Psychosocial Aspects of Living with Lymphedema Patricia Nitkin, Phd - - PowerPoint PPT Presentation

Psychosocial Aspects of Living with Lymphedema

Patricia Nitkin, Phd Candidate, CCC Patient and Family Counselling Services B.C. Cancer Agency Vancouver Centre

Three Kinds of Stories

 Restitution story – being ill as a process of finding restitution…restored  Chaos story – overwhelmed, the story swirls around you  Quest story – transformation, new meanings

Arthur Frank, Univ of Calgary

COMMON DIFFICULTIES & FEARS

 Multiple losses  Family and relationship issues  Symptom management  Exhaustion: emotional, physical, spiritual..  Anxiety/stress management  Sexuality and intimacy issues  Finances and Vocational challenges  Depression  Loss of self image  Dependency  Progression of illness  Pain  Change in roles/ lifestyle  Emotions

COPING AND ADAPTATION

 COPING is what one does about a perceived problem in order to bring about relief, reward, quiescence or equilibrium.

(Weisman & Worden (1977)

• Values and beliefs affect coping.

 ADAPTATION begins when a person manages to incorporate illness into their daily lives and effectively address problems or concerns created by the illness.

Factors which effect Coping with a Chronic Condition

 Previous experience  Support network  Severity of symptoms  Stage of life/family life cycle  Beliefs/values  Personality  Role in the family  Coping resources  Other issues present/unresolved

BIOPSYCHOSOCIAL APPROACH

 Underlying Assumptions  Nothing that we do is purely psychological  Everything that we do causes biochemical changes  We are biophysiological beings – fight or flight principle  Systems driven  Cross cultural differences  Setting goals/therapeutic plan

Key Issues Facing Patients and Families / Friends

 Will anything be normal again?. “I want the old me back..”  Relationship changes (spousal, family, friends, colleagues)  Existential (meaning) of life issues  Multiple losses: physical,practical, intangible  Guilt

Depression

• Some mood changes are to be expected
• Losses and changes are real
• How do you know when you may need help?
• Symptoms remain for an extended period
• Functionality decreases and does not return
• Thoughts of ending one’s life
• Depression is very common for individuals

dealing with chronic conditions

• There is no shame in this
• See your doctor

WHAT HELPS

 Stress management ~ Relaxation techniques  Education  Practical assistance  Respecting your abilities and your limits  Support  Counselling / Group support  Making Meaning  Compassion toward self and others  Community  Focus on the here and now

Support

Types of Support

Emotional Practical Companion Informational

Family Systems

 Family is an emotional system  Individuals and families are shaped by family stories  Significant change in an individual influences system  Reactivity and anxiety  Tension between forces of individuality and togetherness  Times of transition  New responsibilities/roles/boundaries  Periods of upheaval and confusion  Balance seeking  Family life cycle

Healthy Coping Strategies

 Gather information/problem solve  Adapt and adjust ★  Seek support  Express feelings  Seek beauty and joy in nature, music, art ♫  Reduce stress  Individual/family counselling / Group support  Trust in self

ABC

Affect Cognition Behaviour

A change in one component of thoughts, feelings and behaviors will affect other components

Challenges to Coping

 Depression  Poorly managed pain  Lack of knowledge about disease  Knowing the difference between ‘healing’ & ‘curing’  Overwhelm  Lack of support  Additional losses

Counselling Interventions

 Patient/Family centred  Dependent on patient identified needs/areas (motivation)  Based on theoretical frameworks and practice knowledge  Individual, couple, family, group based  Wellness in every aspect of the word - yoga, meditation, moderate exercise, balanced diet, adequate rest  People can begin to gain experience and to redefine all aspects of their lives

Therapeutic Approaches

Cognitive-behavioral  Stress reduction strategies  Distraction  Cognitive restructuring  Positive self-talk  Guided imagery  Problem solving  Supportive expressive  Creative therapies  Psychoeducational  And others

References and Other resources

References  MacKenzie, G. (2006); Sample, S. (2008); MSW Psychosocial Oncology course Resources  BC Cancer Agency website

 www.bccancer.bc.ca/coping with cancer

 Video – Living with Cancer – Emotional Perspectives  The Intelligent Patient Guide to Breast Cancer – Olivotto, Gelmon, McCready, Prittchard, Kuusk  Full Catastrophe Living- Jon Kabat-Zinn