Psycho-Social and Sexual Health: Balancing Acceptance and Change

Psycho-social and Sexual HealthBalancing Acceptance and Change

Andrea Bradford, Ph.D.Department of Gynecologic Oncology and Reproductive Medicine

Fear of recurrence

Sadness/depression

Grief and identity

Family member risk

Personal appearance

Cancer stigma

Personal relationships

Faith/spirituality

0%10%

20%30%

40%50%

60%70%

80%90%

100%

A lot

A little

Not at all

Percentage of Cancer Survivors WhoExperienced Emotional Concerns (n = 3129)

Source: Livestrong Foundation, 2010

Fatigue

Sexual dysfunction

Sleep disturbance

Neurologic symptoms

Urinary dysfunction

Bowel problems

Memory problems

Depression

Anxiety

Leg swelling/lymphedema

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Percentage of Gynecologic Cancer Survivors with Symptoms During or After Treatment (n = 1029)

Westin S, et al. Journal of Cancer Survivorship (2015)

Managing Symptoms:Balancing Acceptance and Change

Acceptance Change

FatalismUnnecessary lifestyle adjustmentHopelessnessPessimism/cynicism

Managing Symptoms:Balancing Acceptance and Change

Acceptance Change

AnxietyFrustration/disappointment

Losing contact with the present

Managing Symptoms:Balancing Acceptance and Change

Acceptance Change

Open, non-judgmental awarenessLiving according to values, goals

Careful choice of interventions based on evidence

Non-judgmental awareness

• Avoidance is only a temporary solution

• Thoughts and feelings come and go; what we do in response determines our outcome

The Struggle Is Part of the Problem

The Struggle Is Part of the Problem

The Struggle Is Part of the Problem

Can you notice your thoughts and feelings of discomfort, and make room for them, without letting them distract you from the task?

Can you stay in the task by distracting yourself from thoughts and feelings of discomfort while thinking about something positive instead?

Gutierrez et al., Behavior Therapy 2004;35:767-783

• Avoidance is only a temporary solution

• Thoughts and feelings come and go; what we do in response determines our outcome

• Interpretations and judgments shape our realities

The Struggle Is Part of the Problem

Be Here Now:An Exercise

• Mindfulness meditation/practice

• “Time outs” for noticing, feeling, grounding in the present

• Forge a different relationship with your thoughts

Developing the Here-and-Now Mindset

• Brief mindfulness-based sex therapy improves sexual function for women, including cancer survivors

• Mindfulness associated with greater arousability and higher rates of orgasm in women

Mindfulness and Sexual Function

Living according to values

A Purposeful Life

• Values are guideposts for actions and decisions

• Values can be attributes we aspire to – not achievements

• Values aren’t things we can “do” but they are qualities of ongoing action

A Purposeful Life

• Honesty

• Compassion

• Family

• Intellectual challenge

• Faith in God

• Fun

• Meaningful work

• Adventure

• Appreciation of nature

• Helping others

A Purposeful Life

• Example: Attending an anniversary party

A Purposeful Life

• Example: Lovemaking

Putting It All Together

• Acceptance and commitment therapy (ACT) shows promise as an intervention to improve emotional adjustment and quality of life

• ACT has been tested in at least one group of women with advanced ovarian cancer

Baseline Session 4 Session 8 Session 1250

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Acceptance and Commitment Therapy Versus Conventional Cognitive-Behavioral Therapy in

Women with Advanced Ovarian Cancer

ACTConventional

FACT

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Rost et al., Cognitive and Behavioral Practice 2012;19:508-517

Baseline Session 4 Session 8 Session 120

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Acceptance and Commitment Therapy Versus Conventional Cognitive-Behavioral Therapy in

Women with Advanced Ovarian Cancer

ACTConventional

BAI A

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vera

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Rost et al., Cognitive and Behavioral Practice 2012;19:508-517

Baseline Session 4 Session 8 Session 120

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10

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Acceptance and Commitment Therapy Versus Conventional Cognitive-Behavioral Therapy in

Women with Advanced Ovarian Cancer

ACTConventional

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Rost et al., Cognitive and Behavioral Practice 2012;19:508-517

Choosing treatments based on evidence

• Does this treatment work better than a placebo for most people?

• What are the possible side effects?

• How can this treatment help me to do the things that are important to me?

Critical Questions

• Physical activity (esp. aerobic exercise)Fatigue, sexual dysfunction

• Cognitive behavioral therapy (including ACT) Insomnia, pain, sexual dysfunction, depression, anxiety

• Self-help/self-management

Beyond Medications:Lesser Used Interventions that Work!

• Common in ovarian cancer survivors, esp. if taking aromatase inhibitors

• It’s not “all in your head”

• Major cause of loss of interest in sex

• Many providers are not aware of optimal treatment

A Word About Painful Sex

Avoidance of physical

contact

Separation/ isolation

Loss of intimacy

Negative feelings

Sexual problem

• Fully commit

• Use reminder systems, diaries, and other tools as recommended

• Judge the effectiveness of a treatment based on the outcomes that are important to you

Trying New Treatments forSymptoms and Side Effects

• Breakthrough symptoms/flare ups

• Tolerance or reduced efficacy of treatment

• When nothing seems to work

• When nothing seems to matter

Have a Plan for…

• Expertise in psychosocial and sexual adjustment after cancer may be hard to find

• “You’ll just have to live with it” is not acceptable

Asking for Help

• Expertise in psychosocial and sexual adjustment after cancer may be hard to find

• “You’ll just have to live with it” is not acceptable

Asking for Support

“Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

Viktor Frankl, M.D., Ph.D.

For more information:

Andrea Bradford, Ph.D.

(713) 756-4466

abradford@mdanderson.org