Positive thinking: A spoonful of optimism

Some people are convinced that the healing power of the mind can help overcome cancer. Others disagree. Now the largest-ever study into the effects of positive thinking aims to find out, reports Clare Rudebeck

While she had cancer, Nicky Jones would sit down for 10 minutes every day and imagine the cancerous cells in her body. She would then picture herself sitting under a waterfall, with the cancer being washed away and replaced by healthy cells. On other days, she would imagine the sun melting the disease away. Her breast cancer is now in remission and she believes that this technique, known as "guided imagery", is partly responsible.

Can the mind wield power over cancer? Nicky believes it can. She has now lived with the disease for eight years and has kept a positive mental attitude about her chances of survival throughout. "I have this feeling that since my body has somehow created the cancer – after all, cancer cannot be caught, it develops within the body – I must therefore somehow have the capability to get rid of it. And if not cure it, then certainly control it," says Nicky, who runs her own advertising agency in Hertfordshire.

While few cancer patients currently use guided imagery, many are encouraged to adopt a "fighting spirit". However, there is no convincing scientific evidence that the mental state of a patient makes any difference to the progress of their cancer. Is positive thinking just a comforting sop to patients whom medicine can not help? Or will science soon prove what some cancer patients have suspected for years – that staying positive can help you to stay alive?

A new study may prove decisive. Professor Leslie Walker, a director of the Institute of Rehabilitation at Hull University, has just begun the largest ever trial into the impact of thought processes on the body's ability to fight cancer. The three-year trial, involving 180 bowel-cancer patients, hopes to show that patients who, like Nicky Jones, use relaxation and guided imagery, will be able to boost their body's natural defences against cancer, ie their white blood cells.

"The notion that images might have powerful effects on us is certainly not new," says Professor Walker. "The advertising industry knows very well how effective the image is in modifying feelings and behaviour. We are interested in using a patient's ability to visualise white blood cells improving their health." The patients will imagine their white blood cells attacking the cancer. The hope is that what the patients imagine happening within their bodies will then actually occur. This is exactly what happened in a smaller study that Professor Walker conducted on 96 breast-cancer patients, which he presented to the British Psychological Society in 2000.

But can the power of the mind help cancer patients to live longer? Those involved in Professor Walker's earlier study may have boosted their white blood cells, but they did not survive any longer. In fact, there is still too little research in the area to be sure. It is hoped that the new study will make the picture clearer. "The jury is still out," says Professor Walker. "There is no convincing evidence that psychological intervention does improve survival. But then, there is no convincing evidence that it doesn't either."

Others are less ambivalent. Nicky Jones is convinced. And the Bristol Cancer Help Centre, where she learnt guided-imagery techniques, has been encouraging cancer sufferers to use their minds to heal their bodies for 23 years. "People are encouraged to play an active role in their health," says Helen Cooke, director of therapy at the centre. "We help them to look at ways to trigger the self-helping mechanisms within the body."

Patients at the centre continue with conventional medical treatment, but also use complementary therapies, including nutritional therapy, spiritual healing, art and music therapy, massage and relaxation. "People explore how their diagnosis has affected them psychologically," says Cooke, "how they feel, how they're coping, the effect their illness is having on their family." Underpinning the centre's approach is the belief that lifestyle and mental attitude affect the body's ability to resist or succumb to disease.

Cooke's experiences at the centre have led her to believe that mental attitude can help cancer sufferers to live longer. "I would never claim it was anything more than anecdotal evidence," she says. "But I do believe that scientists are only now catching up with us."

But the centre's approach is not just about survival rates. "A cancer patient I spoke to this morning said, 'I don't want to spend the next six months dying. I want to get on with living'," says Cooke. "The majority of people don't come because they think we can help them live longer. They come for emotional and spiritual support." As a result, Cooke believes that, even if a positive mental attitude cannot stop the spread of the disease, its impact on a patient's quality of life makes the centre's approach valuable to the future of cancer care.

Others strongly disagree. "The message that the way we cope with cancer might make a difference to how it progresses is pernicious," says Clare Moynihan, a senior research fellow at the Institute of Cancer Research. "I see the damage it causes every day. I get men coming to see me who say, 'I can't fight. My wife wants me to be positive and I can't'. They blame themselves if the disease progresses."

Moynihan says that the belief – despite the absence of scientific evidence – in the power of the mind to stop cancer puts pressure on sufferers who do not find it easy to be cheerful when faced with a bad prognosis. As a result, she believes that cancer patients must be freed from the pressure to be positive. "We need to allow people with cancer to have days when they can say that they are down," she says.

Moynihan's position is supported by scientific evidence. A review published in the British Medical Journal last November looked at 26 studies that asked cancer patients about their mental state. These patients had not been taught techniques to help them cope with their diagnosis. They were simply asked how they were feeling. The review found that whether they were in denial, feeling hopeless, or fostering a fighting spirit, their chances of survival were the same.

She points out that the message that recovery is partially in patients' hands is only found when diseases are not easily cured. It acts as a convenient smokescreen. "You don't hear it when someone has flu or bronchitis. You used to hear it with TB, and now you also hear it with multiple sclerosis and Aids," says Moynihan, a sociologist who has researched cancer treatment for 22 years. When, three years ago, Moynihan discovered that she herself had cancer of the uterus, she says that it was not relaxation techniques and guided imagery that she needed to get her through, but a good relationship with her hospital. "One time, I went to the hospital for an MRI scan and they didn't have my name down. I had to wait for two hours. That was the most distressing thing. I remember thinking, am I going to make it?"

In fact, improving the relationship between a hospital and its cancer patients may itself have a positive effect on survival rates. Professor Walker's first study into the effect of relaxation and guided imagery on 96 breast-cancer sufferers had unexpected results. The 46 patients who used guided imagery and relaxation survived no longer than the others. However, all 96 patients involved in the study survived for longer than average. Professor Walker believes this was because they were all treated in a centre dedicated to keeping patient anxiety to a minimum. The Aberdeen Behavioural Oncology Unit is one of only three cancer units in the country that offer a fully integrated service – surgery, chemotherapy and patient support are all available on the same site. The other two centres have since been set up by Professor Walker in Hull.

"Appointments are unnecessary – patients are welcome to pop in or phone any time. The kettle is always on," says Walker. This means that if a breast-cancer patient spots a new lump one morning, she can see a doctor and organise the necessary treatment before the day is out. Staff are trained in how to spot patients' worries and dispel them as quickly as possible.

By identifying and offering solutions to these anxieties, the staff at these units make having cancer treatment a far less stressful experience. It would seem that giving patients reasons to feel positive about the success of their cancer treatment – instead of asking them to conjure up optimism out of thin air – may well have an effect on their chances of survival.

Bristol Cancer Help: 0117 980 9505