It has been estimated that about a third of cancer patients will experience clinically significant levels of psychological distress. Common responses to the onset of cancer include shock, disbelief, sadness, fear, anxiety, guilt, shame and anger. Even those who have successfully survived the disease are vulnerable. Survivors can become hypersensitive to minor symptoms being a sign that the cancer has relapsed. Even if there are no symptoms the survivor may feel a sense of impending doom.
Anxiety about relapse has been shown to be the largest mental health difference between long term survival and quality of life. Questioning one’s mortality is not the only impact that psychological distress can have on patients. After surviving cancer, quality of life and the ability to lead a life that has meaning and purpose can take a significant hit. Leading a value driven life has been shown to enhance living flexibly which itself can have an impact on survivability.
Mental health practitioners can play a significant role in alleviating psychological distress. Traditionally, interventions have focused on symptom reduction using cognitive or behavioral strategies. Examples of such techniques include deconstructing thoughts or using other approaches that attempt to modify, manage or even eliminate associated negative thoughts. Other techniques use behavioral methods to change physiological experiences.
There is a robust body of research knowledge that supports the notion that attempts at suppressing or denying our internal experiences can actually have detrimental and counterproductive effects. Avoidance strategies are quite prevalent as a coping mechanism with cancer patients. It has been shown that cancer patients who use avoidance-based strategies to cope with cancer related emotions and behaviors are at greater risk of developing psychological distress.
Acceptance and Commitment therapy (ACT) is an approach that is part of the group of therapies that constitute a radical departure from the traditional focus on symptom reduction. The fundamental premise of ACT is that when faced with painful internal emotions, thoughts and physiological experiences we are programmed to respond in a fashion that’s designed to reduce or eliminate them. This is because we are conditioned, biologically and socially, to respond to pain and negative internal experiences as signs of danger or threat. While this is true in many circumstances, we also know that humans are vulnerable to construct and then become overwhelmed by catastrophic outcomes. The tendency to fight these internal aversive experiences promotes a negative spiral that can lead to increasing and self-energizing psychological distress. ACT suggests that an alternative approach of a mindfulness-based acceptance of our internal experiences better addresses the protective function of those experiences and allows us to focus on the larger issues of bringing meaning and purpose to our lives.
Several studies have examined the effects of an ACT based approach to treating cancer patients. Coaching patients in being more successful in emphasizing meaning and purpose in their lives was shown to be directly correlated with relieving cancer related distress and improved well-being in a study involving 107 cancer patients of whom 31 were females with breast cancer. In another study, using ACT principles of bringing a mindful and accepting relationship with relapse fears brought clinically significant reductions in relapse fears for the majority of 12 non-metastatic breast cancer patients. In a third study of 70 stage I and stage II breast cancer patients, researchers concluded that employing acceptance-based coping can successfully reduce psychological distress. A fourth study involving 34 women almost half of whom had breast cancer, promoting psychological flexibility, one of the objectives of ACT, in dealing with cancer related symptoms, led to improvements in well-being.
These studies indicate that the core principles of ACT, mindfulness, acceptance and value based living, hold considerable promise in positively affecting the lives of those who have been impacted by cancer.
Vijay Shankar is a licensed psychologist in private practice. He has offices in Beaverton, Portland and Lake Oswego.
Anne B. Shankar is a licensed clinical social worker in private practice. She has offices in Beaverton and Portland.