Friday, March 13, 2015

Treating Posttraumatic Stress in BRCA Survivors

In an earlier post, I described how breast cancer survivors are often the victims of posttraumatic stress, and frequently display many of the signs and symptoms that are associated with that psychological diagnosis. Things like heightened anxiety, hypervigilance, a change in outlook on life, negative beliefs and expectations about herself or her body, and a change in risk-taking behaviors may be present not just during treatment, but also after treatment has ended.

Now I am going to describe how psychodynamic psychotherapy can help with the disturbing PTSD symptoms that survivors may be experiencing. In addition to discussing problematic symptoms and how the survivor is coping with them, the psychotherapist will work on understanding and appreciating the significance to the client of not only having had breast cancer, but also of each of the treatment interventions to which she was exposed. Today's mainstream cancer treatments, i.e. surgery, radiation, and chemotherapy all act as powerful triggers of complex emotions and earlier traumatic experiences. It is crucial to understand how each breast cancer patient mentally engaged with each of them. Every woman’s breast cancer journey is unique, and is a function of not just her encounters with her medical providers, medical interventions and our health care system, but also of her earlier life experiences. How we engage with the present is always influenced by what we experienced in the past.

It is vital that the psychotherapist assist the client in uncovering and comprehending the psychological meaning to her of what she has been through. For example, what did each treatment modality symbolize to this particular client? Did the chemotherapy represent something positive that was going to destroy cancer cells and restore health, or did it feel like an evil intruder that was wreaking havoc throughout her body? Did the accompanying loss of hair, a well-known side-effect of chemotherapy cause the patient to feel less attractive to her spouse or to potential romantic/sexual partners? Was it experienced as the destruction of an important symbol of femininity? Did it feel like a potent connection to an early attachment figure was destroyed?  Perhaps an early caregiver who expressed love by fixing and combing her hair? Did it have both of these meanings as well as others?

How did all of the physiological and cognitive effects of the treatments (fatigue, nausea, memory loss, loss of mental sharpness etc.) affect things like self-esteem, perception of a benign world, sense of bodily vulnerability, or the person’s sense of their future possibilities?

In order to effectively treat symptoms like depression, anxiety and insomnia over the long term, it is often crucial that psychological meanings be patiently explored, in the context of a safe, psychotherapeutic relationship in which trust and mutual respect have been established and are being carefully nurtured.

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