Cancer as Trauma

DSM-IV

-life threatening illness = trigger for PTSD

Characteristics of Cancer as Trauma

-numerous potential stressors

-diagnosis, prognosis, treatment

-internal sources of trauma

-symptoms, self evaluation, blame

-uncertain future (worry)

When looking at cancer as trauma, consider...

-type of cancer, prognosis

-objective severity vs. perceived severity

-type/duration of treatment

-time since diagnosis/treatment

-timing of onset in lifespan

-history of cancer in family

Impact on Children

-children with cancer don't go through same developmental stages as other kids

-develop trust w/ others/CG

-develop sense of autonomy

-develop initiative and morality

-develop identity

risk factors for children

-age (older)

-race (minority)

-gender (boys)

-poverty (not good health care)

-single parents

impact on parents

-psychological stress, marital strain

-burden of responsibility and guilt

-insurance, employment issues

-isolation from social networks

-make crucial medical decisions

-communicating with children

potential moderators are...

-socioeconomic status

-religion

-social support

**mothers engage in more CG and distress

impact on siblings

-different treatment from parents

-may result in resentment/jealousy

-usually siblings grow closer

family adaptive processes

(protective factors impt for family outcome)

-resources ($, social, emotional support)

-perceptions and outlook

-good communication

-family processes

-adaptation, balance

-reorganize fam life

family adaptive processes

(2 phases)

-acute phase

-more support and help

-"conspiracy of silence"

-chronic phase

-balance patient needs with needs 

of other fam members

-resume normal routines

-lower support from extended fam

chronic illness family model

-change family life to accommodate illness

-focus on "here & now"

-lose focus on prior priorities

-major shifts/changes in roles and routines

factors that lead to unbalanced family functioning

-over involvement of fam members

-over protection

-rigid transactional patterns

-denial/avoidant coping

factors associated with post traumatic growth

-situation specific

-must rebuild beliefs, views about world

-attachment style (secure v. insecure)

anticipatory grief

grief that ppl experience when the start coping with death of close one. 

(when gparents start getting old, grieve their losses)

partial grief

when lose certain parts of role that person had in your life

(ex: when gma moves into nursing home, no more sunday dinners)

even in absence of chronic illness, the person's family may begin...

-spending more time with individual

-plan for end of life care

-help relatives plan for life w/o family member

impact of death on family

-family ties extend beyond death

-death represents:

-loss of memories, history, shared

past

-loss of future plans and interactions

-sense of presence that after death

may be more meaningful

death of parent

-change in sense of self

-child (esp daughters)

-relationships

-loss of natural buffer and support

-child's marital relationship impacted negatively (esp if parent had significant role in fam)

death of parent:

poorer adaptation for...

-younger adults

-daughters

-death of 1st parent

-those with higher edu and income

-when deceased is mother

for caregivers...

-heavy v. light caregiving

-more see caregiving as more difficult than death of loved one

-CG improve in mental health more rapidly in year after death than non CG

old ppl and death

-experience more deaths of ppl close to them

-go to more funerals

-talk and think more abt death

-have more 'brushes' w/ death

grief manifestations

-physical

-loss of sleep

-change in appetite

-psychosomatic complaints

-psychological

-nightmares/dreams

-self destructive thoughts/behaviors

-guilt, anxiety, self blame, sad

kubler-ross's stages

(stage theory)

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

rando's 6 R processes

(stage theory)

1. recognize the loss

2. react to seperation

3. recollect and reexamine the deceased and the relationship

4. relinquish old attachments to deceased and the assumptive world

5. readjust, move back into world, don't forget dead

6. reinvest

Worden

(task based models)

-acknowledge reality of loss

-adjust to environment where deceased is absent

-loosen ties to deceased

dual-process

(task based model)

-loss orientation and restoration

-direct coping not required

tasks of grief for kids

-age appropriate understanding of death

-meaning making around death 

-coping with feelings about death

-commemorating loved ones life 

-moving on (need support)

-children dont grieve in same way as adults

factors that affect coping

-timing and concurrent stressors

-fxn/position of deceased

-relationship with deceased

-family factors, resources vulnerabilites

traumatic grief

-suddenness

-preventable v. random

-violence, mutilation, destruction

-unpleasant encounters with deceased

-multiple deaths

-personal threat of death

-specific types of death

when grief is problematic

-lasting loss of interest in life

-intense anger/hostility

-poor judgement

-upsetting memories that influence daily life

-difficulty acknowledging death

-long term efforts to avoid reminders of dead

-becoming overly active/happy w/o experiencing sense of loss

-efforts to deny death

-develop severe physical manifestations

ambiguous loss

-most traumatizing loss

-a loss that has no verification. unclear and irresolvable, thus w/o closure

-loss can be physical/psychological, but status as absent or present, dead/alive is unclear

2 types of ambiguous loss

1. leaving w/o goodbye (physical absence w/ psychological presence)

2. goodbye w/o leaving (psychological absence with physical presence)

traumatic loss

loss that is sudden, unexpected, unanticipated, and outside realm of whats normal

-horror, helpessness, loss of control

world is dangerous

complicated grief

grief thats compounded by factors leading up to the loss, or that is otherwise difficult to manage in ongoing way

(death of child, death of someone you hate, death of pet)

Guidelines for intervention:

finding meaning

-naming the problem

-normalizing

-spirituality, forgiveness

-rituals

-seeing suffering as part of life

guidelines for intervention:

tempering mastery

-recognize world isnt always fair and just

-decrease blame, soften blame

-externalize blame

-mastering internal self and emotions

guidelines for intervention:

reconstructing identity

-redefine family boundaries

-learning about family secrets

-talk about things that are taboo

guidelines for intervention:

normalizing ambivalence

-conflicted feelings are normal

-guilt and anger are normal

guidelines for intervention:

revising attachment

-develop rituals to grieve what was lost and celebrate memories

-build new human connections

guidelines for intervention:

discovering hope

-finding spirituality

-learn to laugh at absurdity

-find forgiveness

factors that risk difficult transition of fam member being deployed

-history of rigid coping styles

-family dysfunciton

-young families

-families recently moved to new duty station

-foreign born spouse

-fam with young kids

-fam w/o unit affiliation

-pregnancy

predeployment

-training

-wills, power of attorney

-immunizations

-screenings, evaluations

predeployment family

-anticipatory grief

-maybe periods of anger and protest

-emotional detachment

top concerns while deployed:

the deployed person

1. manage bills and income

2. ability to communicate w/ partner

3. housework

4. death/injury

top concerns while deployed:

partner

1. housework

2. ability to communicate with partner

3. bills and income

4. death/injury

the cycle of military

-predeployment

-deployment

-sustainment

-reunion

-reintegration

prevalence of mental illness

-1/5 develop at some point

-75 million children have one

-rates of mental illness decline as age and education increase

DSM-IV:

Axis 1

clinical disorders, including major mental disorders as well as developmental and learning disorders

DSM-IV:

Axis II

DSM IV:

Axis III

DSM IV:

Axis IV

DSM-IV:

Axis V

phases of disastor

predisastor

-warning, threat

impact

heroic

honeymoon

-community cohesion

dissillustionment

-lowest period of time

reconstruction