According to the National Cancer Institute, more than 230,000 women in the United States learn that they have breast cancer each year.1 Because many of them have no family history of breast cancer or other known risk factors, the diagnosis often comes as a devastating surprise. The emotional turmoil that results can affect women's physical health as well as their psychological well-being. This question and answer fact sheet explains how psychological treatment can help these women harness the healing powers of their own minds.
What impact does a breast cancer diagnosis have on psychological well-being?
Receiving a diagnosis of breast cancer can be one of the most distressing events women ever experience. And women may not know where to turn for help.
Distress typically continues even after the initial shock of diagnosis has passed. As women begin what is often a lengthy treatment process, they may find themselves faced with new problems. They may find their personal relationships in turmoil, for instance. They may feel tired all the time. They may be very worried about their symptoms, treatment and mortality. They may face discrimination from employers or insurance companies. Factors like these can contribute to chronic stress, anxiety and depression.
Why is it important to seek psychological help?
Feeling overwhelmed is a perfectly normal response to a breast cancer diagnosis.
But negative emotions can cause women to stop doing things that are good for them and start doing things that are bad for anyone but especially worrisome for those with a serious disease.
Women with breast cancer may start eating poorly, for instance, eating fewer meals and choosing foods of lower nutritional value. They may cut back on their exercise. They may have trouble getting a good night's sleep. And they may withdraw from family and friends. At the same time, these women may use alcohol, cigarettes, caffeine or other drugs in an attempt to soothe themselves.
A breast cancer diagnosis can also lead to more severe problems. For some women, for example, the news leads to depression, which can make it more difficult for them to adjust, make the most of treatment, and take advantage of whatever sources of social support are available. Some women become so disheartened by the ordeal of having cancer that they refuse to undergo surgery or simply stop going to radiation or chemotherapy appointments.
Depression can also decrease women's survival, research shows. According to one analysis, mortality rates were as much as 26 times higher in patients with depressive symptoms and 39 times higher in patients who had been diagnosed with major depression.2
How can psychological treatment help women adjust?
Licensed psychologists and other mental health professionals with experience in breast cancer treatment can help a great deal. Their primary goal is to help women learn how to cope with the physical, emotional, and lifestyle changes associated with cancer as well as with medical treatments that can be painful and traumatic.
For some women, the focus may be on how to explain their illness to their children or how to deal with a partner's response. For others, it may be on how to choose the right hospital or medical treatment. For still others, it may be on how to control stress, anxiety or depression. By teaching patients problem-solving strategies in a supportive environment, psychologists help women work through their grief, fear and other emotions. For many women, this life-threatening crisis eventually proves to be an opportunity for life-enhancing personal growth.
Breast cancer patients themselves aren't the only ones who can benefit from psychological treatment. Partners can also be suffering. In one study, for example, men whose partners were diagnosed with breast cancer were nearly 40 percent more likely than other men to be hospitalized for severe depression and other mood disorders.3 Psychologists can help spouses manage the challenge of offering both emotional and practical support while dealing with their own feelings. Children, parents and friends involved in caretaking can also benefit from psychological interventions.
The need for psychological treatment may not end when medical treatment does. In fact, emotional recovery may take longer than physical recovery and is sometimes less predictable. Although societal pressure to get everything back to normal is intense, breast cancer survivors need time to create a new self-image that incorporates both the experience and their changed bodies. Psychologists can help women achieve that goal and learn to cope with such issues as fears about recurrence and impatience with life's more mundane problems.
Can psychological treatment help the body, too?
Absolutely. Take the nausea and vomiting that often accompany chemotherapy, for example. For some women, these side effects can be severe enough to make them reject further treatment efforts. Psychologists can teach women relaxation exercises, meditation, self-hypnosis, imagery or other skills that can effectively relieve nausea without the side effects of pharmaceutical approaches.
Psychologists can also empower women to make more informed choices in the face of often-conflicting advice and can help them communicate more effectively with their health care providers. In short, psychologists can help women become more fully engaged in their own treatment. The result is an enhanced understanding of the disease and its treatment and a greater willingness to do what needs to be done to get well again. Psychological treatment may even boost women's chances of survival. In one study, for instance, a decrease in depression symptoms was associated with longer survival in patients with metastatic breast cancer.4
Such findings underscore the importance of psychological interventions. In one study, researchers examined the impact of psychologist-led small group sessions that offered strategies for reducing stress, improving mood, changing health-related behaviors and adhering to treatment and care.5 The breast cancer patients who participated in the groups had a 45 percent lower risk of their cancer coming back and a 56 percent lower risk of dying from breast cancer. The results were even more impressive when the researchers excluded patients who attended fewer than 20 percent of the sessions: The remaining participants' risk of dying from breast cancer was 68 percent lower.
What type of psychological treatment is helpful?
A combination of individual and group treatment sometimes works best. Individual sessions with a licensed psychologist typically emphasize the understanding and modification of patterns of thinking and behavior. Group psychological treatment with others who have breast cancer gives women a chance to give and receive emotional support and learn from the experiences of others. To be most effective, groups should be made up of women at similar stages of the disease and led by psychologists or other mental health professionals with experience in breast cancer treatment.
Whether aimed at individuals or groups, psychological interventions strive to help women adjust to their diagnoses, cope with treatment and come to terms with the disease's impact on their lives. These interventions offer psychologists an opportunity to help women better understand breast cancer and its treatment. Psychologists typically ask women open-ended questions about their assumptions, ideas for living life more fully and other matters. Although negative thoughts and feelings are addressed, most psychological interventions focus on problem-solving as women meet each new challenge.
A breast cancer diagnosis can severely impair a woman's psychological functioning, which in turn can jeopardize her physical health. But it doesn't have to be that way. Women who seek help from licensed psychologists with experience in breast cancer treatment can actually use the mind-body connection to their advantage to enhance both mental and physical health.
Thanks to Alice F. Chang, PhD, and Sandra B. Haber, PhD, who assisted with this article.
3 Nakaya, N., Saito-Nakaya, K., Bidstrup, P.E., Dalton, S.O., Frederiksen, K., Stendig-Jessen, M., & et al. (2010). "Increased risk of severe depression in male partners of women with breast cancer." Cancer, 116 (23): 5527-5534.
4 Giese-Davis, J., Collie, K., Rancourt, K.M.S., Neri, E., Kraemer, H.C., & Spiegel, D. (2010). "Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: A secondary analysis." Journal of Clinical Oncology, 29 (4): 413-420.
5 Andersen, B.L., Yang, H., Farrar, W.B., Golden-Kreutz, D.M., Emery, C.F., Thornton, L.M., & et al. (2008). "Psychologic intervention improves survival for breast cancer patients: A randomized clinical trial." Cancer, 113 (12): 3450-3458.
Revised October 2011