Comparative examination of the effects of the SAT-DVD Learning Program Therapy and the
Qigong (the traditional Chinese breathing exercise) Therapy to alleviate stress in cancer
survivors

Noriko Higuchi1), Kazue Nakashima2), Kiriko Murakami2),
Ryoichi Obitsu3), Tsunetsugu Munakata2)
1) Meikai University, Research Building, 1Meikai, Urayasu city, JAPAN
Faculty of Languages and Cultures Department of English
2)Division of Health Counseling Science, Department of Human Care Science, Graduate
School of Comprehensive Human Sciences, University of Tsukuba3) Obitsu Sankeijyuku Clinic

Summary〔Purpose〕 This study aimed to examine the stress-alleviative effects of the self-learning
SAT Imagery Therapy recorded on DVD (hereinafter called as SAT-DVD)in cancer survivors.

With the qigong therapy, a representative alternative medicine that makes use of images, as thecontrol group, various changes before and after the intervention were examined to alleviate
depression, psychological traits and biochemical indexes of salivary immunity.
〔Methods〕 The subjects were 17 cancer survivors (aged 52.2±8.7).
Prospective, pre/post-test intervention, single-arm trial
therapy, SAT-DVD watching therapy.

The study design:

Intervention Methods: the qigong

Psychological indexes were measured by means ofself-report questionnaire before, immediately after and one week after each intervention of theqigong practice and SAT-DVD watching.

Saliva for test was collected before and after each

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intervention and was analyzed statistically.

Measured items: Distinction of sex, age, andpsychological indexes (scales of depression, self-control, difficulty of emotional recognition,
problem solving, dissociative identity, and trauma syndrome).
〔Results and Discussions〕As to the biochemical indexes, significant decline of theadrenocortical hormone level after the qigong intervention and significant rise of salivary
secretory immunoglobulin level after SAT-DVD watching were observed.

As to thepsychological indicators on the other hand, no significant change was observed in the scores ofany psychological characteristics after the qigong intervention while significant decline wasobserved in the scales of depression, self-control, difficulty of emotional recognition and thescores of trauma syndrome after the SAT-DVD watching.
It was presumed that improvement of self-image and alleviation of depression was the possiblemeans that SAT-DVD watching therapy improved immunity responses (the increase of salivary
secretory immunoglobulin) in the cancer survivors.

Keyword: cancer survivor

SAT stress management

depression

salivary SIgA

salivary cortizol

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1.

Introduction

The number of cancer survivors in Japan is estimated to have reached 3,650,000 at the year-end
of 2004 and is forecasted to increase to as many as 5,000,000.1)

According to the study by

Hoffman et al on cancer survivors in the US, long-term cancer survivors are at increased risk ofexperiencing serious psychological distress compared with people who have never been
diagnosed with cancer.2) Also in Japan there are indications of problems of mental health for
rapidly increasing cancer survivors, and particularly problems of their living with fears ofrecurrence and metastasis of cancer.3)

The measure from the view point of mental health is anurgent need for the cancer survivors since the very fear has indirect effects to intensify stress andprevent spontaneous cure.

When it comes to a relation between cancer and psychosocial

factors, studies on the relation between cancer and personality have been known for a long time.
Suppression and denial of emotional expression, failure in coping with stress, and Type C
personality4) characteristically with such resigned reactions as hopelessness and helplessness
have been reportedly related to outset and progression of cancer.

According to Maeda et al4),

the self-suppression type (self-suppression aiming to be appreciated by the people around) andthe type of difficulty in recognizing emotion (having difficulty in recognizing own emotion andinclination to keep going to the end without seeking assistance from the people around) areremarkable as the character traits of the patients after gastric cancer resection. To be more
precise, they have difficulty in recognizing their own senses and emotions and they have little
inclination to express themselves but they are very much persevering.
International Journal of Structured Association Technique No.3

In addition to the above,63

Munakata5) indicated that the dissociative identity type (to see one’s own matter as if it were
somebody else’s in order to remain calm), the problem avoidance type (to avoid facing a mattersquarely and tackle anything with a super-positive attitude of mind) and the self-pity type (to lookat oneself with pity) are also remarkable as the character traits of the patients after gastric cancer
resection.

By all accounts, they have difficulty in recognizing their own senses and emotions,seeking help from the people around and facing up the reality.

Also, they are apt to take asuper-positive attitude of mind and keep going to the end tenaciously alone.

Some people

explain that the immunity against tumor cells gets lowered because they cannot openly express
their displeasure, try to carry out all the way through their duties over-seriously and thus keep
stress chronically in.

Many a prospective cohort study on a causal relation between

cancer-prone personality and outset of cancer reports the relationship between outset of cancer
and depression and emotional suppression.6)-8)

On the other hand, there are some reports

indicating no clear relationship between them.8)-11)

Thus academic opinion is still divided on

this question.
Personality is made up in the core of temperament that is subject to genes and self-image scriptthat creates the behavioral traits based on the temperament.

As to the characters related tostress, there are in the core some hereditary temperament such as anxiety-prone temperament
and tenacious temperament that is highly sensitive to stress.

When people have experiences ofbirth trauma and infancy trauma, the self-image of the others-reward oriented type which easily
over-reacts to stress remains in their memory, the scripts for their behavioral traits are finished,
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and as a result the stress-prone temperament such as self-suppressive, difficult to recognize
emotion, and problem avoidant are believed to be formed.
A person with the stress-prone temperament easily stretches his/her sympathetic nerve and isforced to continuously secrete adrenaline.

Consequently, it easily leads to the decrease oflymphocytes in a leukocyte and the increase of granulocyte due to the continuous secretion ofadrenaline.

The active oxygen released from granulocyte serves to exclude foreign mattersentered into the body.

It is suggested at the same time that it may possibly cause the outset ofcancer by damaging cells and nucleuses and genes in cells.12)
According to some previous reports, cancer patients are so aspiring having strong tenacious
temperament, so thick-skinned that they would not recognize their own emotions and senses, andso solitary without trying to seek help from others.

They try to keep going to the end with theother-reward oriented behavior so that they may be appreciated by other people.

They tend tolack in communications with their families and their family relationship is weakened.13)14) If welook at it from a different angle, the disease called in the name of cancer has some truth to help
the patients find the original way they feel in accordance with their inherited genes, and also findthe necessity of enjoying themselves, of mentally communicating with families, and of theself-reward oriented behavior with which they may seek self-satisfaction and appreciation.15)
On the hypothesis that stress has an influence on the outset of cancer, lots of psychotherapy
have been conducted for cancer patients both domestically and abroad.

Making the survey ofstudies on psychological interventions with the study design of randomized clinical trials, we learn,International Journal of Structured Association Technique No.3

65

from a study on the intervention to breast cancer patients with symptoms of metastasis, life
prolonging effect of the intervention for those in the intervention group.16)
Although longer survival was denied in the follow-up trials, the intervention has proved to haveeffects to decrease psychological stress and ease pains.17) Post operative patients of malignant
melanoma in the short-term cognitive behavioral intervention group reportedly showed moreincrease in the ratio of NK cells compared with those in the control group.18)19) It is reported byRehse et al20) that psychological intervention is valid for improving QOL based on the results ofmeta-analysis concerning the effects of psychosocial intervention for adult cancer patients.
While on the other hand, we see, among studies on randomized socio-psychological intervention,some negative reports that psychological intervention is not effective for longer survival.21)22)
Notwithstanding accumulated researches and studies as seen above, It is hard to say that
evidences for the effects of psychological intervention have been amply provided.
The SAT imagery therapy helps the patient become aware how the self-image is changed withthe changes in other past images as if he/she were brought up by an unconditional caretakerunder improved conditions for his/her own growth. According to our clinical research, it confirms
the weakened behavioral traits of others-reward oriented type such as self-suppression anddifficulty in emotional recognition, as well as the significant effect to enhance the immunity
responses (to increase lymphocyte count and degree of activation) and the rate of tumor
suppressor gene expression.23)24)25)

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In practice, a hypothetical way is used in the SAT imagery therapy: The patients, with themeditative imaging technique to go backwards to the past in the evolutionary process (self - a
fosterer - an ancestor - a biological being - a particulate

being), experiences time regression.

And in the newly created image, their past are changed as if their growing background were
improved and as if they were brought up by those who offered unconditional care.
self-image is also changed in some way or another.

Then, theIn order for them to form their futureself-image, we help the patients become aware of the self-image script that they were brought up
under natural growing background with unconditional care although it has not been transmitted
from their ancestors over generations.

And we encourage them to become aware of the actionplans (major, middle, and minor objectives) for realizing the improved self-image script.

It is theThird Generation Cognitive Behavioral Therapies with which emotional change, cognitive change
and behavioral change are promoted.

We, on the basis of the SAT Imagery Therapy, have beendeveloping the stress management system with resources available for cancer patients forincreasing their mental health, immunity and expression of tumor suppressor genes.
The purpose of this study is to examine the effects of the SAT self-learning program recorded on
DVD with a control group as a basic study for developing a stress management e-learning
program for cancer survivors utilizing web-technique and the SAT Imagery Therapy.

We

adopted the qigong therapy and set it as a control group, partly because it is utilized by many
cancer survivors though it is different from this program in utilizing physical exercise, and partly
because it, utilizing various images, shares common feature of imagery therapy with this program.
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It is hypothesized that watching the SAT-DVD self-learning program for cancer survivors with thecontrol group of the qigong therapy may alleviate depression, change psychological traits,
improve immunity responses/salivary corticosteroid index.

2. Method
Theoretical Background

The Qigong Therapy:

The basic elements of the qigong are said to be the control of body,breathing and mind.

The autonomic nervous system gets stabilized by moving the body,

catching the breath and relaxing.

By exercising the so-called “space time method” centered on

the solar plexus breathing, the effects to prevent recurrence and metastasis of individual diseaseby site are expected for cancer patients.28)
SAT-DVD self-learning program: With this approach to let cancer survivors watch SAT-DVD, weaimed to let them weaken the image of expected death and alleviate the fears by having a senseof gratitude for being alive and change their behavior from the self-reward oriented type to theothers-reward oriented.

A couple of learning assistants sat in company with the subjects of one

to four in number each time and supported their learning through watching the SAT-DVD
including PC operations.

It took 90 minutes only each time for watching the SAT-DVD.

of the support are shown in Table1.

Details

The SAT-DVD watching was executed with interval of 2 to 3

weeks after the qigong intervention.

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To promote their self-understanding the temperament coaching therapy and psychological trait
checking were utilized.

Hereditary temperament, nucleus of one’s nature consisting ofhereditary factors and biological factors related to neurotransmitter, does not change throughout
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one’s lifetime.

Among them all, those who have either “the Persistence Type of Temperament”

observed in perfectionists or “the Anxiety Type of Temperament” represented by pessimism andtendency to be opinionated are inclined to become fearful, solitary and stressful.

So theyneeded to be coached for their self-care activities.
Furthermore, in order to help them change their self-image of suppressing the self andaccumulating it in the soul, blunting the emotion, and staying the course at the sacrifice of the self,
to the new one of enjoying the own life, and exchanging heartfelt communications with theirfamilies and friends, we let them experience the two kinds of imaging works used in the SAT
imagery therapy as shown in Table 1.

We helped them notice the necessity to change their

behavioral trait to the one of the self-reward oriented type that is hard to accumulate stress by
way of letting them know the gap between the innate self obtained through these exercised
self-image trainings (the self protected and brought up at will) and the actual one.

Research Collaborators

A meeting for explaining the study was held for participants to the qigong class sponsored by aclinic specialized in cancer treatment in the Tokyo metropolitan area, and research volunteers
were collected among them.

On explaining the objectives and meaning of the research, close

attention was paid by the researchers including one in charge of practicing qigong to keep
neutrality so that any biased information might not be inputted.

There were 34 prospective

research volunteers: 17 cancer survivors and 17 healthy individuals including families of cancer
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survivors. The intervention period lasted about one year: December, 2007 ~ February, 2008.

Participants

The 17 cancer survivors who had agreed to the explanations on the intended and meaning of theresearch were set as the analysis subject.

Healthy individuals were excluded from the analysis

for the purpose of the study was to examine the stress management therapy for the cancer
survivors.

As to the changes in the psychological indexes, analyzed were the 15 subjects (2males and 13 females) excluding 2 who were not available at the time of research conducted 1
week after the intervention.

Attributes of the study participants are shown in Table 2.

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Ethical Considerations

Approval was obtained for this study from the Board of Examination of Epidemiological Study, theUniversity of Tsukuba.

Explanation on the intended meaning of this research was made inwriting and orally to the subjects and the research was conducted after obtaining the agreementof the subjects.

Study measures
Psychological traits

1.

Self-rating depression scale (SDS, Zung)23)[20 items, maximum of 80 points]:

SDS is ameasures of depression. The higher the points are, the higher the depression.

2.

Scale of self-suppressive behavioral trait (Munakata, 1996)24)25)[10 items, maximum of 20

points]: The scale measures the expectations of favour from those people around by suppressing
own emotions to satisfy those around.

The scale comprises of 10 items; 2 points is given to“always so”, 1 point “usually so” and 0 point “not so”, with total scores of minimum 0 to maximum
20 points.

3.

The scale of problem solving behavioral trait (Munakata, 2001)25) [10 items, maximum of 20

points]: This is the scale to measure the behavioral trait to try to positively, effectively andInternational Journal of Structured Association Technique No.3

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realistically deal with the tasks and problems standing in front.

The scale comprises of 10 items

including “In anything I rather make judgment while confirming the fact”.

The higher the points

are, the more remarkable is the trait to try realistically dealing with the problem for solution.
Lower points in this item suggest the tendency to repeat the same kind of failures and errors forpostponing the solving of problems without facing up to the reality.

It is also believed that there

exist some stressful memories with aversive emotions behind the low points in this item.

4.

The scale of difficulty in recognizing emotions (Munakata, 2001)25)[10 items, maximum of

20 points]: This is to measure the tendency of difficulty in recognizing emotions that is to endure
the hardship without getting emotional and to easily somaticize stress.

5.

The scale of the dissociative identity (Munakata, 2001)25) [10 items, maximum of 20 points]:

This is to measure the scale of dissociative identity, that is the split self, one being embarrassedwith a serious problem and the other calmly watching the former.

The higher the points for thisitem are, the stronger is the emotion of dissociative identity such as fear, impatience and panic.

6.

The scale of the post-traumatic stress syndrome (Munakata, 2001)25) [10 items, maximum of

10 points]: This is to measure the seriousness of traumatic stress symptom.

The higher the

points for this item are, the stronger is the emotional reactions under a specific key situation withthe recognition of trauma.
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Biochemical Indexes

In order to examine the stress management effects of practicing the qigong program and
SAT-DVD electronic self-learning program for the participants, saliva was collected before andafter the qigong class and SAT-DVD watching, and then the changes in the salivary corticosteroid
and salivary SIgA were measured.

1. Salivary corticosteroid (Cortisol): Steroid hormone secreted from adrenal cortex is discharged
into the blood and then is carried to saliva. It is said that stress can be quantitated to some extent
by them.26)

It is known that there is a time lag of about 20 to 30 minutes between stressor andresponse.

2.

Salivary Secretory Immunoglobulin A (salivary SIgA): Salivary SIgA has a major function in

mucosal immunity.

It is said that under stressful conditions the concentration of SIgA, a

complement component of immunity in saliva, is lowered.27)

Analysis

Responses to the questionnaire were collected 5 times in total, namely, before the intervention,
immediately after the qigong class, one week after the qigong class, immediately after watching
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SAT-DVD self-learning program, and finally one week after watching SAT-DVD self-learning
program.
Psychological indexes of the 15 subjects were measured before, immediately after and one week
after intervention.

Their biochemical data, measured before and immediately after intervention,

were statistically analyzed.

Normality of psychological indexes was checked, and the two way

repeated measures (within subjects × within subjects) analysis of variance (ANOVA ) was
conducted.

As to the changes in biochemical data, the Wilcoxon Test, which is a

non-parametric statistical hypothesis test, was used due to the large scale individual variation ofdata.

3. Results

The changes in biochemical indexes between pre- and post- intervention (Table 3)

Before and after each intervention of the qigong practice and the SAT-DVD watching examined
was how the secretion levels of salivary corticosteroid and salivary SIgA immediately after and 1
week after intervention were changed in comparison with those before intervention.
International Journal of Structured Association Technique No.3

Significant
75decline of corticosteroid was observed after the qigong intervention (Z=−2.23, p=0.03).

Alsosignificant was the observed rise of salivary SIgA after the SAT-DVD watching (Z= -2.27, p=0.02).

The changes in psychological traits before and after the intervention (Figure 1)

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Scores for the qigong therapy and the SAT-DVD e-learning program before, immediately and 1
week after intervention were analyzed with the repeated measures (corresponding ×
corresponding) two way analysis of variance (ANOVA). As a result, the interaction effects
between time and intervention were observed in the self-rating depression scale (F(2,24)=4.45,
p= .023).

Now after the examination of simple main effect by the intervention method, thedecline of the self-rating depression scale was observed in the SAT-DVD watching group while nosuch change was confirmed in the qigong group.

As the result of examination by multiple

comparison, improvement of the self-rating depression scale was observed by the fact that itturned out to be significantly lowered immediately and 1 week after watching compared with theone before watching (before intervention ― immediately after intervention; p＜.05, before
intervention ― 1 week after intervention; p＜.05).
Then, the interaction effect of time by intervention was confirmed in the scale of self-repression(F(2,26)=13.94, p< .001).

Now after the examination of simple main effect, significant decline ofscale of self-suppression was confirmed in the SAT-DVD watching group (F(2,26)=21.5, p=.001)
while no significant change was observed in the qigong group either at three points of time of theqigong intervention(F(2,29)=1.219, p=.310, n.s.).

With the fact that in multiple comparison thescores were significantly lowered at both points of time, immediately and 1 week after intervention
compared with those before intervention (before intervention − immediately after intervention;p ＜ 0.5, before intervention − 1 week after intervention; p ＜ .05), the weakened
self-suppression and promoted self-expression were observed.
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Significant change was seen in the scale of problem solving behavioral trait neither as theinteraction effect of time by intervention nor as the simple main effect of respective time andintervention(interaction effect:

F(2,24)=.279, p=.61, simple main effect (time): F(2,24)=1.338,

p=.281, simple main effect (intervention method) : F(1,12)=.915, p=.36).
The interaction effect of time by intervention was not confirmed in the scale of difficulty inemotional recognition (F(2,26)=1.762, p=.192, n.s.), but the simple main effect was confirmed
both at the time of intervention and in the intervention method (intervention method: F(1,13)=18.41, p=.001;

time of intervention: F(2,26)=8.5, p=.002).

Significant changes in scoresby the timing of intervention were confirmed between the two groups.

With the fact that in

multiple comparison the scores were significantly lowered for the SAT-DVD watching group at
both points of time immediately and 1 week after intervention compared with those before
intervention (before intervention − immediately after intervention; p＜0.5, before intervention− 1 week after intervention; p＜.05), blunting of emotion was confirmed to be alleviated.
The interaction effect of time by intervention was confirmed in the scale of the dissociative identity(F(2,24)=3.33, p=.033).

Now after the examination of simple main effect by the intervention

method, significant decline of scale of the dissociative identity was confirmed in the SAT・DVD
watching group while no significant change was confirmed in the qigong group (simple main
effect; at the time of intervention for SAT-DVD watching group: F(2,22)=4.003, p=.003
time of intervention for the qigong group: F(2,29)=0.062, p=.94).

at theAfter the examination withmultiple comparison, significant changes in scores were confirmed by the timing of intervention.
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With the fact that in multiple comparison the scores were significantly lowered for each group 1
week after intervention compared with those before intervention (before intervention −immediately after intervention; p＜0.5, before intervention − 1 week after intervention; p＜.05),
tendency of the dissociative identity was confirmed to be weakened.
The interaction effect of time by intervention was observed in the scale of the post-traumaticstress syndrome (F(2,26)=4.64, p=.019).

Now after the examination of simple main effect by

the intervention method, significant changes in scale of the post-traumatic stress syndrome wereobserved in the SAT-DVD watching group, and after the examination with multiple comparison,
the scores were significantly lowered for the SAT-DVD watching group at both points of time,
immediately and 1 week after intervention, compared with those before intervention (before
intervention − immediately after intervention; p＜0.5, before intervention − 1 week after
intervention; p＜.05),

As to the contents of the program, many of the participants looked to have enjoyed their imaging
experiences in both programs as seen in the following opinions; “It was an enjoyable work to
image the space and the interior of the womb.
linked with the space.

I heard in the practice of qigong that we were

I was excited with the sense of going to and from the space.” “I was

entranced as if I had been in a dream.”
As to the SAT-DVD watching, many of the participants looked to have realized the necessity tolive in a relaxed manner as seen in the following opinions; “I suffer from trifling matters in myInternational Journal of Structured Association Technique No.3

79

everyday life.

I wanted to live in an easy state.” “I thought I had improved fairly successfully myways of thinking and living in my own way, but I was awoken to the fact that actually I had beenleading conventional life with an idea that it must be so and so.

Now I want to explore thepossibility to realize myself in accordance with my visualized self-image by relaxing a bit more
and trusting myself.”
As to the innate self-image and behavioral objectives for living with it, many of the participants
looked to consciously practice the self-reward oriented way of living as seen in the following
opinions; “From time to time I remember and image my inner self.” “I practice to live inaccordance with my innate self-image.” “I practice looking at the displayed memo.”

4. Discussion

Changes in the biochemical indexes

In this study we examined changes in immunity responses for cancer survivors, taking the
SAT-DVD watching and the qigong, one of the alternative medicines, as control groups.

Theqigong reportedly enhances spontaneous cure28), and also reported is that it is effective fordecreasing leukopenia in case it is used in combination with chemotherapies for cancer
patients.29)

Density of salivary corticosteroid showed a significant decline immediately after theqigong class, which suggested its effectiveness for alleviating stress.
International Journal of Structured Association Technique No.3

Corticosteroids increase80when human bodies are exposed to stress and tension while they decrease when human bodies
are in the state of relaxation.26)

Accordingly, the decline in corticosteroid was thought to be

attributable to the acquirement of the state of physical relaxation by participation to the qigong
class.

However, it is known that the level of corticosteroid is subject to diurnal variation with its

peak at 8 o’clock in the morning and gradual decline thereafter until noon.30)

Since the qigong

class was conducted from 9 o’clock until 10 in the morning, effect of diurnal variation on thedecrease of corticosteroid cannot be denied, and therefore, there is a limit to insisting theunmixed effect of the qigong.
The decrease of corticosteroid in the blood was reported by Van der Pompe G et al as the resultof 13 week short-term psychotherapy program for breast cancer patients, but no such significant
change was seen in the density of corticosteroid by the comparison of the levels before and after
our 90 minute SAT-DVD intervention.

However, significant increase was observed in SIgA.

is known that SIgA reflects the psychosomatic stress.

It

SIgA secretion is decreased by placing aburden of stress on the body or bearing negative emotions in mind.27)

It was suggested as aresult of this study that SAT-DVD watching, immediately after carrying it out, had stress alleviating
effect.
It is said that salivary SIgA easily reflects psychosomatic stress27) while salivary corticosteroid
rather physical stress.

When the contents of the intervention program of this time are taken into

consideration, the effect to alleviate psychological stress may have been reflected in the
SAT-DVD watching and the effect to alleviate somatic stress in the qigong class.
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Changes in Psychological Indexes

By the qigong intervention, no change was confirmed in any psychological indexes.

By theSAT-DVD watching on the other hand, improvement was confirmed in all the psychologicalindexes except for the behavioral trait of problem solving type.

After all, those who participatedin the SAT-DVD watching intervention program were promoted to change their self-image to theone in which negative events were hard to be grasped as mental damages, self-expression waseasy and support from the people around was easily sought when necessary.
Surveying the interventions conducted in the past, reported was a case showing the effectivenessto alleviate depression with the combined use of Simonton’s image control method for cancer
care and biofeedback.32) In it, the correlation is studied between alleviation of depression andrecovering “the identity” that can control disease by creating the image of own lymphocytes
attacking and eating cancer cells.

Reported also by Fawzy et al33) was that as the result of thepsychological intervention by the supporting group (tackling the cancer problems with colleagues)
the mortality rate of the subject group showed one third of the control group 5 years after
intervention.

Based on the past reports, the identity of the subject patient and the mutual

supporting have been discussed as the factors of great importance to overcome cancer.
In the SAT-DVD program, unlike other conventional psychological interventions including
cognitive behavioral therapies, the method without depending on the information based on theInternational Journal of Structured Association Technique No.3

82

memory of past experiences is used for promoting the patients to recognize their “innate self”.
To give a full account, if a behavioral change is resolved with the past self-image intact, it isnothing but an extension of the present way of living.
one’s character demonstrated by behavioral trait.

Therefore, it is impossible to change

Human cognition and behavior are fixed by

the self-image obtained from the information based on the memory of past experiences.

We

come to understand how we should better lead the life with the figure of innate self only when we
recognize the difference between “the actual self” and the visualized image of “the innate self” inwhich we were protected unconditionally and lived at will.

That we adopted an imaging work forreconstructing the inner self based on a certain hypothetical way seemed to be an importantfactor for the obtained result.

If we give a thought to descriptive data including opinions together

with changes in the psychological indexes, the followings seem to have been influential; thesubjects realized their innate self, andthey set the concrete and clear-cut behavioral plan

which looked satisfactory and enjoyable for them and they themselves were able to realize thatthey were actually carrying out the plan.

Among the measured behavioral traits, however, nosignificant change of score was observed in the behavioral trait of problem solving type.

Toenhance the ability of problem solving, additional approaches seemed necessary including
showing the subjects a competent role model.

Also, it was considered as one of the major

causes that other latent psychological problems might remain unsolved and disturb enhancementof problem solving ability.
The qigong therapy was confirmed effective for relaxation by the decrease of salivary
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83

corticosteroid, but at the same time it showed changes neither in scale of depression nor in
psychological traits.

With the qigong therapy alone it seemed impossible to help the patients torealize, much less to change, the self-image script (the scenario by which behavioral traits werecreated) that caused stress disorders including cancer.

If the qigong practice is used together

with other programs including the reconstruction of the self-image script, however, it may possibly
become an effective stress management therapy.
The SAT-DVD self-learning system has possibilities to provide many cancer survivors with carefor stress compensating for the weakness of other individual intervention therapies in which thesubject is limited to a small number of people.

The Limits of the Study and Future Tasks

We tried conducting the SAT-DVD watching program with the support by an intervention assistantas one part of the basic study for developing the SAT self-learning system utilizing DVD, but
cancer survivors might not necessarily be familiar with PC operation.

Therefore, the effects ofthe program conducted with the assistant’s support in research of this time may be different fromthose of the program to be individually practiced by a patient alone.

It is required henceforth toclosely examine the effects of the program under the circumstances where a cancer survivor,
operating PC alone, practices this program to be distributed through Web network.

Furthermore,

only short-term effectiveness before, immediately after and 1 week after the program intervention
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84was examined in this study.

It has been untouched and remains therefore as a future task to

examine if the improvements of immunity response and depression are sustainable in the longrun. s the research design this time, we adopted the methods conforming to the single-grouptime-series design and the crossover design.

However, there was a limit to the study that

influence of carryover effects cannot be eliminated since two different kinds of intervention wereconducted to all the subjects in the same order.

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