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self-help

My cancer experience… as an outsider looking in

My cancer experience… as an outsider looking in

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Friday, August 31st, 2018 will be the last day of my postdoctoral fellowship at the Psycho-Oncology Center of the Sainte-Justine Hospital. Wednesday, September 3rd, 2008 was the beginning of my doctoral studies and my thesis focused on breast cancer and one of my clinical internships was at the Psychosocial Oncology Program of the Jewish General Hospital. Since it has been close to 10 years that I have been involved in cancer research and clinical work, I thought I would share some of what I have learned thus far.

The first thing that comes to mind is how resilient people are throughout their cancer trajectory (diagnosis - treatment - survivorship or end of life). Indeed, it requires great strength to be able to cope with a life-threatening diagnosis and adapt to lifestyle changes that can have permanent consequences. A study reviewed 57 published articles and found several personal attributes and characteristics related to resiliency throughout different cancer phases such as optimism, hope, realistic expectations, social support, spirituality and supportive provider communication, etc (Molina et el., 2014). In sum, it is of utmost importance to promote resiliency to meet the psychosocial needs of patients whether they are undergoing treatment, their treatment is completed or whether they are in palliative care. In fact, several cognitive behavioral and existential interventions have been elaborated to foster resiliency to improve quality of life and enable psychological well-being or posttraumatic growth (Loprinzi et al., 2011; Lee, Robin Cohen, Edgar, Laizner, & Gagnon, 2006). 

 

Forces beyond your control can take away everything you possess except one thing, your freedom to choose how you will respond to the situation.

― Viktor E. Frankl

 

The second thing that comes to mind is the word distress. I have read, heard and witnessed that word countless times throughout my cancer experience. Distress is the 6th vital sign in a cancer population and it is estimated that 33% of the cancer population suffer from significant distress (Howell et Olsen, 2011). Also, it has been associated with worsened health-related quality of life, lesser treatment adherence and lower satisfaction with care (Howell et Olsen, 2011). Although it is recommended to screen for psychological distress along the cancer continuum, it has been reported that patient’s distress often goes unnoticed and the patients are not referred to psychosocial services available (Cohen, 2013; Johnsen et al., 2013; Mitchell, 2015). Also, patients considered as “survivors” report distress as several struggle to find a new sense of normalcy or cope with adverse long-term effects.

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Considering that approximately 1 in 2 Canadians will receive a cancer diagnosis in their lifetime and that the survival rate after 5 years is estimated to be 60% (Canadian Cancer Statistics, 2017), it becomes apparent how assessing psychological distress and promoting resiliency is imperative to enable psychological well-being and improve quality of life throughout the cancer trajectory. There are several resources available: several hospitals have a psychosocial oncology department offering several services (psychologist, social worker, spiritual aid, musicotherapy/artherapy, mindulfness/yoga interventions). The Canadian Cancer Society also has a community service locator which is a directory of different services available for patients or caregivers. Lastly, I have suggested several books to patients who have completed their treatment and are seeking support and struggling to find their “new normal”. Please see below for the list of resources and books.

Dans cette tranche de vie, il n’y aura eu ni duel, ni vainqueur, ni vaincu. Juste un magistral coup de poing, des descentes aux enfers sans demi-mesure et ce bain d’humanité

 ― Françoise Stanton, extrait d’un témoignage tiré du livre Tu n’es pas seule

The last point I would like to make is that although my focus has been on the “patient”, I would be remiss not to mention the family and friends of said patient as their cancer experience matters as well. They too show great strength and can experience distress which can go unnoticed, and they too can benefit from some of the above-mentioned resources.

Finally, what I learned thus far is how much I want to keep learning, broaden my cancer experience and share my knowledge.

Stay tuned!


Annélie S. Anestin est une psychologue à la clinique Connecte Groupe de psychologie de Montréal. L’équipe de Connecte aime bien écrire sur les diverses façons d’améliorer notre santé mentale et inclure la psychologie dans notre vie quotidienne. Pour plus de conseils utiles, consultez les blogues de Connecte, les baladodiffusions, suivez-nous sur Instagram @connectepsychology ou aimez notre page sur Facebook.


Books

  • Tu n’es pas seule, L’expérience du cancer : paroles de femmes. Collectif dirigé par Dominique Lanctôt, Les éditions de l’Homme, 2015, qc
  • Man’s search for meaning, Viktor E. Frankl
  • La route du sens, L’art de s’épanouir dans un monde incertain, Jean-Louis Drolet

Links

References

Ministère de la santé et des services sociaux. La détresse des personnes atteintes de cancer : un incontournable dans les soins. Édition: La Direction des communications du ministère de la Santé et des Services sociaux. http://publications.msss.gouv.qc.ca/msss/fichiers/2017/17-902-11W.pdf.

Molina Y, Yi JC, Martinez-Gutierrez J, et al. Resilience Among Patients Across the Cancer Continuum: Diverse Perspectives. Clin J Oncol Nurs. 2014; 18:93-101.

Loprinzi CE, Prasad K, Schroeder DR, Sood A. Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: A pilot randomized clinical trial. Clin Breast Cancer. 2011; 11:364–368.

Lee V, Robin Cohen S, Edgar L, Laizner AM, Gagnon AJ. Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med. 2006; 62:3133–3145.

Howell D, Olsen K. Distress- the 6th vital sign. Curr Oncol. 2011;18:208-210.

Cohen, M. The Association of Cancer Patients' Emotional suppression and their Self-rating of Psychological Distress on Short Screening Tools. Int J Behav Med. 2013: 39;29-35.

Johnsen, A.T., Petersen, M.A., Pedersen, L., Houmann, L.J., & Groenvold, M. (2013). Do Advanced Cancer Patients in Denmark Receive the Help they Need? A Nationally Representative Survey of the Need Related to 12 Frequent Symptoms/Problems. Psychooncology. 2013; 22:1724-30.

Mitchell, A.J. (2015). Screening and Assessment for Distress. Oxford University Press: New York.

Canadian Cancer Statistics, 2017. http://www.cancer.ca/en/about-us/for-media/media-releases/national/2017/canadian-cancer-statistics-media-fact-sheet/?region=on.

What To Do When Therapy Isn’t An Option

What To Do When Therapy Isn’t An Option

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It’s no surprise that we are big advocates of therapy here at Connecte. Therapy can help us manage stress and anxiety, improve our mood and well-being, and cope with life’s ups and downs. It can also be a powerful tool to help us meet our personal and professional goals and reach our potential. Above all, therapy provides a way to feel seen, heard, and understood.

That said, we’re also aware that therapy isn’t always a realistic option. It can take a financial toll, especially when money is tight and insurance coverage is limited. In the public sector, there are often long waiting lists. Therapy also involves a substantial commitment of our time and energy (contrary to expectations, therapy isn’t “just talking’ and it can be hard work!). And sometimes, we’re just not in a place where we’re ready to face past experiences or discuss the things that are weighing heavily on us.

There may come a point when you feel like you could benefit from taking matters into your own hands and taking ownership of your mental health and well-being. Whether you’ve been in therapy before, plan on trying it out for the first time, or are just looking for some strategies you can use to help you cope and maximize your potential, read on to learn how you can move forward when therapy isn’t an option with a few tips from some of the psychologists here at Connecte.

1. Develop a self-care routine

Self-care isn’t selfish, and it isn’t a passing trend or fad. At Connecte, we’re always striving to find ways to incorporate little acts of self-care into daily life and encourage our clients to do the same. It’s a great way to practice #lifetherapy. Coming up with a sustainable self-care routine can help us cope with distress and improve the overall quality of our lives.

One of my favorite ways to help clients come up with a personalized self-care plan is to brainstorm priorities and activities across different domains, including our physical health (e.g., walking outside, attending a yoga class, coming up with a bedtime routine, eating regular, nourishing meals), our emotional well-being (e.g., mindfulness, meditation, journaling), our need for human connection (e.g., seeing friends and family, appreciating small interactions with strangers), and our thirst for creativity (e.g., painting, drawing, reading, interior design). Maryann Joseph also highlights the importance of pursuing creativity: “Take your pain, take your feelings, and make something with them. Channel them into something creative: write, play music, do some wild, cathartic bedroom dancing, plant something, grow something, build something, repair something, make a fiery tomato sauce.”

Self-care ultimately allows us to learn about ourselves, lead a more fulfilling life, and take care of our basic needs and values. Finding ways to incorporate it into your routine can therefore give you a head start for therapy if or when you’re ready.  

2. Create your personal library

Self-help books and resources that guide us through specific therapeutic exercises or approaches can be really helpful. Like anything, this works best when we actually stick with it. If being consistent is a struggle, it can help to set aside a time each week to check in with yourself and catch up on some reading material or exercises. You can even check in with yourself at the same time each week, much like the way you would in therapy. Finding a therapist who can support and guide you through your own self-help exercises can also be extremely beneficial. Luckily, there are so many great resources available, both online and in print. Some of our favorites include Mind Over Mood and Self-Esteem. Danit Nitka also recommends Reinventing Your Life, which is a schema-therapy based read that is aimed at self-guided change. Online, AnxietyBC and the Centre for Clinical Interventions have many helpful handouts and worksheets for coping with anxiety and depression, building assertiveness, cultivating self-compassion, and targeting self-critical views of ourselves and bodies.  Looking for more? You can always find some of our other favorite resources here.

3. Turn to technology

There seems to be an app for everything these days. And while this can make it easier to incorporate things like relaxation and mindfulness into our routines, it also means putting in the time to find the right apps that will work for you. With the increasing evidence that mindful breathing and relaxation are helpful for treating depression, it really is worth it. Some of our favorites include breethe, Headspace, InsightTimer, and Simply Being. Expectful is another resource to guide you through struggles related to fertility, pregnancy, and motherhood. There are also apps and online resources to help you make new friends and expand your support system, including Meetup, MeetMe, Bumble BFF and Peanut (for new mothers).

At the same time, it’s a careful balance. And sometimes it helps to remember to “disconnect to reconnect”. Making an active effort to check our phones, e-mails, and social media less often, or to unfollow accounts, blogs, or posts that may be triggering for a variety of reasons can do wonders for our mental state and our ability to focus on the things that truly fulfill us in the long run.

4. Attend a group

Group therapy can be a really helpful way to work through issues and, in many cases, is often recommended as either an adjunct to or starting point for individual therapy. Maeve O’Leary Barrett and Stéphanie Landry recommend looking into free support groups or workshops that are available through AMI-Quebec, REVIVRE, ANEB (for difficulties related to eating disorders), or the Mont Royal Cemetery (for grief counselling).

Lisa Linardatos also recommends taking part in an extracurricular group and making sure we set aside time for the kind of play that is typically only nurtured in childhood. Whether it’s participating in a team sport or even a bounce class, a creative arts or improv class, a public speaking workshop, or a book club, joining a group activity can be a helpful way to seek out meaningful social interactions, improve our energy and motivation, and build confidence while learning a new skill. Regardless of whether it’s group therapy or simply therapeutic, having an activity outside of the home and feeling socially connected can be so important for our sense of well-being.

5. Open up to close others

Speaking of feeling socially connected, spending time with loved ones, including friends, partners, and family members, is so essential for our mental health. Simcha Samuel says: “Consider sharing your feelings with those you trust. Notice if there are a couple of people in particular with whom you tend to feel especially accepted, understood or supported. Make sure to let them know how much their support means to you and what about their support in particular you have found especially helpful.”. If you’re wondering who to open up to, Jodie Richardson recommends watching this video on the difference between empathy and sympathy. She adds that speaking with a friend can also be a really powerful way to learn how to be a “wise, empathic friend to ourselves and our emotions”.

If you find yourself struggling to find new friends or maintain the friendships you already have, you can always learn more about my work on friendships here. And if calling a friend isn’t a possibility, there are phone lines that offer a listening ear, words of encouragement, or suggestions for social and community level resources.

6. Challenge your assumptions

Sometimes, our resistance to therapy has less to do with practical obstacles and more to do with personal barriers. It’s not uncommon to have biases about what therapy actually looks like or involves. This can be true regardless of whether we have past experiences with therapy.

  • For so many, the thought of entering therapy can feel like a lifelong commitment. In reality, the goal of most therapy experiences is to help you find ways to cope in your everyday life and to essentially become your own therapist. And while every person and experience is different, it’s absolutely possible to make progress in a limited number of sessions.
  • If the cost of therapy is prohibitive, it might help to know that some clinics offer sliding scales (often with an intern therapist) where the fee for each session is based on your financial situation. It’s also not uncommon for therapy to take place every 2 weeks as opposed to every week, especially as things progress.
  • Finally, if you’re concerned about not “clicking” with a therapist, know that it’s all about fit. Research actually suggests that the relationship between a client and therapist actually matters more than the type of therapy that’s practiced! It’s perfectly okay to find someone else with whom you are more at ease and comfortable. Just try to recognize if you might be too quick to give up on a new person or experience.

Challenging some of the assumptions and unhelpful ideas and expectations you have about therapy can ultimately free up space to help you recognize whether you might actually be ready to take the next step of seeing a psychologist or therapist. Until then, focusing on self-care and meaningful connections and using the many resources at your disposal can be an important way to prioritize your health and happiness.


Miriam Kirmayer is a PhD Candidate in the Clinical Psychology program at McGill University in Montreal, Quebec, and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychological medicine40, 1943-1957.

Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Annals of behavioral medicine33, 11-21. 

Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38, 357-361.  

Shakya, H. B., & Christakis, N. A. (2017). Association of Facebook use with compromised well-being: a longitudinal study. American journal of epidemiology185, 203-211.

Romantic Relationships: What’s self-esteem got to do with it?

Romantic Relationships: What’s self-esteem got to do with it?

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When seeking a romantic relationship, we are often encouraged to focus on what we’re looking for in a partner. Do they need to be funny? Kind? Tall? Smart? Are we hoping they’re going to be older, younger, of similar or different backgrounds? Do they have similar life aspirations? Of course, it is helpful to use our values to guide whether we may connect well with a potential partner; however, this mindset often shines the light on the partner’s qualities or values, and shines the light away from what we bring into a relationship. We each not only bring our own special quirks, we also bring in more significant characteristics like our core beliefs (see Maeve’s blog), attachment styles (see Simcha’s blog), and self-esteem. All of these can relate to how we perceive and experience our relationships, and thus it is crucial that we better understand how these impact our view of our partner and relationship in order to make choices that best serve our well-being.

Self-esteem has been shown to relate to relationship satisfaction in both the short- and long-term (Sciangula & Morry, 2009; Orth et al., 2012; Enrol & Orth, 2013). Essentially, what this means is that how we feel about ourselves impacts how we feel about our partners and our relationships. This dynamic can play out in a number of ways, so let’s consider a few examples:

Example 1:

Max, who has high self-esteem, begins dating another individual. Max soon begins to feel that his new partner does not prioritize his needs or make efforts to connect with him, so he may choose to not continue in the relationship because he recognizes his own self-worth and understand that this new partner is not valuing him appropriately.

Example 2:

Olivia, who has lower self-esteem, begins dating someone who does not make time for her or consider her thoughts and feelings. Olivia, however, assumes that she is the problem, that she is not ‘good enough’ and that it makes sense that her new partner is not valuing her as a result. Olivia then chooses to stay in the relationship even though her partner is not behaving in a way that indicates a healthy long term relationship.

Example 3:

Olivia, who has lower self-esteem, begins a relationship with someone who treats her well. At first, she finds this experience positive and enjoyable. However, as time goes on, she begins to grow concerned that there must be something wrong with her partner if they are interested in her. She doubts that she would interest someone who is kind and respectful. So, she begins to look for flaws in her partner and their relationship in order to make sense of the situation. This tendency puts strain on the relationship, creating distance and disconnection in an otherwise healthy and respectful relationship. 

Example 4: Max, with high self-esteem, finds himself in a positive and caring relationship. He trusts that this makes sense and is in line with what he deserves, and thus he is able to allow himself to enjoy the relationship and be vulnerable with his new partner.

As you can see, our self-esteem can serve as the lens through which we view our partner. When we struggle with low self-esteem, we may be more likely to seek relationships that do not promote mutual respect and care. We may also be likely to reject relationships that are in fact healthy (Murray et al., 2001)! So, what can we do about this dynamic?

Step 1: Notice the lens!

In order to make a change, we must first notice that we are projecting our own self-worth onto how we see the relationship. Once we do that, we can then begin to figure out what we can do differently to take care of our needs rather than settle in or change the relationship.

Step 2: Work to improve self-esteem.

Aim to increase self-esteem in order to address the underlying cause. Self-esteem can be modified in a number of ways, including:

  • Recognizing the ‘inner critic’ (see Lisa’s blog) and learning to notice and challenge or let go of these unhelpful thoughts
  • Treat yourself as you would a good friend, imagine speaking to yourself gently and with respect and care (see Andrea’s blog on self-compassion)
  • Work toward personal goals that align with your values
    • By taking actions to help us move towards the things that we care about, we can begin to feel good about the choices we’re making and the impact it’s having 
  • Challenge your beliefs about your self-worth (see Maeve’s blog)
  • Explore a book (Schiraldi, 2016) that provides step by step exercises to work directly on self-esteem
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Tobey Mandel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Sciangula, A. & Morry, M. M. (2009). Self-esteem and perceived regard: How I see myself affects my relationship satisfaction. The Journal of Social Psychology, 149, 143-159.

Erol, Y. & Orth, U. (2013). Actor and partner effects of self-esteem on relationship satisfaction and the mediating role of secure attachment between the partners. Journal of Research in Personality, 47, 26-35.

Orth, U., Robins, R. W., & Widaman, K. F. (2012). Life-span development of selfesteem and its effects on important life outcomes. Journal of Personality and Social Psychology, 102, 1271–1288.

Murray, S. L, Holmes, J. G., Griffin, D. W., …, Rose, P. (2001). The mismeasure of love: How self-doubt contaminates relationship beliefs. Personality and Social Psychology Bulletin, 27, 423-436.

Schiraldi, G. R. (2016). The Self-Esteem Workbook: 2nd Edition. New Harbinger Publications.