Acute Cancer Cognitive Therapy

Abstract

The utility of cognitive therapy (CT) for ambulatory cancer patients is clear but the acute cancer setting significantly shapes the therapeutic interaction, parameters, and delivery of CT. In this article, we describe how to apply CT to acute cancer settings, focusing on how this approach differs from traditionally taught, ambulatory CT. We highlight the importance of a tailored history and formulation, how the cognitive model is applied within an acute cancer context to promote coping and adaptation. Reframing must consider the "grain of truth" to many so-called distorted cognitions, such as "cancer means death." Fear of recurrence is an example of a common reframing challenge. Another is the "tyranny of positive thinking." Here there is avoidance of considering negative outcomes such as death; patients are told to "think positive," leaving them alone at a time of life-threatening crisis. Instead, acute cancer CT utilizes a stance of realistic optimism. Empathy plays a vital role in turning off the bracing reaction to threat and facilitating problem-solving. Successfully combining CT with medications is integral to this model. We also discuss how CT can be applied to discussing prognosis, the desire for hastened death and suicidality, as well as death and dying in general. Because of the ubiquitous nature of cancer, most cognitive therapists will encounter patients with cancer in their practices. Acute cancer CT is a skill set that should be widely taught to cognitive therapists and flagged as a priority for academic programs and professional organizations.

Cognitive behavioral therapies for informal caregivers of patients with cancer and cancer survivors: a systematic review and meta‐analysis

“…Finally, in the traditional cognitive treatment model, the client's emotional struggles are primarily viewed as a result of erroneous and maladaptive cognitions . However, when working with ICs of patients with cancer, there is often validity to the negative thoughts, and traditional cognitive methods may therefore be experienced by the client as invalidating . This could be one explanation for the larger effect size detected for survivors, where the situation is characterized by a factually better outlook.…”

The efficacy of cognitive behavioral therapy for cancer: A scientometric analysis

“…However, the life-threatening urgency as well as the unpredictability and adverse effects of cancer treatment can add to the crisis atmosphere, thus making the implementation of CBT more difficult. Levin and Applebaum ( 38 ) developed a cognitive behavioral treatment framework applicable to the integration of acute healthcare settings and applied it to acute cancer environment. In summary, empathy, coping models and psychopharmacology are core elements of CBT for acute cancer ( 38 , 39 ).…”

“…Levin and Applebaum ( 38 ) developed a cognitive behavioral treatment framework applicable to the integration of acute healthcare settings and applied it to acute cancer environment. In summary, empathy, coping models and psychopharmacology are core elements of CBT for acute cancer ( 38 , 39 ). In addition, perceptions of death, and mortality, are important components of acute cancer CBT.…”

Supervising the delivery of cognitive behavior therapy in medical settings.

“…For example, the thought "I can no longer eat my favorite meals" may be accurate for a patient who made a major lifestyle change due to diabetes. In these instances, intervention should be less focused on changing the thought itself and more on cultivating acceptance of the situation, fostering gratitude and resilience, and living a highquality life despite the disease (Kangas et al, 2014;Levin & Applebaum, 2014;Reigada et al, 2014). In circumstances in which there is excessive worry related to a realistic thought, trainees should aim to address the disproportionate distress, without invalidating the thoughts (Levin & Applebaum, 2014).…”

“…Effective communication is a vital skill when operating on a team within a medical setting, as it offers a multidisciplinary approach to the patient's care and ensures that the different providers are on the same page (Hong & Robiner, 2016;Kirch & Ast, 2017). Effective communication can include consulting with other providers, conceptualizing care from a biopsychosocial framework, and promoting psychological intervention where appropriate (Kazak et al, 2017;Levin & Applebaum, 2014). From a trainee's perspective, lack of communi cation with a medical team can arise for several reasons.…”