Draft
(Please do not quote without
permission)
copyright 1994
Eldon Taylor, Ph.D. and
Charles McCusker, Ph.D
Summary
This study sought to evaluate
the use of subliminal stimuli as an ancillary self care modality for
cancer patients. Subjects consisted of fifty adult terminally ill
oncology patients. Subliminal affirmations were written from principles
in the literature of psychoneuroimmunology and recorded at near liminal
levels on audio tape. The results of this study indicate more research
is warranted in this area. It would appear from the findings that
the tapes did have a positive effect on life expectancy and remission
rates.
Appendix C
Table One (Subjects living
at conclusion of study)
ACKNOWLEDGEMENT
The authors wish to express
their gratitude to the Open Mind Foundation for their support with
this research.
INTRODUCTION
Investigation into the
effects of subliminal influence on behavior and physiological response
is not new; studies into this area of research date back to the 19th
century (Zuckerman, 1960). Subliminal perception refers to the processing
of stimuli too weak in intensity or too brief in duration to be identified
consciously (Borgeat, Boissonneault, Chalout, & Elie (1989), and/or
disguised such as in certain shadowing tasks resulting in an "audio
illusion" (Taylor, 1987 and Taylor 1993). Dixon (1971) prefers the
term unconscious perception to describe all cases when responses are
governed by stimuli of which the recipient is unaware, while the term
subliminal perception is reserved for those cases where the stimulus
is below some independently determined limen. Wolman (1973) defines
the absolute threshold, or stimulus limen, as the intensity at which
a particular sound is just discriminable from silence on a given percentage
of trials.
Research into subliminal
auditory stimuli has been an area of considerable controversy and
debate. Considerable evidence is available to support the assertion
that subliminal auditory stimuli is capable of inducing behavioral
and physiological change. (Dixon & Henley, 1991, Swingle, 1991, Taylor,
1994). Meta-analysis has demonstrated "that subliminal presentation
of drive related stimuli produced significantly stronger effects on
behavior than supraliminal presentation of the same stimuli" (Bornstein,
1990). Indeed, the meta-analytic analysis of Hardaway's also demonstrated
a reliable significance in the subliminal presentation of the Silverman
mommy messages (1990). Urban (1992) states that the present consensus
is that subliminal perception is a real phenomenon and what is left
to be resolved are questions relating to kinds and levels of effects
that can be obtained by this method. Dixon and Henley assert:
From the results of applying
subliminal stimulation to the problems of diagnosis and therapy, three
conclusions may be drawn. First, the data support the view that the
meaning of external stimuli of which the recipient is unaware may
be responded to and determine emotional responses, lexical decisions,
overt behavior, and subjective experience.
Second, they confirm the
reality of psychopathology, that is, of a substrate of emotionally
colored stored information with a potential for producing somatic
symptoms and disorders of thinking, affect, and behavior. Third, to
the extent that the content of psychopathology is screened from conscious
scrutiny and therefore impervious to supraliminal information, so
may it be accessed and ameliorated by drive-related stimuli of which
the subject is not aware. (1991).
In the clinical setting,
subliminal auditory stimuli has been utilized in the realm of psychotherapy
with considerable success. Swingle (1991) reports ten years of work
with subliminal auditory stimulation in a large number of experiments
and currently uses subliminal audiotapes in conjunction with clinical
treatment. Costello and Budzinski (1991, cf. Urban, 1992), in a preliminary
report on the utilization of commercially produced subliminal audiotapes
with a clinical population, report the tape-users' scores of improvement
on several measures were significantly better than those of the control
group and were equivalent to those of the psychotherapy group.
Borgeat et al. (1989)
report that auditory subliminal suggestions can influence cardiac
response to an unrelated and benign stress. Subjects, after listening
to preconscious activating suggestions passively, during a stressing
task that followed the passive listening, and after that task, showed
significant effects of the activation subliminal suggestions during
and following the stressing task. Bourgeat and Goulet (1983) report
that auditory suggestions of an intensity below the recognition threshold
influenced physiological responses: activating suggestions induced
higher heart rate and skin-conductance level than when no suggestion
or deactivating suggestions were present. Corteen and Wood (1972)
in an earlier study, associated city names with shock stimuli and
then embedded these city names in material presented to the non-attended
channel in a dichotic listening task. The shock-associated city names
gave rise to a significant number of autonomic responses even though
the subjects were unaware of them. Roche reported a significant decrease
in symptomology of children diagnosed with Attention Deficit Hyperactive
Disorder (1993) and this author reported a significant increase in
physiological measures associated with distress, as measured by a
polygraph instrument when the drive related subliminal audio message
"danger" was presented (1994).
Evidence thus far supports
the assertion that subliminal auditory stimuli has the potential to
affect physiological processes. To what degree is still a matter of
enquiry due to the limited scope of research that has been conducted
into auditory subliminal stimuli. The purpose of this preliminary
study is to investigate the effect of positive and affirmative auditory
subliminal stimuli on the wellbeing and life expectancy in patients
with a terminal diagnosis of cancer. Specifically, can remission rates
and life expectancy in subjects with terminal cancer be extended using
subliminal auditory stimuli, and if so, to what extent?
Further, the philosophy
of cognitive engineering offers a method of altering belief. Recent
research suggests that belief plays a significant role in the outcome
of disease (Phillips, 1993). The theory behind this form of behavioral
therapy is stated by Ellis as, "by disputing irrational beliefs and
replacing them with rational, realistic, and positive statements,
behavior change is effected" (195-). He offers a simple model for
understanding. The A-B-C model, as it is called, is graphically depicted
as follows:
A-------------------->
B--------------> C (activating event) (belief) (consequence: emotional
& behavioral)
The authors make the supposition
that by changing a belief, a method accomplished by exposure to auditorially
presented subliminal statements that become internalized as self talk,
a form of "semantic priming", which can also be seen as a catalytic
activating event (changing the focus of the perceptual lens), a different
and positively modified interpretation of the event will result. This
difference in interpretation changes expectation which defines many
emotional and behavioral responses (Taylor, 1994).
The theoretical application
of subliminal stimuli in this study assumed:
1. certain diseases could
be the result of behavioral strategies (Taylor, 1993, Rossi, 1986)
2. cancer could be aggravated
by psychological factors such as stress (Seyle, 1974, Locke and Colligan,
1986)
3. psychosocial immunocompetence
conditioning factors influence wellness and recovery (Kiecolt-Glaser
et al, 1984).
4. cognitive behavioral
therapy principles are implementable via subliminal stimuli, altering
belief (expectation) and resulting in a positive influence of disease
outcome (Ellis, 1988).
Cancer treatments either
without proven efficacy, or of questionable methods, have achieved
new levels of popularity, particularly among the well educated (Cassileth
et al, 1991). Treatments such as macrobiotic diets (Bowman, Kushner,
Dawson, & Levin, 1984), high-dose vitamin C (Moertel et al. (1985),
immunoaugmentive therapy (Curt et al. 1986), Laetrile (Moertel et
al., 1981, 1982), as well as others have been subject to investigation.
Cassileth et al. (1991) report that for patients with extensive disease,
there are no significant difference in length of survival between
groups using conventional treatment regimens and unorthodox treatments
such as those mentioned above.
For patients diagnosed
with terminal cancer (distant metastasis at time of diagnosis and
extensive disease), standard methods of treatment (chemotherapy and
radiotherapy) serve to reduce tumor size, diminish pain, as well as
delay disease progression. These treatments are not curative for patients
with a terminal diagnosis of cancer and few other treatment options
are available. Despite this, alternative methods in the treatment
of cancer have received little support or recognition from the medical
profession.
Although the rate of cure
is relatively high for many cancer sites, as with leukaemia and Hodgkin's
disease (American Cancer Society, 1992), many disease sites remain
incurable. Of note, 258,000 people in the U.S. died of cancer in 1988
(American Cancer Society, 1992). For these reasons alone, it makes
sense to explore and research alternative treatment methods that have
the potential to generate improved remission rates in the treatment
of cancer, in conjunction with traditional treatments.
In this preliminary study,
the efficacy of using subliminal auditory perception in the treatment
and control of oncology patients with incurable disease is investigated.
Since this is a preliminary study, stringent controls were not always
possible. Despite this limitation, this study indicates that the use
of positive, self affirming messages delivered to terminal oncology
patients using an auditory subliminal medium can lengthen life expectancy
and improve quality of life. METHOD Subjects
Fifty males and females
over the age of fifty and diagnosed with terminal cancer (defined
as extensive disease with distant metastasis) were recruited through
professional cancer clinics and support groups in seven states. Ten
subjects were lost due to non-deliverable addresses, nine were not
seen for follow-up, one subject's physician was ill and unable to
complete the questionnaire, and no response was received from thirteen
subjects' physicians. Of the seventeen subjects remaining, three were
not included in the study because they were HIV positive, leaving
a total subject population of fourteen. Materials
Subjects were provided
with a subliminal program entitled Cancer Remission. The messages
(Appendix A) were recorded using the "Taylor method" (Kruse, 1992),
applying simultaneous information of both forward and reverse speech.
Messages were delivered within the band width of music slightly beneath
the music's outer edge peak volume. Subjects were instructed to use
the tapes with their home stereo equipment or portable cassette players.
Design and Procedure
During a three and a half
year period, tapes were made available to subjects only with the consent
of their primary physician. Subjects were advised to use the tape
as often as possible, including during sleep. Subjects were assured
that there would be no adverse effects from using the tapes.
Questionnaires were sent
to each subject's physician two to four years after the subjects had
received the subliminal program. The questionnaire consisted of twelve
questions that were rated on a five point scale: 1, strongly disagree;
2, disagree; 3, neutral; 4, agree; and 5, strongly agree. The twelve
questions consisted of four general categories: A, the patient's attitude
toward their disease before they used the program; B, the patient's
attitude toward their disease after they used the program; C, the
patient's survival and quality of life; and D, the physician's perception
concerning their patient's belief that health can be positively effected
by the mind.
Results
Statistics for survival
time in patients with terminal cancer (distant metastasis at time
of diagnosis) from the American Cancer Society is available only for
specific sites in relation to five year survival. No statistic for
an overall survival rate for patients with terminal diagnoses is available.
For this reason, it was not possible to compare the mean survival
in months for the subjects in this study against the mean survival
rate in months for the national average. Also, prognosis and mean
survival time varies depending on the extent of metastasis at time
of diagnosis and the primary site of the disease.
At the conclusion of this
study, which lasted 42 months, six subjects were living and eight
were dead. Of those patients who died, they lived an average of 15
months longer than the original diagnosis would have indicated.
For the six subjects that
were living at the completion of the study, all of the physicians
strongly agreed that the mind or attitude of the patient is relevant
to their health, with the exception of one physician who did not respond
to this question. In the group of patients who were dead at the completion
of the study, the physicians responses were as follows: four strongly
agreed that the mind or attitude of the patient was relevant to the
patient's health, three agreed and one was neutral.
For the subject group
that was alive at the completion of the study, two physicians strongly
agreed that the subliminal program served a valuable function for
the patient, three agreed and one did not respond. For the group that
was dead at the end of the study, five physicians were neutral to
whether they felt the program served a valuable function for their
patient, two strongly agreed and one agreed that the program served
a valuable function for their patient (see tables).
Discussion
Since this is a preliminary
study and no previous studies are available in which to compare the
efficacy of the use of audio subliminal technology in the treatment
of cancer or other disease states, it is difficult to make definitive
assertions on the usefulness or overall effects of this technology
in the treatment or control of terminal cancer. However, the results
of this study strongly suggest that further investigation is warranted.
If the data from the study is evaluated from the perspective of simple
percentages, some interesting and provocative implications emerge.
Of fourteen subjects terminally ill with cancer, 43% were reported
as in remission. For every neutral or negative response from physicians
to question 11 (see appendix B) "I believe that the mind or attitude
of the patient is relevant to their health and/or health care", there
is a deceased patient. This suggests the importance of a positive
physician attitude. Indeed, the expectation of the physician has been
linked to patient outcome in at least one other study. (Phillips,
1994).
The results of this study
suggests that the subliminal cancer tapes provided to the fourteen
subjects did have an effect with some increase in life expectancy
of the subjects in this study, as well as the quality of life these
patients experienced. It is impossible at this point to ascertain
whether other variables may also have played a role, such as physicians
care, type of cancer experienced, or the will of the patient themselves.
Of interest, for the group of subjects alive at the end of the study,
is the fact that these subjects' physicians overall had a higher agreement
level that the tape was of value to their patients, and had a higher
level of belief that the mind or attitude of the patient plays a significant
role in their health. Overall averages at the time subjects entered
into the study did not differ significantly between the two groups,
meaning that subjects in one group did not enter closer to the beginning
or the end than the other group. Future studies assessing the effects
of subliminal technology on the remission rates of subjects with a
terminal diagnosis of cancer will need to employ tighter controls,
limiting the number of confounding variables such as length of time
the tapes are actually used, primary site of disease, extent of metastasis
as determined through CAT scans, MRI's, and other definitive medical
tests, as well as more in depth demographic information. No records
were kept regarding the amount of time subjects actually listened
to the tapes (i.e. number of hours per day). For this reason, it was
not possible to assess whether the actual amount of listening time
was a significant factor in remission rate and response.
It is well documented
that prognosis in cancer patients will vary significantly depending
on the primary site of the disease, stage, number of nodes involved,
and the extent of metastasis that has occurred at time of diagnosis
(American Cancer Society, 1992). In this study, no records of site,
stage and extent of metastasis were considered. For this reason, it
is possible that the subjects who lived longer had less disease than
those patients who were dead at the time the collection of data was
completed. In future studies, a more homogenous and larger sample
would be of benefit in relation to site of disease. Using subjects
with a more similar disease state would eliminate a number of confounding
variables.
As well, expected prognosis
or life expectancy for subjects was determined by their physicians
and no standard criterion was used. Bias on the part of the individual
physicians toward their patient due to coping styles, attitude, response
to treatment, and/or other variables may have affected the prognosis
physicians gave their patients. For example, a patient with a positive
attitude toward their disease may have been given a longer prognosis
than a patient with a negative attitude toward their patient's disease,
independent of other criterion such as disease state.
No control nor placebo
groups were utilized in this study. In future studies control and
placebo groups could be implemented.
CONCLUSION
From the results of this
preliminary study, it appears evident that subliminal auditory stimuli
is likely to be of benefit to patients with a terminal diagnosis of
cancer. Since this is a preliminary study, future investigation into
this area is needed to obtain more concrete results. Since medicine
at present offers little in the way of treatment to a large number
of these terminal patients, it makes sense to pursue any area of investigation
that promises some hope to these people, especially in terms of positive
outcome and cost effectiveness.
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