Faith boosts cognitive management of cancer, HIV

ST News June 15, 2006

New research provides compelling evidence that healthy forms of spirituality play a pivotal role in helping HIV and cancer victims cope with their illnesses. Two recent studies found that patients with fatal diseases were able to improve their physical or emotional well-being when they had a positive understanding of God. Dr. Gail Ironson, a psychologist and psychiatrist at the University of Miami, conducted her research on patients who were HIV-positive, while Jean Kristeller, a psychologist at Indiana State University in Terre Haute, Ind., studied cancer patients.

Ironson and Kristeller delivered separate papers at the University of California, Berkeley, in April, for the 2006 Research Symposium of the Spiritual Transformation Scientific Research Program of the Metanexus Institute on Religion and Science. The Metanexus Institute is supported by the John Templeton Foundation, which also supports Science & Theology News.

Ironson presented data on 100 patients in the Miami area who were living with HIV. She showed that their understanding of the nature of God and their personal relationship with him were the two most important predictors of their rate of HIV progression. Her conclusions were based upon measurements of CD4+ T-cell levels and HIV viral load (See "Defining HIV".

The patients in Ironson’s group who viewed God as loving had a slower disease progression over four years than those who saw God as punishing. Those who did not believe God loved them lost CD4+T-cells three times faster than those who believed God did love them. Ironson concluded that negative religious coping — or the idea that one’s illness is a punishment from God — is detrimental to a patient’s prognosis. (See “Establishing psychological variables”.) An HIV patient’s “view of God is more powerful than the other psychological variables” — including depression — in predicting the rate of disease progression, Ironson said.

Ironson’s work was intriguing and important because it identified key biological markers for outcomes, said Dr. Frederick Hecht, an associate professor of medicine at the University of California, San Francisco. Hecht added that it complements studies that had identified adherence to a retroviral drug regimen as “a really dominant factor” in helping to extend lives.

In a point readily acknowledged by Ironson, Hecht stressed that her findings do not establish a strict cause-and-effect relationship between spiritual beliefs and practices and the rate of progression of HIV.

“The issue of cause and effect is difficult to tease out from this data,” he said. He further cautioned that it was premature to draw any firm implications for those counseling patients with HIV.

Further research is needed to establish a clear causal link between a slower progression in the spread of HIV and certain views about God, said John Frank, a fellow with the Canadian Institute for Advanced Research Population Health Program in Toronto. Citing the once-prevalent belief that hormone replacement therapy was beneficial for all menopausal women, he said, “You can study something that people do in observational studies and be dead wrong.”

Frank added that this danger was probably more the case with spirituality, and he raised the possibility that Ironson’s research subjects joined her study with a greater pre-existing interest in spirituality because they faced a life-threatening illness. Dr. Heidemarie Kremer, one of Ironson’s collaborators at the University of Miami, said that 45 percent of the study’s HIV patients reported that they prayed daily. This figure contrasts with only 28 percent of the American public who do so, according to 2004 statistics from the National Opinion Research Center, a national organization for research at the University of Chicago.

Mind and body and science
In a related presentation, Kristeller reported on the results of the Oncologist Assisted Spirituality Intervention Study, or OASIS. She said that when physicians in Indiana talked with critically ill cancer patients about their spiritual concerns for five to seven minutes, the patients reported after three weeks that they were less depressed and enjoyed a better quality of life. The patients also said they felt that their physicians cared more about their health, which was in contrast to those patients in the study whose physicians did not discuss spiritual matters with them.

Although Ironson’s preliminary results seemed to indicate an association between healthy forms of spirituality and a slower rate of HIV progression, Kristeller said in her study that no common physiological measures or biomarkers — such as CD4+ T-cell levels or viral load — can be applied to cancer patients because there are many different types of cancer, all with different and complex causes.

“Compared to cancer, [HIV] is a single disease,” she said.

Without a set of common biomarkers, Kristeller said that scientific studies could never hope to demonstrate a causal link between spirituality and physical recovery from a given type of cancer. But she added that perhaps the most important type of healing that seriously ill patients can experience — and one that can be measured and facilitated — happens in the mind.

“Our sample is better for looking at broader patterns of spiritual engagement across an entire critically ill population,” Kristeller said. In counseling cancer patients, she said, “the point is not to convey physical health benefits but to convey a sense of how to deal with a crisis.”

While one should not draw hasty conclusions from either the HIV or the cancer research, Kristeller said that science is converging on the important link between mind and body in the lives of critically ill patients.

“Negative religious coping is coming out consistently as toxic,” Kristeller said. Ironson said several studies indicate that an average of about 12 to 15 percent of seriously ill patients fall into this category. Kristeller and Ironson said that the next phase of research, which they will conduct together, would target the problem of negative religious coping. This could be done by “designing an intervention that speaks to those issues,” Kristeller said.

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