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Section 2
Emotional Distress After Diagnosis of Cancer

Question 2 | Test | Table of Contents

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In the last section, we discussed influences or factors that can affect how well clients cope with cancer.   The four types of influences were the disease itself, stage of life, resources, values, and emotional patterns of the client, and social support. 

In this section, we will discuss dealing with discovery.  Let’s examine three issues surrounding dealing with the discovery of the cancer.  These reactions are denial, anger, and a sense of loss.  We’ll also discuss techniques for minimizing the sense of loss.  As you listen to this section, consider your client.  How might he or she benefit from Linda Roberts’ techniques for minimizing the sense of loss described at the end of this section?

3 Reactions to the Discovery of Cancer

♦ Reaction #1. Denial
First, let’s discuss denial.  I find that no matter how long the symptoms have been occuring, no matter how painful they have been, no matter how well prepared clients are for the probability of having cancer, it is still overwhelming when they find out that they have a terminal diagnosis.  In some form or other, denial is a phase most people go through following diagnosis.  But would you agree that accepting that he or she has cancer is one of the steps the client must take to defeat it? 

♦ Reaction #2. Anger
Anger is also natural.  You might have heard one of your clients ask questions like, "Why me!?  Why did it take so long to diagnose?  Why was I misdiagnosed three times!?" These are common frustrations, and, clearly, there are many more. 

♦ Reaction #3. Sense of Loss
In addition to denial and anger, one of the biggest issues that cancer patients struggle with is a sense of loss.  Your client may feel the loss of independence and control, the loss of his or her identity through the client’s change in role as he or she refocuses priorities to battle cancer.  Clients dealing with cancer also experience the loss of jobs or standards of living. 

Good health, energy, even good looks your client might feel like they are gone.  Cheerfulness and sociability, even the closeness of family and friends might seem lost to clients.  Perhaps one of the biggest losses becomes the sense of lost hope and dreams for the future.  If your client is experiencing a loss of hope, you might refer to sections 9 and 10 of this course for more information.  Here are some ways to minimize the other perceived losses.

♦ Technique:  8 Steps to Minimizing the Sense of Loss
Linda Roberts, a social worker at the Memorial Sloan-Kettering Cancer Center in New York provided eight simple but effective ways of minimizing the sense of loss a client with cancer might feel at his or her moment of discovery and in the following months. 
1. Roberts states, "Clients can minimize the sense of loss by first identifying the things they can control, such as choice or doctor, diet, the way he or she spends time, and the people the client associates with." 
2. A second method for minimizing the sense of loss is for the client to try to retain a sense of self as a whole person, not just a patient.  Maintaining family traditions and regular activities as much as possible is one effective way for clients to retain a sense of self. 
3. In addition to identifying that which can be controlled and retaining a sense of self, a third method for minimizing the sense of loss is talking to others who are going through the same thing. 
4. Fourth, clients can concentrate on getting better and feeling gratitude for the things he or she does have. 
5. Fifth, you might consider suggesting to your client that it is normal to have mood swings and more intense emotions than before his or her diagnosis. 
6. Sixth, Linda Roberts encourages her clients to make themselves as physically comfortable as possible.  One way of doing this is to make the hospital room as close to home as possible my bringing in personal possessions.  We’ll discuss more hospital strategies in section 12. 
7. Seventh, clients can minimize a sense of loss by spending as much time as possible with people who care, such as family and friends. 
8. Finally, Roberts suggests that the client integrates his or her cancer experience into his or her life story.  She states, "It’s an important part of a client’s life, but not the only part."  Think of your client.  How might he or she benefit from minimizing the sense of loss as a technique for dealing with discovery?

In this section, we discussed dealing with discovery.  We examined three issues regarding dealing with discovery.  They are denial, anger, and sense of loss.  We also discussed techniques for minimizing the sense of loss.  Would playing this section in a session be beneficial to your client?

In the next section, we will discuss awfulizing.  We will discuss the progression of awfulizing through panic cognitions, the importance of clear decision making, how panic turns to awfulizing, and the stop awfulizing technique. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Cook, S. A., Salmon, P., Dunn, G., Holcombe, C., Cornford, P., & Fisher, P. (2015). The association of metacognitive beliefs with emotional distress after diagnosis of cancer. Health Psychology, 34(3), 207–215. 

Hall, M. E. L., Shannonhouse, L., Aten, J., McMartin, J., & Silverman, E. (2020). The varieties of redemptive experiences: A qualitative study of meaning-making in evangelical Christian cancer patients. Psychology of Religion and Spirituality, 12(1), 13–25.

Henselmans, I., Helgeson, V. S., Seltman, H., de Vries, J., Sanderman, R., & Ranchor, A. V. (2010). Identification and prediction of distress trajectories in the first year after a breast cancer diagnosis. Health Psychology, 29(2), 160–168. 

Kivlighan, D. M. III, Aloe, A. M., Adams, M. C., Garrison, Y. L., Obrecht, A., Ho, Y. C. S., Kim, J. Y. C., Hooley, I. W., Chan, L., & Deng, K. (2020). Does the group in group psychotherapy matter? A meta-analysis of the intraclass correlation coefficient in group treatment research. Journal of Consulting and Clinical Psychology, 88(4), 322–337.

Trudel-Fitzgerald, C., Tworoger, S. S., Poole, E. M., Zhang, X., Giovannucci, E. L., Meyerhardt, J. A., & Kubzansky, L. D. (2018). Psychological symptoms and subsequent healthy lifestyle after a colorectal cancer diagnosis. Health Psychology, 37(3), 207–217.

What are three issues regarding dealing with discovery? To select and enter your answer go to Test.

Section 3
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