he presence of a positive and constructive cognitive framework when approaching problems is crucial to successful problem solving (A. M. Nezu €J Perri, 1989). Helping patients to adopt such a realistic optimism, however, can be an especially challenging task for clinicians who work with individuals who are overwhelmed with the emotional experience of cancer. Such patients may simultaneously experience emotions of fear, anger, sadness, guilt, and embarrassment. These emotions may operatively interfere with one's information processing and tend to overshadow objective and constructive thinking. Following a diagnosis of cancer, it is not unusual to observe such emotional interference even in individuals who have typically used more rational thinking in past stressful situations. In other words, cancer may have a unique and profound effect on one's ability to cope successfully. In an attempt to process the information surrounding cancer and its treatment, as well as these profound interruptions in coping ability, some people may attribute their distress to internal factors such as weakness or faulty traits. Conversely, other individuals may perceive cancer to be an extreme situational problem for which psychological improvement is not possible. As such, they may view a complete cancer cure as the only means by which to alleviate distress.Development of a more positive orientation to problems involves a combination of cognitive and emotional
Overviewf amily members and friends who care for cancer patients at home are becoming increasingly important in the provision of health care. They are responsible for managing care in the home, including monitoring the illness, carrying out prescribed treatments, informing health-care professionals when problems arise, and providing emotional and social support for the patient. With the increase in the number of people living with cancer, more and more family members are having to take on these responsibilities. In addition, as a result of changes in the health-care system represented by shorter hospitalizations and more reliance on outpatient care, tasks, which until recently have only been assigned to trained, supervised health-care personnel, are being shifted to family caregivers.Unfortunately, family caregivers who are assuming these responsibilities are often uninformed about what they should do, unskilled in carrying out medical duties, and emotionally unprepared as well. As a result, there is significant risk of compromising the quality of patient care and of causing significant caregiver burden and morbidity. Studies of spouses of seriously ill patients have reported eating disorders, sleep disturbances, anxiety, and depression because of the stresses of caregiving (Kristjanson &
Presen ting the Ration aleWe have found the following examples, analogies, and slogans to be helpful in emphasizing the importance underlying this process and the Copyright American Psychological Association. Not for further distribution.Problem Definition and Formulation 1 159 exercises associated with PDF training. Optimally, examples that directly relate to the patient's cancer experience, professional or personal experiences, and hobbies or recreational activities should be chosen to facilitate identification with the concepts. Depending on the patient's cognitive abilities, interests, or cultural background, different examples can be more appropriate and, thus, more effective. Once a patient accepts the rationale for this problem-solving component, he or she will be more likely to understand its applicability to stressful areas in his or her life. These following scripts are presented as possible alternative examples of how to convey the rationale of problem definition and formulation. Again, the PST counselor should use one that is particularly relevant to a given cancer patient. PROBLEM SOLVING AS TRAVELINGProblems that remain vague and unclear become more frustrating or troublesome than may be necessary. For example, if you try to visit a friend in New York without further instructions, you may wind up in Buffalo, Rochester, or Queens. Simply looking at a map without any specific destination or guidelines would be overwhelming because there are many highways, roads, bridges, and tunnels that could lead you in an infinite number of directions. Taking many of these paths may lead you in the wrong direction, place you in dangerous territory, or cause you unnecessary time and expense. However, if you clearly define your intended destination by identifying a city, a town, and a specific address, you will be able to locate the best course of travel for your journey. You can even make your own map. Furthermore, additional details, such as landmarks, construction sites to avoid, or cross streets, will further clarify your route. Solving a problem can be thought of as successfully reaching the end of the trip. How comfortable, exciting, and educational the traveling will be depends initially on knowing where and how to reach the destination. THE HEALTH-CARE TEAM AS PROBLEM SOLVERSWhen individuals do not feel well physically, physicians, nurses, and other health-care professionals will use similar problem-solving techniques to clarify and understand the problem and to establish realistic goals for treatment. Without clearly defining the health problem, a physician may not know whether to examine the person's eye, arm, or gastrointestinal system. Does the patient need an aspirin or a tonsillectomy? Similarly, persons who are experiencing emotional distress The first task in defining and formulating a problem is to gather important information about its specific nature. Cancer and its treatment present numerous novel situations for which most people do not have previous experience to draw on. Many people, however, ha...
Relevance lo Cancer he basic notion underlying the relevance of problem-solving therapy for cancer patients essentially lies in the moderating role that problem-solving coping serves regarding the general stress-distress relationship (A. M. Nezu & D'Zurilla, 1989; A. M. Nezu et al., 1989). More specifically, the more effective people are in resolving or coping with stressful problems in general, the more probable it is that they will not experience significant distress. Conversely, if a person has difficulty in coping with such difficulties, he or she will likely experience depression, anxiety, and other distress symptoms. Research that we, and others, have been conducting during the past two decades has provided substantial support for this general thesis (e.g., Kant, D'Zurilla,
Overview, Process, and Related Clinical Issues 0 ve rvie w n this section of the book, we present a detailed therapy manual that provides specific guidelines in conducting problem-solving therapy (PST) for cancer patients. In the present chapter, we discuss various general clinical issues, such as the structure of problem-solving therapy, assessment guidelines, the therapist-patient relationship, and the use of adjunctive therapeutic strategies. I W h a t Is PST for Cancer Patients?PST encompasses a collection of strategies aimed at helping individuals to understand the nature of problems in living and directs their attempts at changing the nature of the problematic situation itself, their reactions to them, or both. PST for cancer patients is especially focused toward psychosocial problems related to cancer and its treatment. As with other applications of PST, this one emphasizes (a) a collaborative relationship between patient and therapist; (b) an ongoing assessment of progress (or lack of progress); (c) the goal of increasing skill competencies regarding specific cognitive, affective, and behavioral targets, including
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