The Contributions of Lydia Temoshok, PhD

Director of The Behavioral Medicine Program, Biotechnology Institute

University of Maryland Medical School

Co-Author, The Type C Connection: The Mind-Body Link to Cancer and Your Health

“I’ve described the experience of cancer as a crossroads in your life, when you’re confronted with both danger—and opportunity…..What changes you make turn this experience from what (at first) may seem like a prison sentence into an opportunity for healing and a better life.” 

Lydia Temoshok, PhD

Can our emotions and behavior affect our risk of getting cancer--

and our recovery from this disease? 

This is the question Dr. Temoshok was asked to consider back in 1979, when she agreed to begin an intriguing and controversial research study with melanoma patients.  Richard Sagebiel, MD, head of the Melanoma Clinic at the University of California San Francisco, had begun to notice “a strange pattern of stress and coping” common to most of his patients.  He had begun to think this might be a significant factor in the connection between cancer and behavior and contacted Temoshok to discuss the potentials for a formal research study.

Temoshok had already been studying the effects of stress on health while on staff at The University of California School of Medicine. She is a psychologist nationally recognized in the fields of behavioral medicine, psychosocial oncology and HIV/AIDS research.  Temoshok now began to spend time at the Melanoma Clinic, interviewing patients and conducting a preliminary investigation.  What she found was so exciting and ripe with potential for changing the development and treatment outcome of this dreaded disease, that she made the decision to devote all her time to the study of the psychology of cancer patients. 

What Temoshok found in interviewing these 150 patients was a striking and amazingly similar pattern of behaviors.  These melanoma patients were overwhelmingly nice.  Yes, they were excessively nice, pleasant to a fault, uncomplaining and unassertive.  They went far out of their way and changed their schedules to make time to talk with her—so as not to disappoint her.  They seemed extremely worried about their disease progression--but not for themselves.  They worried about the effect it was having on their families:  “I’m fine, but I’m really worried about my husband.  He takes things so hard…” 

Describing the Type C Behavior Pattern

In effect, they were in a form of denial and using it as a coping strategy.  Temoshok began to suspect that there was much more than simple denial at work and she soon began to recognize a common pattern.  These patients were “pleasers” who had spent their entire lives trying to be accepted by others—spouses, parents, siblings, coworkers, friends etc.  In fact, their very identities seemed to be derived from how they were perceived by others in their lives.  Temoshok describes this as “Out of touch with their primary needs and emotions, they look to others for signals on how to think, feel and act.”  She named this set of behavior traits and coping methods the “Type C” phenomenon and she developed her theories from psychological, social and biological perspectives.

“….What they shared was a manner of handling life stress.  The melanoma patients coped by keeping their feelings under wraps. They never expressed anger, and rarely did they acknowledge fear and sadness. They maintained a façade of pleasantness even under the most painful or aggravating circumstances.  They strived excessively to please people they cared about, to please authority figures, even to please strangers.”

Temoshok devised a series of scientific studies to explore Type C behavior patterns and found a strong correlation with the development and progression of cancer—though by no means was this a case of cause and effect. There are many risk factors for developing cancer, however Temoshok did uncover a profound relationship between repressed emotions and the depression of the immune system—our first line of defense against cancer.

“Type C behavior is an extreme version of coping methods many of us employ—we appease others, deny our true feelings and conform to social standards.  But my study of the melanoma patients led me to convincing evidence that our physical health is compromised when we chronically repress our needs and feelings to accommodate others. I was able to find evidence that this coping style weakens our immune defenses and leaves us more vulnerable to cancer progression.”

The landmark book “Type A Behavior and Your Heart” had already identified the Type A behavior pattern and its connection to the development of heart disease.  Those exhibiting Type A behavior patterns are almost pathologically impatient, highly charged and competitive, filled with anger and hostility which they express freely, and are consistently focused on their own needs.  Now for the first time its polar opposite, the Type C behavior pattern, was identified and correlated with immune dysfunction and the development and progression of cancer.  Temoshok points out that most healthy people lie somewhere in the middle between these two polarities of Type A and Type C.  This healthy middle ground is sometimes identified as the Type B pattern.

It is not whether we have stress in our lives—for surely we all have many highly stressful factors in our lives.  Rather it is how we cope with these stressful circumstances that is a determining factor in the state of our health.  Temoshok summarizes this concept: “Stress per se is not a critical factor in illness—it’s the strength or weakness of one’s coping mechanism.”

After extensive psychological testing and interviews, Temoshok identified strong Type C patterns in at least three quarters of the 150 melanoma patients she studied.  Type C was not who these people were (their personalities)—it was the behavior pattern they used to cope with outer stress and inner distress.  She found that these patients exhibited most or all of the following behaviors:

• They did not express emotion and were often unaware of any feelings of anger, past or present.

• They tended to not experience or express any other negative emotions such as fear, anxiety or sadness.

• They were patient, unassertive, cooperative and appeasing with work, social and family relationships and also compliant with external authority.

• They were overly concerned with meeting others’ needs and insufficiently engaged in meeting their own needs.  They were often self-sacrificing to an extreme.

She also observed and scientifically verified the following facts:

• Patients who were more emotionally expressive had thinner tumors and more slowly dividing cancer cells and a much higher number of lymphocytes (immune cells) invading the tumor.

• Patients who were less emotionally expressive had thicker tumors and more rapidly dividing cancer cells, with far fewer lymphocytes invading the tumor.

Avoiding Self-Blame and Guilt

Clearly wanting to avoid creating a situation where cancer patients blame themselves for bringing on their cancers, Temoshok spends an entire chapter in her book explaining how using a “compassionate self awareness of Type C behavior” can help patients rise above self-blame or victim behavior.  Those with Type C behavior patterns are notoriously prone to guilt and self-blame already. Knowledge is power however, and using this information to shift self-destructive behavior patterns can make the all important difference in surviving for some people.  Most of us use coping mechanisms we developed in childhood to survive life’s inevitable traumas.  Recognizing where these patterns no longer serve us and are in fact hurting us is the first step to a transformed life on many levels. 

“I also learned that people did not bring cancer on themselves.  Their Type C behavior began unwittingly and persisted without conscious volition.  No one can be blamed for mind-body factors in cancer, because no one intentionally develops the cancer-prone behavior pattern.  Furthermore, without knowledge of the Type C/cancer link, how could someone realize that his behavior might impact his cancer defense system on a molecular level?”

“I realized early in my research that Type C behavior had been each person’s best attempt to cope with the pains, stresses, humiliations and unmet needs of early childhood.  Later in life, this coping method had liabilities—both mental and physical—that the person could become aware of and change, in order to lead a healthier and more meaningful existence.  Type C behavior is associated not only with cancer but with many other diseases caused by immune dysfunction.” Temoshok has subsequently worked extensively with these theories as they relate to HIV/AIDS patients.

Repression of Anger is Common with Cancer Patients

Of note is Temoshok’s identification of the repression of the emotion of anger as a primary psychological defense mechanism with cancer patients.  She is careful to explain the difference between repression (unconscious and unaware) and suppression (knowledge of the anger, but choosing not to express it), which is generally not as destructive to the immune system.  Is there a healthy expression of anger?  Temoshok quotes author and spiritual teacher Stephen Levine in describing healthy anger as having “the quality of an unwillingness to allow things to remain as they are.”  Seen in this way, anger can be used as a straightforward and positive force in one’s life—as an agent of constructive internal and external change—and should be expressed appropriately and released. 

This type of healthy anger should not be confused with resentment, which can fester beneath the surface for long periods of time and literally eat away at us.  She reflects on the importance of forgiveness in the following statement:  "We must evaluate the contribution that factors such as forgiveness may have on health -- both across the board and for those already afflicted with serious and chronic life-threatening conditions."  Some people will need to take time to process and express old angers and resentments, while some, like Greg Anderson (covered in a chapter in this report) will be able to leap directly into forgiveness and release.  Don’t judge yourself if this is a slow and difficult process for you.  Just keep moving through it.

How Type C Behavior Patterns Contribute to Cancer

Temoshok devotes part of her book, published in 1993, to a discussion of the mind-body science behind how the mind, emotions and body interact on a physiological level to cause disease.  She notes, “The answers are beginning to be understood, in the wake of a veritable scientific revolution in the study of psyche and soma.”  Candace Pert (covered in a chapter in this report) would publish her ground-breaking book, Molecules of Emotion, four years later in 1997—demonstrating scientifically and dramatically for the first time the complex neuropeptide system and the actual process whereby our emotions create actual physiological change in our cells and organs.  These changes can be health-promoting or health limiting.

“Our entire view of health and illness is undergoing a seismic change.  The strongest wave of change is the recognition that mind-body relationships can have a profound effect on our state of health or disease.  A new science, Psychoneuroimmunology, is charting a labyrinth of mind-body connections involving brain structures, chemical messengers and immune cells.  Researchers in this young field are discovering that how we think and feel alters the strength of our immune system, the body’s network of defense against disease.”

This is empowering information indeed because it means we can understand which behaviors and ingrained patterns we can begin to change to strengthen our immune systems and thereby allow our bodies to organically prevent disease from occurring—or to help heal ourselves when imbalances (diseases) are already present.

You Can Transform Your Type C Behavior and Begin to Heal

Temoshok’s book also outlines theories and processes to shift Type C behavior patterns.  She calls it “Type C: Transformation for Recovery.” Here are stories of patients she has worked with and the profound effect that even small shifts of the Type C patterns can have on the course of their disease.  The basics of the Type C transformation process includes nine goals tailored specifically for cancer patients:

• To develop awareness of your needs.

• To discover your inner guide.

• To reframe your ideas about your feelings.

• To learn the skills of emotional expression with doctors, nurses, friends and family members.

• To take charge of your medical care.

• To get the social support you need.

• To secure your legitimate rights.

• To work through hopelessness.

• To cultivate fighting spirit.

Finding the right professional help with shifting these patterns is tantamount to survival in many cases. It’s important to discover which type of psychotherapy or other therapeutic approach works best for you.  These can include supportive-expressive and psychospiritual counseling, hypnotherapy, meditation, visualization, dreamwork, energy balancing techniques, art and music therapies, biofeedback, many kinds of bodywork, and other excellent tools. One way to describe your therapeutic goal to prospective counselors is that you want to transform any part of your coping style that might create a dysfunction or a weakening of your immune defenses and therefore make you more vulnerable to disease development or progression. There are mind-body techniques available in most alternative or complementary clinics and even some conventional medical centers now.

Temoshok offers the following affirmation for cancer patients to use to reinforce these nine goals.  If you’ve recognized yourself in some of the characteristics of the Type C pattern, you may want to write this short narrative out and read it through daily.  Remember—small steps and small victories accumulate over time to get you where you want to ultimately be.  Celebrate each one.

“My mind and body need as much rest and relaxation as possible.  In order to get well, I must pay attention to my needs above all else. This may seem self-centered, but I know that I’m a very giving person—I have been my whole life—and now I need to be indulged a bit.  I have to take care of myself so that I have the best chance for recovery.  If I try to be courageous at all times and strong for other people, I’ll be falling back into my old pattern.  I realize now that it’s depleting to play that role.  I’m optimistic about getting well but I can’t simply rid myself of all negative thoughts.  I’m going to give myself permission to be sad, grumpy and scared.  I find it a great relief to allow these feelings to come out with other people—it was a strain to hide them all the time.  I want to be a “good patient,” but I can no longer live up to the label “perfect patient.”  I’m going to take as much time as I need to get well.  These are gifts I’m giving myself, and they make me feel good about myself and my recovery.” 

Dr. Lawrence LeShan, a leading cancer psychotherapist described in another chapter within this report and a recognized pioneer in the field of Psychoneuroimmunology, describes these same concepts in the following quote.  He states that each of us must develop "a fierce and tender concern for all parts of ourselves so that no part of our being is left standing outside the door, whimpering:  'Is there nothing for me?’  Too many people feel undervalued and unworthy. How many times have we allowed societal messages or our own negatively-programmed inner voices to override the truth of our being?”

This is the beginning of the Type C Transformation and the shift toward embracing all parts of us, including our “shadows,” and unleashing the healing potential we all carry within us. 

NOTE:  Dr. Temoshok’s book with co-author Henry Dreher, is currently out of print, however there are used copies available through Amazon.com and other book-sellers. You may want to find a copy and read it as there are many stories included of cancer patients who used these theories and techniques with inspiring and profound results.