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Coping with Serious Illness

Q. How important is it to treat the mind as well as the body during a serious illness?

A. When people are ill, it's important to deal with the illness on the physical, emotional and spiritual levels. If you treat just the body, you short-change yourself.  We don't know exactly how the mind/body connection works, but we do have biochemical evidence that there's a connection.

Q. What are some areas where psychology can help those patients diagnosed with a serious illness?

A. There are six areas where psychology can help:

finding the best fit in medical interventionsforming a support group to help the patient dealing with the needs of family and friendsreducing the side effects of medical treatments (like chemotherapy)managing painhelping patients cope with the "after-illness experience."

Q. How has psychology helped with specific illnesses?

A. AIDS Psychological interventions are helping gay, HIV--positive men better deal with their diagnosis, using stress management techniques, social support and body relaxation training. The interventions are intended to counteract the fact that, for some people, finding out that they are HIV-positive may lead to social isolation and poor coping strategies that could suppress the immune system.

Heart Attacks Psychological interventions can help before and after heart attacks. Brief psychological counseling before medical procedures produces shorter stays in the critical-care unit, less emotional distress and shorter hospital stays. And after heart attacks, group therapy for recovering heart patients improves psychological well-being and cuts the death rate in the first three years of recovery. In addition, research has shown that two hours of psychological counseling per week for seven weeks reduces by 60 percent the rate of rehospitalization for heart patients.

Cancer Cancer patients who have psychological interventions have shown an improved quality of life as well as improved their physical health. Targeted group therapy and relaxation training have been shown to improve patients' moods, lower their emotional distress and improve their ability to cope with their illnesses.

Organ Recipients Psychologists can also help medical teams identify the best transplant candidates. Psychologists are extensively involved in assessing who is most capable of dealing with the required medical regimen. Psychologists also intervene with those who are weak on such skills, but who can develop them through behavioral change strategies and support.

Q. Why is it so important for patients who are diagnosed with a serious illness to deal with their feelings at an early stage?

A. Being upset about having a serious illness is perfectly normal and reasonable. Patients need to feel a sense of mourning, loss and fear -- all of that is reasonable. The goal is to let them experience it and move through it then they can emerge stronger and are more likely to manage their negative emotions. If they feel they have to cover up every negative emotion, they can't get beyond those feelings.

Q. What is the first reaction most patients have when they have been diagnosed with a serious illness such as cancer?

A. The first reaction with cancer is a fear for loss of life. 'Cancer equals death' is the first thing people go through. Am I going to die? After that issues begin to differ for each person on what happens next. What treatment do I undertake? How do I make a choice? Will it be effective? What else can I do to conquer my illness?

Q. There are many options available as to what treatment patients should have. How can talking with a psychologist best prepare them for making that choice?

A. Overall, talking to a psychologist is an empowering process. Sometimes patients have to fight for what they want. Sometimes they need to push a bit. Most patients are uncomfortable pushing and asking questions because they're not the expert and it feels disrespectful.

Also, psychology is helpful for coping with the side effects of treatment. Some people give up chemotherapy, even though it may threaten their life, because they can't deal with the side effects.

Too often, a patient's psychological needs throughout the treatment regime are not taken into account. Making an educated choice with the patient means weighing both their psychological needs and their medical needs.

Q. How can psychology help people to manage their pain?

A. Psychologists can help people manage their pain by giving them language to describe the pain both to themselves and to physicians (is it shooting or numbing pain, for example) and can suggest helpful medications or use hypnosis as a pain management intervention.

Q. How are friends, family and loved ones affected by a personís serious illness?

A. Serious illness can affect the whole family, not just the patient. Psychology deals not only with the patient, but also with his or her aging parents, children, spouse, or friends who are involved with that patient's treatments. The stress on a partner is enormous -- they're taking over the other person's role, the financial burden, the burden of children, while simultaneously containing their own feelings. The stress on the caretaker cannot be understated. And children feel stress too. Parents mistakenly assume that theyíre hiding the illness from children in the family, but children often know when something is wrong. The aging parents also are affected. Their child is dying. They may be in their 70s and their child may be 40, but it's still their child. There are many, many people affected when someone is seriously ill.

Q. Some believe that after that last physical therapy treatment, the illness is gone. Isn't it true that the battle is really just beginning?

A. The rest of the world may want the patient to go back to normal after the treatment is over, but the survivor of a serious illness will never return to who they were. They may still be upset, anxious and worried. They've lost the protective umbrella of being under physician care. They're afraid they'll have a recurrence or they are left with bodily disfigurement. They're not back to themselves. They need to be reintegrated into the world. Psychology can help long after the physical therapy is over.

Q. Are there any positives that come out of dealing with a chronic illness?

A. One study shows that dealing with a serious illness such as cancer can make people reassess their lifeís priorities and get a better sense of who they are.

With thanks to Sandra Haber, PhD, a psychologist in private practice in New York City, an associate clinical professor of psychology at the Derner Institute at Adelphi University and a fellow of the American Psychological Association; Michael Antoni, PhD, and Neil Schneiderman, PhD, of the University of Miami; and Mary Ellen Olbrisch, PhD, of Virginia Commonwealth University

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