CBT for Cancer Patients

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CBT for Cancer Patients

Summary:
– approx 1 in 3 Americans are likely to develop cancer at some point in their life
– approx 600,000 Americans die annually as a result of cancer, with approx 1/3 of such people experiencing clinically-significant distress (depression, existential anxiety, pain, suicide etc.,)
– these stats are expected to rise over the coming decade as the US society ages
– for many cancer sufferers it is the first time they have ever engaged with a psychologist
– need to provide what psychoanalysts describe as a “holding environment” or what CBT practitioners might describe as a “present moment” – where the patient is validated & listened to without any effort to change them
– therapy is an opportunity to receive psychoeducation (information & tools) about the interaction of the mind, emotions & behaviour
– use the best CBT & science to help patients:
1) behavioural activation studies done by Jacobson
2) emergence of Acceptance & Commitment Therapy
3) Mindfulness

the therapist identifies organising principles when approaching cancer patients:
1) normalise experience & suffering – review DSM-5 – may include spiritual considerations
[to recognise pain is an inherent part of human life – therefore, why resist something so fundamental to human existence]
2) strengths, resilience & human values – we have reserves within us to meet the challenges that life imposes – these are already behavioural & psychology resources many people
3) balancing acceptance, mindfulness & change processes
– we know that worrying,rumination & negative thinking are highly implicated in the maintenance of depression & anxiety
4) balancing cognitive & experiential interventions in CBT
– there is a layering of cognitions, with the most accessible being the negative automatic thoughts (NATS)
– then there are the rules & assumptions, which are accessible but do take more time to discover
– then there are core beliefs & schemas
[this can be thought/verbal/visual]
5) self-processes – the self is not a thing – it is a set of verbs – the self is encoded verbally, emotionally, behaviourally (including in posture)
– if a patient is cringing, withdrawing – he practices mindfulness with them which is soothing & observes the self & accepts
6) disciplined use of a therapist-self – radical genuineness – using tools of CBT, ACT & mindfulness themselves to manage & cope
– a place of safety & genuineness
– Rollo May: the therapist will remain with you through your journey through Hell (like Virgil did in Dante’s Inferno)
7) model context to understand suffering
– circular models – map out with the client:
– activating events, cognitions, images, self-states, posture, actions, urges,
– what are the consequences of behaving in this manner? In a particular situation [for e.g. Not going to an appointment – I feel better as I do not have to feel or handle/manage my anxiety]
– idea: to widen the lense to look at how Cognitions, emotions & behaviours interact

– guided discovery is a (soft) way to both validate & help the patient understand why they may be stuck & experiencing problems
– guided discovery helps them to see patterns in their life & how & why they have come to this point in their life

– anxiety patients (general): typically over-estimate threat & under-estimate their ability to cope
– in the case of a cancer-sufferer, they may not be over-estimating threat, but they may be under-estimating their personal resources
– therapists still look for mis-appraisals, but with a much softer focus on this aspect of treatment presentation as cognitive Distortions may not in fact be present
– having said that, cognitive biases may be present – I have x months to live, so why bother? [& then miss out on being present with their spouse, children etc.,]

– there are also diagnostic issues to consider – how much are the depressive symptoms informed by medication treatments & outcomes of the cancer itself (disrupted sleep etc.,)

– sufferers also often need practical assistance for problems which may be informing their depression/anxiety – for e.g. A cancer patient felt guilt & worried about their disabled adult child feeling that she had “abandoned” her despite the mother having contracted cancer & having no control over the course/severity of the disease
– therapist organised for ongoing care arrangements to be put in place & organised for the legal guardian to talk with & re-assure her that her disabled child would be cared for

Validation strategies (Linehan) – 6 levels [type in Marsha Linehan & radical acceptance into Youtube – to see a 4 minute video]

– existential issues arise immediately – a cancer diagnosis strips bare the profoundly ephemeral nature of life – it can give rise to paralysing fear & profound sadness
– he notes that often your values lies in your pain (this can bring up incredible resilience, joy, grief &/or regret)

– exposure & cancer patients with anxiety
– they are often in an “exposure” situation – in the medical system
– is there anxiety/avoidance preventing them getting good treatment?
– is there a need to “ratchet down” anxiety & the stress response as they continue to go through & receive treatment within the medical system?
– to self-soothe (palm massage for e.g.) & dampen arousal [may also include pharmacological interventions]

Source: CBT WNC CBT Radio 8 March 2017
http://www.cbtradio.org

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