Narrative Therapy to Prevent Illness-Related Stress Disorder

Abstract

Cancer strikes more than 47% of males and 38% of females (Landis, Murry, Bolden, & Wingo, 1998) during their lifetimes. People are living longer (American Cancer Society, 2000) but not necessarily more satisfactory lives in the posttreatment period (Baum & Posluszny, 2001; Kangas, Henry, & Bryant, 2002). Mortality rates from cancer are decreasing to the point that the American Cancer Society has now considered certain cancers chronic rather than acute illnesses. With an expected life span of many years, attention has turned to the impact of the event in the posttreatment phase. Cancer patients experience heightened anxiety just prior to the completion of treatment as they prepare to transition from the medical system monitoring their health to monitoring it themselves (Eakes, Rakfal, Keel, & Gaiser, 1996; Kaasa et al., 1993; Tjemsland, Soreide, & Malt, 1996a, 1996b). Anxiety rises again after the completion of treatment due to the fear of recurrence (Andrykowski, Cordova, McGrath, Sloan, & Kenady, 2000; Hampton & Frombach, 2000; Mundy et al., 2000). Research has found that approximately 13% of cancer patients experience symptoms of posttraumatic stress disorder (PTSD) in the posttreatment phase of cancer recovery, and 46% experience subclinical signs of distress. Subclinical signs mean that the person is experiencing considerable distress but the distress has not reached the level of a clinical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994). More than 94% of cancer patients report that the experience was the most traumatic event they have ever experienced (Andrykowski et al., 2000; Baum & Posluszny, 2001; Kangas et al., 2002). There is no doubt that cancer is a traumatic stressor and that there is a paucity of interventions to assist patients with long-term reactions (Kangas et al., 2002; Solomon & Johnson, 2002). Adjustment to living with or having had cancer is multidimensional, involving emotional, cognitive, behavioral, physical, and social features (Stanton, Collins, & Sworowski, 2001). Emotional components include depression and anxiety; cognitive components include a sense of foreshortened future, the inability to concentrate, preoccupation, and appraisals of the illness and oneself; behavioral demands include role fulfillment or changes and meeting the demands of the illness; social components involve personal relationships, social comparisons, support, and the stigma of cancer, for example, discrimination in the workforce due to being a medical risk; and, finally, existential components include reevaluation of the meaning and purpose of one's life and setting priorities accordingly (Stanton et al., 2001). Although considered multifaceted, the types of interventions offered cancer patients include education, social support groups, and psychoeducational groups on effective coping and problem solving (F. I. Fawzy, Fawzy, & Canada, 2001; Scheier & Carver, 2001). The predominant therapies used in cancer interventions are the cognitive and behavioral approaches. These approaches are symptom focused; identify factors related to a particular problem; and attempt to modify the factors that cause or maintain the problem, specifically the social environment, thoughts, and feelings (Redd & Jacobsen, 2001). These approaches have been found to be highly effective with compliance (Richardson, Shelton, Krailo, & Levine, 1990), coping (Blanchard, Toseland, & McCallion, 1996; N. W. Fawzy, 1996), symptom control (Burish, Snyder, & Jenkins, 1991; Cain, Kohorn, Quinlan, Latimer, & Schwartz, 1986; Decker, Cline-Elsen, & Gallagher, 1992; Spiegel & Bloom, 1983), and increasing a sense of control (Baider, Uziely, & Kaplan De-Nour, 1994; F. I. Fawzy et al., 1990; Watson, Greer, Pruyn, & Van den Borne, 1990). They also fit well within the medical system's philosophy of identifying and treating what is wrong now. …