple effect sizes. Psychol Bull. 1986; 99(3): 400–406.CrossRef
24.
Levav I, Kohn R, et al. Cancer incidence and survival following bereavement. Am J Public Health. 2000; 90(10): 1601–1607.CrossRefPubMed
25.
Kvikstad A, Vatten LJ, et al. Widowhood and divorce in relation to overall survival among middle-aged Norwegian Women with cancer. Brit J Cancer. 1995; 71(6): 1343–1347.PubMed
26.
Kvikstad A, Vatten LJ. Risk and prognosis of cancer in middle-aged women who have experienced the death of a child. Int J Cancer. 1996; 67(2): 165–169.CrossRefPubMed
27.
Michael YL, Carlson NE, Chlebowski RT, et al. Influence of stressors on breast cancer incidence in the women’s health initiative. Health Psychol. 2009; 28(2): 137–146.CrossRefPubMed
28.
Lechner SC, Tennen H, Affleck G. Benefit finding and growth. In: Lopez S, Snyder CR, eds. Oxford handbook of positive psychology. 2nd ed. New York: Oxford University Press; 2009: 633–640.
29.
Tennen H, Affleck G. Benefit finding and benefit-reminding. In: Snyder CR, Lopez SJ, eds. Handbook of positive psychology. New York: Oxford University Press; 2002: 584–597.
30.
Taylor SE. Adjustment to threatening events: A theory of cognitive adaptation. Am Psychol. 1983; 38: 1161–1173.CrossRef
31.
McAdams DP. The stories we live by: Personal myths and the making of the self. New York: William Morrow; 1993.
32.
Brickman P, Coates D, Janoff-Bulman R. Lottery winners and accident victims: Is happiness relative? J Pers Soc Psychol. 1978; 36: 917–927.CrossRefPubMed
33.
Ross M. Relation of implicit theories to the construction of personal histories. Psychol Rev. 1989; 96: 341–357.CrossRef
34.
35.
Stanton AL, Bower JE, Low CA. Posttraumatic growth after cancer. In: Calhoun LG, Tedeschi RG, eds. Handbook of posttraumatic growth: Research and practice. Mahwah: Lawrence Erlbaum Associates; 2006: 138–175.
36.
Zoellner T, Maercker A. Posttraumatic growth in clinical psychology: A critical review and introduction of a two component model. Clin Psychol Rev. 2006; 26: 626–653.CrossRefPubMed
37.
Sumalla EC, Ochoa C, Blanco I. Posttraumatic growth in cancer: Reality or illusion. Clin Psych Rev. 2009; 29: 24–33.CrossRef
38.
Lechner SC, Carver CS, Antoni MH, Weaver KE, Phillips KM. Curvilinear associations between benefit finding and psychosocial adjustment to breast cancer. J Consult Clin Psych. 2006; 74: 828–840.CrossRef
39.
McGregor BA, Antoni MH, Carver CS, et al. Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. J Psychosom Res. 2004; 56(1): 1–8.CrossRefPubMed
40.
Antoni MH, Lehman JM, Kilbourn KM, et al. Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol. 2001; 20(1): 20–32.CrossRefPubMed
41.
Lechner SC, Carver CS, Antoni MH. Challenges in studying positive change after adversity: Illustrations from research on breast cancer. In: Park CL, Lechner SC, Antoni MH, Stanton AL, eds. Medical illness and positive life change: Can crisis lead to personal transformation? Washington: American Psychological Association; 2009: 51–62.
42.
Spiegel D, Bloom JR, Kraemer H, Gottheil E. Psychological support for cancer patients. Lancet. 1989;2(8677):1447–1447.CrossRefPubMed
43.
Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial support on survival in metastatic breast cancer. New Engl J Med. 2001; 345(24): 1719–1726.CrossRefPubMed
44.
Spiegel D, Butler LD, Giese-Davis J, et al. Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer—a randomized prospective trial. Cancer. 2007; 110(5): 1130–1138.CrossRefPubMed
45.
Ehrenreich B. Bright-sided: How the relentless promotion of positive thinking has undermined America. NY: Metropolitan Books; 2009.
46.
Cameron LD et al. Cognitive and affective determinants of decisions to attend a group psychosocial support program for women with breast cancer. Psychosom Med. 2005; 67: 584–589.CrossRefPubMed
47.
Andersen BL, Farrar WB, Golden-Kreutz DM, et al. Psychological, behavioral, and immune changes after a psychological intervention: A clinical trial. J Clin Oncol. 2004; 22(17): 3570–3580.CrossRefPubMed
48.
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 Psychiat. 2001; 58(5): 494–501.CrossRefPubMed
49.
Classen CC, Kraemer HC, Blasey C, et al. Supportive-expressive group therapy for primary breast cancer patients: A randomized prospective multicenter trial. Psycho-Oncol. 2008; 17(5): 438–447.CrossRef
50.
Coyne JC, Lepore SJ, Palmer SC. Efficacy of psychosocial interventions in cancer care: Evidence is weaker than it first looks. Ann Behav Med. 2006; 32(2): 104–110.CrossRefPubMed
51.
Babyak MA. What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med. 2004; 66(3): 411–421.CrossRefPubMed
52.
Scott-Sheldon LA et al. Stress management interventions for HIV+ adults: A meta-analysis of randomized controlled trials, 1989 to 2006. Health Psychol. 2008; 27(2): 129–139.CrossRefPubMed
53.
Miller GE, Cohen S. Psychological interventions and the immune system: A meta-analytic review and critique. Health Psychol. 2001; 20(1): 47–63.CrossRefPubMed
54.
de Visser KE, Eichten A, Coussens LM. Paradoxical roles of the immune system during cancer development. Nat Rev Cancer. 2006; 6(1): 24–37.CrossRefPubMed
55.
Nielsen NR, Gronbaek M. Stress and breast cancer: A systematic update on the current knowledge. Nat Clin Prac Oncol. 2006; 3(11): 612–620.CrossRef
56.
Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. J Am Med Assoc. 2007; 298(14): 1685–1687.CrossRef
57.
Stefanek ME, Palmer SC, Thombs BD, Coyne JC. Finding what is not there: Unwarranted claims of an effect of psychosocial intervention on recurrence and survival. Cancer. (in press).
58.
Coyne JC, Stefanek M, Palmer SC. Psychotherapy and survival in cancer: The conflict between hope and evidence. Psychol Bull. 2007; 133(3): 367–394.CrossRefPubMed
59.
Coyne JC, Thombs BD, Stefanek M, Palmer SC. Time to let go of the illusion that psychotherapy extends the survival of cancer patients: Reply to Kraemer, Kuchler, and Spiegel (2009). Psychol Bull. 2009; 135(2): 179–182.CrossRef
60.
Holland JC, Lewis S, eds. The human side of cancer: Living with hope, coping with uncertainty. New York, NY: Harper Collins Publishers; 2000.
61.
62.
Snyder CR, Lopez SJ, eds. Handbook of positive psychology. New York: Oxford University Press; 2002.
63.
Lopez SJ, Snyder CR, eds. Oxford handbook of positive psychology. 2nd ed. New York: Oxford University Press; 2009.
64.
Joseph S, Linley PA, eds. Trauma, recovery and growth: Positive psychological perspectives on posttraumatic stress. Hoboken: Wiley; 2008.
65.
66.
Tennen H, Affleck G. Assessing positive life change: In search of meticulous methods. In: Park CL, Lechner SC, Antoni MH, Stanton AL, eds. Medical illness and positive life change: Can crisis lead to personal transformation? Washington: APA Press; 2008: 31–49.
67.
Costa PT Jr, McCrae RR. Personality continuity and the changes of adult life. In: Storandt M, VandenBos GR, eds. The adult years: Continuity and change. The master lectures. Washington DC; 1989; 8: 41–77.
68.
Henry B, Moffitt TE, Caspi A, Langley J, Silva PA. On the ‘remembrance of things past’: A longitudinal evaluation of the retrospective method. Psychol Assess. 1994; 6: 92–101.CrossRef
69.
Robins RW, Noftle EE, Trzesniewski KH, Roberts BW. Do people know how their personality has changed? Correlates of perceived and actual personality change in young adulthood. J Pers. 2005; 73: 489–521.CrossRefPubMed
70.
Wilson AE, Ross M. From chump to champ: People’s appraisals of their earlier and present selves. J Pers Soc Psychol. 2001; 80: 572–584.CrossRefPubMed
71.
Kirkpatrick LA, Hazan C. Attachment styles and close relationships: A four-year prospective study. Person Relationship. 1994; 1: 123–142.CrossRef
72.
Karney BR, Coombs RH. Memory bias in long-term close relationships: Consistency or improvement? Pers Soc Psychol Bull. 2000; 26: 959–970.CrossRef
73.
Karney BR, Frye NE. “But we’ve been getting better lately”: Comparing prospective and retrospective views of relationship development. J Pers Soc Psychol. 2002; 82: 222–238.CrossRefPubMed
74.
Chapman LJ. Illusory correlation in observational report. J Verbal Learn Verbal Behav. 1967; 6: 151–156.CrossRef
75.
Schacter DL. The seven sins of memory: How the mind forgets and remembers. New York: Houghton Mifflin; 2001.
76.
Meehl PE. When shall we use our heads instead of the formula? J Couns Psychol. 1957; 4: 268–273.CrossRef
77.
Frazier P, Tennen H, Gavian M, Park C, Tomich P, Tashiro T. Does self-reported post-traumatic growth reflect genuine positive change? Psychol Sci. 2009; 20: 912–919.CrossRefPubMed
78.
Tedeschi R, Calhoun LG. The posttraumatic growth inventory: Measuring the positive legacy of trauma. J Trauma Stress. 1996; 9: 455–471.CrossRefPubMed
79.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington: American Psychiatric Association; 1994: 4.
80.
Yanez BR, Stanton AL, Hoyt MA, Tennen H, Lechner S. Predicting stress-related growth: How do distinct forms of growth relate to coping and adjustment to adversity? Unpublished manuscript; 2009.
81.
Evans DL, Leserman J, Perkins DO, et al. Severe life stress as a predictor of early disease progression in HIV infection. Am J Psychiatr. 1997; 154: 630–634.PubMed
82.
Glaser R, Kiecolt-Glaser JK. Stress-induced immune dysfunction: Implications for health. Nat Rev Immunity. 2005; 5: 243–251.CrossRef
Metadata
Title
Positive Psychology in Cancer Care: Bad Science, Exaggerated Claims, and Unproven Medicine
Authors
James C. Coyne, Ph.D.
Howard Tennen, Ph.D.
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
Annals of Behavioral Medicine / Issue 1/2010
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-009-9154-z

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