Vincent van Gogh completed this oil painting, called “At Eternity’s Gate,” a few months before his death, while recovering from a critical relapse in his health.
“Finding a sense of meaning is always possible — even during the final months, weeks, and days of our lives,” says psychiatrist William S. Breitbart, Vice Chair of Memorial Sloan Kettering’s Department of Psychiatry and Behavioral Sciences.
In a recent study, Dr. Breitbart and his colleagues found that people in the late stages of cancer might benefit from meaning-centered psychotherapy, a treatment aimed at helping patients sustain and enhance a sense of meaning, purpose, and peace.
Published in the April 20 issue of the Journal of Clinical Oncology, their findings show that the therapy, which involves talk sessions and contemplation exercises, can temporarily improve the quality of life of terminally ill patients.
Finding Meaning and Purpose toward the End of Life
Dr. Breitbart explains that meaning-centered psychotherapy was developed to fill a void in the area of palliative cancer care, as not much research had explored support for terminally ill patients in dealing with loss of meaning and spiritual well-being.
“During their final weeks or months of life, many of our patients suffer from feelings of despair, demoralization, and hopelessness, which in extreme cases can lead to a wish to end one’s life sooner,” he explains. “Our studies have shown that such distress often is related to an existential crisis people struggle with at the end of their lives, when questions emerge about mortality and the ultimate value of our existence.”
Helping people develop and maintain a sense of purpose might be an effective way to alleviate this type of suffering – within or outside a religious context, Dr. Breitbart notes.
The study enrolled 120 people with late-stage tumors who were being treated at Memorial Sloan Kettering, and who had six months or less left to live, according to the prognosis given by their physicians. Patients were randomly selected to receive seven sessions of meaning-centered psychotherapy or massage therapy. Those receiving psychotherapy met for one hour with a therapist to explore personal sources of meaning such as love, relationships, and work, and to talk about universal themes such as hope, legacy, and the impermanence of life.
After their last treatment session, people receiving meaning-centered psychotherapy reported an improvement in their quality of life and spiritual well-being, and also reported feeling less burdened by physical symptoms such as pain. In contrast, no significant benefit was observed in patients receiving massage therapy.
Individual and Group Therapy for Patients, Survivors, and Caregivers
Dr. Breitbart and his colleagues have developed different models of meaning-centered psychotherapy for individuals as well as groups of eight to ten patients. The current study focuses on the individual model, which is more suitable for people with terminal disease.
Additional studies are now under way to validate the benefit of meaning-centered psychotherapy for a larger group of patients with advanced cancer. Memorial Sloan Kettering researchers are also adapting the therapy for people who are not terminally ill — including cancer survivors and caregivers — but who may be experiencing a decline in spiritual well-being.
Dr. Breitbart says his research on meaning-centered psychotherapy has been influenced by the work of the late Viktor Frankl, an Austrian psychiatrist and neurologist. In his famous 1946 book titled Man’s Search for Meaning, Dr. Frankl, a Holocaust survivor, argues that life never ceases to have meaning, not even in the face of intense suffering and death.
“My experiences caring for people with terminal disease have taught me the same,” Dr. Breitbart affirms. “I never cease to be amazed at the clarity with which dying people are capable of viewing their lives in light of what ultimately has mattered to them the most.”