Fighting on
all Fronts

Psychosocial intervention programmes provide vital support in fighting some of life’s biggest battles.

The Department of Social Work and Social Administration (DSWSA) has been working for around 20 years on developing a Mind-Body-Spirit approach to coping with illness, or serious stress-inducing situations.


Two of the leaders in the field are Dr Celia Chan Hoi-yan and Professor Cecilia Chan Lai-wan,
Si Yuan Professor in Health and Social Work. Most recently their techniques have been used in two experimental approaches, both backed by Knowledge Exchange funding: a lung cancer fighter course and a programme designed to help couples going through the stress of in vitro fertilisation (IVF) procedures. While clearly disparate problems – both are times when people are under extreme duress.


Dr Celia Chan Hoi-yan, Assistant Professor at DSWSA, has been collaborating with HKU’s Department of Obstetrics and Gynaecology in developing a self-help psychosocial support exercise called the Body-Mind Wellness Intervention Programme, tailormade for women undergoing IVF treatment. Dr Chan’s work is taking the research to a new level of sophistication, and she is seen as a leader in the fertility and women’s health fields.


The programme was developed based on the findings of a study carried out between 2013 and 2015 by Dr Chan’s team. It was the first longitudinal study in Hong Kong to examine anxiety and depression levels among infertile women whose IVF cycles were unsuccessful, and the results indicated women benefited from the intervention.


Participants were divided into three groups: the first received spiritual contents and behavioural techniques; the second were given the spiritual contents only; and the third got only the health information.


The hypothesis was that those women receiving spiritual contents and practising behavioural techniques during their waiting period after IVF treatment, will have a more significant reduction in anxiety, depression and psychosocial distress than the two other groups, and the findings confirmed this.


The self-help ‘Body-Mind Wellness Intervention Programme’ is a self-administered psychosocial programme designed specifically for women undergoing IVF treatment. Every participant receives a booklet of self-help body-mind techniques.

“More and more research is confirming the positive effects of psychosocial interventions,” said

Dr Chan. “Psychosocial interventions refer to a range of non-drug therapies including individual counselling, group activities, relaxation training, and education on symptom management.”

The programme includes a series of exercises participants can do at home. The Mind and Body aspects include acupressure exercises, qigong, taijiquan and the Spirit part includes reflective exercises.


“The focus on spirituality is important,” Dr Chan said, “and this is part of a global trend. Spirituality looks at how we deal with suffering, be it physical or emotional pain. How we conceptualise spirituality is key, and it is important to note this is not religiosity – people who are not religious can be spiritual and have spirituality.”

The focus on spirituality is important, and this is part of a global trend… How we conceptualise spirituality is key, and it is important to note this is not religiosity – people who are not religious can be spiritual and have spirituality.

Dr Celia Chan Hoi-yan

Taboo subject


For women having IVF, stress is often worsened by not being able to talk about what they are going through. “Infertility is still a taboo subject in Chinese society and in Hong Kong there is insufficient recognition of, and support for, the needs of infertile women within both their social and familial networks,” said Dr Chan.


“Undergoing IVF is a life-changing experience. In most cases it fails – the success rate is under 30 per cent – so for most there will not be a happy outcome. Also, the IVF process itself is demanding both physically and mentally.”


IVF begins with hormonal treatment, followed by egg retrieval, then egg transfer, after which there is a two-week waiting before doctors can confirm if the process has been successful and pregnancy has been achieved.


“We start briefing the women before the process begins, so they know what to expect and can get into a positive frame of mind,” said Dr Chan. “The most stressful time for them is the two-week waiting period.”


Based on the 2013–2015 study’s results, the team developed a pilot psychosocial intervention exercise attended by 42 participants. “The initial reaction from some women was, ’why should I do this – this is private’,” said Dr Celia Chan. “But those who came said it really helped. It also offers most of them a unique opportunity to meet other women in the same situation. It is a chance to share what they are going through.


“We hope it will help bridge a gap in psychological services in Hong Kong. In other countries counselling is mandatory for women undergoing IVF. The UK, for example, already has self-help programmes. There is no tradition of counselling in this area in Hong Kong, despite the fact that there are so many psychological, social and ethical issues associated with IVF. Part of the problem is lack of resources – we need more funding for this kind of counselling.


Dr Chan’s team is currently recruiting a second group of participants for the next set of workshops. They come from both public and private hospitals, and are told about the programme by doctors, nurses and embryologists.


Since 2010, Dr Chan has also been working with the Hong Kong Society for Reproductive Medicine, collaborating on running training courses for medical staff and social workers to give them the psychosocial mindset to provide more holistic care for their patients. Thirty healthcare professionals have attended each of the four courses run so far – attending 10 lectures and a personal growth workshop.


Additionally, Knowledge Exchange funding also supports people who miscarry after IVF treatment has resulted in pregnancy. “This is a very traumatic experience, and services such as bereavement counselling can help,” said Dr Celia Chan. “For women undergoing IVF, we want the intervention programme to help them look at their life as a whole, and see that it has worth whether or not it includes children.”

Professor Cecilia Chan (sixth from left), Dr Celia Chan (seventh from right) and the Body-Mind-Spirit team.

Living with lung cancer


Professor Cecilia Chan is another key pioneer in psychosocial intervention, having first worked in this field in 1993 in collaboration with Stanford University’s Department of Psychology, which developed psychosocial groups to help patients with end-stage breast cancer. She published the first edition of her Body-Mind-Spirit training manual back in 2001. The book, entitled An Eastern Body-Mind-Spirit Approach, is currently undergoing a third update.


She currently heads up the DSWSA’s research team working in collaborating with the Hong Kong Cancer Fund on the Lung Cancer Fighter Course. “Research findings have confirmed the positive effects of psychosocial interventions as a complementary therapy to medical treatments,” said Professor Cecilia Chan. “In the case of lung cancer, patients today have a better chance of a cure or prolonged survival than ever before, but they still need to be able to cope with intense stress of living with and fighting this illness.


“We have developed a holistic approach to dealing with the challenges that lung cancer patients and their family caregivers face on their journey with this cancer. Previously, intervention was done with patients alone, but when someone has cancer the whole family is effected by their illness. Often the family is more stressed by it than the patient. If the family can learn to cope they can help the patient deal with the illness, so these courses have mutual benefits.”


The course teaches patients and caregivers about the disease itself and related symptoms, such as pain, fatigue and shortness of breath, as well as the physical side-effects of treatments like chemotherapy. Then it explores with them the mental effects such as depression, lack of sleep and anger.


“Cancer releases many different emotions within the family,” said Professor Cecilia Chan. “It can enhance relationships, bringing people closer in a time of strife, but often it also sparks disputes, especially when difficult decisions have to be made. In extreme cases, feelings can become so entangled that one person’s illness ends up becoming a disaster for the whole family.”

Our work aims to ascertain the value of psychosocial intervention as a tool in the battle to cope with life-changing events.

Professor Cecilia Chan Lai-wan

Positive outcomes


Results after the first programme, which was undertaken by 65 pairs of patients and caregivers, have been very positive. Participants said they felt better able to cope after the course, happier in themselves and often relationships had improved.


This is in keeping with international studies which have also shown that when patients’ coping capacity is enhanced after intervention, not only their health indicators improve, but the quality of life of their caregivers also improves. The research by the HKU team has demonstrated that, after participating in psychosocial interventions, patients showed improved immunity, reduced pain and depressive symptoms, better sleep quality, a slowing down of disease progression, a lower rate of recurrence and prolonged survival. Their self-efficacy and skills to cope with disease symptoms were also enhanced.


In the early sessions, patients are put in one group and caregivers in another. Senior Research Assistant Michelle Tam Yi-jun explained: “This is because patients often can’t talk explicitly about their illness to family as they don’t want to burden them, but they find they can talk with other cancer sufferers.


“And it is equally important for the caregivers, who tend to put their own lives on hold while caring for a family member with cancer. The caregivers also find they can say things they can’t say to the patients – including expressing anger. Often they find the illness harder to accept than the patient does – they can get angry at the patient’s stoicism. Further, both the patient groups and the caregivers say they felt it was OK to cry in the group, which was a relief as they didn’t want to cry in front of each other.”


Some exercises the pairs are asked to undertake during the course are specifically aimed at encouraging them to talk about what is happening – in fact some of their homework necessitates it. A mother and son who participated said before the intervention sessions they couldn’t bear to discuss her illness. But then because of the assignments they had to start talking, and now they are able to discuss it openly. “Even though the mother has been diagnosed as stage four cancer,” said Miss Tam, “they are using the time remaining to create happy experiences, and it has brought them closer.”


Professor Cecilia Chan, concluded: “Our work aims to ascertain the value of psychosocial intervention as a tool in the battle to cope with life-changing events. For patients who have been diagnosed with end-stage lung cancer we want to help them to learn to treasure every moment. Don’t waste time on worrying or being angry, channel energy into enjoying life. The intervention encourages them to share their values, to think about what is important in life and to pass those thoughts on to their families. This is more valuable than leaving them money.”


Dr Celia Chan and Professor Cecilia Chan have worked – together and separately – on psychosocial research for some 15 years. “We want to develop evidence-based practices,” said Dr Celia Chan. “That is in keeping with global trends, and under Professor Cecilia Chan’s leadership, Social Work at HKU is moving in this direction.” 

A mock group therapy session.