The diagnosis and treatment of cancer exerts considerable impact on the quality of life and functioning of many patients and their families. An essential component of the treatment of cancer is the care of the patients' psychological, emotional and spiritual well-being. Psychosocial interventions which aim to increase psychological and emotional well-being and to improve the course of the illness have been increasingly used in conjunction with medical treatments.
Psychological preparation for surgery can improve both physical and psychological outcomes after surgery. It is also possible that appropriate psychological intervention can reduce the high levels of emotional distress experienced by many women with breast cancer.
There are techniques that can be learned to improve a women's adjustment to the diagnosis, treatment and after care of breast cancer. All members of your treatment team may play a role in strengthening your resources and fostering a sense of optimism and hope.
Psychosocial support includes cognitive and behavioral intervention, group and individual counselling, informational and educational treatment, peer support and complementary therapies.
Under this category of interventions are methods that focus on changing specific thoughts or behaviors and on teaching coping skills. This would include problem solving, goal setting, lifestyle management, stress-coping training, identifying dysfunctional concerns, attitudes and beliefs. Also included under this category are behavior modification or reinforcement, progressive muscle relaxation training, meditation, hypnotherapy, desensitization and guided imagery. Not only do these interventions decrease anxiety, worry and depression but they also have potential to reduce anticipatory nausea and other symptoms from radiotherapy and chemotherapy.
Coping Skills Training
Each individual will be impacted by the personal meaning that they assign to a diagnosis of cancer and this will affect their coping strategies. Cognitions, or thoughts, are powerful determinants of how we can feel and the choices that we make. When a belief or thought is based on a premise that is irrational or distorted, an increase in distress may be experienced unnecessarily. With cognitive restructuring or coping skills training, you can be taught to identify and challenge negative automatic thoughts that are underlying your anxiety or depression. With cognitive reappraisal you can learn to focus on the positives, identify personal strengths, and improve your goal setting and problem solving skills. Psychological distress can be significantly lowered by learning these skills. Since the mind and body are connected, when you lower your emotional distress you have the ability to impact your body in a positive way as well.
With coping skills training you can experience a positive change in your emotional adjustment, social functioning and overall management of your illness.
Supportive counselling can be experienced in both an individual or group format. The goal of supportive care in either approach is to enhance quality of life by allowing women to discuss their feelings and concerns. Having a safe environment in which to express the emotional reactions to cancer facilitates being able to cope with anger, fear, anxiety, loss of control, changes in body image, guilt, grief or sadness. These are powerful emotions that need to be validated and understood. To internalize these feelings could have a negative impact on your body and its ability to heal and recover in an optimum way.
Although it is common and normal to experience intense, unpleasant and distressing emotions surrounding the diagnosis, treatment or recurrence of cancer, these adjustment challenges can compromise psychological and physical health. Both individual and group intervention can provide a tremendous amount of emotional support to enhance coping and improve quality of life.
While pain can have physiological causes, it can also be caused by emotional stress alone. To the cancer patient, pain can sometimes be a frightening experience. When we are afraid, our body often becomes tense and this tension can in turn create more pain and more fear. You can learn to interrupt the cycle of pain that you may be experiencing. Applying relaxation and mental imagery techniques can help in reducing the tension which can lessen the pain. You can also learn to strengthen your belief in your ability to manage the pain better and thereby decrease the fear component of pain.
Body Image and Rebuilding Confidence
Although it is often difficult to talk about, many women feel concerned about how they will look and feel about their bodies after surgery and treatment. It is important to be able to discuss how you may feel about the changes in your appearance, concerns about reconstruction, scars, prostheses, the impact on your self-image and sexuality. Being able to grieve the changes in your body image and learning to rebuild your self-esteem and confidence are important parts of recovery.
Guided Imagery & Relaxation Training
Progressive Muscle Relaxation is a technique that has been widely used to teach individuals how to manage the tension and pain that can be a habitual response to stress. With the releasing of muscle tension your pain condition and emotional distress can be positively altered. People with high degrees of anxiety particularly in anticipation of surgery and treatment can benefit from relaxation training. This includes PMR and also meditation and guided imagery. Significant reductions in anxiety and depression can be experienced when a person learns to apply these techniques. Guided imagery is a method of self-direction where one visualizes images that reflect desired health outcomes. This process can also bring about attitude changes, all of which have the potential to enhance your health and recovery in some ways.
When you master these skills you may begin to reclaim your feelings of being in control. When we experience a sense of mastery over aspects of what is happening to us, we also feel better about ourselves.
A lack of information can be a barrier to a personal sense of power over one’s choices. Programs that offer supportive counselling and knowledge building components can decrease anxiety, enhance understanding and provide you with information that allows you to take action. Education about breast health, treatment options, diet, exercise, information on the disease and current research can facilitate your adjustment to the illness and enhance a sense of mastery. Different health professionals are valuable resources for you to access to enable you to learn how to cope better and improve emotional well-being. Information about complementary treatment that can enhance quality of life and improve mood is available and can be used in conjunction with medical treatment of the disease.
Spirituality Faith and Healing
There is often a belief in a higher power that an individual brings with them as they face the stress of surgery, cancer and possibly death. Many people also believe in the efficacy of prayer for their healing and recovery. If you have spiritual practices, you can implement them and bring comfort in the face of your diagnosis. Whatever your preferences may be, it is possible to allow the strengthening of spirituality to bring peace of mind, security and safety. Since spiritual beliefs form a vital part of the way some people view life, it is possible to use this framework to reach a sense of meaning and purpose and to transcend above the disease and have gratitude for other aspects of life.
Empowerment & Hope
Positive effects on emotional adjustment, treatment and disease-related symptoms are experienced when the person with cancer takes an active role in their well-being. Emotional adjustment includes feeling less depressed and anxious and also improving ones’ mental attitude toward the illness. Improved self-esteem and coping styles contribute to increased feelings of personal power and control.
As you learn to manage the illness and impact on your life, social functioning can improve as relationships with family, friends and work can become less stressful. With time you can learn how to balance self-care with other responsibilities and recreation. Problem-solving and decision making are skills that are improved as you learn to mobilize your personal and external resources. Relaxation therapy can teach you to have increased control over pain, fatigue and stress.
There are many things available to you in assisting you to enhance your ability to cope with an illness, with surgery and in your healing and recovery. Although there may be things about your illness that you do not have control over, the healing spirit within your mind and body has the power to influence your sense of well-being in a positive manner. Having the courage to access this inner resource can bring you a sense of peace, comfort and gratitude for what you value in life. It is my hope that you would know that you are not alone in this journey.