Many critics admit that medical treatment of stress is ineffective because it only reduces some psychological effects but do not propose long-term solution to cancer patients. Today, treatment typically combines drugs and behavior therapy aimed at the symptoms.. Strategies for cancer patients address their anxiety, problematic relationships, and their need for a predictable routine to obviate some of the need to impose an inner-directed routine on the external one. Strategies are recommended specifically to address needs for acceptance/approval, external control, internal control, appropriate engagement, and encouragement.
Coping strategies are the most effective for cancer patients because they allow patients to avoid medication and help to cope with stress. All candidates have some element of pathophysiology to account for their complaints. Yet the stress report may vary greatly — in intensity, frequency, and quality. There are undoubtedly some subtle physical elements that at least partially account for individual differences in stress reports between patients with similar cases. “From a medical perspective, the best treatments offer a physical cure; however, from a psychological perspective, the best treatments maximize a patient’s ability to heal emotionally, socially, intellectually, and spiritually” (Donaghy 6).
That is, some patients are more likely to report stress with a lower level of nociceptive input. Such stress-sensitive patients may benefit by a course of pre- or postoperative training in stress-coping skills. Preoperatively, stress-coping skills may be used on patients whose reports seem disproportionate to their injuries, in order to determine how much control they can gain over stress. Coping skills approaches have, to various degrees been shown to be effective in reducing subjective stress sensations (Feldman and Broussard 117). The concept of self-efficacy has been applied to chronic pain. It has been suggested that patients engage in specific types of stress-coping behaviors, such as physical exercise, biofeedback, or hypnosis, to the extent that they believe they can perform these behaviors and that the behaviors will either reduce the stress or improve their functioning.
Coping skills training has the additional advantage of confirming that the patient’s stress experience has a physiological basis, while at same time demonstrating that these noxious sensations are controllable through the patients own efforts. Thus, the patient can also can experience an enhanced sense of self-efficacy. Anger and other feelings relating to work are not easily nor quickly modifiable. Cognitive-behavioral intervention, including “refraining” of anger-producing situations, and “brainstorming” new solutions may be of value. Vocational counseling to explore the patients aptitudes and capitalize on strengths, can help the patient out of the malaise, suspiciousness, and low self-esteem that often accompany impending job termination. “Practicing contributes to one’s confidence in achieving the desired behaviors (performance accomplishments). Seeing a model achieve the desired behavior, or listening to the model describe the desired behavior, contributes to an individual’s confidence in achieving a similar behavior (vicarious experience)” (Lev and Owen 131). Often, once such patients have learned stress-coping skills, they find they have achieved sufficient control that they are less interested in having surgery.
Many patients may continue to have difficulty coping with even this reduced stress. As all of these interventions require a significant investment of time, and may also rely on a concrete knowledge of the patient’s functional ability level, therapy aimed at dealing with vocational issues should be undertaken in the postoperative period. Cognitive-behavioral techniques are best applied as a postoperative intervention Pistrang and Barker 439). These techniques usually require multiple sessions and could delay otherwise necessary surgery. Furthermore, it may be difficult for the patient to develop a realistic, positive set of beliefs before the outcome of the surgery, in terms of stress relief and improved function, is known. “Helping clients to better comprehend and manage their illness through informational and emotional support and combining this with exercises geared toward finding meaning in their lives will ultimately help them cope with the physical, social, and developmental issues affected by this disease” (Curtis and Juhnke 131).
Medical treatment is used in treatment but has short-term effects only. Antidepressant medication is not sufficient to produce long-term improvements in motivation and emotional status. Such results often require some psychological intervention aimed at altering the patients stress-related beliefs (Donaghy 6). Numerous studies have shown that such cognitive-behavioral interventions are successful with chronic patients, producing improvements in functional ability and decreased health care utilization as well as reductions in self-reported stress. As these are applied to cancer patients, they often involve identifying the patient’s pattern of negative stress-related beliefs and the environmental triggers for such beliefs. The patient then works on developing a less negative, more adaptive set of beliefs in response to the environmental triggers (Livneh 40). Such medication may have the additional benefit of providing some element of stress relief. “Such patients’ emotional reactions can quickly be stabilized through the short-term use of anxiolytics and hypnotics if desired” (Donaghy 6).
Psychological interventions in the context of cancer are similar to those used with chronic patients. In general these interventions are symptom oriented, specific, or brief. Treatments with these goals are especially useful in the fair prognosis patient who is placed on hold pending the outcome of psychological intervention. These patients may have a history of noncompliance or may demonstrate questionable commitment to their own role in recovering from the back injury. If the patient makes a commitment and carries through on it, this bodes well for the outcome of invasive procedures (Donaghy 6).
Some suggested motivation and compliance interventions are discussed here. Many cancer patients have difficulties with pacing activities (Pistrang and Barker 439). Frequently patients in high demand jobs will take large doses of narcotic medication in order to cover their stress, so that they can work longer hours or exercise more. Such patients frequently have difficulties slowing down and use activity for purposes of stress relief. Of necessity, many of these patients will need to modulate activity levels postoperatively to allow themselves time to recover. “Personal control or the ability to use self-restraint is another strategy adopted by survivors of cancer to cope with the stresses evoked by the disease. It was found to be a predictor of positive psychosocial adaptation” (Livneh 40). It is recommended that such patients keep preoperative records of daily activities, exercises, and medication. Paced activities may get them used to a more relaxed lifestyle and force them into learning other stress-relieving skills (Lev and Owen 131).
In sum, there is a medical treatment for some stress symptoms of cancer patients (anxiety, depression), but psychological counseling is more acceptable and effective for this group of patients. Stress coping strategies involve external locus of control, cognitive errors, poor self-efficacy, and avoidance. These beliefs act to make the patient less depressed, immobilized, and hopeless. The psychological counseling may be helpful in altering such negative beliefs and improving emotional status.
Works Cited
Curtis, R.C., Juhnke, G.A. Counseling the Client with Prostate Cancer. Journal of Counseling and Development, 81 (2003): 160.
Donaghy, K. B. Fostering Sound Medical Treatment Decision Making: A Focusing on Treatment Choices for Breast Cancer. Annals of the American Psychotherapy Association, 6 (2003): 6.
Lev, E.L., Owen, S.V. Counseling Women with Breast Cancer Using Principles Developed by Albert Bandura. Perspectives in Psychiatric Care, 36 (2000); 131.
Livneh, H. Psychosocial Adaptation to Cancer: The Role of Coping Strategies. The Journal of Rehabilitation, 66 (2000): 40.
Feldman, B.N., Broussard. A. Men’s Adjustment to Their Partners’ Breast Cancer: A Dyadic Coping Perspective. Health and Social Work, 31 (2006): 117.
Pistrang, N., Barker, Ch. Partners and Fellow Patients: Two Sources of Emotional Support for Women with Breast Cancer. American Journal of Community Psychology, 26 (1998): 439.