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Coping with Cancer Interventions for the Family
Cancer & Family continuing education MFT CEUs

Section 3
Cancer Diagnosis Reactions (Part 3)

CEU Question 3 | CE Test | Table of Contents | Cancer
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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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
First, let’s discuss a reevaluation of beliefs as a common reaction.  Ned stated, "I always thought I could turn to my faith.  But since Theresa got cancer, I’m not even sure what that means anymore.  I believed God would give me strength, but now I have none!"  I stated to Ned, "Living with Theresa’s cancer can affect your spiritual beliefs.  It may make your belief stronger or weaker, or you may develop an entirely new interpretation of what is sacred.  Some of my clients have used this experience as an opportunity to strengthen their spirituality.  Though reevaluating your beliefs may be the hardest work you’ve ever done, it can also be the most rewarding."  Think of your Ned.  What coping strategies might you implement if your client begins to reevaluate his beliefs?

Reaction # 9 - The Desire to Bargain
Next, let’s discuss the desire to bargain.  Ned found himself bargaining with whomever he felt he could pray to.  Ned stated, "I guess I’m just hoping that by making promises I can improve Theresa’s situation."  Clients like Ned bargain to gain a sense of control.  Bargaining helped Ned feel that he could help his wife.  If you are treating a client who has a loved one with cancer and is bargaining to gain a sense of control, could the technique for gaining control from the last track be productive?

Reaction # 10 - Anxiety
In addition to a reevaluation of beliefs and the desire to bargain, a common reaction your client may present is anxiety.  Clearly, a positive cancer diagnosis provides the client with many anxiety triggers.  Does your client frequently worry about thoughts such as ‘What’s the doctor going to say when he emerges from the operating room?’ or ‘What are the test results going to show?’ or ‘What will happen to me, to our house, or to our children?’  Your client may get tense, worried, or short tempered.  When Ned went through periods of anxiety, he stated, "I find myself sleeping less, forgetting things, and making poor decisions.  If I knew what was going to happen next, I wouldn’t feel so anxious."  As a cognitive behavioral intervention, Ned used uncertainty training.

3-Step Technique:  Uncertainty Training
Regarding Ned’s use of uncertainty training as an intervention for his anxiety, there were three steps. 

Step # 1 - Cost vs. Benefits of Uncertainty
In the first step, Ned examined the cost and benefits of uncertainty.  Ned identified his anxiety was as unproductive worry because it involved unanswerable questions, chain reactions, unsolvable problems, things that are unknowable, demands for perfect solutions, relying on anxiety as a guide, and the demand for total control.  

For example, consider Ned’s worry "I might get cancer, too."  This worry includes a number of the Elements of Unproductive Worry:
-- it’s an unanswerable question… ("It’s possible"),
-- it’s based on a chain reaction ("My health problems will go misdiagnosed and I will end up with a serious problem"),
-- it’s not solvable (you cannot eliminate possibility),
-- it’s unknowable (if it’s continually misdiagnosed, then you cannot eliminate future misdiagnosis),
-- it demands a perfect solution (absolute certainty), and
-- it demands that Ned control the outcome ("I have to get complete reassurance"—something that is impossible).  
Therefore, would you agree that Ned’s anxiety over the possibility of cancer might qualifies as an unproductive worry?

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
Next, let’s look at the second step in uncertainty training.  This step requires the client to flood themselves with uncertainty.  Reality is clearly uncertain.  I find it helpful for clients to realize they don’t know for sure what will happen tomorrow or the next day. 

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
In addition to the two steps involved in uncertainty training, let’s discuss thought stopping.  You already know that thought stopping involves noticing a client noticing that he or she has an unwanted thought and then mentally yelling, "Stop!"  The idea is that the client cannot stand having this thought.  I find that for anxiety clients thought stopping may not work and it actually can make things worse, because the client is led to believe that the thought— "It’s possible that I have a brain tumor"—is a thought that he or she needs to fear and get rid of.  In contrast to this, thought flooding about uncertainty teaches clients like Ned that he can have thoughts about what is possible, yet do nothing to neutralize the thought.

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
Finally, a common reaction can be hope.  Like a reevaluation of beliefs, hope can be a productive reaction.  Ned stated, "The only thing that keeps me going is hope.  Even on your client’s darkest days, he or she may discover they have many hopes.  Think of your Ned.  Does he still have hope?  How might you help your client reinvent hope if it has been lost?

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. 

Garrido-Hernansaiz, H., Rodríguez-Rey, R., & Alonso-Tapia, J. (2020). Coping and resilience are differently related depending on the population: A comparison between three clinical samples and the general population. International Journal of Stress Management, 27(3), 304–309.

Granek, L., Nakash, O., Ariad, S., Shapira, S., & Ben-David, M. (2019). Cancer patients' mental health distress and suicidality: Impact on oncology healthcare workers and coping strategies. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 40(6), 429–436.

Hall, M. E. L., Shannonhouse, L., Aten, J., McMartin, J., & Silverman, E. (2020). The varieties of redemptive experiences: A qualitative study of meaning-making in evangelical Christian cancer patients. Psychology of Religion and Spirituality, 12(1),

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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