CBT for Psychological Well-Being in Cancer: A Skills Training Manual Integrating DBT, ACT, Behavioral Activation and Motivational Interviewing

258 Pages·2017·1.24 MB·English

by  Mark Carlson

CBT for Psychological Well-Being in Cancer
CBT for Psychological
Well-Being in Cancer
A Skills Training Manual Integrating
DBT, ACT, Behavioral Activation and
Motivational Interviewing
Dr. Mark Carlson
Thiseditionfirstpublished2017
©2017JohnWiley&SonsLtd
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Thisworkisdedicatedtomyson,Spencer.
Thankyouforsharingtheworldthroughyourexperience:Youstoptoseethe
beautywhenothersrushby,youlovewithoutcondition,youlaughwithyourwhole
being,youopenyourhearttoallaroundyou,youarestronginlife,youhavean
undyingcuriosity,youfindhopeandcompassionwhenmanydonot,youbelieve,
andyouareamazing!Ihopethatyoustayconnectedtowhoyouareandwhatyou
arecapableofdoingevenintimesofpainanddiversity.KnowthatIloveyouwithall
ofmybeing,Iwillalwaysbewithyou,andIamproudtobeyourdad.
Contents s
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Acknowledgments ix
1 IntroductiontoCBTforPsychologicalWell-BeinginCancer:Orientation
totheManual 1
2 CancerStatisticsandtheScopeoftheTopic 3
3 IntroductiontotheTAGConceptforGroupand/orIndividualTherapy 10
4 ClinicalManual 20
GeneralCurriculum 20
Sessionfocus:Orientingtheindividualtotherapy 20
Sessionfocus:Skillstraining 24
Sessionfocus:Interventionsandstrategies 29
Sessionfocus:Safetyassessmentandcontracting 35
Sessionfocus:Cognitiveandbehavioralanalysis 41
Sessionfocus:Self-regulationandillnessperceptions 48
Sessionfocus:Chronicillness 53
BiologicalCurriculum 57
Sessionfocus:Increasedfunctioningandqualityoflife 57
Sessionfocus:Goalsettingandmotivation 61
Sessionfocus:Orientationtochange 67
Sessionfocus:Workingwithyourteam 73
Sessionfocus:Adherencetotreatmentprotocols 78
Sessionfocus:Pain 84
Sessionfocus:Healthyhabitsandsleep 90
PsychologicalCurriculum 94
Sessionfocus:Anxiety 94
Sessionfocus:Depression 99
Sessionfocus:Traumaandretraumatization 105
Sessionfocus:Increasingresiliencythroughstressmanagement 110
viii Contents
Sessionfocus:Angermanagement 115
Sessionfocus:Findingmeaning 120
Sessionfocus:Stigma 126
SocialCurriculum 132
Sessionfocus:Intimacy 132
Sessionfocus:Problemsolving 137
Sessionfocus:Nurturingsupportsystems 142
Sessionfocus:Managingconflict 149
Sessionfocus:Demoralizationandremoralization 154
Sessionfocus:Stylesofinteracting 164
Sessionfocus:Griefandloss 168
HandoutsandHomework 174
References 239
Index 245
Acknowledgments s
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Iwouldliketothankmyteamformakingthisworkareality.
Brittany Hamann – for all of your hard work, contributions, and dedication to this
project.
MeaganKarsten–foryourpassionandcontributions.
Dr.AmyGimbel–foryourwillingnesstodowhateverisneededandforyourcontri-
butions.
Dr.MorganCusack–forbelievinginthisworkandyourdedication.
Dr.LanePederson–foryourfriendshipanddrive.
Shelley–foryoursupportandstability.
Dr.SteveGirardeau–foryourwisdomandguidance.
TheentireteamatWiley.
MomandDad–foryourunwaveringsupport.
Julie–forbeingthereeverystepoftheway!
Chapter 1 l
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Introduction to CBT for a
M
Psychological Well-Being in
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Cancer: Orientation to the Manual
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When the word “cancer” is mentioned, people typically pay attention. When it is in
e
the context ofa medical appointment, or when discussingtesting results, oneof our i
r
biggestfearsmaybecomereality.Mosteveryoneknowssomeonewithcancer.There O
are stories of triumphs and stories of pain in every family. Reactions to the diagnosis
of cancer, its treatment, and its course vary greatly between individuals. Although
individualreactionsmaybequitedifferent,therearemanycommonthemesfoundin
whatisexperiencedandwhatisneeded.Thefirstmainthemeisthatcanceraffectsan
individual’sfunctioningandtheirqualityoflife.Theothermainthemescanbeorga-
nizedintobiological,psychological,andsocialperspectives.Thefocusofthismanual
istoaddressthecomplexneedsofindividualsdiagnosedwithcancer.Sincethereare
morethan100typesofcancer,Ihavechosennottofocusonanyonespecifictype.It
seemedmoreappropriatetoaddressthecommonreactionsandissuesthatindividuals
with cancer experience. This is not designed to be an exhaustive and all-inclusive
work,butratheranotherstepinthedirectiontowardtreatingthewholeperson.
Chapter 2 provides an overview of cancer statistics and treatments, to orient the
reader to the enormity of the impact of cancer. Chapter 3 outlines a proposed treat-
mentstructurethataddressesflexibletreatmentmodalitiesfortheprofessional.Chap-
ter 4 makes up the bulk of the manual, and is organized into four sections: general,
biological,psychological,andsocial.Thegeneralsectionconsistsofsixheadingsthat
orient the clinician to the treatment of this population, ranging from skills training
toworkwithsafetyissues.Thebiologicalsectionaddressesthemessuchastreatment
compliance and self-advocacy. The psychological section addresses issues of anxiety,
depression,findingmeaning,andmore.Thesocialsectionfocusesontheindividual’s
needs,aswellastheneedsoftheirsupportsystemsandstrategiestoincreasehealthy
interactions.
Each section of Chapter 4 is presented with an outline of its contents, beginning
withanintroductiontothetopicandpointsofdiscussion.Thediscussionpointscan
CBTforPsychologicalWell-BeinginCancer:ASkillsTrainingManualIntegratingDBT,ACT,Behavioral
ActivationandMotivationalInterviewing,FirstEdition.MarkCarlson.
©2017JohnWiley&Sons,Ltd.Published2017byJohnWiley&Sons,Ltd.
2 CBTforPsychologicalWell-BeinginCancer
becoveredineithergrouporindividualtherapyasawaytogroundtheindividualand
exploretheirexperience.Thesectionsthentransitionintosetsofskillstoteach,which
aredesignedtoincreasethepatient’sfunctioningandqualityoflife.Theyalsoprovide
assessments tools, which can be used to track progress or identify key aspects of the
patient’s functioning. Participants are encouraged to practice the skill sets in session
using handouts, and to generalize what they are learning outside of the therapeutic
sessionsbycompletingthehomeworkassignments/trackingtoolsandreviewingthem
inthefollowingsession.Thesectionsconcludewithnotestotheclinician,whichare
designedtohighlightkeypointsandprovidesuggestions.
Thereisno“right”waytoincorporateamanualizedapproach.Thegoalistofocus
ontheneedsoftheindividualseekingservices,whilestrivingtoincreasetheirfunction-
ingandqualityoflife.Ourhealthcaresystemismovingtowardintegratedhealthcare.
Thismanualisdesignedtoassistinnarrowingthegapbetweenhealthcareprofessions
by integrating different treatment approaches in order to increase overall health and
wellness.TheWorldHealthOrganization(1948)defineshealthasastateofcomplete
physical,mental,andsocialwell-being,andnotmerelytheabsenceofdiseaseorinfir-
mity. This definition has not changed since it was adopted in 1948, and I hope this
workwillhelpcliniciansmoveinthedirectionofembracingit.
Chapter 2 c
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Cancer Statistics and the T
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Scope of the Topic h
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The prevalence and cost of cancer are a growing concern in the United States and t
beyondourborders.Thereisanimmenseneedforcoordinationofmedicalandpsy- d
chologicalmanagementtotreatindividualssufferingwithcancerandresidualcondi- n
tions that often result from the disease. The American Cancer Society reported that a
in2013“about1,660,290newcancercasesareexpectedtobediagnosedintheUS”, s
c
with“about580,350Americans…expectedtodieofcancer,almost1,600peopleper
i
day.” It further estimated that in 2014 there were 14.5 million Americans alive with t
s
ahistoryofcancerandthatby2024therewillbe19million.CurrentlyintheUnited i
t
States, “men have a 1 in 2 lifetime risk of developing cancer; for women, the risk is a
t
a little more than 1 in 3” (American Cancer Society, 2013). “Cancer is the second
S
most common cause of death in the US, exceeded only by heart disease, [account-
r
ing]forabout1ofevery4deathsin2013”(AmericanCancerSociety,2013).Nearly
e
one-fourth of people with chronic conditions also reported experiencing limitations c
n
to daily activity due to their illness and experienced clinical mental health concerns.
a
“The5-yearrelativesurvivalrateforallpersonsdiagnosedwithcancerbetween2002
C
and 2008 is 68%, which is up from 49% in 1975–1977” (American Cancer Society,
2013).Thisindicatesthat“60%of1-yearcancersurvivorsexperienceclinicallysignif-
icant concerns about disease recurrence influencing the individual’s functioning and
qualityoflife”(AmericanCancerSociety,2014).
Survival from chronic health conditions brings new challenges for individuals
throughout their lifespan, including lifelong and acute physical, psychological, and
social adjustment difficulties. According to the American Childhood Cancer Orga-
nization (2013), “Two-thirds of those who survive the disease develop at least one
chronichealthconditionthatisclassifiedassevereorlife-threateningcausedbylate-
effectsoftreatment.Theseeffectsoftenincludeheartdamage,lungdamage,infertility,
cognitiveimpairment,growthdeficits,hearingloss,andsecondcancers.”Childhood
CBTforPsychologicalWell-BeinginCancer:ASkillsTrainingManualIntegratingDBT,ACT,Behavioral
ActivationandMotivationalInterviewing,FirstEdition.MarkCarlson.
©2017JohnWiley&Sons,Ltd.Published2017byJohnWiley&Sons,Ltd.