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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:
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,
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. |
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