The following article was originally published in the Herald Tribune Media on October 21, 2009
A breast cancer diagnosis is an enormous physical health crisis, but it is also a huge psychological and emotional impact. The mental health crisis calls for its own form of treatment.
Emily Leinfuss spoke with Deborah Kaufman – an expert on anxiety and trauma – about the psychological aspects of living through breast cancer diagnosis and treatment, the after effects, and what kind of help is available.
Q: I understand women often suffer from PTSD, major depression or psychological distress after a breast cancer diagnosis. This is understandable, but what can they do, or what treatment is advisable?
A: As with any personal challenge or crisis, the treatment of choice is based on the unique needs and sensibilities of the individual. Currently there is still little integration between medical treatment for breast cancer and treatment that addresses the psychological issues.
So, women have to find their own way to get help and address the psychological issues. If they have already used counseling and psychotherapy to deal with life challenges, they generally use this familiar route for help. If this is outside of their prior experience, it may be difficult to seek this kind of help when they may be overwhelmed by scheduling of medical visits and the sense of panic that often accompanies a cancer diagnosis.
For some women, individual psychotherapy can be very helpful during and after cancer diagnosis and treatment.
For other women, a support group can be helpful. The Wellness Community of Southwest Florida offers support groups for women with breast cancer as well as other services for people diagnoses with cancer and for their family members.
Q. I read an older (1989) study that said mind-body interventions – such as psychotherapy and group therapy – do not increase breast cancer survival rates. Have further studies changed this conclusion?
A. More recent research may indicate an increase in survival for patients receiving psychological intervention. A 2008 study conducted by researchers from Ohio State University and James Cancer Hospital found that psychotherapy to decrease stress decreased inflammation as well as depression and that these multiple benefits spoke to the importance of including psychological intervention in comprehensive cancer care for emotionally distressed patients.
What may be even more significant than survival rates alone is the improved quality of life for women who receive such intervention and support. I believe that further research will contribute to the understanding the value of psychotherapy for improved overall health and overcoming health challenges.
Q. How does psychotherapy, counseling or group therapy help those who are struggling with breast cancer?
A. The interventions can help by:
• Decreasing fear and other uncomfortable emotions
• More effective management of stress
• Identifying and increasing positives ranging from outlook and self-image to support to participation in life affirming activity
• Improved mood
These factors have a positive impact on the immune system. I believe that how I feel about myself and my life has an impact on my physical wellbeing that is as great as or even greater than diet and exercise. The combination of these factors has a synergistic effect that increases our chances for overall health whether we are challenged by a disease or just working on preventative maintenance.
My personal discovery has been reinforced over my years as a psychotherapist, working to help people achieve and maintain a greater sense of peace, happiness and balance in their life.
Q. Is there a different set of problems for men than women?
A. Absolutely! Research has demonstrated significant differences in sensation, perception and autonomic nervous system function between male and female subjects. I recently was directed to an article by Leonard Sax, MD, PhD, the executive director if the National Association for Single Sex Education that discusses the significance of gender differences in learning. These gender differences affect the way we respond to the way we respond to stress from childhood. The male response tends to stress tends to be more influenced by the sympathetic nervous system (fight or flight) while the female response to stress tends to be more influenced by the parasympathetic nervous system (rest and digest). Women can become “lethargic, emotionally paralyzed and even nauseated” when dealing with stress. Even the air temperature of the ideal learning environment is approximately six degrees higher for females than males.
So, going along with the gender difference theories discussed in that article, medical language that includes words like ‘fighting’ the diseases can further exacerbate feeling of powerlessness and fear. The same can be true about aggressive medical treatment approaches.
Q. What about other “mind-body” activities, such as yoga, massage and acupuncture: how do these modalities impact those who struggle with breast cancer?
A. Yoga, massage and acupuncture strengthen the immune system. A strong immune system is vital to cancer recovery and maintaining ongoing health. The immune system is also strengthened by experiencing love whether it is love of people, animals, flowers, music, and spirituality. And let’s not forget about the importance of humor and laughter as immune system boosting activities.
Q. There is a major impact on families and friends of breast cancer sufferers. What advice can you give to them – to both support themselves and their friend?
A. First of all, I recommend that anyone who wants to provide support should take an honest look at their own fears and fantasies so that they do not project them unto the person they want to help. If this seems very challenging, it might be useful to seek the help of a counselor or psychotherapist to help decrease their own anxiety so that they are more available to support their loved one.
Since the needs of women with breast cancer are person and individual, in order to provide real support, it is important to find out what your loved one wants and needs in the way of support. Do not assume that you know, rather take the time to find out. Be available without being intrusive.
Q. The number of breast cancer deaths has declined steadily in recent years. What in important to know about living life as a breast cancer “survivor”?
A. From my perspective, it is more about recovery than survival. It is about living life one day at a time as with any of life’s challenges. Recovery is personal and individual. There is no right way.
Deborah S. Kaufman, LCSW, of Anxiety and Trauma Resolution Associates (www.anxietyresolve.com) is a Certified Gestalt psychotherapist and is a Licensed Clinical Social Worker in Sarasota, FL. She maintains a private practice specializing in anxiety disorder, childhood trauma, and sexual abuse.