The Impact of Cancer on Mental Health

KEY POINTS

• Cancer diagnosis can cause severe mental distress to patients as well as their families and friends.
• Psychedelic therapy is used for depression and anxiety in cancer patients, and has potential for loved ones.
• Treating a patient and a loved one together can help them manage mental health challenges together.
• Trust and transparency are paramount for psychedelic treatments.

A cancer diagnosis can be terrifying and often has a destabilizing impact on a person’s mental health. This impact is also felt by the patient’s family and friends, who find their world turned upside down overnight.

Traditionally, cancer care has focused on the physical dimensions of the patient experience, but there is increasing recognition of the mental aspects and the need to support loved ones involved. This is not a trivial issue: Approximately 20–25% of patients and 13-58% of caregivers are diagnosed with adjustment disorder (AD), a psychological disorder associated with depression, reduced quality of life, and risk of suicide.

Psychedelic-Assisted Therapy (PAT) in Cancer Care

I’ve worked as a therapist since 2017 and have seen the destructive reach of cancer, personally and professionally. I became interested in psychedelic-assisted therapy (PAT) because I believed it could provide healing for patients when delivered within the right environment. PAT combines therapy or psychological support with the administration of psychedelic substances such as psilocybin and MDMA and is being investigated for the treatment of various mental health conditions. Interest in its application to cancer patients has seen a resurgence in recent years. A number of studies, including two from Johns Hopkins University and New York University, have looked at psilocybin therapy for depression and anxiety in cancer patients. However, there has been little study of PAT with patients and loved ones.

Applying Psychedelic-Assisted Therapy to the Patient-Caregiver DYAD

This potential of MDMA-assisted therapy to address emotional distress is being explored in a clinical study at our clinic, Sunstone Therapies, for adjustment disorder in dyads of patients with cancer and a concerned significant other. The study is looking at the effectiveness of the therapy in managing AD and in creating more joyful and connected relationships while at least one partner is living with a cancer diagnosis.

MDMA as a molecule has the potential to be particularly well-suited to addressing mental distress in cancer patients, as it decreases activity in the amygdala, reducing fear, and increases levels of oxytocin, serotonin, and dopamine. While more research is needed into the mechanisms of action of MDMA, it appears to help the brain be more receptive to change.

MDMA is thought to widen the window of tolerance in the nervous system, linking emotions and memory to the ability to think logically. Experiences previously avoided no longer feel so overwhelming. This may lead to greater connectedness between partners as well as a renewed sense of self. The accompanying therapy provides psychological support during the experience, as well as guidance in preparation and integration sessions before and after the drug administration.

PAT involves an altered state of consciousness and requires a greater willingness to dive into the unknown than does more traditional therapy. In developing the dyad study, we’ve drawn on a deep well of resources taken from couples therapy, mindfulness-oriented therapies, and CALM, a therapeutic intervention for working with individuals living with cancer.

Our intention was to create an iterative framework that acknowledges the unique focus of this study and the need for innovative mental health treatments for this population. The participants engage in individual and joint therapy before and after each session to integrate the psychological material that arises. We hypothesize that this protocol may help reduce fear in the face of a cancer diagnosis and address how to go on living when you may be dying. This can be hugely reparative for the individuals involved, as well as in their relationship with each other.

The Role of the Therapist

My work as a therapist with psychedelics, particularly in the dyad context, has highlighted the need to be mindful of how PAT can allow people to go to great depths in a short amount of time. The presence of both partners in the room allows couples to rapidly address a lot of issues head-on, with the therapist acting as a witness. Sharing the experience may facilitate the development of emotional intimacy and allow the pair to discuss things that have bee difficult to express or address. At the same time, dyadic therapy brings complexities. In addition to the cancer diagnosis, couples often come with historic, relational, cultural, and systemic issues that contribute to the pair’s mental health challenges and relationship struggles. The room dynamic is also a factor: Four people are present, including the therapist and a co-therapist. This can lead to a complex network of transference, countertransference, and confidentiality, as individuals navigate deep feelings of vulnerability.

Trust and transparency are paramount; there’s a need to acknowledge the intimacy and intensity of the experience up front. The job of therapists is to earn trust, to keep participants physically safe, and to ensure psychological boundaries are there to support them. Given the time frame involved, we must also prepare for the termination of the treatment at the outset; we’re not their ongoing therapists, and it’s important to acknowledge that.

Looking Beyond the Patient and the Disease

Studies of psychedelic-assisted therapy with patients and loved ones are in their infancy, but preliminary data indicate that it could offer potential when applied to the patient-caregiver dyad. More research is needed to deepen understanding. If successful, it could advance cancer care, and enable oncologists and other medical professionals to look beyond the patient and the disease to focus on mental as well as physical health for patients and their loved ones.

References

Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. The Lancet Oncology. 2011;12(2):160–174

Asai M, Akechi T, Nakano T, et al. Psychiatric disorders and background characteristics of cancer patients’ family members referred to psychiatric consultation service at National Cancer Center Hospitals in Japan. Palliat Support Care. 2008;6(3):225–230.

Lee Y, Lin P-Y, Chien C-Y, Fang F-M. Prevalence and risk factors of depressive disorder in caregivers of patients with head and neck cancer. Psychooncology. 2015;24(2):155–161. Applying psychedelic-assisted therapy to the patient-caregiver dyad