A Treatment for Despair and Loss of Meaning

Meaning-Centered Psychotherapy in Cancer Patients

Posted Jun 25, 2015

The Psychotherapy Laboratory within the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center was established about 12 years ago, and I have been the Director of the Lab from at its inception. In addition to developing interventions for anxiety, depression, PTSD, bereavement, and fear of recurrence in cancer patients, we have also studied an array of existential problems that had no established interventions.

Some of these issues were such constructs as despair, suffering, loss of dignity, demoralization, hopelessness, and loss of meaning in life. On the surface, it doesnt sound like much fun to research these subjects, and the fact is that many of our colleagues started to call us the "Laboratory of Despair."  But the fact is, these were extraordinarily challenging, exciting and critically relevant areas of clinical intervention research.

Despair, for instance, is an interesting word. Etymologically, it comes form the French:  De - meaning without; and espoir - meaning hope. So despair, for many, meant "without hope". But in fact the French word "espoir" also means  "breath" like respiration and to "inspire" and exhale; or "spirit".  So despair also means "without spirit"; and for us Despair became a term we used for that state in which our cancer patients lost the "essence" of what made them human.  We needed an intervention for that! There was no medication for that problem! 

What often was at the heart of despair was a sense of profound loss of meaning in one's life when presented with a cancer diagnosis that forced one to confront mortality. "Loss of Meaning" and "Despair" were two profound and related clinical problems that often led patients to desire a hastened dath or request physician assisted suicide.  In response to this problem we developed a counseling intervention we called "Meaning-Centered Psychotherapy- MCP". It was inspired by the work of Viktor Frankl , a Vienesse Psychiatrist who survived Auscwitz concentration camp.

We've studied MCP in 4 randomized controlled trials (3 funded by the NCI), and we've been able to show that MCP reduces despair, enhances meaning, and as a result reduces hopelessness, depression, desire for hastened death, physical symptom distress and improves quality of life.

In November 2015 I gave a talk on Meaning Centered Psychotherapy for Advanced Cancer Patients at the NCRI conference in Liverpool. (Here is the 17 minute video of an interview I did right after the lecture.)

The below pieces about Meaning Centered Psychotherapy which appeared in the ASCO Post May 25 2015 issue.

http://www.ascopost.com/issues/may-25,-2015/meaning-centered-group-psych...

http://www.ascopost.com/issues/may-25,-2015/potential-power-of-meaning-c...

http://www.ascopost.com/issues/may-25,-2015/in-search-of-meaning-a-perso...