Cancer is a reality that each of us, more or less directly, found itself crossing.
It can be something that paralyzes, sometimes annihilated, which seriously risks threatening identity; The path you usually face can upset the life of the person directly interested and also of those around them, not only on a physical but also psychological level.
In the collective imagination, cancer continues to be associated with physical and psychic suffering, anguish, helplessness, death (Costantini, Grassi and Biondi, 1998). After a diagnosis of cancer, whatever it is, certainly everything changes meaning: family, social and professional relationships, the relationship with one’s body, its values, the meanings attributed to suffering and death.
In the face of these changes, a strong and constant state of confusion, a sense of impotence, imbalance and loneliness, all often aggravated by the reactions of relatives and friends, in most cases frightened and not prepared to face the new situation, can be generated.
The oncological population is actually subject to a high psychopathological risk, since it is found to face situations to say the least stressful such as diagnosis, debilitation, in many cases the mutilation due to surgery, aggressive therapies; Without forgetting the state of dependence that can be generated, forced removal or not from one’s life environment and, last but not least, the risk of death.
The oncological patient therefore needs to be treated in all aspects of his pathology; It is appropriate to take care of the psychological correlates that the disease inevitably brings with it, all the paths that can lead to the improvement of the quality of life of patients must be pursued, circumscribing the risk of psychopathological effects that could aggravate the clinical picture.
Psychology in this way is increasingly determined to assume a relevant role in assisting patients with cancer. The numerous research in this area investigate, in addition to the presence of psychological disorders and the level of quality of life, also information strategies, psychological support techniques and social support models.
In particular, in the context of cognitive-behavioral psychotherapy, psychological support takes on an important role to manage the stressful events resulting from the disease, to contain the emotional factors, the psychological reactions of the patient who could negatively influence the course of the physical disease itself and the effectiveness of the care themselves.
Since the secondary psychic discomfort to oncological pathologies invests about half of patients and a third of family members, it is assumed that psychoncology, or psychology and psychotherapy applied to cancer, assumes a central role.
According to some research, emotional stress and its management could be in relation to the incidence of cancer and to its emotional states, especially the extreme and chronic ones could influence the physiological aspects and coping skills. It is therefore important to investigate the possible physiological effects of stress on the progression of the disease so as to develop and evaluate new treatments.
The diagnosis and cancer treatment triggers emotions such as anxiety, fear, sadness and anguish; It is precisely the management of them, which represents a non -marginal problem for patients, but at the same time provides an important therapeutic opportunity.
Psychological therapies assist the oncological patient in every phase of the disease, the psychological dimensions are caught by the diagnosis at the end of the treatment. These interventions are intended to decrease the feelings of alienation, isolation, impotence, feeling overlooked in the oncological patient.
Through treatment we try to reduce anxiety, to clarify perceptions and incorrect information that can sometimes be dangerous; People are helping to feel less inept and disheartened, encouraging them to acquire greater responsibility and response ability to medical treatments.
In the face of the growing awareness of these problems associated with such a serious illness and its treatment, a variety of supportive interventions for patients and family members has developed. These therapies have positive psychological and physiological effects.
Their effectiveness depends on the training and ability of the therapist, the latter’s relationship with patients, nature and the content of the intervention, the main objectives and the expected results.
The literature on this focuses on four main types of interventions, all inserted within the vast panorama of cognitive-behavioral psychotherapy:
- Behavioral therapy (includes relaxation and biofeedback);
- Psychoeducation (includes training in coping skills and provides information so as to increase the patient’s sense of control);
- Cognitive psychotherapy
- Support groups (people help to express their emotions).
Psychotherapy does not represent alternative therapy, but an important tool to relieve the psychological suffering of patients and family members determined by the disease.
The group in oncology, in particular the one of the type supportiveseems to have greater clinical effectiveness than individual interventions; It is certainly not possible to deny that it better the capacity for reaction to the disease by observing the methods of reaction of the members of the group. The latter becomes the context of sharing and analysis of common obstacles, developing a sense of universality that relieves the feeling of solitude and helplessness.
This intervention proposes as a focal area the meaning of interpersonal relations, considered as a driving force of the group and focal area of the intervention; It contrasts the feelings of helplessness and uselessness by helping each other between members; It improves the ability to communicate and emotional expression both in the here and time of the group and in the external reality.
Participating in group therapy allows comparisons with difficult aspects of such an experience, a comparison capable of directing the growth of patients’ skills in citing their own death fears, better management of symptoms and reconstruction of priorities. Such a therapy encourages participants to take on an active role in their treatment, to feel free to ask questions, to open up to others and to reduce the sense of isolation and misunderstanding.
Many participants establish deep bonds of friendship, finding themselves outside the group. Together they can share, take part in the construction of a new sense of self, new priorities and responsibilities, the reconstruction of communication lines with important people.
Within these groups, the subjects find a space in which they can deal with painful and delicate issues, which probably outside that context would avoid dealing, such as the meaning of the disease, the famous “Why me?!”; In such a place their fears and anxieties can be explored and perhaps managed.
In summary, the purpose of such a group is to create an environment where patients receive support from others and express feelings and ideas at full speed, exchange information and experiences, there is support for personal problems. The group performs the function of container of all these anxieties.
The groups can also be open or closed (they start and end together) and more or less numerous depending on the type of intervention. Some studies on group therapies with patients who have already expressed the disease have shown that the group improves adaptation to the disease.
It seems that short (12-16 sessions) and structured cognitive behavioral therapy improve adaptation in patients in the initial disease phase. Those who are already in an advanced phase of the disease benefit from group treatments without a time defined a priori, unstructured and based on an interaction between the members. The usefulness of the individual groups seems to be significantly correlated to the therapist’s objective and the technique and style of conduction consequently chosen.
Another theme to be addressed in this area concerns the formation of the therapist. He should have a good experience in group therapy, as well as in working with oncological patients, being able to establish significant relationships, manage the strong reactions that could unleash themselves, face suffering.
It must be able to maintain its role even if sometimes it would be useful to cross the boundaries, to be emotionally present, to possess “a mind capable of moving and being surprised” (Neri, 2002), helping the group to do the same.
In addition to the psychological changes, some research have considered some biological changes as results of group interventions or even there have been studies that have tried to highlight their effects on the survival of patients with cancer. The consequences of a group intervention in terms of quality of life, psychological discouragement, coping skills, immune functions and survival time (Hosaka and Al., 2001) were assessed.
In Italy something is moving in this sense, but we are still at the beginning, a long way is still to be traveled, few centers have developed group psychotherapy programs. It is thus important to encourage the active import of group therapies in Italy, adapting them to reality, Italian culture since, looking at literature on the matter, it is not possible to deny that groups protect patients from continuous stress, provide the opportunity to give and receive support, to express their thoughts and feelings relating to how it is to live with such a disease.
Considering the psychological aspects of the disease, the psychophysical health of the patient is protected which can feel equipped to better face one’s illness.
In the face of such a scenario, all you can do is welcome the important contribution given by group-behavioral cognitive psychotherapy to oncological patients in a critical moment of their lives.
Psychoncology will have to integrate medical treatments, will have to make its resources available, promoting a global vision of the pathology, in which a mutual influence between psyche and soma dominates.
