Psychosocial Aspects of Living with Lymphedema Patricia Nitkin, Phd - PowerPoint PPT Presentation

Psychosocial Aspects of Living with Lymphedema Patricia Nitkin, Phd Candidate, CCC Patient and Family Counselling Services B.C. Cancer Agency Vancouver Centre

Three Kinds of Stories  Restitution story – being ill as a process of finding restitution…restored  Chaos story – overwhelmed, the story swirls around you  Quest story – transformation, new meanings Arthur Frank, Univ of Calgary

COMMON DIFFICULTIES & FEARS  Depression  Multiple losses  Family and relationship  Loss of self image issues  Dependency  Symptom management  Progression of illness  Exhaustion: emotional, physical, spiritual..  Pain  Anxiety/stress management  Change in roles/ lifestyle  Sexuality and intimacy issues  Emotions  Finances and Vocational challenges

COPING AND ADAPTATION  COPING is what one does about a perceived problem in order to bring about relief, reward, quiescence or equilibrium. (Weisman & Worden (1977)  Values and beliefs affect coping.  ADAPTATION begins when a person manages to incorporate illness into their daily lives and effectively address problems or concerns created by the illness.

Factors which effect Coping with a Chronic Condition  Previous experience  Support network  Severity of symptoms  Stage of life/family life cycle  Beliefs/values  Personality  Role in the family  Coping resources  Other issues present/unresolved

BIOPSYCHOSOCIAL APPROACH  Underlying Assumptions  Nothing that we do is purely psychological  Everything that we do causes biochemical changes  We are biophysiological beings – fight or flight principle  Systems driven  Cross cultural differences  Setting goals/therapeutic plan

Key Issues Facing Patients and Families / Friends  Will anything be normal again?. “I want the old me back..”  Relationship changes (spousal, family, friends, colleagues)  Existential (meaning) of life issues  Multiple losses: physical,practical, intangible  Guilt

Depression  Some mood changes are to be expected  Losses and changes are real  How do you know when you may need help?  Symptoms remain for an extended period  Functionality decreases and does not return  Thoughts of ending one’s life  Depression is very common for individuals dealing with chronic conditions  There is no shame in this  See your doctor

WHAT HELPS  Stress management ~ Relaxation techniques  Education  Practical assistance  Respecting your abilities and your limits  Support  Counselling / Group support  Making Meaning  Compassion toward self and others  Community  Focus on the here and now

Support

Types of Support Emotional Practical Informational Companion

Family Systems  Family is an emotional system  Individuals and families are shaped by family stories  Significant change in an individual influences system  Reactivity and anxiety  Tension between forces of individuality and togetherness  Times of transition  New responsibilities/roles/boundaries  Periods of upheaval and confusion  Balance seeking  Family life cycle

Healthy Coping Strategies  Gather information/problem solve  Adapt and adjust ★  Seek support  Express feelings  Seek beauty and joy in nature, music, art ♫  Reduce stress  Individual/family counselling / Group support  Trust in self

ABC Affect Behaviour Cognition A change in one component of thoughts, feelings and behaviors will affect other components

Challenges to Coping  Depression  Poorly managed pain  Lack of knowledge about disease  Knowing the difference between ‘healing’ & ‘curing’  Overwhelm  Lack of support  Additional losses

Counselling Interventions  Patient/Family centred  Dependent on patient identified needs/areas (motivation)  Based on theoretical frameworks and practice knowledge  Individual, couple, family, group based  Wellness in every aspect of the word - yoga, meditation, moderate exercise, balanced diet, adequate rest  People can begin to gain experience and to redefine all aspects of their lives

Therapeutic Approaches Cognitive-behavioral  Supportive expressive  Stress reduction strategies  Creative therapies  Distraction  Psychoeducational  Cognitive  And others restructuring  Positive self-talk  Guided imagery  Problem solving

References and Other resources References  MacKenzie, G. (2006); Sample, S. (2008); MSW Psychosocial Oncology course Resources  BC Cancer Agency website  www.bccancer.bc.ca/coping with cancer  Video – Living with Cancer – Emotional Perspectives  The Intelligent Patient Guide to Breast Cancer – Olivotto, Gelmon, McCready, Prittchard, Kuusk  Full Catastrophe Living- Jon Kabat-Zinn