Бесплатный фрагмент - Cancer Patients

Disclaimer

This material is provided for informational and educational purposes only. It is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.

Psychological Dynamics of Cancer Patients: Emotional and Psychological Dimensions

Cancer not only impacts a patient’s physical health but also profoundly affects their emotional and mental well-being. Psychological support for cancer patients is a crucial component of a holistic treatment approach, addressing both diagnosis and the challenges of navigating the numerous psychological difficulties associated with the disease.

1. Emotional responses to the diagnosis

When an individual receives a cancer diagnosis, they undergo a spectrum of emotions. These encompass:

Shock and bewilderment: Numerous patients often struggle to accept their cancer diagnosis. This may present as both physical and emotional numbness, accompanied by a sense that reality is incongruent with their circumstances.

— Denial: A prevalent psychological mechanism. Patients may reject the reality of their illness, evade conversations about the diagnosis, and fail to take it seriously. This behavior assists them in managing the emotional weight during the initial stages.

Anger: Upon recognizing their illness, many individuals experience profound resentment and anger towards their circumstances, the medical system, and those in their vicinity. This anger may be directed both outwardly and inwardly.

— Fear: Anxiety regarding your life, apprehension about pain, dread of death, and concern over future medical procedures — these are all typical responses to a diagnosis.

— Depression: When an individual comprehends the full extent of their illness, depression may ensue, characterized by apathy, despondency, and a diminished interest in life and future prospects.

— Acceptance: In the advanced stages of the disease, the patient may arrive at the acceptance phase, recognizing the inevitability of the situation and seeking ways to coexist with the illness.

2. Psychological characteristics throughout the treatment process

— Therapeutic interventions and stress: Chemotherapy, radiation therapy, and surgical procedures can induce considerable physical and psychological distress. Hair loss, physical debilitation, fatigue, and potential side effects contribute to further psychological challenges.

— Body image disturbances: Hair loss, weight loss, surgical procedures, and alterations in appearance can profoundly affect self-esteem and body image. Such changes frequently correlate with feelings of shame or isolation.

— Social isolation and loneliness: Numerous patients experience feelings of loneliness, even in the presence of support from family and friends. Challenges in communication, particularly when others refrain from discussing the illness or are uncertain about how to provide assistance, can exacerbate feelings of isolation.

3. Psychological assistance and counseling

Psychological support for cancer patients constitutes a vital component of treatment and recovery. Essential strategies for psychological support encompass:

— Psychotherapy: Cognitive Behavioral Therapy (CBT), psychoanalysis, and various other modalities of psychotherapy can assist patients in managing internal conflicts while alleviating anxiety and depression. CBT, in particular, enables patients to identify and modify detrimental thought patterns, a process that is particularly crucial in the context of chronic stress.

— Support groups: Engaging with individuals who have undergone similar experiences can serve as a vital source of support. These groups facilitate the sharing of experiences, provide emotional assistance, and offer strategies for coping with challenging times.

— Family-centered therapy: Psychological support extends beyond the patient to include their loved ones. The illness of one individual impacts all family members, making it essential for them to receive assistance in managing the stress related to the diagnosis and treatment.

— Palliative care: As the disease advances to its terminal phase, the focus of psychological support may shift — it aims to enhance the quality of life, facilitate acceptance of inevitability, and alleviate the fear of death.

4. The influence of diagnosis on personality and perspective.

For numerous individuals, a cancer diagnosis prompts a profound reevaluation of their lives. Patients frequently find themselves questioning their values, priorities, and aspirations. This experience may lead to an intensified spiritual exploration, a curiosity about philosophical inquiries, and reflections on the significance of life and death.

Some individuals become increasingly open and receptive to change as their illness advances, while others may succumb to despair and lose hope for the future. A patient’s support network, relationships with loved ones, and capacity to adjust to new living circumstances are crucial factors in this process.

5. Psychological traits at various stages of the illness

— Early stage: During the initial phases of the disease, the patient’s mental state may exhibit tension and anxiety. It is crucial for the patient to obtain precise and comprehensible information regarding their condition, along with support from family members and healthcare professionals.

— Middle stage: During active treatment, the patient endures considerable stress associated with medical procedures, declining health, and potential side effects. This period necessitates heightened support for the patient in managing depression and anxiety.

— Terminal stage: At this phase, the primary emphasis is on psychological support designed to alleviate both physical and emotional suffering. Patients may receive assistance with matters concerning forgiveness, reconciliation, and preparation for the concluding stage of life.

6. The influence of cancer on the patient’s life and interpersonal relationships.

Cancer can profoundly affect not only a patient’s physical health but also their social life and relationships with loved ones. It frequently necessitates a reevaluation of priorities and modifications to habits and lifestyle. It is essential for patients to obtain support from both their healthcare team and their social network.

7. Psychological approaches for overcoming illness

— Fostering positive thinking: In the face of challenges, numerous patients can tap into their inner resources to sustain optimism and hope. Contemplating the significance of life, emphasizing positive elements, and pursuing personal growth can significantly contribute to psycho-emotional recovery.

— Meditation and relaxation: Certain patients employ meditation, relaxation, and deep breathing techniques to alleviate stress and anxiety, thereby enhancing their overall well-being and quality of life.

— Creative practices: Music, drawing, and writing serve as valuable avenues for self-expression and emotional catharsis. Creativity enables numerous patients to articulate feelings that are challenging to verbalize.

Psychotherapeutic approaches for cancer patients

Psychotherapeutic approaches for cancer patients are essential in providing support, aiding them in managing the emotional and psychological challenges linked to the illness. It is crucial that psychotherapy for cancer patients is integrated with medical treatment and considers the unique characteristics of each individual, including their disease stage and psychoemotional condition.

The primary methods of psychotherapeutic engagement with cancer patients can be categorized into several groups, each designed to address specific psychological challenges that emerge in the context of an oncological diagnosis.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is among the most effective psychotherapeutic techniques employed in the treatment of cancer patients. CBT seeks to alter harmful and distorted thoughts and beliefs that may intensify a patient’s anxiety, depression, and fears.

— Objectives of the CPT:

— Decreased levels of anxiety and depression.

— Support in accepting the diagnosis and adjusting to new living conditions.

— Modifying detrimental behavior patterns, including avoidance, anxiety regarding the future, and stress.

— Instructing the patient in stress management and emotional regulation techniques.

— Methods:

— Cognitive restructuring: recognizing and disputing negative and distorted thoughts (e.g., the belief that cancer equates to a death sentence) to cultivate more realistic and adaptive attitudes.

— Behavioral activation: the impetus to engage in proactive behaviors, pursue enjoyment and fulfillment, notwithstanding the illness.

— Relaxation techniques: employing breathing exercises and progressive muscle relaxation to alleviate stress and anxiety.

2. Humanistic Psychotherapy

The humanistic approach centers on acknowledging and fostering the individuality of each patient. This perspective highlights the importance of nurturing the patient’s inner development, their aspiration for self-actualization, and their comprehension of their own intrinsic worth, even in the face of illness.

— Objectives of humanistic therapy:

— Assisting the patient in discovering the significance of life amidst illness.

— Support in achieving inner harmony and embracing your emotions.

— Assist in enhancing self-esteem and self-acceptance.

— Methods:

— Carl Rogers’s client-centered therapy fosters a secure and nurturing environment that encourages patients to candidly articulate their feelings and experiences. This methodology enhances self-expression and deepens awareness of one’s personal experiences.

— Existential therapy: exploring inquiries regarding the meaning of life, the fear of death, and the acceptance of life’s finiteness. This approach assists patients in cultivating resilience in the face of illness by fostering an understanding and acceptance of the inevitability of death.

3. Psychodynamic psychotherapy

Psychodynamic therapy assists patients in recognizing unconscious mental processes that may affect their perception of illness, their reactions to treatment, and their emotional experiences. This approach emphasizes the fundamental causes of psychological challenges.

— Objectives of psychodynamic therapy:

— Recognition of unconscious conflicts and experiences that may hinder the adaptation process to the disease.

— Addressing traumatic experiences that may have preceded the illness or contributed to its onset.

— Assist in addressing internal conflicts related to feelings of fear, guilt, or depression.

— Methods:

— Engaging with unconscious processes: interpreting symbols, dreams, and the patient’s subconscious reactions, with the goal of bringing awareness to concealed emotions and their impact on the illness.

Transference: an examination of how the therapeutic relationship can mirror and clarify the patient’s interactions with others and their emotional reactions to illness.

4. Group therapy

Group therapy serves as a vital approach for cancer patients, enabling them to feel supported and recognize that they are not alone in their journey. This environment fosters the sharing of experiences, acceptance, and social interaction, which is particularly crucial during extended treatment periods.

— Objectives of group therapy:

— Sharing of experiences and support among individuals facing comparable challenges.

— Alleviating feelings of loneliness and social isolation.

Enhancing social connections and fostering a sense of understanding.

— Methods:

— Support group: fostering a secure and nurturing environment for the candid expression of emotions and experiences.

— Groups dedicated to addressing specific issues: for instance, a group for individuals at a particular stage of illness or for those who have undergone significant events during treatment (surgeries, chemotherapy).

5. Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) assists patients in embracing their emotions, including pain, fear, and anxiety, without attempting to suppress or evade them. This approach is grounded in an awareness of personal values and a commitment to taking action, regardless of illness and challenges.

— Objectives of the ACT:

— Assisting the patient in embracing all their emotions, including those that are distressing.

— Alleviation of stress and anxiety regarding unchangeable circumstances (such as death or an incurable illness).

— Concentrate on initiatives designed to enhance the quality of life and preserve the significance of existence.

— Methods:

— Mindfulness: the practice of concentrating on the present moment while accepting feelings and thoughts without judgment.

— Engaging with values: comprehending what holds significance for the patient and making decisions grounded in these values, irrespective of the illness.

6. Palliative psychotherapy for individuals with terminal cancer

Palliative psychotherapy seeks to assist patients in the terminal phases of illness. Its primary objective is to alleviate emotional distress and facilitate acceptance of the inevitability of death.

— Goals:

— Alleviation of the fear of death and the fear of suffering.

— Support in preparing for the end of life, encompassing forgiveness, resolution of unresolved conflicts, and reconciliation with oneself and loved ones.

— Alleviating feelings of loneliness and isolation.

— Methods:

— Existential therapy: support in comprehending the significance of life and death, as well as addressing spiritual concerns.

— Loss therapy: addressing the emotions linked to the experience of loss, including one’s own life and the loss of social roles and connections.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an evidence-based psychotherapeutic approach that emphasizes the interconnection between thoughts, behaviors, and emotional regulation. For individuals diagnosed with cancer, CBT can offer substantial support during the initial diagnosis and throughout the treatment process — including chemotherapy, radiation therapy, and surgery — as well as during rehabilitation. The following outlines the essential aspects and principles of CBT’s application for cancer patients.

The primary objectives of cognitive-behavioral therapy (CBT) in the context of cancer patient care.

— Decreased levels of anxiety and depression

Most patients diagnosed with cancer endure considerable stress, frequently accompanied by symptoms of anxiety or depression. Cognitive Behavioral Therapy (CBT) assists in identifying and rectifying cognitive distortions (e.g., catastrophizing, dichotomous thinking, negative self-evaluations), thereby alleviating distress.

— Enhancing resilience techniques (resilience strategies)

Cancer treatments entail considerable emotional and physical strain. Through cognitive-behavioral therapy (CBT), patients acquire effective coping strategies for managing pain, fatigue, and emotional challenges, alongside practical lifestyle modifications such as enhancing sleep quality and organizing relaxation activities.

— Development of a constructive attitude towards treatment and rehabilitation

When a patient gains a clearer understanding of the nature of their fears and misconceptions regarding treatment (“therapy is ineffective,” “there is no purpose,” etc.), it becomes easier for them to construct a realistic perspective of their prospects, accept assistance, and engage more actively with healthcare professionals.

— Fostering a sense of agency and purpose orientation

Oncology patients frequently encounter a reduced sense of control over their lives, leading to an uncertain future. Cognitive Behavioral Therapy (CBT) assists patients in restoring their inner confidence, discovering personal significance in their lives, and establishing goals, even if they are modest and short-term.

2. Cognitive Behavioral Therapy methods and techniques employed in oncology

— Psychoeducation

— Clarifying to patients and their families the characteristics of anxiety and depressive disorders.

— Offering insights into the ways in which thoughts shape emotions and behavior.

— An overview of self-help techniques (e.g., relaxation exercises).

— Identification and alteration of automatic thoughts

— Recognizing detrimental automatic thoughts related to the illness (e.g., “I will not be able to pursue this treatment,” “My life has come to an end”).

— Converting these thoughts into more realistic and adaptive perspectives.

— Collaborating with diagrams and installations

— Examining entrenched beliefs regarding oneself, the world, and the future that may perpetuate feelings of hopelessness or guilt.

— Cultivating new, more adaptable and supportive attitudes that facilitate the healing process.

— Techniques for relaxation and stress management

— Progressive muscle relaxation, breathing techniques, mindfulness meditation.

— Instructing the patient to react more effectively to stressful situations, thereby diminishing psychophysiological stress.

— Behavioral studies

— They are employed to evaluate and challenge maladaptive beliefs.

For instance, if a patient fears that illness will hinder their ability to communicate with loved ones, the therapist and I design and implement “experiments” to illustrate that connections with others can be preserved and enhanced.

— Analytical abilities

Cancer patients frequently encounter a myriad of challenges, including navigating bureaucratic procedures, modifying their diet, and organizing their daily routines.

CBT provides systematic techniques for problem analysis and the identification of constructive solutions, thereby alleviating feelings of helplessness.

3. Efficacy of Cognitive Behavioral Therapy in Cancer Patients

Research indicates that the application of cognitive-behavioral techniques in oncopsychology contributes to:

— Decrease in the intensity of anxiety and depressive symptoms.

— Enhancing the quality of life in both physical and psychological dimensions.

— Enhanced compliance with treatment (patients demonstrate greater responsibility in adhering to physicians’ recommendations and timely undergoing procedures).

— Enhanced sense of control and personal efficacy, which can positively influence overall well-being and motivation.

4. The function of the psychotherapist and the interdisciplinary approach

Cancer treatment necessitates a holistic approach. A psychotherapist or clinical psychologist proficient in cognitive behavioral therapy (CBT) is frequently included in a multidisciplinary team of specialists, which may consist of oncologists, surgeons, radiologists, nurses, and social workers. Key points:

— Collaboration with the attending physician

A psychologist or psychotherapist must be cognizant of the treatment protocol and potential side effects to effectively engage with the patient.

— Collaboration with family members

Support from loved ones is essential, as the environment significantly influences the patient’s emotional well-being.

Family consultations are conducted, and skills in communication and support are imparted.

— Considering individual characteristics

The severity of the diagnosis, the stage of the disease, and the patient’s personal history are all considered when formulating a psychotherapeutic care plan.

5. Pragmatic recommendations for patients and specialists

— Establishment of a “psychological contract”

Before initiating Cognitive Behavioral Therapy (CBT), it is essential to engage in a discussion with the patient regarding the therapeutic objectives and to elucidate the principles and structure of the process, including the frequency of sessions and assigned homework.

— Homework

CBT places significant emphasis on independent work between sessions, including the recording of thoughts and emotions, maintaining a self-observation diary, and practicing relaxation techniques.

— Cultivate self-sufficiency skills

— Recognize stress triggers and effectively implement self-regulation techniques promptly (such as breathing exercises and brief relaxation breaks).

Utilize self-help letters, maintain a gratitude journal, or a “success journal” to foster a positive mindset.

— Evaluating and re-evaluating progress

Regular discussions with the patient regarding their condition, fluctuations in emotional state, and challenges in adhering to recommendations facilitate timely adjustments to the treatment plan.

1. Journal of reflections and sentiments (cognitive assessment)

Goal: to assist the patient in comprehending the connection between their thoughts, emotions, and behaviors, recognizing negative automatic thoughts (NAMs), and initiating the process of modifying them.

Description:

— Utilize a notebook or employ designated printed forms.

— Throughout the day, particularly in challenging or stressful situations, document:

— Situation: Describe an instance when you experienced anxiety, sadness, or another intense emotion.

— Emotions/Feelings: What particular emotions emerged? How intense were they (on a scale of 0 to 10)?

— Automatic thoughts: What thoughts crossed your mind? (For instance: “I cannot manage,” “The treatment will be ineffective,” “It is all futile.”)

— Alternative perspectives: What is a more pragmatic and constructive approach to reframe this situation?

— Result: In what ways did your emotional state shift following the re-evaluation of your thoughts?

2. Cease Contemplation Technique

Goal: To diminish the intensity of negative automatic thoughts and anxiety during moments of heightened emotional turmoil.

Description:

When you recognize that you are beginning to fixate on distressing or despairing thoughts, assertively tell yourself (either vocally or mentally): “Stop!”

— Envision a visual or auditory representation that signifies cessation — such as a red stop sign or a sharp noise.

Then redirect your focus to an activity that may serve as a distraction (for instance, take several deep breaths or engage in a different task).

— Following a brief pause, you may redirect your focus to more constructive thoughts or revisit the “Thought Diary” to discover alternative expressions.

3. Progressive muscle relaxation (as proposed by Jacobson)

Objective: to alleviate physical tension and anxiety, develop the ability to identify bodily signals, and engage in intentional relaxation.

Description:

— Make yourself comfortable, whether lying down or sitting, preferably in a quiet location.

— Alternate between tensing and relaxing various muscle groups (arms, shoulders, face, neck, back, abdomen, legs).

— As you contract each muscle group, count to 5–7, concentrating on the sensation of tension.

— Gradually release the tension and observe the contrast between the states of tension and relaxation.

— Proceed for 10–15 minutes.

At the conclusion of the exercise, take several deep breaths in and out, gently open your eyes (if they were closed), and stretch.

It is beneficial to engage in this exercise consistently (1—2 times daily), particularly during times of heightened anxiety or prior to procedures.

4. Visualization “Sanctuary” (or “Isle of Tranquility”)

The objective is to assist patients in mentally “relocating” themselves to a tranquil environment during stressful situations, such as challenging procedures, thereby alleviating anxiety and panic responses.

Description:

— Assume a comfortable position, either sitting or lying down, and gently close your eyes.

— Inhale and exhale deeply several times, concentrating on the experience of your breath.

— Envision a location (whether real or imagined) where you experience tranquility, security, and comfort. It might be a cherished beach, the mountains, a snug room, or similar.

— Attempt to vividly “depict” in your imagination the colors, sounds, scents, and tactile sensations of this location.

— Remain there for a few moments, attuning to the pleasant sensations and lightness.

Open your eyes and reengage with reality, striving to preserve a sense of tranquility.

This visualization may be conducted whenever the patient encounters significant stress or pain, contingent upon the physician’s approval.

5. Behavioral Experiments

Goal: to evaluate the validity of negative beliefs in practice and broaden the “zone” of potential behavior, thereby enhancing the sense of control.

Description:

— Identify the patient’s negative belief, such as: “I can no longer communicate with my friends because they pity me.”

— Conduct an “experiment”: request the patient to select one or two close individuals and organize a brief meeting or phone call.

— Prior to the “experiment,” document your prediction: “What precisely do you anticipate? To what degree?”

— Hold a meeting or conference call.

— Upon completion, evaluate the actual outcomes against the anticipated catastrophic scenarios: “What succeeded? How did it unfold?”

— Document your conclusions: were your apprehensions warranted, or did everything ultimately prove to be more straightforward and less daunting?

6. Behavioral activation and the organization of pleasurable activities

The objective is to assist the patient, particularly in a state of depression, in reintroducing small yet significant and pleasurable activities that foster a sense of fulfillment and enhance mood.

Description:

Together with the patient, a list of “pleasurable” or “supportive” activities is created, which may include reading a book, listening to music, taking a short walk, engaging with a pet, or creating art.

— Develop a weekly schedule that incorporates one or two activities each day. Take into account the patient’s condition; at times, these sessions may be brief, lasting only 5 to 10 minutes.

At the conclusion of the day, the patient reflects on the extent to which they achieved their objectives. If they were not successful, the underlying reasons are examined (such as physical discomfort, lack of motivation, or anxiety), and strategies to modify the task are explored (including reducing the duration or altering the format of the activity).

Regularly engaging in the exercise enhances the sense of control and elevates the emotional state.

7. Technique “Identifying Anxiety and Practicing Self-Care”

Goal: To identify early indicators of heightened anxiety or depressive mood and to swiftly implement self-support strategies.

Description:

The patient compiles a list of indicators that anxiety or a decline in strength is escalating (for instance, accelerated heartbeat, a sensation of pressure in the chest, and persistent thoughts regarding the future).

For each symptom, a corresponding “response” action is devised, ranging from a brief pause for deep breathing to contacting a loved one or journaling in a thought diary.

When the initial signs manifest, the patient attempts to “intercept” the escalating anxiety by employing pre-established techniques such as relaxation, redirecting attention, or seeking support from a friend or psychologist.

8. Journal of Gratitude and Positive Experiences

Goal: to cultivate a more optimistic perspective on life and to assist in recognizing even the smallest positive moments throughout the treatment process.

Description:

At the conclusion of the day, the patient records 3–5 aspects for which he feels gratitude or that brought him joy (this may include a pleasant conversation, delectable food, sunny weather, or support from the medical staff).

It is essential to avoid seeking the “grandiose” and instead focus on the simple, everyday pleasures.

Regularly engaging in this exercise aids in redirecting attention away from negative thoughts regarding the illness and contributes to emotional stability.

9. Mindfulness practices

Goal: to cultivate the ability to focus on the present moment, avoiding immersion in thoughts of the future or the past, and to alleviate the experience of pain and fear.

Mindfulness: A One-Minute Pause

— Close your eyes or direct your gaze toward a fixed object.

— Inhale slowly, concentrating on the sensations as the air flows through your nostrils and throat, and as your chest expands.

— Subsequently, exhale gently, focusing on the process of exhalation.

— If your thoughts begin to wander, gently redirect your attention to your breathing.

— Continue for 1 to 2 minutes (or for as long as is comfortable).

— At the conclusion, please indicate whether your well-being has shifted.

10. Exercise “Correspondence to Yourself”

Goal: to enhance self-reliance, manage self-criticism, and address feelings of loneliness or guilt.

Description:

— Encourage the patient to compose a letter to themselves during a challenging time, addressing themselves as if they were a dear friend (with warmth, compassion, and understanding).

In the letter, you may highlight your strengths and accomplishments (even minor ones) throughout the treatment process, convey your support, and articulate your aspirations for the near future.

The letter is preserved and can be revisited whenever feelings of helplessness, anxiety, or sadness emerge.

General guidelines for executing exercises

— Regularity: the more consistently the patient engages in the exercises, the more significant the impact. Even 5–10 minutes daily can produce beneficial outcomes.

— Flexibility: If your physical condition prevents you from completing the exercise fully (for instance, if you feel excessively fatigued), modify the format (reduce the duration, perform it in a more comfortable position, etc.).

— Support from others: loved ones can assist by reminding the patient to allocate time for relaxation, joining in walks, or providing a listening ear when the patient articulates their automatic thoughts.

— Feedback with the therapist: review outcomes, challenges, and achievements with the psychologist/psychotherapist to refine the program.

Below is a hypothetical example of a cognitive-behavioral session, lasting approximately 45 to 60 minutes, with a cancer patient. This illustration serves solely for demonstration purposes; actual sessions may differ based on the disease stage, the patient’s overall health, the specific challenges encountered, and the therapist’s unique approach.

Approximate framework and progression of the session

1. Initiating communication and assessing the current status (5—10 minutes)

— Welcome and Configuration

— Therapist (T): “Good day, Ivan. How are you feeling today?”

— Patient (P): “Hello. I feel somewhat fatigued today, yet overall, I am in a better state than I was last week.”

— Brief emotional evaluation

The therapist inquires about the levels of anxiety, depression, or pain using a straightforward scale (e.g., 0 to 10).

— T: “On a scale from 0 to 10, with 0 indicating no anxiety and 10 representing the highest level of anxiety, how anxious do you feel today?”

— P: “I estimate approximately 6.”

— Agenda formulation

— T: “In our previous session, we discussed your concerns regarding the upcoming round of chemotherapy. Today, I propose we revisit that topic. Is there anything else you would like to include in the work plan?”

At this stage, the therapist and patient collaboratively establish the topics to be addressed during the session, thereby creating an “agenda.”

2. Review of assignments and progress (5–10 minutes)

— Verifying homework completion

— T: “We concurred that you would attempt to maintain a diary of your thoughts and emotions, particularly during moments of heightened anxiety. Were you able to accomplish this?”

— P: “Indeed, I documented my reflections multiple times in preparation for my medical appointment.”

— Examination of records

— T: “Let us examine your notes. What thoughts frequently occurred to you?”

— P (reads out): “I recorded: ‘I will not be able to manage the treatment’, ‘I will be isolated when I fall ill’.”

— T: “What alternative perspectives have you considered exploring?”

— P: “I attempted to reassure myself that I had prior experience with therapy and managed to navigate through it.”

— Strengthening positive experiences

“It’s commendable that you identified an example from your past experience. After all, you have faced challenges previously and successfully navigated through them.”

3. Concentrate on the present issue or emotion (15–20 minutes)

— Choosing a subject

— T: “In light of your notes, let us examine the apprehension linked to the forthcoming chemotherapy regimen. Which thoughts induce the greatest unease?”

— P: “Primarily, I have concerns regarding significant side effects and the potential impact on my ability to maintain my usual lifestyle. At times, it appears to be futile.”

— Recognition of automatic thoughts and beliefs

— T: “What is the first thought that arises when you consider the prospect of upcoming chemotherapy?”

— P: “I envision a perpetual state of malaise, where I remain reclined consistently, leading to a complete withdrawal of social interest from others.”

— T: “Do you believe that when you face difficulties, those around you will abandon you?”

— P: “Indeed, I fear that I may become a burden.”

— Cognitive restructuring

— T: “Let us examine the extent to which these thoughts align with reality. Can you recall instances from your life when you faced challenges and others remained by your side?”

— P: “During my previous treatment, my sister and friend assisted me with groceries and maintained regular contact.”

— T: “Thus, even during your moments of despair, you were not isolated. How does this influence your conviction that others will ultimately abandon you?”

— P: “Perhaps I am exaggerating. I fear a recurrence, but I was not alone during that time either.”

— Cultivating more realistic perspectives

— T: “Which concept appears more feasible at this moment?”

— P: “Numerous individuals are genuinely inclined to assist me if I communicate my needs to them.”

— T: “What are your feelings when you concentrate on this thought?”

— P: “The situation is becoming somewhat more tranquil.”

4. Practical exercise or technique (10 minutes)

— Selection of equipment

“Today, I would like to present a brief relaxation technique that you can utilize at home when you sense anxiety beginning to arise.”

— Brief progressive muscle relaxation

“Sit comfortably, with your feet flat on the floor and your hands resting on your knees. We will systematically tense and relax various muscle groups.”

The therapist instructs the patient methodically: “Tighten the muscles in your feet and shins… maintain for 5 seconds… relax. Now your hips…” and continues accordingly.

— Examination of sensations

After the exercise, the therapist inquires about the patient’s sensations during relaxation, particularly in areas where tension diminished.

5. Concluding and organizing “assignments” (5–10 minutes)

— Reflection

— T: “What aspects of today’s session were significant for you?”

— P: “I came to understand that my fear of solitude had been unfounded on multiple occasions, and that my loved ones genuinely provided support.”

— Formulating a strategic action plan

— T: “Let us devise a plan for the week:

— Maintain a thought journal, particularly during moments of apprehension regarding treatment.

— Consider practicing muscle relaxation techniques for 5 to 10 minutes each evening.

“Engage in a ‘behavioral experiment’: reach out to friends or family via text or call, express your concerns, and observe their reactions. Document the outcomes.”

— Clarification of inquiries

— P: “Understood, I will make an effort. If significant fears emerge, I will document them and consider alternative options.”

— T: “Precisely correct.”

— Completion

“Thank you, Ivan, for your efforts today. I look forward to seeing you next week to assess our progress.”

Key aspects of such a session:

— Structured: at the outset of the session, an agenda is reviewed.

— Concentrate on particular thoughts and emotions: the therapist assists the patient in recognizing the “event-thought-emotion-behavior” connection and reevaluating maladaptive beliefs.

— Practical exercises: may include cognitive (thought registration), behavioral (experiments, activation), and body-oriented (relaxation, breathing techniques).

— Homework: an essential element of CBT designed to assist the patient in consolidating new skills and reviewing material between sessions.

— Support and empathy: the therapist exhibits acceptance and understanding, fostering a secure environment that encourages the patient to articulate their feelings openly.

Cognitive behavioral therapy (CBT) for cancer patients frequently yields significant positive outcomes, enhancing both the patient’s psychological well-being and their engagement in treatment. The following outlines the primary effects and potential transformations that patients may encounter during and after CBT.

Decreased levels of anxiety and depression

— Alleviating anxieties related to illness, pain, and treatment.

— Mitigation of depressive symptoms through the modification of negative automatic thoughts and participation in “pleasurable” or socially meaningful activities.

— Enhancing emotional regulation via mindfulness training, relaxation techniques, and behavioral strategies.

A patient who was once in a perpetual state of anxious anticipation regarding negative news, following a course of cognitive behavioral therapy, observes that anxiety no longer pervades daily thoughts and has transitioned to a “background” presence rather than an “overwhelming” one.

2. Enhancing the quality of life

Physical well-being can be enhanced through consistent relaxation techniques, stress alleviation, and heightened motivation to comply with treatment protocols.

Psychological well-being improves as individuals experience heightened confidence and a greater sense of control over various facets of their lives.

Social engagement and involvement in family or community events can be revitalized by alleviating self-isolation stemming from anxiety or exhaustion.

A patient who once shunned gatherings with loved ones starts to participate in family events once more or extends invitations to friends.

3. Development and enhancement of adaptive coping strategies

— Recognizing automatic, catastrophic thoughts (“I won’t be able to manage the treatment,” “Everyone will abandon me once they learn about the diagnosis”) and substituting them with more realistic perspectives.

— Engaging in proactive problem-solving rather than passively awaiting or evading challenges (for instance, the patient acquires skills to plan and distribute energy effectively throughout the day).

— Regularly employing relaxation techniques such as progressive muscle relaxation, breathing exercises, and mindfulness meditation.

A patient undergoing a panic attack prior to a procedure employs the Stop-Thought technique or swiftly transitions to a brief breathing exercise, which aids in diminishing the severity of the panic.

4. Enhancing adherence to treatment

With consistent support for the patient within the context of cognitive behavioral therapy, his trust in the medical staff and confidence in the treatment’s efficacy grow.

— Enhanced collaboration with physicians: patients demonstrate a greater willingness to adhere to medication regimens, comply with dietary guidelines, and participate in physiotherapy sessions.

The incidence of missed medical appointments decreases, as the apprehension linked to unfavorable news or discomfort from procedures diminishes.

A patient who had previously discontinued treatment due to psychological challenges now consistently attends all scheduled chemotherapy sessions following cognitive behavioral therapy and remains in contact with the treating oncologist.

5. Enhancing interpersonal relationships

Many patients express that they experience increased understanding from others when they articulate their experiences, emotions, and needs openly.

The sense of guilt or “burden” towards loved ones diminishes, leading to the development of a healthier self-esteem.

Supportive relationships are enhanced: the patient exhibits greater confidence in seeking assistance, leading to a decrease in social isolation.

A patient who felt embarrassed to seek assistance from children or a spouse learns to articulate requests (“I’m struggling today; could you assist me with the shopping?”), and family members respond with empathy.

6. Enhanced sense of control and personal efficacy

An enhancement in self-efficacy is observed: the patient recognizes that, despite the gravity of the diagnosis, he can exert influence over his emotional state and specific facets of daily life.

— New interpretations and a more optimistic perspective for the future arise.

The patient may cultivate an inclination towards an active lifestyle, considering the constraints of their physical limitations.

A patient starts engaging in charitable initiatives and joins a support group for cancer patients, sensing that he can contribute meaningfully and impact his surroundings.

7. Prolonged consequences

— Resilience against relapses of anxiety and depressive disorders: regardless of whether the condition enters remission or deteriorates, the patient maintains cognitive restructuring and stress management abilities.

— Cognitive and behavioral flexibility: the patient is able to adapt more swiftly to changes in health and new medical recommendations.

— Cultivating healthy habits, including regular exercise, mindful eating, and fostering social connections.

Factors Influencing the Effectiveness of CBT

— Timeliness: the earlier psychological support is initiated, the greater the likelihood of preventing severe anxiety or depression.

— Regularity and duration: Cognitive Behavioral Therapy (CBT) typically yields optimal results when conducted over several sessions, supplemented by interim assignments and follow-up meetings to assess progress.

— Multidisciplinary approach: enhanced collaboration among psychologists, oncologists, and other specialists.

— Engagement of family and loved ones: When the patient’s immediate surroundings are actively engaged and provide support, the outcomes of CBT may be significantly enhanced.

Humanistic psychotherapy

Humanistic psychotherapy is a discipline within psychology and psychotherapy that emphasizes the individuality and intrinsic worth of the human personality, the freedom of choice, and the quest for self-actualization and meaning. In the context of working with cancer patients, this approach entails fostering a secure and accepting environment where patients can candidly share their experiences, seek support, and contemplate significant issues pertaining to illness, life, and death.

Below, we will examine the characteristics, objectives, and fundamental principles of humanistic psychotherapy in the context of assisting cancer patients.

Fundamental tenets of the humanistic approach

— Reverence for the individual

A humanistic therapist perceives the patient as a distinct individual, rather than merely a “carrier of a diagnosis.” This approach underscores the patient’s inherent value and dignity, along with their subjective experience.

— Unconditional Positive Esteem

Rogerian therapy, a prominent method within the humanistic framework established by C. Rogers, is founded on the principle of nonjudgmental acceptance. The therapist cultivates an environment in which the client can freely express thoughts and emotions without the apprehension of being judged.

— Empathy and authenticity (congruence)

The therapist endeavors to genuinely comprehend the patient’s inner world, demonstrates empathy, and maintains authenticity (congruence) in expressing his or her feelings and reactions.

— Concentrate on the present moment

“It is essential not only to reflect on the past or be anxious about the future but also to embrace each moment fully. This perspective is particularly beneficial for individuals who may grapple with fears regarding the future or feelings of regret about the past.”

— Self-actualization

Humanistic psychologists perceive each individual as inherently capable of growth, creativity, and development. Even in the face of a severe diagnosis, patients can pursue and discover new meaning, thereby unlocking resources and spiritual dimensions of life.

2. Aims and objectives of humanistic psychotherapy for cancer patients

— Support in acknowledging the diagnosis and adjusting to treatment

Creating an emotionally secure environment in which the patient can discuss their fears, pain, and disappointments; the therapist assists them in accepting the reality of the diagnosis without succumbing to total hopelessness.

Mitigation of feelings of loneliness and alienation

Cancer frequently leads to social isolation, often stemming from misunderstanding or fear among others. Humanistic therapy fosters a connection in which the patient is acknowledged and listened to without bias.

— Discovering and enhancing the significance of life

The existential-humanistic approach, as articulated by V. Frankl, R. May, I. Yalom, and others, emphasizes inquiries into meaning: “Why am I living?” and “How can I fully utilize my allotted time?” This perspective is particularly pertinent when an individual confronts a challenging diagnosis and grapples with life-and-death questions.

— Enhancing self-esteem and self-worth

Illness can adversely affect a patient’s self-perception: “I am not the same as I once was,” “My life will never be fulfilling.” A therapist assists the patient in recognizing their intrinsic worth, the importance of their emotions, and the significance of their life experiences.

— Assistance in the decision-making process

Oncology patients frequently encounter challenging decisions, such as whether to pursue aggressive treatment or decline it, and whether to engage in experimental therapies. A humanistic therapist refrains from offering advice, instead guiding the patient to comprehend their values and make choices that resonate with their personal identity.

3. Approaches and strategies in humanistic therapy for cancer patients

— Client-centered therapy (Carl Rogers)

The foundation consists of empathetic listening, non-judgmental acceptance, and authenticity.

The patient directs the process, articulating their feelings and thoughts, while the therapist supports the patient, assisting them in recognizing and integrating their internal experiences.

— Existential perspective

When engaging with cancer patients, issues surrounding the fear of death, guilt, responsibility, and the significance of life frequently emerge.

The therapist assists the patient in confronting these questions rather than evading them, encouraging the development of a personal perspective and a reevaluation of their values.

— Gestalt therapy

— A focus on the awareness of one’s own emotions and experiences in the present moment.

— Can be utilized when addressing unprocessed emotions such as anger, resentment, and fear. For instance, the “empty chair” technique facilitates dialogue with an imaginary interlocutor, which may include loved ones or one’s future or past self.

— Meaning-centered therapy (V. Frankl’s logotherapy)

The pursuit of significant goals and values that assist an individual in discovering reasons to live, even amidst challenging circumstances.

— Engaging with the acceptance of death’s inevitability while upholding human dignity.

— Components of art therapy

— Producing drawings, collages, sculptures, composing letters, or maintaining a diary.

— Aids in articulating and comprehending the inner self, while also alleviating psycho-emotional stress.

4. Characteristics of the “therapist-patient” relationship within the humanistic paradigm

— Interpersonal communication

The therapist refrains from adopting a paternalistic stance (“I am the expert, and you are the patient”) and endeavors to engage in dialogue as equals, acknowledging their own vulnerability and humanity.

— Emotional assistance

A warm and welcoming atmosphere provides the patient with a sense of companionship in their experiences.

— Therapist self-disclosure (when suitable)

— Occasionally, a humanistic therapist may disclose certain feelings or thoughts to support the patient and demonstrate the authenticity of the relationship; however, this is approached with great care and intention.

— Patient autonomy and accountability

A therapist does not impose predetermined solutions or dictate how a patient should live “correctly.” Instead, they assist the individual in comprehending their desires and identifying what is most genuine and meaningful.

5. Impacts and outcomes of humanistic psychotherapy in cancer patients

— Diminished levels of despair and hopelessness

When a patient finds meaning and value in their life, even in the face of a serious diagnosis, symptoms of depression and existential anxiety diminish.

— Enhancing personal dignity and self-worth

The patient ceases to identify solely as a “sick person” and recognizes his identity as encompassing more than the diagnosis.

Enhanced comprehension of your own emotions and needs

The capacity to articulate fears, anger, and disappointment fosters clarity in emotional states and diminishes internal conflicts.

— Enhancing communication with loved ones

Openly articulating emotions and the capacity to establish your boundaries and requests fosters the development of warmer and more trusting relationships.

— Establishing or redefining life objectives

Some patients discover new interests, such as creativity, volunteering, and socializing, and establish daily or weekly goals, thereby restoring a sense of fulfillment in life.

6. Pragmatic recommendations for professionals

— Considering physical condition

Cancer patients may endure pain, significant fatigue, and adverse effects from treatment. When selecting techniques, it is crucial to take these limitations into account, often favoring shorter or less intense sessions.

— Adaptable session framework

In humanistic therapy, a “free flow” of conversation is both permitted and encouraged; concurrently, the therapist observes significant themes such as fear, guilt, loneliness, and the quest for meaning.

— The therapist’s emotional stability

When dealing with intricate diagnoses, specialists may encounter burnout or compassion fatigue. It is essential to seek supervision, obtain support from colleagues, and engage in self-reflection.

— Interdisciplinary collaboration

The humanistic approach does not preclude the incorporation of other psychotherapeutic methods, nor does it diminish the importance of close collaboration with oncologists, nurses, and social workers. This integration facilitates the delivery of holistic support to the patient.

— Collaborating with family

If the patient desires, family members may be incorporated into the therapeutic process (family sessions, group meetings), during which roles, emotions, expectations, and methods of mutual support are explored.

Below are various exercises and techniques employed in humanistic (existential-humanistic, client-centered, etc.) psychotherapy for cancer patients. These exercises aim to enhance self-understanding, discover personal meaning, and offer emotional support. It is essential to tailor each practice to the patient’s present condition (both physical and psychological) and, when necessary, collaborate with the treating physicians.

1. Exercise “Dialogue with Illness” (Elements of Gestalt Therapy)

Goal: to articulate and comprehend the emotions linked to a cancer diagnosis, alleviate internal tension, and cultivate a more holistic perspective on the illness.

How to execute:

— Arrange two chairs (or envision a second chair in your mind).

The patient occupies one chair, while the “disease” (or its representation) is envisioned on the opposite chair.

The patient engages with the illness as if it were an interlocutor, articulating emotions such as fear, anger, and resentment, while posing inquiries such as, “Why have you manifested? What do you seek from me?”

The patient then transitions to the “site of the ailment” and endeavors to respond on its behalf, drawing upon the sensations and thoughts that arise.

— Finally, engage in a discussion with your therapist regarding the insights gained during the dialogue. What emotions emerged? How has your perspective on the illness evolved?

Comment: Although the responses to the illness may appear paradoxical, this exercise facilitates the patient’s expression of repressed experiences and fosters symbolic insights.

“Self-Support Letter”

Goal: to cultivate a warm and accepting attitude towards oneself (Unconditional Positive Regard), to sustain internal resources, and to diminish self-blame or self-devaluation.

How to execute:

Invite the patient to compose a letter to themselves from the viewpoint of a “kind, wise friend” or the “nurturing aspect of their personality.”

— In the correspondence:

— Acknowledge the challenges the patient is presently encountering.

— Convey empathy, support, and unconditional acceptance (free from criticism or reproach).