Each year 185,000 women in this country learn that they have breast cancer. Because less than a quarter of them have genetic or other known risk factors, the diagnosis often comes as a devastating surprise. The emotional turmoil that results can affect women's physical health as well as their psychological well-being. This question-and-answer fact sheet explains how psychological treatment can help these women harness the healing powers of their own minds.
What impact does a breast cancer diagnosis have on psychological well-being?
Receiving a diagnosis of breast cancer can be one of the most distressing events women ever experience. And women may not know where to turn for help.
Distress typically continues even after the initial shock of diagnosis has passed. As women begin what is often a lengthy treatment process, they may find themselves faced with new problems. They may find their personal relationships in turmoil, for instance. They may feel tired all the time. They may be very worried about their symptoms, treatment and mortality. They may face discrimination from employers or insurance companies. Factors like these can contribute to chronic stress, anxiety and depression.
Why is it important to seek psychological help?
Feeling overwhelmed is a perfectly normal response to a breast cancer diagnosis. But negative emotions can cause women to stop doing things that are good for them and start doing things that are bad for anyone but especially worrisome for those with a serious disease. Women with breast cancer may start eating poorly, for instance, eating fewer meals and choosing foods of lower nutritional value. They may cut back on their exercise. They may have trouble getting a good night's sleep. And they may withdraw from family and friends. At the same time, these women may use alcohol, cigarettes, caffeine or other drugs in an attempt to soothe themselves.
A breast cancer diagnosis can also lead to more severe problems. Researchers estimate that anywhere from 20 to 60 percent of cancer patients experience depressive symptoms, which can make it more difficult for women to adjust, participate optimally in treatment activeness and take advantage of whatever sources of social support are available. Some women become so disheartened by the ordeal of having cancer that they refuse to undergo surgery or simply stop going to radiation or chemotherapy appointments. As a result, hey may get even sicker. In fact, studies show that missing as few as 15 percent of chemotherapy appointments results in significantly poorer outcomes.
How can psychological treatment help women adjust?
Licensed psychologists and other mental health professionals with experience in breast cancer treatment can help a great deal. Their primary goal is to help women learn how to cope with the physical, emotional and lifestyle changes associated with cancer as well as with medical treatments that can be painful and traumatic. For some women, the focus may be on how to explain their illness to their children or how to deal with a partner's response. For others, it may be on how to choose the right hospital or medical treatment. For still others, it may be on how to control stress, anxiety or depression. By teaching patients problem-solving strategies in a supportive environment, psychologists help women work through their grief, fear and other emotions. For many women, this life-threatening crisis eventually proves to be an opportunity for life-enhancing personal growth.
Breast cancer patients themselves aren't the only ones who can benefit from psychological treatment. Psychologists often help spouses who must offer both emotional and practical support while dealing with their own feelings, for instance. Children, parents and friends involved in care taking can also benefit from psychological interventions.
The need for psychological treatment may not end when medical treatment does. In fact, emotional recovery may take longer than physical recovery and is sometimes less predictable. Although societal pressure to get everything back to normal is intense, breast cancer survivors need time to create a new self-image that incorporates both the experience and their changed bodies. Psychologists can help women achieve that goal and learn to cope with such issues as fears about recurrence and impatience with life's more mundane problems.
Can psychological treatment help the body, too?
Absolutely. Take the nausea and vomiting that often accompany chemotherapy, for example. For some women, these side effects can be severe enough to make them reject further treatment efforts. Psychologists can teach women relaxation exercises, meditation, self-hypnosis, imagery or other skills that can effectively relieve nausea without the side effects of pharmaceutical approaches.
Psychological treatment has indirect effects on physical health as well. Researchers already know that stress suppresses the body's ability to protect itself. What they -now suspect is that the coping skills that psychologists teach may actually boost the immune system's strength. In one well-known study, for example, patients with advanced breast cancer who underwent group therapy lived longer than those who did not.
Research also suggests that patients who ask questions and are assertive with their physicians have better health outcomes than patients who passively accept proposed treatment regimens. Psychologists can empower women to make more informed choices in the face of often-conflicting advice and can help them communicate more effectively with their health care providers. In short, psychologists can help women become more fully engaged in their own treatment. The result is an enhanced understanding of the disease and its treatment and a greater willingness to do what needs to be done to get well again.
What type of psychological treatment is helpful?
A combination of individual and group treatment sometimes works best. Individual sessions with a licensed psychologist typically emphasize the understanding and modification of patterns of thinking and behavior. Group psychological treatment with others who have breast cancer gives women a chance to give and receive emotional support and learn from the experiences of others. To be most effective, groups should be made up of women at similar stages of the disease and led by psychologists or other mental health professionals with experience in breast cancer treatment.
Whether aimed at individuals or groups, psychological interventions strive to help women adjust to their diagnoses, cope with treatment and come to terms with the disease's impact on their lives. These interventions offer psychologists an opportunity to help women better understand breast cancer and its treatment. Psychologists typically ask women open-ended questions about their assumptions, ideas for living life more fully and other matters. Although negative thoughts and feelings are addressed, most psychological interventions focus on problem-solving as women meet each new challenge.
A breast cancer diagnosis can severely impair women's psychological functioning, which in turn can jeopardize their physical health. It doesn't have to be that way. Women who seek help from licensed psychologists with experience in breast cancer treatment can actually use the mind-body connection to their advantage to enhance both mental and physical health.
The American Psychological Association Practice Directorate gratefully acknowledges the assistance of Alice F. Chang, Ph.D., and Sandra B. Haber, Ph.D., in developing this fact sheet.
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A publication of the American Psychological Association Practice Directorate