Although many people associate post-traumatic stress disorder (PTSD) with veterans returning from war or victims of violent crimes, PTSD can occur in anyone who has had a life-threatening experience—including patients who have experienced cancer. PTSD is a mental condition that can be caused by any major trauma, such as being seriously injured or seeing someone die. PTSD causes a person to have negative thoughts and feelings that affect daily life long after the trauma has passed.
About 5% of cancer patients have PTSD. Cancer patients are more likely to develop cancer-related PTSD if they are young, are diagnosed with advanced disease, or go through invasive treatments such as surgery. PTSD is also more likely to develop in cancer patients who do not have enough social support or have had PTSD or other psychological conditions before. Fortunately, help is available for patients with PTSD.
“Cancer is not an easy thing to go through, treatment is not an easy thing to go through, and dealing with PTSD, stress, depression, or any of those things is certainly not an easy thing to go through,” said Catherine Powers-James, Ph.D., a psychologist in the Integrative Medicine Program at The University of Texas MD Anderson Cancer Center. “But you don’t have to do it alone.”
People with PTSD may have the following symptoms:
- persistent, unwanted memories, nightmares, or flashbacks about the trauma;
- an urge to avoid situations related to the trauma;
- negative changes in thinking or mood; and
- irritability or aggression, excessive alertness, being easily startled, risky or destructive behavior, difficulty concentrating, and/or difficulty sleeping.
In people with PTSD, these symptoms last longer than a month, cause distress or interfere with daily life, and are not due to a cause other than the trauma. A diagnosis of PTSD can be confirmed only by a mental health care provider such as a psychiatrist or a psychologist.
For people with symptoms of PTSD, the National Center for PTSD suggests some first steps toward a diagnosis at http://bit.ly/2JbU6GQ, and a PTSD screening tool from the Anxiety and Depression Association of America can be found at http://bit.ly/2ucDsBg. At MD Anderson, psychologists in the Integrative Medicine Program can diagnose PTSD.
Fortunately, therapy can help relieve the symptoms of PTSD. The most effective treatments for PTSD are prolonged exposure therapy and cognitive processing therapy. In prolonged exposure therapy, patients are gradually and safely exposed to the sources of their trauma, both through the imagination and in reality. In cognitive processing therapy, patients talk about their traumatic experience and identify troubling thoughts related to the trauma. These troubling thoughts often include safety concerns and issues related to trust, power and control, esteem, and intimacy.
“One of the big issues with PTSD is that people will try to avoid what reminds them of the trauma, but they start to generalize, so all of a sudden they’re avoiding a lot of things in their lives,” Dr. Powers-James said. “Cognitive processing therapy and exposure therapy help to eliminate some of that avoidance.”
In another form of PTSD therapy, called expressive writing, patients write about their traumatic experiences during therapy sessions. And for some patients with PTSD, antidepressants may be appropriate.
Advice on finding a therapist who can treat PTSD is available on the National Center for PTSD Web site at http://bit.ly/2KKBQ8U.
Better mental health after cancer
Many cancer survivors report positive psychological changes, such as better relationships, more passion, or a greater appreciation for life. This outcome, called post-traumatic growth, can be a goal for cancer patients undergoing therapy for mental health issues. Post-traumatic growth can be encouraged by reflecting on the traumatic experience, finding a restored sense of safety, writing in a journal, envisioning life after trauma, and acknowledging the negative and figuring out how it has led to growth. This growth also can be nurtured by connecting with others or sharing one’s story.
“Post-traumatic growth is a gradual process,” Dr. Powers-James said. “Even if you’re currently experiencing PTSD or another psychological issue, there are resources out there to help you, and hopefully we can get you to that other side where you feel that you’re living a better, healthier lifestyle than you were before.”
For more information, ask your physician, contact the Integrative Medicine Program at 713-794-4700, or visit www.mdanderson.org.
OncoLog, August 2018, Volume 63, Issue 8