When you are diagnosed with cancer, you are likely overwhelmed by uncertainties. Your oncologist has talked to you about the prognosis and has unveiled treatment options to care for your physical health. But cancer also weighs on your psychological health — an area that is often neglected. The Massachusetts General Hospital’s Cancer Outcomes Research Program (CORe) team uses cognitive behavioral therapy (CBT) to help cancer patients cope mentally and emotionally with their disease, and improve their quality of life.
Associate Director of CORe, licensed clinical psychologist Dr. Joseph Greer, says, “CBT is not new, but adapting it to the patient with cancer is novel.” For those with cognitive issues — the worriers — CBT focuses on reducing stress and anxiety through reframing negative thoughts, deep breathing, progressive muscle relaxation and mindful meditation exercises.
For those who have behavioral issues — the avoiders — Dr. Greer says the treatment is different. They are the ones who may try to avoid scans or procedures, such as MRIs, injections of chemo infusions. CBT teaches them to overcome the fear of the care they need. “We do a series of exposures in increments,” he says. For example, if a patient is fearful of an MRI, Dr. Greer’s team might start by taking the patient to the room where the scan is to be performed. He then might see the actual equipment and learn what it does. “This might seem strange,” Dr. Greer says, “but we might also have the patient practice lying his head under the bed at home.” This allows him to become more comfortable with feeling of what it’s like to have something closing in around him. “By introducing behavioral exposure in a systematic way, we help them confront their fears.”
Fear and stress are understandable emotions that cancer patients feel, and that brings on anxiety. “When there’s higher anxiety,” Dr. Greer explains, “patients often experience worse pain and treatment side effects, and their quality of life suffers.” CBT is short-term intervention that includes 10-12 50-minute sessions to speak with the individuals and discover how they typically deal with their anxiety. This, then, determines a course of action to bolster their coping skills.
In the case of younger cancer patients who may have children at home, anxiety can be that much greater. “I think those individuals need an extra level of care,” Dr. Greer suggests. Mass General offers a program to support families and teach parents how to talk to children about cancer.
“I specialize in working with patients who have advanced cancer,” Dr. Greer says. They often have more doctor appointments, so he prefers pragmatic tailoring of their treatment. He will meet them at their oncologist’s office, or before or after a treatment. He says, “Many of these patients really want to talk about the existential issues that come up.” They discuss how having cancer has changed their life goals and personal relationships, and talk about end-of-life concerns.
Dr. Greer and his research team — members from oncology, nursing, palliative care, psychiatry and psychology — are just finishing a ground-breaking four-year study that will translate their CBT treatment methods to mobile technology. “It will be one of the first mobile apps to have actual evidence to support its’ benefits for treating anxiety in patients with cancer,” Dr. Greer says.
The app is mostly video based and is made up of seven modules. These video lessons teach breathing and relaxation techniques, and help patients manage their cancer-related worries and day-to-day functioning. Because there is a shortage of clinicians, the app provides a way of reaching out to more patients.
By using cognitive behavioral therapy, targeted mindful-meditation exercises and introducing mobile technology, Dr. Greer and the CORe team help cancer patients cope with the anxiety that accompanies their disease, thus improving their quality of life.
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