In Honor of National Breast Cancer Awareness Month
Resilience refers to “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress” (American Psychological Association [APA]). A key concept in resilience is that it is developmental and reflects a process, rather than a trait. You are practicing resilience already in your everyday life—plowing through work despite a professional setback, developing strong relationships with people despite interpersonal conflicts, and sustaining significant losses in your close circle of family and friends. However, adversity can take many forms, and when it comes to physical and mental health hardships, like cancer, trauma, or depression, resilience can play a particularly important role in shaping future outcomes and prognosis.
Psychological disorders in cancer patients are extremely common. Studies suggest that 15-20% of cancer patients have mood disorders such as depression and dysthymia, 11-35% have adjustment disorders, and 5-16% have anxiety disorders, such as posttraumatic stress disorder (PTSD). A major study published in JAMA Oncology followed 304,118 Swedish patients with cancer over a 12-year period to examine whether the risk of developing a psychological disorder changes before and after a cancer diagnosis, by comparing to a matched cohort of over 3,000,000 adults without cancer. The findings, published only a few months ago, indicated that the overall risk for all disorders (depression, anxiety, substance use, somatoform, and stress/adjustment disorders) began to increase in the months leading up to a diagnosis, was 6.7 times greater during the week after cancer diagnosis, and remained elevated even 10 years post diagnosis.
This suggests that a cancer diagnosis (across many forms and stages of cancer) increases the risk for these mental health problems, and that effective treatment should involve both medical and psychological approaches. Screening for depression and anxiety in cancer patients is improving, although the evidence is still fairly limited regarding best treatment approaches for comorbid psychological disorders. Although more research is warranted regarding optimal treatment strategies specifically in cancer patients, an effective individualized approach to care can be developed in conjunction with a mental health clinician.
Given that receiving any life-threatening diagnosis like cancer comes along with significant stress and psychological distress, what constitutes a “normal” and “abnormal” reaction to receiving such a diagnosis? This determination is best made by a clinician, who would conduct a full assessment of one’s physical and mental health history. In general, clinicians assess several factors including onset and duration of symptoms, severity of symptoms, and interference or distress caused by the symptoms. For example, maladaptive adjustment to a cancer diagnosis is usually determined by excessive emotional or behavioral symptoms beyond what would be expected within 3 months of the stressor, and which persists even after the stressor has ended.
Despite the elevated risk of mental health problems in cancer patients, there is evidence that resilience factors, such as having an optimistic outlook, good support network, strong emotion and stress management skills, may contribute to better recovery in cancer patients. A cancer diagnosis does not inevitably lead to adverse negative mental health problems. Indeed, the vast majority of patients with a cancer diagnosis do not develop major depression or anxiety disorders like PTSD. Positive coping strategies that build resilience appear to be essential to the relationship between a cancer diagnosis and long-term recovery.
One aspect of resilience is having good social support. Prospective studies (which follow large numbers of people over long periods of time) have shown that people who are socially isolated have higher rates of morbidity and death than those who have friends. This has also been supported by animal research showing that socially isolated rats show a suppressed immune response, and that chronic levels of stress through social isolation can put undue wear and tear on the immune system. It is therefore critical when faced with cancer to share it with others and develop a strong support team. Friends and family members’ perception of the illness can also influence recovery, so it is important to stay connected to supportive helpers. Being resilient does not mean being free of any negative emotions. Rather, it is about how you handle the negative emotions. Resilience means acknowledging both the highs and lows, and allowing the support of others during times of adversity.
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By Angela Fang, Ph.D. - Expert Psychologist