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On the last track we discussed four additional common reactions to the news of cancer. They were insurmountable burdens, loss of control, grief and guilt.
On this track we will finish our discussion of the eleven common reactions to cancer with 4 final reactions. These are a reevaluation of beliefs, the desire to bargain, anxiety, and hope. As you listen to this track, evaluate your client. Might the techniques on this track benefit your client as an intervention to his or her reaction to the cancer of a loved one?
11 Common Family Member Reactions (#8- #11)
Reaction # 8 - A Reevaluation of Beliefs
Reaction # 9 - The Desire to Bargain
Reaction # 10 - Anxiety
3-Step Technique: Uncertainty Training
I felt that I could now examine what the costs and benefits were of Ned accepting uncertainty for unproductive worry. For example, I asked Ned to ask himself, "What are the costs and benefits to me of accepting that it’s possible that I have cancer?" The benefits were that if he accepted it as possible—and accepted that he cannot eliminate possibility—then Ned didn’t have to take action on it.
I stated, "Perhaps you will worry less and give up trying to control something you cannot control. The costs are that you may be immediately more anxious and think you are letting your guard down. If you experience this reaction, then ask yourself, "Exactly what action can I take today that will really help me?" Since the worry is about undiagnosed cancer the only action available is to see a doctors. This is an endless enterprise."
Think of your Ned. How can you help your client examine the costs and benefits of accepting uncertainty?
Step # 2 - Flood with Uncertainty
I stated to Ned, "You can make an educated guess, but you cannot say for sure. When you do not tolerate uncertainty, your thoughts are something like the following: ‘It’s not certain that things will be OK; if I don’t know for sure, I should worry until I do know for sure; I’ve been worrying and I still don’t know for sure, so I should keep worrying until I am absolutely certain it will be OK.’" In contrast to worry; which is the search for certainty, in uncertainty training clients practice having the thought thousands of times that "I don’t know for sure" or "It’s always possible that something terrible could happen."
Ned’s thought was that he might have cancer even though there was no real evidence that he did. Ned experienced no symptoms common with cancer. But he continued having this intrusive thought. So he worried and scheduled repeated appointments with oncologists. To further involve Ned in uncertainty training, I had him practice repeating for twenty minutes each day, "It’s always possible that I could have cancer."
I told him to do nothing to neutralize this thought—not to try to reassure himself, just practice having the thought "It is always possible." As expected, Ned’s anxiety went up—and then it went down as he repeated this thought hundreds of times. Whenever Ned had the thought, "I wonder if I have a cancer," I had him repeat it two hundred times. Ned began to realize that having a thought about what is possible could be tolerated. In fact, he later reported that it started to become boring.
Step # 3 - Thought Stopping
Acceptingly uncertainty is a core strategy for clients dealing with anxiety. Once your client accepts that he or she can never know for sure, then that client can recognize that continuing to worry to gain certainty is a total waste of time. Practicing flooding themselves with uncertainty thoughts—repeating them endlessly without doing anything to gain certainty—helps clients recognize that they can live with uncertainty. Perhaps you might relate it to getting on the elevator thousands of times. It is no longer feared because it has become boring. Think of your client who has a loved one with cancer. Could he or she benefit from uncertainty training?
Reaction # 11 - Hope
On this track we discussed 4 additional reactions. These are a reevaluation of beliefs, the desire to bargain, anxiety, and hope.
On the next track we will discuss conversation guidelines. The first five guidelines as described on this track will be ask first, if they don’t want to talk, knowing what to say, giving advice, and saying cancer.
Peer-Reviewed Journal Article References:
Dunn, M. J., Rodriguez, E. M., Barnwell, A. S., Grossenbacher, J. C., Vannatta, K., Gerhardt, C. A., & Compas, B. E. (2012). Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis. Health Psychology, 31(2), 176–185.
Infurna, F. J., Gerstorf, D., & Ram, N. (2013). The nature and correlates of
change in depressive symptoms with cancer diagnosis: Reaction and adaptation. Psychology and Aging, 28(2), 386–401.
Sohl, S. J., Levine, B., Case, L. D., Danhauer, S. C., & Avis, N. E. (2014). Trajectories of illness intrusiveness domains following a diagnosis of breast cancer. Health Psychology, 33(3), 232–241.
Online Continuing Education QUESTION 3
Uncertainty training is extremely beneficial for family members. What cognitions does unproductive worry create? To select and enter your answer go to CE Test.
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