Psycho-social and Sexual HealthBalancing Acceptance and Change
Andrea Bradford, Ph.D.Department of Gynecologic Oncology and Reproductive Medicine
Fear of recurrence
Sadness/depression
Grief and identity
Family member risk
Personal appearance
Cancer stigma
Personal relationships
Faith/spirituality
0%10%
20%30%
40%50%
60%70%
80%90%
100%
A lot
A little
Not at all
Percentage of Cancer Survivors WhoExperienced Emotional Concerns (n = 3129)
Source: Livestrong Foundation, 2010
Fatigue
Sexual dysfunction
Sleep disturbance
Neurologic symptoms
Urinary dysfunction
Bowel problems
Memory problems
Depression
Anxiety
Leg swelling/lymphedema
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Percentage of Gynecologic Cancer Survivors with Symptoms During or After Treatment (n = 1029)
Westin S, et al. Journal of Cancer Survivorship (2015)
Managing Symptoms:Balancing Acceptance and Change
Acceptance Change
FatalismUnnecessary lifestyle adjustmentHopelessnessPessimism/cynicism
Managing Symptoms:Balancing Acceptance and Change
Acceptance Change
AnxietyFrustration/disappointment
Losing contact with the present
Managing Symptoms:Balancing Acceptance and Change
Acceptance Change
Open, non-judgmental awarenessLiving according to values, goals
Careful choice of interventions based on evidence
Non-judgmental awareness
• Avoidance is only a temporary solution
• Thoughts and feelings come and go; what we do in response determines our outcome
The Struggle Is Part of the Problem
The Struggle Is Part of the Problem
The Struggle Is Part of the Problem
Can you notice your thoughts and feelings of discomfort, and make room for them, without letting them distract you from the task?
Can you stay in the task by distracting yourself from thoughts and feelings of discomfort while thinking about something positive instead?
Gutierrez et al., Behavior Therapy 2004;35:767-783
• Avoidance is only a temporary solution
• Thoughts and feelings come and go; what we do in response determines our outcome
• Interpretations and judgments shape our realities
The Struggle Is Part of the Problem
Be Here Now:An Exercise
• Mindfulness meditation/practice
• “Time outs” for noticing, feeling, grounding in the present
• Forge a different relationship with your thoughts
Developing the Here-and-Now Mindset
• Brief mindfulness-based sex therapy improves sexual function for women, including cancer survivors
• Mindfulness associated with greater arousability and higher rates of orgasm in women
Mindfulness and Sexual Function
Living according to values
A Purposeful Life
• Values are guideposts for actions and decisions
• Values can be attributes we aspire to – not achievements
• Values aren’t things we can “do” but they are qualities of ongoing action
A Purposeful Life
• Honesty
• Compassion
• Family
• Intellectual challenge
• Faith in God
• Fun
• Meaningful work
• Adventure
• Appreciation of nature
• Helping others
A Purposeful Life
• Example: Attending an anniversary party
A Purposeful Life
• Example: Lovemaking
Putting It All Together
• Acceptance and commitment therapy (ACT) shows promise as an intervention to improve emotional adjustment and quality of life
• ACT has been tested in at least one group of women with advanced ovarian cancer
Baseline Session 4 Session 8 Session 1250
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Acceptance and Commitment Therapy Versus Conventional Cognitive-Behavioral Therapy in
Women with Advanced Ovarian Cancer
ACTConventional
FACT
-G A
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core
Rost et al., Cognitive and Behavioral Practice 2012;19:508-517
Baseline Session 4 Session 8 Session 120
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Acceptance and Commitment Therapy Versus Conventional Cognitive-Behavioral Therapy in
Women with Advanced Ovarian Cancer
ACTConventional
BAI A
nxie
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vera
ge S
core
Rost et al., Cognitive and Behavioral Practice 2012;19:508-517
Baseline Session 4 Session 8 Session 120
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10
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Acceptance and Commitment Therapy Versus Conventional Cognitive-Behavioral Therapy in
Women with Advanced Ovarian Cancer
ACTConventional
BDI-I
I Dep
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Aver
age
Scor
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Rost et al., Cognitive and Behavioral Practice 2012;19:508-517
Choosing treatments based on evidence
• Does this treatment work better than a placebo for most people?
• What are the possible side effects?
• How can this treatment help me to do the things that are important to me?
Critical Questions
• Physical activity (esp. aerobic exercise)Fatigue, sexual dysfunction
• Cognitive behavioral therapy (including ACT) Insomnia, pain, sexual dysfunction, depression, anxiety
• Self-help/self-management
Beyond Medications:Lesser Used Interventions that Work!
• Common in ovarian cancer survivors, esp. if taking aromatase inhibitors
• It’s not “all in your head”
• Major cause of loss of interest in sex
• Many providers are not aware of optimal treatment
A Word About Painful Sex
Avoidance of physical
contact
Separation/ isolation
Loss of intimacy
Negative feelings
Sexual problem
• Fully commit
• Use reminder systems, diaries, and other tools as recommended
• Judge the effectiveness of a treatment based on the outcomes that are important to you
Trying New Treatments forSymptoms and Side Effects
• Breakthrough symptoms/flare ups
• Tolerance or reduced efficacy of treatment
• When nothing seems to work
• When nothing seems to matter
Have a Plan for…
• Expertise in psychosocial and sexual adjustment after cancer may be hard to find
• “You’ll just have to live with it” is not acceptable
Asking for Help
• Expertise in psychosocial and sexual adjustment after cancer may be hard to find
• “You’ll just have to live with it” is not acceptable
Asking for Support
“Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
Viktor Frankl, M.D., Ph.D.