Transcript Lisa_bialy

Coping with Cancer
Dr. Lisa Bialy, PsyD
[email protected]
415-948-8823
Survivors’ Day 2008
This is your brain on cancer.
Fight or Flight
Response/Survival
• Normal response to
survival situation.
• Overuse causes
damage.
• Lowered immune
functioning, higher
burnout, more
stress.
The 6 Feared “D’s”
• 1) Discomfort
• 2) Dependency
• 3) Disfigurement
• 4) Disability
• 5) Disruption
• 6) Disengagement
• 7) Death
(Holland et al, 2001)
Doing the Right Thing…
• Treatment choices.
• Personality changes
• Is this making me
sicker?
You are already coping…
Understanding Coping Styles
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Distancing/Denial
Accepting
Escape-Avoidance
Problem Solving
Confronting
Self-controlling
Seeking social support
Substance Abuse
• Avoidant response
• Exacerbated by
illness
• Loss of control
• Fear of pain, tx,
outcomes
• Interferes with tx
Coping Skills and QOL
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Thought stopping
Affect regulation
Exercise, diet
Relaxation
Emotion expression
Humor
Distraction
Information
4 Phases of Treatment
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Diagnosis
Active Treatment
Follow-Up
Future and Possible Recurrance
Myths about
Depression/Anxiety
• All patients with cancer are
depressed/anxious and need help.
• Patients with cancer manage well and
very few need help coping.
• Talking about depression/anxiety makes
matters worse.
Prevalence of Depression
• About 47% cancer patients experience
depression at some point during their
illness (Derogatis et al, 1983).
• Of these, most fit criteria for Adjustment
Disorder, smaller number for Major
Depressive Disorder.
• 90% of above secondary to disease or
tx.
Why do people get
depressed?
• Physical compromises.
• Life changing event.
• Stress of decision
making.
• Fear of future.
• Pain, loss of freedom,
changes in lifestyle.
• Medication Interactions.
• Thoughts of death.
Treatment for
Depression/Anxiety
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Psychotherapy
Social Support
Medication
Psycho-education
and coping skills
How does psychotherapy
work?
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Normalizes negative feelings.
Facilitates communication.
Supports fears and hopes.
Reinforces existing coping skills.
Develops new coping skills.
Focuses on Quality of Life
Individual, Couples, or Families
What is meaningful helps.
• Support and love
from family and
friends.
• Finding personal
meaning, creating
rituals.
• Hobbies, activities,
beliefs, reflection.
Grief Work
• Normal response to loss, whether from
death of a beloved, loss, or injury.
• Usually proportionate to disruption
caused by loss.
• Loss is normal part of life for everyone.
Stages of Grief
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Denial/Shock
Anger
Bargaining
Depression/Sadness
Acceptance
(“On Death and Dying” Kubler Ross)
Recognizing Grief
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Insomnia
Appetite changes
Aimlessness
Hopelessness
Excessive guilt
Psychomotor
retardation
Specific Psychosocial
Interventions
Targeted Approaches/Solutions
Relaxation Training
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Breathing
Meditation
Hypnosis
Music
Exercise
Guided Imagery
Sleep Disturbance
• 48% prescribed
medications for
cancer patients are
hypnotics (sleep
aids).
• 44% psychotropics
sleep aids.
Sexual Dysfunction
• Medication side
effects
• Treatment side
effects
• Depression
• Fear of intimacy
• Couples Therapy
Communication with Medical
Professionals
• List of questions and
concerns.
• Education
• Collaboration/
coordination of care
by point person.
Caregiver Burnout
• Empathic effort takes its
toll
• Express negative or
exhausting feelings
• Self-care essential
• Support for caregivers
• Re-focus on what is
important in own lives
Group Interventions
• Benefits social support, communication
skills, coping responses, and immune
functioning.
• Feedback from other patients and
caregivers.
• Mixed diagnosis/prognosis?
Case Presentation
Multi-method Interdisciplinary
Treatment of Cancer
Couple Dealing with Cancer
• 40 y/o male, w/kids,
engaged to be
married
• Recently diagnosed
with Colon cancer
• Tx- surgery, 6
rounds of chemo,
possible radiation
Woman with Breast Cancer
• 55 y/o married
Chinese American
woman, w/ 2 kids.
• Communication
struggles w/ family
and doctors.
• Cultural
Considerations.
Palliative Care
• 70 y/o “Type A” male
with metastatic
cancer.
• Wife, 2 kids and 3
grandchildren.
• End of life decisions.
• Meaning making.
• Saying goodbye.
Summary
• Advances in cancer dx and tx promising
but treatment decisions increasingly
complex.
• Coping responses inherent.
• Depression and anxiety common.
• Social support essential.
• Self-care facilitates caregiving.
References
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