Self Hypnosis Article

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Contemporary Hypnosis 127Contemp. Hypnosis 23(3): 127–140 (2006)Published online in Wiley InterScience(www.interscience.wiley.com) DOI: 10.1002/ch.318

A QUALITATIVE STUDY OF THE EXPERIENCE OF SELF-HYPNOSIS OR JOHREI IN METASTATIC BREAST CANCER

USING INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS

Bryan M. Bennett, Tannis M. Laidlaw, Prabudha Dwivedi, Akira Naito,John H. Gruzelier

Imperial College and Goldsmiths College, London

Abstract

In this paper we explore the meaning and experience o living with breast cancer that had

returned ater conventional treatment. We ocus on the process o learning and applyinga specic psychological intervention to aid with the coping process. O sixteen womenwho were randomized to sel-hypnosis training, Johrei training or a control wait-listgroup, eight agreed to be interviewed. Interviews were recorded, transcribed and thenanalysed using interpretative phenomenological analysis. The major themes that concep-tualized living with the return o breast cancer were sel-identity, sel-blame, social isola-tion and eelings o being constrained. The themes relating to psychological interventionwere gaining a sense o control and empowerment, normalizing and re-attribution, and a

powerul military metaphor or dealing with the actual cancer. Copyright © 2006 British

Society o Experimental & Clinical Hypnosis. Published by John Wiley & Sons, Ltd.

Key words: breast cancer, interpretative phenomenological analysis, Johrei,sel-hypnosis

Introduction

Being diagnosed with breast cancer is a traumatic event or any woman. Degner, Hack,O’Neil and Kristjanson (2003:170) describe it as a ‘pivotal lie event’. Indeed, it is a timewhen a woman is aced with many philosophical and metaphysical questions, as well as

with dicult choices. During this search or meaning and answers to questions, the ear that the disease may return or spread may also lead to additional anxiety and distress.For some it does return.

Researchers and clinicians have manipulated various psychosocial variables withsome degree o success, improving areas such as quality o lie, coping, psychologicaland spiritual well-being and physical unctioning in patients with cancer, specically

breast cancer (van Weert, Hoekstra-Weebers, Grol, Otter, Arendzen, Postema and vander Schans, 2004; Baider, Andritsch, Uziely, Goldzweig, Ever-Hadani, Homan, Krennand Samonigg, 2003; Marchioro, Azzarello, Checchin, Perale, Segati, Sampognora,Rosetti, Franchin, Pappagallo and Vinante, 1996; Lin and Bauer-Wu, 2003).

Here we examine with qualitative methods the relatively under researched issue o women’s response to the return o breast cancer and subsequent treatment. This accom-panies a quantitative study (Laidlaw Bennett Dwivedi Naito and Gruzelier 2005) The



128 Bennett et al.

ers have elicited the meanings that women subscribe to in coping with their disease(Jensen, Back-Petterson and Segesten, 2000; Landmark, Standmark and Wahl, 2001;Richer and Ezer, 2002). Studies point to the act that women nd meaning in their diseasethrough at least eight categories. The categories include: challenge, enemy, punishment,weakness, relie, strategy, irreparable loss and value. They are based on the work o

Lipowski (1970) and coping strategies. Lipowski identied eight areas that have beenthe ocus o much o the research in the area o coping with cancer (Barkwell, 1991; Fie,1994; Degner, 2003). Lipowski (1970) urther states that three actors are considered when a meaning is applied to illness and disease. These are intrapersonal, disease-related and environmental actors, and in combination determine the subjective meaning and the coping strategies the individual employs. Lipowski postulated that the way in whichwe experience and give meaning to our illness or disease infuences recovery. This givesrise to the opportunity that by changing the way we give meaning to illness, we may beable to infuence recovery.

However, the meanings, experiences and the reality o living with the return o breast

cancer lack the same depth o knowledge. Moreover, the experience o applying a psy-chological intervention in metastatic breast cancer rom a qualitative dimension requiresurther attention.

In this paper we explore the phenomenological aspect o learning and applying a psychological intervention and the perceived dierence made in coping with the returno the disease. Two psychological interventions were used in this study, namely sel-hypnosis and Johrei which is a Japanese non-touch healing method aimed at spiritual

purication o body and mind. Initial scientic laboratory trials in students acing thestress o examinations have shown that both interventions provided benets psychologi-cally (Laidlaw, Naito, Dwivedi, Enzor, Brincat and Gruzelier, 2003) and immunologi-cally (Naito, Laidlaw, Henderson, Farahani, Dwivedi and Gruzelier, 2003), with a

particularly strong immunological result. In act to our knowledge, the increase in thenumber o natural killer cells, which characterized the Johrei group during exam stress,has not been reported beore; the typical achievement through psychological interventionhas been maintenance o pre-stress levels refecting the buering o the stress induced reduction in the number o natural killer cells.

Sel-hypnosis has been well researched, disclosing benets or mood and putative benets or immune unction (Kiecolt-Glaser, Glaser, Strain, Stout, Tarr, Holliday and Speicher, 1986; Gruzelier et al., 2001a; Gruzelier, Smith, Nagy and Henderson, 2001b;

see Gruzelier, 2002a, 2002b or review).In this study, the sel-hypnosis intervention ocused upon two aspects o psychoneu-roimmunological research; the use o creative visualization o immune-enhancingimagery (Kiecolt-Glaser, Glaser, Strain, Stout, Tarr, Holliday and Speicher, 1986;Gruzelier, Clow, Evans, Lazar and Walker, 1998; Naito et al., 2003), and stress control(Kiecolt-Glaser, Glaser, Shuttleworth, Dyer, Ogrocki and Speicher, 1987; Laidlaw, 1994;Laidlaw, 1999; Laidlaw and Willett, 2002; Laidlaw et al., 2003). The importance o visualization has been demonstrated, by showing that the eects on immunology and health were superior in students whose hypnosis included visualization compared withthose in whom the visualization component had been replaced by urther deep relaxation

imagery (Gruzelier et al., 2001a).Johrei, the second intervention, is a Japanese non-touch, laying-on-o-hands method.a Japanese non-touch, laying-on-o-hands method., laying-on-o-hands method.laying-on-o-hands method.-hands method.hands method.

It can be classied as a type o subtle energy medicine under the complementary subtle energy medicine under the complementaryunder the complementarycomplementary



Self-hypnosis or Johrei in metastatic breast cancer 129

ling, this to the recipient through the palm o a gently outstretched hand. Johrei is based this to the recipient through the palm o a gently outstretched hand. Johrei is based this to the recipient through the palm o a gently outstretched hand. Johrei is based to the recipient through the palm o a gently outstretched hand. Johrei is based the palm o a gently outstretched hand. Johrei is based palm o a gently outstretched hand. Johrei is based a gently outstretched hand. Johrei is based gently outstretched hand. Johrei is based gently outstretched hand. Johrei is based outstretched hand. Johrei is based Johrei is based based on the concept that ‘one can heal onesel by healing others’, or the participant acts as‘one can heal onesel by healing others’, or the participant acts asone can heal onesel by healing others’, or the participant acts as’, or the participant acts as

both ‘channeller’ and receiver. Johrei has its own philosophical background, with theJohrei has its own philosophical background, with thewith thename o Johrei literally meaning ‘purication o the spirit’. Through upliting the par-literally meaning ‘purication o the spirit’. Through upliting the par-ticipant’s spiritual awareness a Johrei session aims to give unique skills or coping withohrei session aims to give unique skills or coping withskills or coping withcoping with ping withwith

illness psychologically as well as providing a relaxing experience. The experience o providing a relaxing experience. The experience o a relaxing experience. The experience o The experience o xperience o Johrei is one o a sel-contained time to be quiet, mindul and kindly, concentrating on, mindul and kindly, concentrating onmindul and kindly, concentrating on, concentrating onconcentrating oning onthe recipients’ benet as well as one’s own.’ benet as well as one’s own. benet as well as one’s own.one’s own.own..

Methodology

Participants and recruitment Patients rom this study participated in a larger quantitative study (see Laidlaw et al., 2005). All the women had been diagnosed with metastatic breast cancer, and had beenattending regular outpatient clinics at Charing Cross Hospital, London. All were given

written inormation about the study and asked to sign a consent orm beore the study began. About 100 women were initially approached with 37 agreeing to participate inthe original quantitative study. At the time o asking people to participate in the qualita-tive study involving semi-structured interviews, 8 people agreed to be interviewed: 4rom sel-hypnosis, 2 rom Johrei and 2 rom the control group (both o whom subse-quently trained in sel-hypnosis). No one reused or other than health reasons. Theresponse rate was low due to the severity o the disease. This study was approved by thelocal Research Ethics Committee o Chelsea and Westminister NHS Trust.

Training in psychological interventionAll participants were randomly assigned to one o three conditions: sel-hypnosis, Johreior wait-list control. Ater three months controls were randomized to one o the interven-tion techniques.

In the sel-hypnosis training group, 4 weekly training group sessions were held ini-tially over a month, with CDs or tapes provided or home practice. Each session wasdevoted to learning a new skill, and culminated in a hypnosis script that was to be rein-orced by home practice over the coming week. Any missed sessions were made upindividually. Ater this initial training period, group meetings were held once a month.These meetings were partially support group in ormat, but always included a new hyp-

nosis experience; some o these scripts were included in new CDs. Participants wereencouraged to practise the sel-hypnosis on a daily basis and they were able to choosewhich hypnosis they wanted to work on.

The training o Johrei also consisted o our training sessions, examining the corealso consisted o our training sessions, examining the coreed o our training sessions, examining the core principles needed to practise Johrei techniques such as ‘healing onesel by healingothers’. An introduction to Johrei philosophy emphasized the importance o awarenesso spiritual well-being, harmony and balance, aesthetics and appreciation o the naturalappreciation o the naturalthe naturalnaturalaturalalenvironment, especially natural arming practices. In essence, the practitioner, also, especially natural arming practices. In essence, the practitioner, alsoespecially natural arming practices. In essence, the practitioner, alsonatural arming practices. In essence, the practitioner, alsoknown as the ‘Channeller’, imagines light entering through their body and being con-centrated through an outstretched hand towards the recipient. The practitioner, without

touching the recipient, slowly moves their hand rom the head down to the kidney area,ront and back. The procedure takes approximately 15 minutes. The participants wererequested to practise Johrei daily with a partner however at the end o training sel



130 Bennett et al.

In both interventions, adherence to daily practice was high, with all participants indi-cating that they did practise on a daily basis during the initial our week training period.It was noted though, that ater this training period adherence ell signicantly. Partici-

pants explained that they would practise the intervention whenever they elt the need.

InterviewsEach o the interviews took place at either Charing Cross Hospital or the participant’shome, whichever was the more convenient. Researcher (TL), the only emale investigator,conducted all o the interviews primarily because o gender and sensitivity to the natureo the disease under investigation. The interviews all took place ater a three-monthtraining period o either Johrei or sel-hypnosis. All the interviews were tape-recorded with the participants’ consent, and aterwards transcribed. The interviews were semi-structured and allowed them to talk reely about any aspect o cancer and the psychologi-cal intervention that they were trained in. Each interview lasted between orty and ninetyminutes.

The intention was to talk about, and explore as much as possible, the individual and personal meaning o the cancer returning, and their perception o the process o the psychological intervention on the cancer and the individual. At the end o the intervieweach participant was asked whether there was anything that they would like to talk aboutthat they thought relevant to the study that the interviewer had not already asked. Thisensured that we recorded very personal and meaningul data relevant to each

participant.While the interview schedule was fexible the ollowing key areas were explored:

1. How do participants experience being a ‘returned cancer’ patient; and what kind o impact has this had on various aspects o normal living?

2. How have participants experienced their intervention and has this changed over time?

3. How does practising the intervention relate to their health?

Because o the nature o questioning, researcher TL debrieed all the participants toensure that no issues were remaining ater the interview process.

Data analysis

The way in which the transcripts were analysed was adopted rom Smith, Jarman and Osborn (1999). This method, interpretative phenomenological analysis (IPA), aims tocapture the meaning to the participant o the phenomena under investigation. It is amethod o analysis that is increasingly being used in health psychology and allows theresearcher to gain unique insights into the world o the participant. It allows data to beextracted that might otherwise be dicult to obtain, or missed using standardized quan-titative research questionnaires. Although other qualitative methodologies could have

been employed in this study, IPA was thought to be an excellent methodology compatiblewith the therapeutic paradigm employed. Furthermore, given the nature o the diseaseand therapeutic relationship with each participant, using IPA allowed the individual to

express and develop meaning to their view o the world in which they live and dealingwith their disease.

Each transcript was read several times to be amiliar with the content Recurrent




o ‘master themes’. These master themes were constantly checked back with the originaltranscripts to ensure that they were still explanatory o the original interview data.

Reliability and validityInternal coherence and presentation o evidence are two important criteria to assess the

reliability and validity o qualitative research (Smith, 1996). Thereore in order to satisythese conditions each theme presented within the paper will be supported by originaldiscourse rom participants.

Results

The meaning and experience of returning breast cancerThe experience o living with cancer that had returned had a signicant impact on manyaspects o the women interviewed. O particular interest were our emerging themes,which relate to the conceptualization o what it means to have breast cancer again. The

themes that emerged related to:

• internal negative reactions (sel-identity, constrained emotionally and socially);• internal behaviour (sel-blame, attribution o physical symptoms, empowerment,

control, normalizing, constrained physically);• external behaviour (social isolation, normalizing);• social perceptions (social isolation).

All o the themes could be placed within one or two o these our concepts dependingon the context o the discourse. All themes emerged as a general pattern throughout the

interviews. Interestingly, some o these themes do emerge or women receiving a rstdiagnosis o breast cancer; however, there were some subtle dierences in some o thecategories. In the transcript extracts which ollow, the names used are pseudonyms.Unless stated otherwise each o the comments reers to the return o breast cancer and not the initial onset o the disease.

‘Self-identity’The women had changed with the diagnosis that the cancer had returned or spread. Theywere aware rom that moment o diagnosis that they were dierent rom other women.It was noteworthy that the perception o ‘sel’ changed beore there were any surgical

or medical procedures that may change the physical ‘sel’, and that this change wasapparent at the rst diagnosis o breast cancer.

When participant Lynne was diagnosed with breast cancer she said:

I was kind o in a daze and my mother was going through ovarian cancer at the time, sothat was occupying a large portion o my mind . . . and I remember though . . . standingon the tube station [underground station] and looking around at other people and think-ing . . . um, I’m dierent rom you . . . (Lynne)

Furthermore, when thinking about the surgical interventions available when a diagnosis

o breast cancer returning is made, the issue o perceived gender or that person arises.

I h h h ld ‘ ll ld [ i l d ] l ’



132 Bennett et al.

Accordingly, important or this participant, ollowing the diagnosis that the cancer had returned, was not only the question o her gender, but also her perception o how otherswould see her, particularly the medical proession. These two excerpts demonstrate theinternal orces o negative sel-interpretation o body image and negative values o worth.On a more positive note, some o the participants recognized that the given diagnosis,

and perceiving themselves as ‘dierent’ rom others and their ‘old sel’, could be used to their advantage.

My riends are very nice and they make exceptions or you. You know i you say you don’twant to do something, they say ‘oh well just let it go, she must be tired, doesn’t eel verywell’. So I get out o things I don’t want to do, whereas it would be dicult normally . . . itmakes you a little celebrity because you’re ill. (Catherine)

‘Self-blame’On diagnosis o breast cancer returning nearly all o the women elt somehow responsible

or their own misortune. Interestingly none blamed any other issues such as genetics or environmental actors. They ound meaning in that they had somehow brought the cancer on, either by thought or as punishment or something they had done in the past.

I tried to look ater mysel a bit better but I still elt I was indestructible, and that I could work 20 hours a day and be ne, and go out lots, and I didn’t really take on board . . . soI blame mysel a little because I really didn’t look ater mysel that much. (Amanda)

Amanda demonstrates a willingness to accept the cause o her breast cancer returningas being her responsibility because o her busy liestyle and, on refection, that she did

not take care o hersel as much as she should have when initially diagnosed with breastcancer. Another participant also expressed this theme o sel-blame when talking aboutthe breast cancer returning and spreading:

. . . the rst time around, it’s total, it’s nothing to do with me, something that has happened.This time it’s much more to do with me, what I’m doing and what I should be doing.(Catherine)

Catherine is willing to accept that the rst time she developed breast cancer was due tosomething out o her control, however, when it returned it was very much something to

do with her own behaviour.

I didn’t want to tell anyone, I intended not telling anyone. I also said it was my ault, and I really did, because when I was small I bashed into this little girl I didn’t like, and I really bashed her bosom. (Pat)

Here Pat attributes the cause o her breast cancer returning to this incident. The participants rantically search their past experiences, even rom early childhood, to try and nd some justication or the breast cancer returning. Pat also raises another important themethat emerged throughout the interviews, that o ‘social isolation’.

‘Social isolation’Throughout many o the interviews ‘social isolation’ was discussed by each o the par




strategy, it was oten done in order to protect rom identiying with any orm o cancer.The social isolation may also have been a orm o not only protecting the ‘sel’, but also

protecting amily members and riends. These women, who had previously had a diag-nosis o breast cancer, would have experienced various orms o social isolation in therst episode o the disease. However when the cancer returned the social isolation expe-

rienced here may actually be a orm o control. The social isolation that emerged refected both physical and emotional isolation.

. . . um, I suppose talking a lot to riends . . . um, but also covering up, quite a lot, particu-larly with my parents and so on . . . I realized that the only way to cope was to carry onas normal, as ar as possible. (Anne)

In this example Anne realized that the only way she elt able to cope was not to tell some people about her diagnosis. She perhaps elt that she had an obligation to protect her parents. This led to an enorced emotional isolation where social support rom her parents

was the sacrice or their protection. However, sometimes even when there was someorm o disclosure, social isolation still occurred, with the result being the same as non-disclosure and a lack o social support.

I am more willing to talk about it . . . I wasn’t when it rst happened. I couldn’t cope withall the questions o concern and all the denial . . . and so I did, I told many more riends,and again I lost some o them. (Elizabeth)

Elizabeth’s experience helps us to understand some o the internal confict that a personhas to deal with when considering whether they should disclose their diagnosis o the

breast cancer returning. When considering whether or not to disclose a diagnosis, it isclear that the individual does think about the consequences o social isolation.

I thought no one would speak to me . . . that they would catch it or I was some kind o leper, and I couldn’t get over it. (Pat)One person . . . who I didn’t really see or ten years . . . got in touch in November lastyear . . . but when I was rushed to hospital in May he was called, and since then . . . whenI want to talk to him it’s like a sixth sense and he avoids me completely. (Amanda)

Pat identies how social isolation aected her. It is very interesting that she compares

hersel to a leper. Unortunately this comparison was not developed urther in theinterview.

‘Constrained’A theme that was identied in all o the interviews was the experience o eeling con-strained. This theme was expressed not only in terms o physical but also emotionalconstraint. Moreover these experiences were projected through time. Participantsexpressed eeling constrained in the present, and perceived the uture to be the same.

I try to live in the present . . . but when I was diagnosed I had so little hope – do you knowI wouldn’t even buy a pair o socks. I thought I’m not going to wear them out, I’ll do withthe one’s I have. (Mary)



134 Bennett et al.

I can’t leave, I’m tied to Charing Cross. You know . . . you can’t say I’m going – I’m goingto live in Suolk. You think what hospital am I going to be with there? So you’re chained to your bloody disease in a way. (Catherine)

The eeling o being constrained and restricted because o the cancer returning wasclearly expressed where the dimensions o time and place in their world were almostnon-existent. Regarding the meaning and experience o breast cancer returning to these

participants, these can be classied into internal and external directed attitudes and behaviour. Internally directed themes concentrated rst on sel-identity, which encom- passed concerns about altered perceptions o sel, and perceived as both dierent and compromised, particularly regarding gender and emininity. This second diagnosis wasnot always seen as a disadvantage, similarly to the rst diagnosis, but also having the

potential gains o the conventional illness role. More pervasive was the negative attribu-tion o blame or the condition, where in some way they elt responsible or their ownafiction. Social isolation and withdrawal were also expressed, oten as a orm o coping

and protection. However, withdrawal also had negative consequences through emotionalisolation and anxiety about losing riends and social support, through disclosure o thesecond cancer diagnosis.

The meaning and experience of the psychological intervention

Regarding the initial reaction, on the whole, all were pleased irrespective o the interven-tion they received. There was also a clear message o approval that neither involved any

pharmacological products:

I wanted to do it, especially because it didn’t involve any chemicals . . . I tried to comewith an open mind as possible. I am excited about learning new things. (Elizabeth,sel-hypnosis)Well, I was very pleased, I was very pleased that Charing Cross was doing a study, itwasn’t just chemotherapy, I just thought how wonderul that at least it has come into ahospital environment, it’s being taken seriously. (Catherine, Johrei)

These two particular interventions do not have serious side-eects. Following the rstdiagnosis all o the women had undergone chemotherapy, surgery, or other pharmaco-logical treatments with some unpleasant side-eects. They aced these a second timewhen the cancer had returned. It is understandable that their initial reactions to theseinterventions, with no negative side-eects, were very positive.

Regarding how they made sense o the intervention and their breast cancer ollowingtraining, all spoke about how the intervention helped them, relating this to real lie eventsabout living with breast cancer.

Sense of control and empowerment A sense o control and empowerment were the two biggest themes that emerged romthe interviews. Participants mentioned these at least twice throughout their interview.

It has given me time to stop and think o it, not just at a biological level, you know, doctorsdoing this chemotherapy . . . approaching cancer in a dierent way. I’m more in control,telling my body what it’s got to do. (Catherine, Johrei)




problems, and it gives you, I suppose, that little space where you can go. (Mary,sel-hypnosis). . . the rst thing I noticed ater any session, whether it be with you, and it was better once we had tapes and things, was that ater a session I elt revitalized. Although I mighthave elt terribly tired beorehand, I elt quite strong and able to go home and do all sortso things . . . I just got on with my lie. (Alice, sel-hypnosis)

The participants expressed the belie that the intervention they practised helped them,not only to unction better but to take control. This seems to be very important to thesewomen who having had breast cancer beore were now being diagnosed with it again.Instead o handing control to another person they elt as though they were active agentsin their own ‘treatment’. Furthermore, they were able to conceptualize that their lie wasnot ended because o this second diagnosis.

Normalizing and attributionThroughout the interviews another emerging theme was that o ‘normalizing’ and re-

attributing physical sensations. ‘Normalizing’ has been identied as an important themein ovarian cancer. Ekman and colleagues (2004) conducted a qualitative study and identi-ed that women with ovarian cancer rated normality as one o the contral themesdescribed in their discourse.

Ater completing a course o sel-hypnosis or Johrei many o the participants ound that they were able to change the way in which they attributed the cause o some physicalsensations. They reported through the interviews that they were better able to deal with

pain, anxiety and interrupted sleep by rephrasing the cause, thus gaining a better under-standing o the processes underlying their illness.

Well my coping skills at the moment are basically treating mysel as normal . . . I want tosurround mysel with ‘normality’. (Lynne, sel-hypnosis)I mean at rst I put every little ache or twinge or pain at the cancer door, and then youhave to stand back and say, hang on, that’s got nothing to do with it – that’s atoothache! . . . now I sleep or our hours and that’s quite good. Apart rom the act that Iknow that the hot fushes are down to the Tamoxien, I would say that probably as you getolder you don’t sleep, you don’t go to bed and sleep right through. (Alice, sel-hypnosis)I try not to dwell on cancer, I try not to think about it too much. In the beginning I tend to think i you sneeze, well it’s cancer, i you twist your ankle, oh it’s cancer . . . and thatgoes on or a while, and then you realize that the cancer is in one part o your body and the rest o your body is carrying on doing the things it normally does, and so I don’t dwell

on cancer. (Mary, sel-hypnosis)I wonder i there might have been a connection, I was doing so well in the rst term, theautumn term, and then I stopped doing the Johrei regularly and my health deteriorated,and I thought that was quite interesting. (Amanda, Johrei)

These examples show that the individuals concerned are not in denial or simply ‘orget-ting’ about the act that they have breast cancer and that it had returned, but that theyappraised the phenomena and made attributions based on evidence, and not solely onemotion, or catastrophizing. They illustrate the theme o being ‘normal’. They also refectthe emotions that breast cancer patients may eel with respect to being treated as normal,and the act that they wanted to continue doing ‘normal’ everyday activities.

‘Something in the tool bag!’The actual meaning ascribed to the experience o psychological interventions shows the



136 Bennett et al.

. . . the act that I had the secret weapon that I could use. I could do something. (Pat,Johrei)I don’t know whether I can quantiy whether it has done me any good medically, mentallyit’s something else on my shel that I can make use o, and I know that it has not done meany harm. (Alice, sel-hypnosis)It’s a tool that I’ve got in my bag that’s always there . . . and I can dip back into it, and

hopeully that’s what I’d really like to do. (Lynne, sel-hypnosis)

These examples illustrate the meaning that each o the participants has given to theintervention with a use o terms suggesting that they perceive the intervention to besomewhat powerul, something that can x things, and something that can be used todestroy bad things. There were no apparent dierences between each intervention group’sdiscourse and meaning.

Regarding the meaning and experience o the intervention, these can be classied similarly as the experience o dealing with the breast cancer returning. From a behav-ioural context these women were enthusiastic to learn and practise. This in turn infu-

enced adherence, refecting the act that most practised on a daily basis during the study period, and many stated that they continued to practise long ater the training and ollow-up period. Internally directed attitudes o having a sense o control and empowermentmeant that participants were able perceive taking control o their lives again. This wasurther enhanced by the ability to reattribute physical sensations enabling a better, and more normal, quality o lie. Importantly, none o the participants reported any negativeeects o either sel-hypnosis or Johrei.

Discussion

This study adds insight and inormation to those already published in the area o breastcancer and psychological interventions or breast cancer. Here the participants were

patients with breast cancer that had returned or spread ater a course o conventionaltherapy. Results support much o the previous research ndings or rst time diagnosed

breast cancer patients, and extend understanding to the impact o the return o breastcancer. However, because o the small sample size results should be viewed with somecaution.

The two main areas explored were the themes associated with a diagnosis o breastcancer returning, and with what it means to use the psychological intervention. The

themes that emerged about diagnosis were:

• sel-identity;• blaming onesel or the cancer;• eeling that others were isolating them or that they elt isolated rom others; and • eeling physically and emotionally constrained and also constrained in time.

The themes that emerged in relation to the psychological intervention were:

• gaining a sense o control or eeling empowered;• normalizing the condition and re-attributing physical symptoms not related to the

diagnosis; and • having the use o a new tool or weapon.




as a major emerging theme. All ound a positive meaning in the psychological interven-tion and reported that they coped better as a result o practising it.

Refecting back on Lipowski’s eight categories only three were described in our study: punishment, weakness and strategy. Both punishment and weakness were refected inthe internal negative reactions and internal negative behaviour. The theme o strategy

was refected in what we have dened as external behaviour, where the second diagnosiso breast cancer was used to the advantage o the participant or their gain.

More recently, Luker, Leinster, Owens and Beaver (1996) described some o themeanings o illness or women with breast cancer. They suggested that the most popular choice o meaning was challenge, meaning that these individuals viewed the illness asa challenge using adaptive coping strategies, similar to goal-orientated behaviour. Theyurther suggested that this particular approach promotes positive eelings about diseaseand illness. However, perceiving illness as a challenge can also be maladaptive. Whena woman is diagnosed with breast cancer or the rst time, adopting this meaning may

be useul. It may well help them to keep a positive attitude and to maintain a quality o

lie similar to that beore the diagnosis. What happens though when they were told thatthe cancer has spread, or that it has returned? When this occurs there may be a sense o sel-responsibility (Lupton, 1994) and there is a natural tendency to blame onesel. Thiswas a pattern that emerged in our participants. It is no surprise then that the category o challenge did not emerge as a theme throughout our study. Albeit in a small sample, wehave demonstrated that here is a perceived dierence between those women receiving arst diagnosis o breast cancer and those receiving a diagnosis that the cancer hasreturned or spread.

Furthermore, Lupton (1994) describes the dominant discourse surrounding cancer ashope. However, in the experiences o our participants, although there is an element o hope the main discourse is more active and more aggressive than a description o hope.This dierence in the dominant discourse may be due to the act that our participantswere patients with metastastic breast cancer and not patients receiving their rst diag-nosis o breast cancer. This makes sense i we consider ‘hope’ as a airly passive attribute.Ater receiving the rst diagnosis and ‘hope’ not keeping the cancer away, a more aggres-sive and active attribute might be adopted when the cancer is diagnosed as havingreturned.

To our knowledge this is the rst research to look at the meanings given to experienc-ing sel-hypnosis or Johrei intervention or metastatic breast cancer. Although other

studies have examined the experience o living with cancer, this study adds urther insight into the dynamic process o learning and applying these two interventions, par-ticularly in women who have metastatic breast cancer. The experience o learning and using either sel-hypnosis or Johrei appeared to be a positive one or these participants.Irrespective o the type o intervention we investigated, the sel-hypnosis or Johrei par-ticipants gave positive meanings to the process. Similar constructs are ound where theonset o breast cancer has been studied; however, perhaps the crucial dierence betweenthese and women with returning breast cancer is the way in which they cope. This would have consequences or the type o care oered to these individuals.

Although the two interventions are similar, they do have stark dierences in proce-

dural mechanics. For example, in sel-hypnosis participants are engaged in ocussed attention and are asked to use visualization techniques. In the practice o Johrei, theparticipant acts as both channeller and receiver engaging in both active and passive roles



138 Bennett et al.

opposite changes in anterior brain asymmetry, with increased let hemisphere power ollowing a course o sel-hypnosis (and relaxation) and increased right hemisphere

power ollowing training in Johrei (Gruzelier et al., in preparation). This is in keepingwith more inward ocussed attention with hypnosis and more outward directed diuseattention and mindulness with Johrei. Notwithstanding these dierences, participants

rom both sel-hypnosis and Johrei described their experience as powerul, almost to the point o using a military metaphor.

The study does have some limitations that should be careully considered when con-cluding. The sample size was very small. Women with metastasis are oten very ill,especially when undergoing active treatment such as radiotherapy or chemotherapy.Thereore participating in an interview that covers some personal and emotional areaso one’s lie may have been too much or some. Obviously, this then leads to a highlyselected sample. Overall, the interview covers a vast area and this is refected in theanalysis. Future research should ocus on specic areas, especially changes in copingstrategies, rather than covering so much in one interview.

In summary, and acknowledging the limitations o the study, we reported the mean-ings ascribed to living with a second diagnosis o breast cancer with regard to internallyand externally directed positive and negative attitudes and behaviour or participants inthis study. Furthermore, and importantly, the meanings o learning and applying a non-

pharmaceutical intervention were reported as internally directed positive attitudes whichmay have enhanced coping and the general quality o lie o these women. Future studiesin this area should look specically at the dierences between rst time diagnosed cancer

patients and those where the cancer has returned. Identiying areas where there are di-erences between coping strategies employed in these two groups may lead to better health care provision, and improvements in understanding the needs o individuals witha return diagnosis o breast cancer.

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Address for Correspondence:

Professor John H. Gruzelier

Department o Psychology

Goldsmiths College

Lewisham Way

New Cross

London SE14 6NW

UK Email: [email protected]



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