This feature by Elizabeth Cohn Stuntz, LCSW and Ronda Oswalt Reitz, PhD is Part 2 of 2 in this blog about the way DBT Skills can help patients cope with cancer. In the first part here, Elizabeth and Ronda shared the story of Maria, who was diagnosed with cancer. They presented two skills, mindfulness and labeling emotions to regulate them. In part two, they explore additional DBT strategies that can help cancer patients and their loved ones feel less helpless and have more faith in their ability to cope.
Patients may benefit from learning ways to rebalance unproductive thinking with a fuller and more accurate view of the situation. Maria discovered the value of noticing assumptions about an unknown future that are not based on facts. She found that checking the facts helped minimize unnecessary upset over inaccurate ideas and ensure that her decisions are made on reliable information. In addition, she realized she can get a broader and more complete perspective of her situation when she viewed what was happening as if in a helicopter above. She found it useful to consider what else might be true about a situation, reaction or relationship. Dialectical thinking can help add an overlooked perspective. Indeed, a cancer diagnosis is more complex than merely one way or the other. Patients are rarely totally healthy or dying immediately, in control or powerless. In dark moments, it was valuable for Maria to both validate her dark thoughts and keep in mind the seemingly opposite. Indeed, she saw it was possible to be both terrified and have hope. Desmond Tutu said, “Hope Is being able to see that there is light despite the darkness.” Going back and forth as if on a seesaw seeing both light and dark helped Maria keep in mind that change was inevitable. The sun always comes up after a dark night.
Maria also discovered the way productive actions, such as distractions or soothing sensations could help her to manage physical and emotional agitation. Pleasurable, funny events, mastery, and contributing can balance feelings of sadness or helplessness. Humor has been found to boost mood, diminish pain, strengthen the immune system, and protect against the damaging effects of stress. While, at a challenging time like this, it may feel like too much to ask to consider any positive parts of life, research shows that gratitude is worthwhile. Patients who made a weekly list of five things for which they were grateful were significantly happier and reported fewer health problems than groups that focused on hassles or only wrote about ordinary events.
Maria also found that knowing effective ways to communicate to herself and others was a useful part of coping with cancer. She was able to balance self-doubt and criticism with compassionate self-talk by using the same understanding and encouraging tone and words to herself that she would offer a beloved friend. Self-compassion has been shown to strengthen resilience in the face of stress and may even increase immune response. When Maria’s coping style and wish for privacy did not match that of her loved ones, DBT interpersonal effectiveness skills were very useful. It was helpful for her to have ways that protect a relationship when she wanted to let dear ones know that their cheerful attempts at reassurance can sometimes feel invalidating. When she worried that she was asking too much of others, it was valuable for her to have effective ways to ask for what she wanted and needed. She used communication strategies with colleagues to address concerns about memory/attention difficulties and a wish to be seen as capable. She also found it helpful to have constructive ways to ask her doctor for more time, information, and input on decisions without overly apologizing, while protecting the relationship and her self respect.
Lastly, facing the threat of not living as long as hoped or imagined can sometimes offer a wise mind moment of clarity about who or what matters most. In the face of illness, relationships and sources of meaning may be seen in a new light. Priorities may change. Some people start to more deeply cherish those who are most important to them. Others recognize the importance of maintaining emotional connection even when they aren’t able to do the same physical activities together. Even when Maria couldn’t attend her son’s soccer game, she learned not to overlook the seemingly simple value of her physical presence at other everyday moments. Issues of faith and spirituality sometimes become more central as people search for a connection to something larger to help find their truth and/or feel less separate and alone. Spirituality is now considered an essential element of optimal supportive care for patients with advanced cancer. Spirituality has been linked to better immune functioning, lower risk developing cancer, greater emotional/ physical health, pain tolerance, and survival. At this time, many renew or find new personal, spiritual, and/or communal relationships. Some begin to deepen their connection to their own values, ideals, nature, science or religion. Others may use secular readings, meditations, songs, or their own words to express what’s in their heart.
Ronda Reitz is collaborating with Elizabeth Stuntz on a curriculum to offer a roadmap for providers to teach DBT skills for cancer to patients and their loved ones. The curriculum will also provide standardization of the approach for research purposes. If you are interested in more information, offering the curriculum, conducting research or being informed about updates, go to copingwithcancerdbt.com.
Looking for more insight on applications of DBT skills in the real world? Read here for a post about Family Dinners and Emotion Regulation!
Ronda Oswalt Reitz, PhD is the Coordinator for Dialectical Behavior Therapy (DBT) services for the Missouri Department of Mental Health. In this role, she is charged with the implementation, support, and evaluation of DBT programming in public mental health settings statewide. Read her full bio here.
Elizabeth Cohn Stuntz, LCSW is a cancer survivor and a student of Zen. She is also a psychotherapist practicing from contemporary psychoanalytic and Dialectical Behavior Therapy (DBT) perspectives. She serves on the faculty of Westchester Center for Psychoanalysis and Psychotherapy. After many years of providing social and emotional services for people with cancer and their loved ones, Stuntz partnered with Marsha Linehan (developer of DBT) to create a program of coping skills. They are the co-authors of Coping with Cancer: DBT Skills to Manage Your Emotions and Balance Uncertainty with Hope. Read more of her bio here.