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In Breast Cancer, Dr. Suzanne M. Miller demonstrates her approach to counseling women with breast cancer. The goal of her cognitive–social approach is to help women with the many challenges associated with treatment for breast cancer.
In this session, Dr. Miller helps a woman with her fears surrounding the diagnosis and treatment of the disease, gives her strategies for better communication with her health care team, and counsels her on the conflicting needs of her and her husband.
When patients are diagnosed with breast cancer, they embark on a complex journey that poses many different challenges. Emerging evidence suggests that a cognitive–social approach, which takes into account mind–body interactions, is useful in helping women to negotiate the psychological challenges of this journey. In the early stage of disease, these phases include the initial diagnosis, active treatment, the reentry phase following active treatment, and the extended survivorship phase.
Key concepts and processes in this approach include the following:
During the diagnosis phase, facilitating treatment decision making through the clarification of treatment beliefs, values and goals, and self-efficacy expectations is a priority for patients. It is also important to normalize feelings of anxiety and fear and to facilitate communication with both the health care team and the family.
During the active treatment phase, it is important for the therapist to provide a reliable source of support for the loss of control and sense of self that accompany entry into the patient role, as well as to provide coping strategies for ongoing pain and symptom management, strategies for rectifying unmet communication needs with the medical team and the family, and plans for dealing with the shifting of life priorities and values.
During the reentry and extended survivorship phases following active treatment, patient concerns include coping with persistent fears of disease recurrence and the experience of residual bodily symptoms and dysfunction. Women also begin to more actively search for meaning in the experience and to rethink their prediagnosis life values, goals, and priorities.
The specific demands on the patient change at each phase of the breast cancer journey, although certain themes remain constant.
High monitors (women who typically attend to health threats, scan for external and bodily cues, and exaggerate the significance of threat cues) can benefit from strategies that enable them to manage anxiety and achieve the intense level of information and support they require during the active treatment phase, which facilitate the processing and acceptance of threat after active treatment.
Low monitors, however, often need help attending to and gathering necessary information for treatment decision making when they are diagnosed, as well as identifying the changes in self- and body-image that have occurred. They also benefit from action planning strategies and encouragement for maintaining adherence and screening efforts during the post treatment phase. Social support groups can be a valuable component of therapy in both cases.
The therapeutic agenda needs to take into account where the woman is on her breast cancer journey. It is important to establish a supportive dialogue with the woman to assess and address, at each given phase,
her risk perceptions and self-construals of vulnerability
her cancer treatment- and self-efficacy related beliefs and expectations;
her values and goals—especially as they relate to cultural issues and where she is in her life cycle
her disease-related distress and worries; and
her self-regulatory strategies and skills for managing anxiety, finding meaning, and dealing with practical challenges.
Relevant techniques include supportive listening, knowledge provision, assertiveness training, identifying the pros and cons of different treatment and life options, normalization of feelings and reactions, probing for meaning, reinforcement of existing goal-oriented behaviors, and the development of new coping repertoires and skills.
It is particularly potent if the therapist can begin to introduce the key themes and topics in a preventive fashion so that the patient can develop a sense of psychological preparedness and readiness for what is to come.
An important source of clarifying information about the available disease options and prognosis, for the patient as well as the therapist, is the Cancer Information Service (CIS). The CIS is part of the National Cancer Institute and can be reached by phone (1-800-4-CANCER) or through the Web site. Another important resource is the American Cancer Society (1-800-ACS-2345).
In this video, Dr. Miller explores the breast cancer experience of a woman who was diagnosed 2 years ago with early stage breast cancer and is now in the extended survivorship phase.
Issues around diagnosis and treatment emerged about her fears and panic at diagnosis, her communication problems with the health care team, the conflicting needs between herself and her husband, and the loss of control associated with being in the patient role. Ongoing issues include her difficulties in fully processing and accepting the experience, her intrusive and invasive thoughts about recurrence, and her search for new meaning and identity.
At this phase of her recovery, the psychological issues around self and meaning can begin to be more deeply explored and may be facilitated by some couple or family sessions.
About the Therapist
Suzanne M. Miller, PhD, is a senior member in the Division of Population Science at Fox Chase Cancer Center, as well as director of the Psychosocial and Behavioral Medicine Program, director of the Behavioral Research Core Facility, and director of the Center of Excellence in Breast Cancer. She earned her PhD from the University of London (Maudsley Hospital) and is an adjunct professor at the University of Pennsylvania, the Institute for Health, Health Care Policy and Aging Research at Rutgers University, and the Department of Obstetrics/Gynecology at Temple University Hospital.
Dr. Miller is a fellow of the American Psychological Association (APA), the recipient of the Cancer Information Service Partner in Research Award (2001), and the American Cancer Society Cancer Control Award (2002).
She founded and chairs the Behavioral Oncology Special Interest Group of the American Society of Preventive Oncology and sits on the steering committee of the Cancer Special Interest Group of the Society of Behavioral Medicine. Dr. Miller also serves on the executive committee of the American Society of Preventive Oncology and the editorial boards of Cancer Epidemiology, Biomarkers, and Prevention and the Journal of Women's Cancer.
She has been invited as a Distinguished Visiting Professor by the University of Bologna in Italy (2003) and by the Foundation for Aging and Health in Japan (2003). She chairs the Peer Review Committee on Psychosocial, Behavioral, and Policy Research of the American Cancer Society.
Dr. Miller's research interests focus on decision making, adjustment and quality of life, behavioral change, and coping across the spectrum of cancer prevention and control—from cancer risk through disease through survivorship.
Dr. Miller is the editor of Individuals, Families, and the New Era of Genetics: Biopsychosocial Perspectives (with S. McDaniel, J. Rolland, S. Feetham, 2006). Dr. Miller also has written numerous book chapters and journal articles.
Antoni, M. H. (2003). Stress management interventions for women with breast cancer. Washington, DC: American Psychological Association.
Holland, J. C. (1998). Psycho-oncology. New York: Oxford University Press.
Miller, S. M. (1995). Monitoring versus blunting styles of coping with cancer influence the information patients want and need about their disease: Implications for cancer screening and management. Cancer, 76, 167–177.
Miller, S. M., Fang, C. Y., Diefenbach, M. A., & Bales, C. (2001). Tailoring psychosocial interventions to the individual's health information-processing style: The influence of monitoring versus blunting in cancer risk and disease. In A. Baum & B. Andersen (Eds.), Psychosocial interventions for cancer (pp. 343–362). Washington, DC: American Psychological Association.
Miller, S. M., McDaniel, S., Rolland, J., & Feetham, S. (Eds.). (2006). Individuals, families, and the new era of genetics: Biopsychosocial perspectives. New York: Norton.
Spira, J. L., & Reed, G. M. (2003). Group psychotherapy for women with breast cancer. Washington, DC: American Psychological Association.