The Field of Psycho-Oncology

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is provided
00:03 --> 00:07by Smilow Cancer Hospital and AstraZeneca.
00:07 --> 00:09Welcome to Yale Cancer Answers with your
00:09 --> 00:12host doctor Anees Chagpar. Yale Cancer
00:12 --> 00:14Answers features the latest information
00:14 --> 00:16on cancer care by welcoming oncologists
00:16 --> 00:19and specialists who are in the forefront
00:19 --> 00:21of the battle to fight cancer. This week,
00:21 --> 00:23it's a conversation about Psycho-
00:23 --> 00:25Oncology with Doctor Jennifer Kilkus.
00:25 --> 00:27Dr Kilkus is an assistant professor of
00:27 --> 00:30psychiatry at the Yale School of Medicine,
00:30 --> 00:33where Dr Chagpar is a professor
00:33 --> 00:34of surgical oncology.
00:35 --> 00:37Maybe we can start off by you telling us a
00:37 --> 00:39little bit about yourself and what you do.
00:39 --> 00:43Sure, I am a clinical health psychologist.
00:43 --> 00:46I've been in practice since about
00:46 --> 00:482014 and primarily worked in large
00:48 --> 00:50health systems helping to improve
00:50 --> 00:52behavioral health and psychological
00:52 --> 00:55services for cancer patients.
00:55 --> 00:58So when we talk about
00:58 --> 00:59psychological services,
00:59 --> 01:02I think a lot of people get a bit
01:02 --> 01:04confused about all of the different
01:04 --> 01:07types of people that we talk about,
01:07 --> 01:09so we talk about social workers
01:09 --> 01:11we talk about psychologists,
01:11 --> 01:12psychiatrists.
01:12 --> 01:15Can you break it down for us and help
01:15 --> 01:17us to understand the differences and
01:17 --> 01:19the nuances between all of those?
01:20 --> 01:21Absolutely, and that's
01:21 --> 01:22a great point.
01:22 --> 01:24I often have to explain to people
01:24 --> 01:26what's different from what I do versus
01:26 --> 01:28what a psychiatrist does versus what
01:28 --> 01:30a clinical social worker does.
01:30 --> 01:33So a psychologist is someone with
01:33 --> 01:34a doctoral degree
01:34 --> 01:35in psychology.
01:37 --> 01:39What I tell people is I went to school for a very
01:39 --> 01:41long time to help learn strategies
01:41 --> 01:43and tools to assist people in
01:43 --> 01:46managing their emotional and their
01:46 --> 01:48physical symptoms more effectively.
01:48 --> 01:49I don't prescribe medication,
01:49 --> 01:52so that's a big difference between what
01:52 --> 01:54I do versus what a psychiatrist does,
01:54 --> 01:56and a psychologist can do
01:56 --> 01:57many different things.
01:57 --> 01:59Our degree is pretty versatile,
01:59 --> 02:03but what I use my degree to do is to focus
02:03 --> 02:06on intervention therapy.
02:06 --> 02:08I mainly provide therapy
02:08 --> 02:10services for cancer patients using
02:10 --> 02:13my degree and a social worker is pretty
02:13 --> 02:16similar as far as what they do.
02:16 --> 02:18They also have a lot of variability
02:18 --> 02:20in what they can do with their degree.
02:20 --> 02:23Clinical social workers may provide
02:23 --> 02:25psychotherapy services as well.
02:25 --> 02:26They may also,
02:26 --> 02:27for example,
02:27 --> 02:30we have clinical social workers who provide
02:30 --> 02:32navigation services for our patients.
02:32 --> 02:34Help get them connected to
02:34 --> 02:36resources and their degree
02:36 --> 02:38is just not quite as long as a PhD,
02:38 --> 02:40so their degree usually runs between
02:40 --> 02:43around three years or so versus
02:43 --> 02:45I believe I wrapped up finally about
02:45 --> 02:47seven years in to my doctoral program.
02:48 --> 02:51And so when people also refer to counselors,
02:51 --> 02:54are those psychologists?
02:54 --> 02:56Are those social workers?
02:56 --> 02:58Is that a different group
02:58 --> 02:59of people altogether?
02:59 --> 03:02Or is that just a term that's used
03:02 --> 03:04interchangeably for people who
03:04 --> 03:06provide counseling services as
03:06 --> 03:08part of their scope of care?
03:08 --> 03:11It's generally used interchangeably with
03:11 --> 03:13psychotherapy or therapy counseling,
03:13 --> 03:16but there are folks that have a specific
03:16 --> 03:18degree and they're called licensed
03:18 --> 03:19Professional counselors and those
03:19 --> 03:22degrees tend to be around two to three
03:22 --> 03:24years as well before they can be licensed
03:24 --> 03:26independently to provide counseling.
03:26 --> 03:28But it seems to be that people use the term
03:28 --> 03:30counseling interchangeable with therapy.
03:32 --> 03:34And here at Yale Cancer Answers,
03:34 --> 03:37we're often talking about cancer
03:37 --> 03:39patients in their journey.
03:39 --> 03:42So talk a little bit about how
03:42 --> 03:45mental health, which seems to
03:45 --> 03:48be a really big topic right now,
03:48 --> 03:49kind of plays into the
03:49 --> 03:50cancer patients journey.
03:50 --> 03:52At the top of the show,
03:52 --> 03:54we kind of talked about
03:54 --> 03:56we were going to
03:56 --> 03:57talk about Psycho Oncology,
03:57 --> 03:59so maybe you can give us a
03:59 --> 04:01definition of what that is and
04:01 --> 04:04how mental health plays
04:04 --> 04:05into a cancer patients journey?
04:06 --> 04:09Sure, psycho Oncology is a subspecialty
04:09 --> 04:12of the field of health psychology,
04:12 --> 04:17which is applying biological, physiological,
04:17 --> 04:19social and psychological understanding
04:19 --> 04:23of disease to help understand how
04:23 --> 04:27people cope and also how we can use
04:27 --> 04:29understanding of those processes
04:29 --> 04:32to help people change behaviors.
04:32 --> 04:34For example, smoking cessation
04:34 --> 04:37or helping people adhere to screening
04:37 --> 04:40recommendations and psycho oncology
04:40 --> 04:43specifically is applying those behavioral
04:43 --> 04:46and social science ideas to the
04:46 --> 04:48challenges that cancer patients face,
04:48 --> 04:50specifically, which are many,
04:50 --> 04:52the treatments for cancer.
04:52 --> 04:54It can be so challenging in harsh
04:54 --> 04:57and taxing on the body that those
04:57 --> 04:59things can trigger some symptoms that
04:59 --> 05:02we would classify as mental health.
05:02 --> 05:03Or vice versa,
05:03 --> 05:05mental health symptoms could worsen
05:05 --> 05:08some of the challenges that come along
05:08 --> 05:10with cancer treatments alongside just
05:10 --> 05:12the general idea of of being diagnosed
05:12 --> 05:15with the Big C, such
05:15 --> 05:17a life threatening and scary disease,
05:17 --> 05:19which as you could imagine,
05:19 --> 05:22would make anybody feel fearful.
05:22 --> 05:24But the treatments also tend to
05:24 --> 05:27compound those things and make that
05:27 --> 05:29struggle a little bit more challenging.
05:29 --> 05:31And so psycho oncologists really
05:31 --> 05:32focus on helping patients
05:32 --> 05:34manage both the emotional and the
05:34 --> 05:36physical side of cancer treatments
05:36 --> 05:38and well into survivorship as well.
05:39 --> 05:41You know when you were talking,
05:41 --> 05:44it seemed to me that there's really different
05:44 --> 05:46groups of patients that I could see
05:46 --> 05:50your services being useful for,
05:50 --> 05:52so they're the patients
05:52 --> 05:55who are well who have not yet
05:55 --> 05:56been diagnosed with the big C,
05:56 --> 05:59but who may be at risk.
05:59 --> 06:02So when you were talking
06:02 --> 06:03about behavior modification,
06:03 --> 06:05smoking cessation we know that smoking
06:05 --> 06:08is a key driver of many cancers.
06:08 --> 06:10A patient may not have been
06:10 --> 06:12diagnosed with cancer yet
06:12 --> 06:14but your services would still be
06:14 --> 06:17helpful in helping patients to
06:17 --> 06:20quit smoking or other
06:20 --> 06:21lifestyle modifications.
06:21 --> 06:23We've talked on this show about obesity,
06:23 --> 06:24for example,
06:24 --> 06:28and getting people into the right
06:28 --> 06:31mindset to to adopt those healthy behaviors.
06:31 --> 06:33So that's one group of patients.
06:33 --> 06:34And then there's the cancer patients.
06:34 --> 06:36And then there's the survivors.
06:36 --> 06:38So in talking about these three
06:38 --> 06:40categories of patients, I guess,
06:40 --> 06:42can you dive a little bit more into
06:43 --> 06:45the strategies that you would use in
06:45 --> 06:47helping the first group of patients?
06:47 --> 06:49The patients who,
06:49 --> 06:50and I'm sure many of our listeners
06:50 --> 06:52right now are thinking,
06:52 --> 06:54especially with the new
06:54 --> 06:55year just around the corner,
06:55 --> 06:57I really ought to develop
06:57 --> 06:58some healthier habits.
06:58 --> 07:01I know that these habits that I currently
07:01 --> 07:03have, over eating, not exercising,
07:03 --> 07:04smoking, drinking,
07:04 --> 07:06and so on and so forth increase
07:06 --> 07:08my risk of cancer.
07:08 --> 07:10But how can I
07:12 --> 07:14help myself to set some resolutions
07:14 --> 07:17and behavior modification that can help?
07:17 --> 07:20Can you give people some tips and
07:20 --> 07:22also tell us when they should
07:22 --> 07:24start seeking out professional
07:24 --> 07:26help to make those behavior
07:26 --> 07:27lifestyle modifications?
07:28 --> 07:31We are lucky in that we have
07:31 --> 07:34a very robust tool in our tool belt
07:34 --> 07:36called cognitive behavioral therapy
07:36 --> 07:39which some may have heard of that is
07:39 --> 07:42really considered the gold standard in
07:42 --> 07:44managing depression and anxiety symptoms,
07:44 --> 07:47but has been more studied in recent years
07:47 --> 07:51on how we can use CBT to help manage
07:51 --> 07:53both those behavioral changes you're
07:53 --> 07:57mentioning as well as emotional issues
07:57 --> 07:58moving forward. Whether
07:58 --> 08:01you're talking about a cancer patient
08:01 --> 08:03or someone who just wants to make
08:03 --> 08:05some changes because behavior is not
08:05 --> 08:07something that exists in isolation.
08:07 --> 08:09Behavior also exists in response
08:09 --> 08:12to how we think about things and
08:12 --> 08:15how we feel about things and so
08:15 --> 08:17CBT focuses on the relationship
08:17 --> 08:20between our thoughts, our behaviors,
08:20 --> 08:22our emotions, and more recently,
08:22 --> 08:25research has focused on the
08:25 --> 08:26physical sensations as well.
08:26 --> 08:27An example,
08:27 --> 08:30maybe if you're feeling anxious,
08:30 --> 08:32people tend to have changes in their body.
08:32 --> 08:33Their heart may race.
08:33 --> 08:35They may have difficulty
08:35 --> 08:36with hyperventilation,
08:36 --> 08:38which is something that
08:38 --> 08:40when it's intense enough,
08:40 --> 08:42could actually bring someone to the
08:42 --> 08:43emergency room because they think that
08:43 --> 08:45they may be having a heart attack and
08:45 --> 08:47so CBT looks at those four components,
08:47 --> 08:50and prioritizes which of these things
08:50 --> 08:54seems to be the biggest barrier for making
08:54 --> 08:57the changes that you want to change.
08:57 --> 08:59So one thing that I notice a lot in practice
08:59 --> 09:01when folks want to make some
09:01 --> 09:03kind of behavior change as they
09:03 --> 09:04tend to go really big at first,
09:04 --> 09:07and then they inevitably end up not
09:07 --> 09:10getting where they want to go because
09:10 --> 09:13they may have set those goals too
09:13 --> 09:15high in the beginning instead of
09:15 --> 09:17maybe starting slow and just
09:17 --> 09:19taking some time to reach their goal.
09:19 --> 09:21And you could imagine if you've
09:21 --> 09:23done that over and over again,
09:23 --> 09:25you may start to have thoughts like Oh well,
09:25 --> 09:27what's the point? Why even bother?
09:27 --> 09:27I can't do this,
09:27 --> 09:29and then you may throw in the towel.
09:29 --> 09:32And so when you're
09:32 --> 09:34meeting with someone like myself,
09:34 --> 09:36to focus on those issues,
09:36 --> 09:38we want to know what has been
09:38 --> 09:40difficult about getting to the place
09:40 --> 09:42where you want to go in the past.
09:42 --> 09:44And usually it follows in one of those
09:44 --> 09:46categories of thoughts, behaviors,
09:46 --> 09:48emotions or physical sensations.
09:48 --> 09:50And I would suggest for someone if
09:50 --> 09:52they're thinking about whether or not
09:52 --> 09:54they need to work with a professional,
09:54 --> 09:56is how successful have you
09:56 --> 09:57been in the past,
09:57 --> 09:59and are you able to identify where
09:59 --> 10:01you might have gotten off the
10:01 --> 10:03path of where you wanted to go?
10:03 --> 10:05And if you're not sure, if it feels
10:05 --> 10:07like you need someone to help work
10:07 --> 10:09with you to set some clear goals
10:09 --> 10:10and have some accountability and
10:10 --> 10:12work with you on building momentum,
10:12 --> 10:14then that might be a time to reach
10:14 --> 10:16out to a professional for some help.
10:17 --> 10:19And so in order to do that,
10:19 --> 10:21how do people access
10:21 --> 10:23Psychological services?
10:23 --> 10:25Do they go through their family doctor
10:25 --> 10:27or do people come to you just straight
10:27 --> 10:30off the street and say, you know,
10:30 --> 10:33I'm interested in
10:33 --> 10:33quitting smoking.
10:33 --> 10:35I'm interested in losing weight.
10:35 --> 10:38How do people generally find
10:38 --> 10:40psychologists and psychiatrists
10:40 --> 10:42and counselors and social workers
10:42 --> 10:44to help them with these with
10:44 --> 10:46these behavioral modifications?
10:46 --> 10:48If they haven't been diagnosed
10:48 --> 10:49with cancer yet?
10:50 --> 10:52There are a lot of different avenues for
10:52 --> 10:54that, but oftentimes people may find
10:54 --> 10:55a provider through their insurance,
10:55 --> 10:58as insurance will list what services
10:58 --> 11:00are covered and who are the
11:00 --> 11:02providers that take your insurance.
11:02 --> 11:04People also find me through word of mouth,
11:04 --> 11:06so they might have a friend or a family
11:06 --> 11:08member who had spoken to me at one point,
11:08 --> 11:11or they may have heard me speak at a
11:11 --> 11:14group and people can also search different
11:14 --> 11:17websites that host different
11:17 --> 11:20platforms for finding a provider.
11:20 --> 11:22For someone like myself,
11:22 --> 11:24I'm a board certified clinical
11:24 --> 11:25health psychologist,
11:25 --> 11:27so I have a specialty in health and
11:27 --> 11:29you can search specifically for that.
11:29 --> 11:31A board certified clinical health
11:31 --> 11:33psychologist through the American Board
11:33 --> 11:34of Professional Psychology to find
11:34 --> 11:37folks in your state that have that
11:37 --> 11:39designation and would likely be more
11:39 --> 11:42able to help in the realm of health change.
11:43 --> 11:45Great information, all right.
11:45 --> 11:48Let's look at the second category
11:48 --> 11:51so the newly diagnosed cancer
11:51 --> 11:53patient, you can imagine,
11:53 --> 11:55when you've
11:55 --> 11:56been given that diagnosis,
11:56 --> 11:59your world kind of turns upside down,
11:59 --> 12:02and it's not uncommon for people
12:02 --> 12:06to a have anxiety, but
12:06 --> 12:09it may also turn into,
12:09 --> 12:11you know, depression.
12:11 --> 12:14Some people may turn to substance abuse.
12:14 --> 12:17They may have issues in terms of
12:17 --> 12:18relationships, especially because
12:18 --> 12:20it's not just the patient
12:20 --> 12:22going through that diagnosis,
12:22 --> 12:24it also affects family,
12:24 --> 12:28workplaces, and so on and so forth.
12:28 --> 12:30How do you manage dealing with
12:30 --> 12:33all of that when patients are
12:33 --> 12:35newly diagnosed with cancer?
12:37 --> 12:38It is a lot, and if you think about it,
12:38 --> 12:40it really does affect almost
12:40 --> 12:42every aspect of someone's life.
12:42 --> 12:44Maybe not everyone all of the time,
12:44 --> 12:47but even things like work.
12:47 --> 12:48If somebody is so sick that they
12:48 --> 12:49can't make it to work anymore,
12:49 --> 12:51then they might start having
12:51 --> 12:52financial problems.
12:52 --> 12:54Maybe they can't perform the same
12:54 --> 12:56roles that they did in their
12:56 --> 12:58household and that might lead to
12:58 --> 12:59some relationship conflict.
12:59 --> 13:01Not to mention the physiological aspects
13:01 --> 13:03of the cancer treatment itself.
13:03 --> 13:05So there are a lot of different
13:05 --> 13:09ways folks can struggle through this
13:09 --> 13:11process and I keep coming
13:11 --> 13:13back to CBT because it's just such
13:13 --> 13:14a handy tool because it's such a
13:14 --> 13:16big umbrella and there's so many
13:16 --> 13:18different things that we can do with that.
13:18 --> 13:19But again,
13:19 --> 13:22we can breakdown what are the challenges?
13:22 --> 13:24Are they controllable or uncontrollable?
13:24 --> 13:25If they're controllable,
13:25 --> 13:27we might problem solve or help
13:27 --> 13:29resolve some of the barriers and that
13:29 --> 13:30way of looking at what are concrete
13:30 --> 13:32steps that someone could take,
13:32 --> 13:33or if it's uncontrollable then
13:33 --> 13:35we look at managing the emotion
13:35 --> 13:37and maybe helping choose
13:37 --> 13:39coping strategies that are more
13:39 --> 13:41helpful. Things like substance abuse,
13:41 --> 13:42those kinds of things tend to help
13:42 --> 13:43really well in the short term,
13:43 --> 13:45and that's why people do them.
13:45 --> 13:46But they're not the best for long
13:46 --> 13:48term coping or for long term health,
13:48 --> 13:50and so we can help someone
13:50 --> 13:52get the big picture of
13:52 --> 13:54what are the biggest issues and
13:54 --> 13:56prioritizing the ones that are
13:56 --> 13:57most important.
13:57 --> 13:58Starting with that controllable,
13:58 --> 14:00uncontrollable framework and then
14:00 --> 14:02using the tools that CBT provides
14:02 --> 14:04us to help get more specific.
14:05 --> 14:07We'll talk a lot more about what
14:07 --> 14:09things people can do from
14:09 --> 14:10a practical standpoint,
14:10 --> 14:11right after we take a short
14:11 --> 14:13break for a medical minute.
14:13 --> 14:15Please stay tuned to learn more
14:15 --> 14:17about The Field of Psycho-Oncology with my
14:17 --> 14:18guest doctor Jennifer Kilkus.
14:19 --> 14:21Funding for Yale Cancer Answers
14:21 --> 14:23comes from Smilow Cancer Hospital,
14:23 --> 14:25where physicians collaborate with
14:25 --> 14:27diagnostic and interventional
14:27 --> 14:28radiologists, gastroenterologists,
14:28 --> 14:31and pathologists to provide expert care
14:31 --> 14:33for patients with pancreatic cancer.
14:36 --> 14:39yalecancercenter.org/GI.
14:39 --> 14:41Breast cancer is one of the most common cancers
14:41 --> 14:42in women. In Connecticut alone,
14:42 --> 14:45approximately 3500 women will be
14:45 --> 14:47diagnosed with breast cancer this year,
14:47 --> 14:49but there is hope,
14:49 --> 14:50thanks to earlier detection,
14:50 --> 14:52noninvasive treatments and the
14:52 --> 14:53development of novel therapies
14:53 --> 14:55to fight breast cancer.
14:55 --> 14:57Women should schedule a baseline
14:57 --> 14:59mammogram beginning at age 40 or
14:59 --> 15:01earlier if they have risk factors
15:01 --> 15:02associated with the disease.
15:02 --> 15:04With screening, early detection,
15:04 --> 15:06and a healthy lifestyle,
15:06 --> 15:08breast cancer can be defeated.
15:08 --> 15:10Clinical trials are currently
15:10 --> 15:12underway at federally designated
15:12 --> 15:14Comprehensive cancer centers such
15:14 --> 15:16as Yale Cancer Center and at Smilow
15:16 --> 15:18Cancer Hospital to make innovative
15:18 --> 15:20new treatments available to patients.
15:20 --> 15:23Digital breast tomosynthesis or 3D
15:23 --> 15:25mammography is also transforming breast
15:25 --> 15:27cancer screening by significantly
15:27 --> 15:29reducing unnecessary procedures
15:29 --> 15:32while picking up more cancers.
15:32 --> 15:35More information is available at
15:35 --> 15:36yalecancercenter.org. You're listening
15:36 --> 15:38to Connecticut Public Radio.
15:39 --> 15:41Welcome back to Yale Cancer Answers.
15:41 --> 15:43This is doctor Anees Chagpar
15:43 --> 15:45and I'm joined tonight by my
15:45 --> 15:46guest Doctor Jennifer Kilkus.
15:46 --> 15:48We're learning about her work
15:48 --> 15:49in the field of Psycho oncology
15:49 --> 15:51and right before the break
15:51 --> 15:53Jennifer, you were telling us about
15:53 --> 15:56the role that Psycho oncology
15:56 --> 15:58can play for a cancer patient whose
15:58 --> 16:01world may have been just shattered with a
16:01 --> 16:04new diagnosis who may be facing anxiety,
16:04 --> 16:06who may be facing issues of
16:06 --> 16:08depression or substance abuse,
16:08 --> 16:10who may have issues in their work,
16:10 --> 16:12in their relationships,
16:12 --> 16:14and I'm just wondering a few things.
16:14 --> 16:17So first of all, does every patient,
16:17 --> 16:19every cancer patient,
16:19 --> 16:21need a Psycho oncologist?
16:21 --> 16:22Is that something that they should be
16:22 --> 16:24talking to their oncologist about?
16:24 --> 16:26Or is it only the patients who are
16:26 --> 16:28really struggling with that diagnosis
16:28 --> 16:30that should be asking for that service?
16:32 --> 16:33I would say that no,
16:33 --> 16:35it's actually surprising that many
16:35 --> 16:38cancer patients are able to cope just
16:38 --> 16:40fine with the resources that they
16:40 --> 16:42have available in their community.
16:42 --> 16:44So they might have a really
16:44 --> 16:45strong social support network,
16:45 --> 16:49or they may already have a provider in
16:49 --> 16:52the community and we estimate somewhere
16:52 --> 16:55around 30 to 40% of patients may
16:55 --> 16:57meet criteria for a major depressive
16:57 --> 17:00disorder and anxiety disorder at some
17:00 --> 17:02point throughout their diagnosis
17:02 --> 17:02and their treatment,
17:02 --> 17:04depending on which measures we're using
17:04 --> 17:06and which researcher we're asking.
17:06 --> 17:08But for the most part,
17:08 --> 17:11many patients tend to cope very well
17:11 --> 17:13despite how challenging this can be.
17:13 --> 17:15So I would say for patients who
17:15 --> 17:17really feel like these symptoms are
17:17 --> 17:19persisting and they're really finding
17:19 --> 17:23it hard to get by with their day-to-day
17:23 --> 17:24activities because of their symptoms,
17:24 --> 17:26that would be a good time to talk
17:26 --> 17:28to your oncologist about connecting
17:28 --> 17:29with someone for some help.
17:30 --> 17:32The other thing that strikes me
17:32 --> 17:35is that very much like we've seen
17:35 --> 17:37with mental health in general,
17:37 --> 17:39it seems to be something that a lot
17:39 --> 17:41of people don't want to talk about.
17:41 --> 17:44They don't want to admit they oftentimes
17:44 --> 17:46feel like they may be perceived
17:46 --> 17:50as being quote weak if they admit
17:50 --> 17:52that they're struggling to cope.
17:52 --> 17:55And how do you get over that?
17:55 --> 17:57What advice do you have for people to
17:57 --> 17:59broach that subject with their physician
17:59 --> 18:02so that they can start getting some help?
18:02 --> 18:05I am so glad that you brought that up
18:05 --> 18:07because if I had a number one soapbox issue,
18:07 --> 18:10it would be the messaging that we get not
18:10 --> 18:12just with cancer but in our culture as a
18:12 --> 18:14whole about those narratives of having
18:14 --> 18:17to be strong and struggle through things.
18:17 --> 18:19And those types of narratives really
18:19 --> 18:22make it difficult for people to
18:22 --> 18:24acknowledge that they may be struggling
18:24 --> 18:26and reach out for help,
18:26 --> 18:28because the message that they get everywhere
18:28 --> 18:31that they look at is that is somehow wrong,
18:31 --> 18:33or that you're failing in some way.
18:33 --> 18:35But the reality is,
18:35 --> 18:37that most people struggle with this,
18:37 --> 18:39and that's what's more normal.
18:39 --> 18:41It's more normal to struggle
18:41 --> 18:43and to have difficulty with
18:43 --> 18:45challenging situations in our lives,
18:45 --> 18:48and we don't often give people an
18:48 --> 18:50opportunity to have that witness.
18:50 --> 18:52And so if there are folks listening
18:52 --> 18:54who have struggled with that,
18:54 --> 18:57I would just encourage you to
18:57 --> 18:59question where that came from,
18:59 --> 19:02and if you would have the same
19:02 --> 19:03types of expectations
19:03 --> 19:05if somebody that you cared about in your
19:05 --> 19:06life thought that.
19:06 --> 19:08Because oftentimes
19:08 --> 19:10we're very hard on ourselves in a way
19:10 --> 19:13that we wouldn't be for other people,
19:13 --> 19:15and I think that of course,
19:15 --> 19:16as a psychologist,
19:16 --> 19:18this is easy for me to say,
19:18 --> 19:19but I think that asking for help is
19:19 --> 19:21the biggest sign of strength because
19:21 --> 19:23you're acknowledging that this is
19:23 --> 19:25something that you can't manage on your own,
19:25 --> 19:27and that's risky.
19:27 --> 19:28It's vulnerable,
19:28 --> 19:30and so it's possible to feel that
19:30 --> 19:32and still ask for help.
19:32 --> 19:33It's possible to
19:33 --> 19:36push through that and in speaking
19:36 --> 19:37with an oncologist,
19:37 --> 19:39all of them have seen people struggling
19:39 --> 19:41at different points of their diagnosis.
19:43 --> 19:46And so it's not a surprise if you do
19:46 --> 19:47even just a little bit of research,
19:47 --> 19:49if you just Google,
19:49 --> 19:51say cancer and anxiety or cancer and stress,
19:51 --> 19:53you'll see how common it is and
19:53 --> 19:55how common it is to ask for help
19:55 --> 19:57and how many different avenues
19:57 --> 19:59there may be out there for support.
20:00 --> 20:03I think that one key message for
20:03 --> 20:05people whether you've been diagnosed with
20:05 --> 20:09cancer or not is that it's OK to not be OK.
20:09 --> 20:12And it's OK to say I'm not OK and I
20:12 --> 20:15could really use some help and the
20:15 --> 20:18good news is that help is out there,
20:18 --> 20:21but sometimes that help needs to be asked
20:21 --> 20:24for because people don't have ESP, right?
20:24 --> 20:26So you need to kind of take that
20:26 --> 20:28step and I agree with you, it's a
20:28 --> 20:30vulnerable step, right?
20:30 --> 20:33But it's OK to say I'm not OK,
20:33 --> 20:36and I think more and more people
20:36 --> 20:38now are realizing that,
20:38 --> 20:42and so I hope that that message gets across.
20:42 --> 20:45But the other thing I think that is
20:45 --> 20:48really helpful is for people to understand
20:48 --> 20:51in a practical and pragmatic way,
20:51 --> 20:53what is the benefit of seeing
20:53 --> 20:55a mental health provider,
20:55 --> 20:57whether it's a psychologist, a psychiatrist,
20:57 --> 20:59a counselor or social worker,.
20:59 --> 21:01Can you provide us
21:01 --> 21:04some tangible benefits that you get
21:04 --> 21:06because some people may be thinking OK,
21:06 --> 21:08what are
21:08 --> 21:09they gonna do?
21:09 --> 21:10I mean,
21:10 --> 21:11we're going to talk about my
21:11 --> 21:12childhood or something,
21:12 --> 21:16and I think that there's a lot of
21:16 --> 21:18misperceptions about what exactly you
21:18 --> 21:20do and what are the tangible benefits
21:20 --> 21:23of working with a counselor or mental
21:23 --> 21:26health professional to kind of cope
21:26 --> 21:29with either the physical symptoms
21:29 --> 21:31or the psychological symptoms.
21:31 --> 21:33Or simply to get through the day
21:33 --> 21:36and cope with all of the peripheral
21:36 --> 21:38things that are happening with you
21:38 --> 21:41in terms of relationships at home,
21:41 --> 21:43at work, and so on.
21:43 --> 21:45And I've heard all
21:45 --> 21:47of those things and more when I
21:47 --> 21:49meet someone for the first time,
21:49 --> 21:51so they have gotten over that hump of OK,
21:51 --> 21:52I'm going to make an appointment.
21:52 --> 21:54I'm going to go to the appointment,
21:54 --> 21:56but what do we do now?
21:56 --> 21:58There is a lot of misinformation and
21:58 --> 22:00misunderstanding about what psychologists
22:00 --> 22:02and counselors and social workers do.
22:02 --> 22:05There are some that focus on understanding
22:05 --> 22:08how your childhood shaped who you are today.
22:08 --> 22:10When we're dealing with something like cancer
22:10 --> 22:12and something that's very here and now,
22:12 --> 22:15we're focused on what tools are the most
22:15 --> 22:18useful for helping improve your symptoms
22:18 --> 22:21and helping improve your quality of life.
22:21 --> 22:24And so to use an example that I see often,
22:24 --> 22:26fatigue is one of the biggest challenges
22:26 --> 22:29that cancer patients experience as they're
22:29 --> 22:31going through their treatment and well
22:31 --> 22:34beyond when their treatment is completed
22:34 --> 22:36and if we're using looking at how CBT
22:36 --> 22:39skills vary based and a present moment
22:39 --> 22:42focused approach could help with that.
22:42 --> 22:44I would work with someone on
22:44 --> 22:46identifying what behaviors might be
22:46 --> 22:48continuing that cycle of fatigue,
22:48 --> 22:50and oftentimes with fatigue comes
22:50 --> 22:52depression and when we feel
22:52 --> 22:54depressed or when we feel like we
22:54 --> 22:56can't do the things we used to do,
22:56 --> 22:57a lot of people tend
22:57 --> 22:59to withdraw and so they may struggle
22:59 --> 23:01to do the activities that used to bring
23:01 --> 23:04them pleasure or feel meaningful to them,
23:04 --> 23:05or they may be spending a lot of
23:05 --> 23:08time in bed or on the couch and those
23:08 --> 23:10things unfortunately tend to make
23:10 --> 23:12both fatigue and depression worse.
23:12 --> 23:15So we might focus on how can we gradually
23:15 --> 23:19increase activity overtime and in a way
23:19 --> 23:22that balances both energy and mood.
23:22 --> 23:23So paying attention to what things
23:23 --> 23:26have the biggest bang for the buck
23:26 --> 23:27for improving mood and energy.
23:27 --> 23:29And building up slowly over time
23:29 --> 23:31again so we don't get into a cycle
23:31 --> 23:32where we're doing too much
23:32 --> 23:35and then the bottom drops out and and we
23:35 --> 23:38just give up because it's too difficult.
23:38 --> 23:40And so you can see how
23:40 --> 23:41in that scenario,
23:41 --> 23:43I'm not providing advice.
23:43 --> 23:45I'm also not talking about anybody's
23:45 --> 23:45childhood.
23:45 --> 23:47I'm suggesting skills and strategies
23:47 --> 23:50that are focused on the problem at hand.
23:50 --> 23:52And what could actually be done
23:52 --> 23:54to help improve things overtime.
23:55 --> 23:57Yeah, I think that's
23:57 --> 23:58so important.
23:58 --> 23:59And it really is, you know,
23:59 --> 24:03kind of tangible advice like guidance.
24:03 --> 24:04Just like a coach.
24:04 --> 24:06You know when you're a kid and
24:06 --> 24:08you're playing Little League or
24:08 --> 24:11or you're learning the piano.
24:11 --> 24:12You always have a teacher or a
24:12 --> 24:14coach who's trying to make you
24:14 --> 24:16better and and give you those tips.
24:16 --> 24:18Those skills that will help
24:18 --> 24:20you in improving whatever it
24:20 --> 24:22is you're trying to improve.
24:22 --> 24:25And I think working with a mental
24:25 --> 24:28health professional in that way may
24:28 --> 24:31provide you those same kinds of skill
24:31 --> 24:34sets that will help you to overcome
24:34 --> 24:36the challenges that come with that.
24:36 --> 24:39I think the other piece though is
24:39 --> 24:42the emotional piece and you know,
24:42 --> 24:45dealing with just the huge array of emotions
24:45 --> 24:48that you get with a cancer diagnosis.
24:48 --> 24:51And for some people I think that so
24:51 --> 24:54much can compound one thing on top of
24:54 --> 24:57another thing on top of another thing.
24:57 --> 25:00And there are cases where
25:00 --> 25:03people can actually get
25:03 --> 25:06suicidal with all of the things
25:06 --> 25:08building up leading to outcomes
25:08 --> 25:11that really didn't need to happen.
25:11 --> 25:14So talk a little bit about how people
25:14 --> 25:17can overcome some of the emotional
25:17 --> 25:20baggage and all of the things that
25:20 --> 25:23just seem to layer on when they're
25:23 --> 25:25going through a cancer journey where
25:25 --> 25:28you know sometimes it just feels like
25:28 --> 25:30there's a tiny straw that can
25:30 --> 25:31break the camels back.
25:32 --> 25:34And I think that's
25:34 --> 25:35exactly what happens,
25:35 --> 25:37and I often talk to people about
25:37 --> 25:40that these aren't as if we were
25:40 --> 25:42dealing with each stressor individually.
25:42 --> 25:43They do become something different
25:43 --> 25:45when they compound like that and
25:45 --> 25:47and they become something bigger
25:47 --> 25:49and more more difficult to manage,
25:49 --> 25:51but I think the strategy is the
25:51 --> 25:52same as teasing apart all those
25:52 --> 25:54different pieces that are tangled up
25:54 --> 25:57and looking at them one by one and
25:57 --> 25:59how they interact with each other.
25:59 --> 26:01And so it may be that someone,
26:01 --> 26:04like the example that I mentioned,
26:04 --> 26:06comes with more behaviorally
26:06 --> 26:08motivated symptoms where they're
26:08 --> 26:11having a hard time connecting
26:11 --> 26:12with people or they've withdrawn,
26:12 --> 26:14and it may be that somebody is coming
26:14 --> 26:16to me with more symptoms that are more
26:16 --> 26:18driven by the thoughts that they have like,
26:18 --> 26:19this is hopeless,
26:19 --> 26:22or I'm never going to get past this,
26:22 --> 26:25and so we would just take those pieces one
26:25 --> 26:28at a time and address them as they come,
26:28 --> 26:30and oftentimes they have a downstream effect.
26:30 --> 26:31So once you can start
26:31 --> 26:33getting some distance from
26:33 --> 26:36thoughts and thinking about them in
26:36 --> 26:37a more objective or balanced way,
26:37 --> 26:40then it may become easier to do some
26:40 --> 26:42of the things behaviorally that might
26:42 --> 26:44also help you feel better and vice versa.
26:44 --> 26:47And so it's not
26:47 --> 26:49I wouldn't say a simple process or
26:49 --> 26:51or maybe it is a simple process,
26:51 --> 26:52but not an easy one,
26:52 --> 26:54but that's why it's helpful
26:54 --> 26:56to have someone like a coach.
26:56 --> 26:58And that's why I often think of
26:58 --> 27:00myself like a coach or like a teacher
27:00 --> 27:01to help observe those things.
27:01 --> 27:04And help point out where can we start
27:04 --> 27:07so that we can have the most success
27:07 --> 27:10the quickest and then go from there.
27:10 --> 27:12I think that that's so key, is
27:12 --> 27:14that oftentimes when you're feeling
27:14 --> 27:16overwhelmed like it's just one thing
27:16 --> 27:18on top of another thing on top of
27:18 --> 27:21another thing on top of another thing,
27:21 --> 27:23it's sometimes helpful to have an
27:23 --> 27:25objective lens and outside person
27:25 --> 27:29to kind of break things down for you
27:29 --> 27:31into little pieces and to give you
27:31 --> 27:34some skills to understand how you can
27:34 --> 27:36deal with each of the little pieces.
27:36 --> 27:38It might be more manageable
27:38 --> 27:40than trying to deal with
27:40 --> 27:42the overwhelm of many things
27:42 --> 27:44all compounded at once.
27:44 --> 27:47And actually if we look at what happens
27:47 --> 27:48physiologically and neurologically
27:48 --> 27:50when we become overwhelmed,
27:50 --> 27:52it's actually really difficult to
27:52 --> 27:55do that for ourselves because our
27:55 --> 27:57frontal lobe is really what helps
27:57 --> 27:59us think through things clearly and
27:59 --> 28:01problem solve and to sort through
28:01 --> 28:03things and organize for ourselves.
28:03 --> 28:06And when we're feeling very emotional,
28:06 --> 28:07that part of our brain isn't
28:07 --> 28:09activated as much. Instead,
28:09 --> 28:10the part of our brain,
28:10 --> 28:13our amygdala, is really on
28:13 --> 28:15overdrive in our sympathetic nervous system.
28:15 --> 28:17That's our fight or flight response.
28:17 --> 28:18That's what our body does when
28:18 --> 28:19we're in danger.
28:19 --> 28:21When it thinks we're in danger, it
28:21 --> 28:22really takes over,
28:22 --> 28:24and it becomes very challenging
28:24 --> 28:25to think clearly,
28:25 --> 28:26and that's part of the reason why
28:26 --> 28:28it's so helpful to have someone
28:28 --> 28:30outside to be able to objectively
28:30 --> 28:32help guide you through those things.
28:32 --> 28:34Doctor Jennifer Kilkus is an
28:34 --> 28:35assistant professor of psychiatry
28:35 --> 28:38at the Yale School of Medicine.
28:38 --> 28:39If you have questions,
28:39 --> 28:41the address is cancer answers at
28:41 --> 28:44Yale.edu and past editions of the
28:44 --> 28:46program are available in audio and
28:46 --> 28:48written form at yalecancercenter.org.
28:48 --> 28:50We hope you'll join us next week to
28:50 --> 28:52learn more about the fight against
28:52 --> 28:54cancer here on Connecticut Public Radio.
28:54 --> 28:55Funding for Yale Cancer
28:55 --> 28:57Answers is provided by Smilow
28:57 --> 29:00Cancer Hospital and AstraZeneca.

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November 21, 2021

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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