Mark D. Gilbert, MD,

Director, Mind-Body Medicine Skills Group Program,

University Arizona Health Network,

Associate Director, Psychosocial Oncology and Director of Professional Development, Arizona Cancer Center;

Associate Professor of Clinical Psychiatry,

University of Arizona

‘Choosing the Path Less Traveled….’

Resilience, Optimism and Hope in Cancer Survivorship

Compassion means to be intensely together with those who suffer.

The point of this attentive presence with a patient is not on curing or fixing a problem – instead, it is simply being in the moment.

Compassion welcomes and provides sanctuary for all that is unpredictable, imperfect, incomplete, awkward, pinched and unspoken.

BurnoutA debilitating psychological condition brought about by unrelieved work stress, resulting in:

• Depleted energy and emotional exhaustion

• Lowered resistance to illness

• Increased depersonalization in interpersonal relationships (patients become numbers)

• Increased dissatisfaction and pessimism

Increased absenteeism and work inefficiency

Education

- Illness

- MBM

-Stress

- Imagery

- Spirituality

- Forgiveness

- Hope

- Nutrition

- Humor

- Cognitive

Restructuring

- Emotional

Awareness

- Sleep Hygiene

- Movement

Awareness

- CAM

Relaxation Techniques

Autogenic Training

Meditation

- focusing

- mindfulness

- movement

Biofeedback

Guided Imagery

Music and Sound

Genograms

Life Maps

Spirit Boxes

CBT exercises

Journaling

Eating Meditation

YogaFacilitator lead Talking Circle

Resilience in the EyeResponsibility – Attitude – Awareness Purpose – Empowerment- Connection

PNI of Resilience, Optimism and Hope

strong social bonds

DHEA Cortisol Hb1ac Hardiness Positive Emotional Granularity Switching Cognitive Set

Hippocampal Volume and HPA axisChildhood trauma

Stress InoculationCRH 1 and CRH 2

Locus Ceruleus and NENPY

COMTGalanin

SerotoninDopamine

Neural Reward CircuitryActin-Polymerization Protein (APP)

cAMP response element binding proteinBrain-derived neurotropic actor (BDNF)

Fear=learning and extinction of amygdala response

The Tree on Resilience Mountain –Other Contributions

Emotional Development

Resilience, Optimism and Hope

Optimism

optimists believe that discrepancies between their goals and their current attainment will be resolved- minimizing depression, anger and shame

PNI of Resilience, Optimism and Hope

Hope as a noun (there is always hope), a verb (I hope) an adjective (hopeful) and an adverb (hopefully)

With cancer hope of a cure or prolonged survival, and in terminal illness hope defined as a struggle to come to terms with the multiple losses in a changing reality

hiding or distorting the truth is not hope-engendering;hope best engineered through honesty and empathy by framing hope in a wider context (relationships, belief, control, dignity, inner peace, humor, meaningful events, achievable treatment goals - Clayton)

Hope

Emotional Life as a Cancer Survivor FEAR (RECURRENCE AND FUTURE TESTS AND TREATMENTS e.g. THE AVASTIN STORY)

SEPARATION

RE-ENTRY

FEELING REMNANTS

ROLE CHANGE

NEW PERSPECTIVES

RENEWED RELATIONSHIPS

RENEWED PURPOSE

SYMPTOMS (PAIN, FATIGUE, BRAIN FOG, INFERTILITY, SEX)

Living as a Cancer Survivor

The 10 Choices that will Determine Which Road The Survivor Will Take