Intervention for Cancer Patients-ihj-Dr_Vajpeyi

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Intervention for Cancer Patients-ihj-Dr_Vajpeyi

  1. 1. Intervention for Cancer Patients: A Qualitative Study Dr. Laxmi Vajpeyi Babu Banarasi Das National Institute of Technology and Management LucknowThis Research Paper is a piece of a Project entitled “Intervention for Cancer Patients”, funded byUGC, New Delhi.Address: 4/549-550, Vibhav Khand, Email ID: laxmi.vajpeyi@gmail.com Gomti Nagar, Lucknow. 1
  2. 2. ABSTRACTThe present study is conducted on cancer patients suffering from breast or cervix cancer. Anintervention is also planned for the study. In pre intervention condition twenty cancer patientswere administered measures of psychological characteristics of optimism, future orientation,perceived control, symptom reporting, quality of life and coping strategies. Then those patientswere screened, who scored low on optimism, future orientation and perceived control scale andusing more maladaptive coping strategies. These patients then attended 10 intervention sessions.Intervention was scheduled for 15 days with 10 sessions. In post test intervention the counseledpatients again completed the psychological measures used in the pre test condition.The results of quantitative measures and case studies of counseling showed that cancer patientswho believe that they had control over at least some aspects of their illness were better adjustedto illness, use more active coping strategies and also plan something for near or distant futurethan the patients who do not have such beliefs. The intervention sessions indicated that thosepatients who enjoyed more social and psychological resources from their family or friends reliedmore on active coping such as positive appraisal and seeking guidance and lesson avoidancecoping, especially emotional discharge found that optimistic patients seem to cope in more activeproblem oriented way.It can be concluded on the basis of the findings of the study that psychological dispositions likehaving a sense of control, optimism and future oriented outlook along with supportive and caring 2
  3. 3. relationships enhances the tendency to effectively and actively manage a deadly chronic diseaselike cancer.KEYWORDS: Cancer, Counseling, Social support, Optimism, Coping, Intervention. Introduction Cancer is a set of more than 100 diseases that have several factors in common. Allcancers result from dysfunction in DNA is the part of the cellular programming that controls cellgrowth and reproduction. Normally DNA ensures the regular slow production of new cells but incase of this malfunctioning DNA causes excessively rapid cell growth and proliferation.Cancerous cells provide no benefit to the body, but harm severely. Uncontrollable cell divisioncauses cancer. These cells form a visible mass or tumor. This initial tumor is called the “PrimaryTumor” cells from the primary tumor can break off and lodge elsewhere in the body where theythen grow into “Secondary Tumors”. This process is called “Metastasis”. A cancer which hasspread to other organs is called “Metastatic”. Some species are more vulnerable to some cancer than others becausemany cancers are species specific. Many cancers run in families. Recent discoveries implicategenetic factors in a subset of colon cancer and breast cancer. These facts will help in assessingthe risk status of many individuals. Many things run in families beside genes including diet andother life style factors that may influence the incidence of a disease. 3
  4. 4. Ethnicity is also linked to cancer. For example, in the United States, Anglo menhave a bladed cancer rate twice that of another groups and a relatively high rate of malignantmelanoma. The prostate cancer rate among blacks is higher than the rate for any other cancer inany other group. Japanese Americans have an especially high rate of stomach cancer, whereasChinese Americans have a high rate of liver cancer. Some cancers are culturally linked throughlifestyle. The probability of development of some cancers change with socioeconomic status.Type C or cancer prone personality characteristics were also suggested by researchers studyingin the field of personality. Cancer prone personality has an individual who is easy going andacquiescent, repressing emotions that might interfere with smooth social and emotionalfunctioning. Bahnson (1981) proposed that cancer patients use particular defense mechanisms,such as denial and repression. The so called Type C or cancer prone personality has beencharacterized the muting of negative emotions and the potential for learned helplessness. Lack or loss of social support has also been proposed to affect the onset andcourse of cancer. The absence of a current social support network has been tied to a higherincidence of cancer. A substantial body of research suggests link among stress, coping andcancer, individuals who cope with stress by being acquiescent and pleasant and by repressingnegative emotions may be more likely to develop malignancies. Cancer has been tentatively tiedmore specifically to problems with social support and to stressful life events. Stress may alsoimpair DNA repair, when lymphocytes are confronted with an antigen, they typically respondwith increases in cellular DNA and subsequent proliferation. This fact suggests the importance ofthe DNA link in the development of cancer. 4
  5. 5. Thus, we can say that DNA dysfunction is the major cause of cancer. Somestudies suggest that cancers are related to many factors, like life style, social support and socio-economic status. Some researchers suggested that Characteristics of Type C or cancer pronepersonality is the cause of cancer. Cancer is the second leading cause of death. However, more than one third ofcancer victims live at least 5 years after their diagnosis, thus creating many rehabilitation issues.Cancer creates a wide variety of problems including physical disability, family and maritaldisruptions, sexual difficulties, self esteem problems, social and recreational disruptions andgeneral psychological distress. Cancer takes a substantial toll, both physically and psychologically. The physicaldifficulties usually stem from the pain and discomfort cancer can produce, particularly in theadvancing and terminal phase of illness. Difficulties also arise as a consequent of treatment.Many cancer patients also receive debilitating follow up treatments such as radiation therapy andchemotherapy. Recent work suggests that patients may also develop conditioned immunesuppression in response to repeated pairings of the hospital, staff and other stimuli with theimmunosuppressive effects of chemotherapy. Psychological problems also arise as aconsequence of cancer, which is one of the most frightening and poorly understood diseases inour country. Some researchers have mentioned that cancer patients are “Victimized” by familymembers and friends. They may be avoided and even isolated by others, whose terror about thedisease and mistaken conceptions make unable to provide badly needed social support. 5
  6. 6. Certain coping strategies appear to be helpful in dealing with the problemsrelated to cancer. Coping through social support, focusing on the positive distancing were allassociated with less emotional distress whereas cancer patients who coped with their cancerrelated problems through cognitive and behavioral escape avoidant strategies, showed moreemotional distress. In many ways coping with a diagnosis of a chronic illness is like coping withany other severely stressful event. The appraisal of a chronic disease as threatening orchallenging leads to the imitation of coping efforts. One notable point is that the copingstrategies identified have few direct action factors like planful problem solving of confrontingcoping. This may be because certain chronic illnesses in this case, cancer raise so manyuncontrollable concerns that coping strategies employed favor distraction, avoidance andemotional regulation. There is also some evidence that those who employ multiple copingstrategies cope better with the stress of chronic disease than those who engage in a predominantcoping style. People have to increase their coping skills to manage the stressful situations. Someof the coping skills are: • Ability to relax and remain calm and composed in times of stress. • Ability to understand the nature of problems and think of possible and feasible solutions. • Ability to set realistic objectives and goals and try to achieve them. • Ability to have more realistic and appropriate attitude, knowledge and change the behavior as required by the situation. 6
  7. 7. • Ability to get the help of family members and others in facing the situation or the problem. • Maintain self-esteem and take control of the situation.To develop these coping skills following suggestions can be made to patients:Introspection: Every body knows his assets and limitations, his strengths and weaknesses, hisresources in terms of knowledge, money materials. People must feel proud of their assets; theydon’t worrying about their weaknesses and limitations. People should try to improve himself andreduce their limitations. “Do not compare own self with others who are better than you”.Cultivate Relationship: Stop criticizing others, stop finding fault with others. Show respect toelders and love to the youngsters, Cultivate friendship. “Expect not too much from the familymembers, friends and colleagues, relatives.”Role Play in Proper Ways: Each one of us have to play different roles in our family, occupationand social life.“Understand the role and responsibilities and make an honest effort to fit into the role asexpected in your community.” 7
  8. 8. Resource Management: Whether it is time money, materials, every one of us have constraints.None of us have the luxury of having unlimited resources. “We have to plan, prioritize ourneeds and allot time, money and materials accordingly”.Understand problem and Situation: Before we play action or reaction to the problems, try toknow how and when problem started, who has contributed to it, what are the aggravating factorsand what could be the outcome?Positive Attitude: Be optimistic and tell yourself that you will succeed; you will be able tomanage and sail through the problems. “Keep trying and keep working.”Sharing of Failures and Frustrations: Suppressed feelings are painful and make the peopleunhappy and uncomfortable. “Ventilation helps the people to feel good and comfortable.”Relaxation: In between the busy schedule of life, every people try to find a few minutes to relax.“Look at flowers, plants, trees, birds or children and enjoy the nature’s creation.”Do Not Be Anxious about Death: Death may strikes us many time but never anxious aboutDeath because it’s not in our hands. “Be happy and comfortable with what you have.” Cancer related pain and its associated distress provide a paradigm in whichto apply Counseling schedules for general use with cancer patients and their families. Counselingis a helping process which by way of talking and discussing helps the client to find solutions and 8
  9. 9. feel comfortable. These processes have the potential to reduce isolating dysfunctional andmaladaptive responses that lead to a sense of control and of self efficacy. Increased awareness ofunexamined thoughts feelings and behaviors within the patient, family and health care teamstimulates the potential for the emergence of a true therapeutic alliance. It starts with the firstcontact of the client with the counselor. Generally counseling is done in three stages as givenbelow:First Stage: Client comes in contact with the counselor. They develop trust and rapport witheach other. The client is helped to talk about his perceived problems and his emotional reactions.He is assured of help to find solution to his problems.Second Stage: Understanding the problems, the factors which appear to be the cause, aggravateor become hurdles in finding solutions for the problems are identified and understood. Relianceand scientific explanations are worked out.Third Stage: After knowing the measures taken by the individual to solve the problem and theresults of the same, he is helped to –i. Work out both short and long term solutions.ii. Reduce the severity of problems.iii. Cope with the problems, if no solution is possible. 9
  10. 10. Thus, the main goal of counseling is the individual is encouraged to keeptrying to improve his conditions using the available resources and feel comfortable in thisongoing struggle. With this in view this study tried to counsel cancer patients to use activecoping strategies, inculcate optimism, futurity and sense of control in them. The cancer patientswere make realized through counseling that although they are afflicted with very serious diseasebut if they use their resources, e.g., family, friends etc. properly, they actively cope with theproblems arouse by the cancer and perceive quality in life. MethodParticipants 10
  11. 11. Fifty female cancer patients from Hanuman Prasad Poddar Cancer Hospital Gorakhpur, sufferingfrom breast or cervix cancer participated in the study. They were at first or second stage ofcancer. Their mean age was 51.4 years. About 90 percent of the patients were illiterate and camefrom rural middle class family background.Intervention PlanIn pre intervention condition fifty cancer patients were administered measures of psychologicalcharacteristics of optimism, future orientation, perceived control, symptom reporting and copingstrategies. Then those patients were screened, who scored low on optimism, future orientationand perceived control scale and using more maladaptive coping strategies. These patients thenattended 10 intervention sessions. Intervention was scheduled for 15 days with 10 sessionsaccording to the following scheme.Session 1: Forming a good rapport, establishing a working relationship, attempting to showinterest with her problem.Session 2: After baseline assessment of the LOT, FO, Perceived control the patient wasconvinced to take part in intervention.Session 3: Enlisting the problems in coping (psychological, social, financial and any other) andemphasis on active coping strategies.Session 4: Identification of the causes of disease and beliefs of patients.Session 5: Assessment of the impact of illness on the patient.Session 6: Focusing on optimism and perceived control.Session 7: Identifying defense/coping mechanisms. 11
  12. 12. Session 8: Suggesting alternatives/ tips for better coping.Session 9: Reinforcing/ reinstalling Hope.Session 10: Consolidation of the cognitive behavioral intervention.In post test intervention the counseled patients again completed the psychological measures usedin the pre test condition.MeasuresLife orientation test: Scheier and Carver (1985) have developed Life Orientation Test tomeasure dispositional optimism. The scale had an internal reliability of 0.76 and test-retestreliability of 0.79.Perceived Control Scale: M...Agarwal, A.K.Dalal, D.K.Agarwal and R.K. Agarwal developedthe perceived control scale. The co-efficient alpha for this scale was 0.78.Future Orientation: A variation of the technique used by Made (1972). This technique wassuccessfully adopted and used by Agarwal and Tripathi(1979) and Agarwal (1980). The formulafor calculation of proportion for future event is: Total Future Events/ Total Events. Theproportion was converted into arcsine x to get the future orientation score. The internal reliabilityof this technique was found high. 12
  13. 13. P.G.I. Health Questionnaire: Developed by Verma, Wig and Prasad (1985) this scale consistsof a total of 38 items which were related to physical and psychological distress. Reliability of thetest using retest and split half methods was 0.80 and 0.86 respectively.Coping Operation Preference Enquiry (COPE): Carver, Scheier and Weintraub (1989)developed this scale. The retest and split half reliability was found 0.71 and 0.79 respective.WHO Quality of life: In order assess the quality of life in health care settings in India, thisquestionnaire was developed by a team of researchers of World Health Organization (WHO),namely Saxena, Chandirmani and Bhargava (1998). The original long version of the scaleconsists of 100 items related to domains, like Physical Health, Psychological Health, SocialRelationships, level of Independence and Environment. The short version of the scale was usedfor the present investigation, which consists of 28 items related to four facets: physical,psychological, social, and environmental.Procedure 13
  14. 14. This study was conducted with fifty female cancer patients. The research participants wereadministered measures in the following order: Personal memorandum, Life orientation test,Future orientation test, Symptom reporting, Perceived control, Coping scales and Quality of lifeMeasures appeared in the same manner for all the participants. They were informed about thepurpose of the study. When these patients completed questionnaires they were thanked andexcused. After this baseline assessment the participants were screened and low scorerparticipants were convinced to take part in counseling sessions. All 13 low scorer participantsagreed to take part in counseling session. The detail of the 10 session was already given inresearch design section. After counseling the post intervention session was done in the samemanner as had been conducted in the pre- intervention. Results Findings of the present investigation were presented in two sections. Inthe first section the quantitative analysis was presented and in the second section the cases of thecounseled cancer patients were described.Quantitative analysis: Table 1 shows scores on all the psychological measures of all the 50cancer patients. The general findings of the study are that psychological dispositions like havinga sense of control, optimism and future oriented outlook along with supportive relationships 14
  15. 15. enhances the tendency to effectively and actively manage the chronic disease. These dispositionscan be foster in patients through interventions.Table 1 show that there were significant mean differences on optimism, perceived control,symptom reporting, my future, future orientation and quality of life in pre and post testconditions. Table 2 shows scores on different coping strategies. There were significant meandifferences on Active, Acceptance coping strategies and a significant t on Acceptance copingstrategy. There were no significant mean differences on humor and substance use andmaladaptive coping strategies.Qualitative analysis: In this section of results the cases of each counseled patient is presents.The patients were individually intervened for perceiving the brighter side of the adverse event,looking forward and plan for future and they were encouraged to perceive increased control intheir life during the intervention sessions the counselor tried to emphasize on those psychologicalcharacteristics on which individual patients had low score. Hence, each patient was counseledaccording to hr respective need. The detailed description of the counseling sessions of eachpatient is given below-Case study 1: Mrs. Nazma aged, 45 years, illiterate, house wife, is suffering from ovary cancer,diagnosed 6 months, earlier. The results of her baseline assessment showed that she was losinghope. Her way of thinking was pessimistic. She thought that nothing would be good in her way.She doesn’t want to think her future and she feels that everything in her life is uncontrollable.Then she attended 10 counseling sessions. During the counseling sessions she listens carefully tothe counselor. Now she improves herself and her way of thinking. She used active coping 15
  16. 16. strategy to reduce stress. She thought optimistically in stressful situation. She tries to thinkbrighter side of adverse rent. She understood that how thinking will determines what we feel.Now she tries to look forward. She has also improved in her perception that things are not totallyuncontrollable. All these changes are seen in post test assessment.Case study 2: Mrs. Kamrunissa, aged 50 years, a house wife, belongs to the rural area, uppermiddle class family, is suffering from uterus cancer. After baseline assessment it was found thatthe patient was low scored in optimism and personal control but she had lowest scored in futureorientation. She felt that her life is coming to an end. She had no hope for her future. She saidthat her future is in dark. Then she attended 10 counseling sessions. After attending thesesessions she shows some changes in her way of thinking. She says that evens her suffering fromthis deadly disease but is not an end of life. Now she recognizes the positive side of events andthinks optimistically. She tries to make her life beautiful in her limited resources because shethought pain is the part of life and everybody has their own pains. Now she used active copingstrategy, she believes in God and finds comfort in prayer and meditation. She had suggestionsfrom others in stressful situation. She was improved on future orientation in post test condition.Case study 3: Mrs. Dharma Devi, aged 45 years, illiterate, house wife, belongs to middle classsuffering form uterus cancer. After baseline assessment, the results indicate that even she waslow scorer in all measures but she had lowest score on coping scale. She was pessimistic and hadno hope for life. She blamed herself for all that happened to her. She accepted that in herstressful situation she criticize herself for all her troubles. She thought that she was unable tocontrol anything, which happened with her. She accepted that her future is not secure. She hadlived a very challenging life but at last her disease defeated her. Even she was surrounded with 16
  17. 17. many problems she has co-operated very much in the counseling session. She attended allcounseling sessions. Then she tries to understand that how she changes her way of thinking, hercoping patterns and how it will benefit in her treatment. She was used active coping strategy inpost test condition. She was actively coping in stressful situation. Her way of thinking isoptimistic. She assured herself to make her life peaceful until death.Case study 4: Mrs. Kamlawati Devi, aged 48 years, house wife, belongs to rural area, sufferingfrom intestine cancer. Before attending the counseling session she was pessimistic and notsatisfied with her life. She tells to the counselor that she failed in accomplishing herresponsibilities. She accepted that she doesn’t try to make situation better in stressfulcircumstances because it is not in her hand. She felt that everything is uncontrollable in her lifeand she can’t do anything, she feels very helpless. Then she attended 10 counseling sessions. Shesaid that hr family members don’t take care of her needs. She thought that her family membersare totally tired of her illness. After attending 10 counseling sessions she felt comfortable butpost test results shows that she had not improved very much.Case study 5: Mrs. Usha Shukla aged 52 years, illiterate, house wife, from rural background,suffering from intestine cancer. The pre test condition results shows that the patient scored lowon optimism, coping, personal control but she was lowest score on future orientation. Thepatient’s way of thinking is pessimistic. She has no hope for her life. She was tried with herillness. She can’t control her mental peace. She was always in stressful mind set. She can’tunderstand the cause of hr illness. In the counseling sessions she tries to understand whatcounselor wants to say. She showed much interest to improve herself. She is a god fearing personand believes in prayer and meditation. She was used adaptive coping strategy to reduce stress in 17
  18. 18. her life. She had emotional support and suggestions from others which helped her to reducestress. In post test condition the results showed that she was improved her on future orientation.Case study 6: Mrs. Manju Rai, aged 45 years, house wife, educated up to intermediate, belongsto the middle class urban family is suffering from uterus cancer. The results of the baselineassessment indicated that even the patient scored low on all measures but she had lowest scoreon personal control. The patient thought that most of things in her life are uncontrollable. Herfuture is bleak. She co-operated in counseling sessions scheduled for 15 days with 10 sessions.She catches every point very easily and she understands that everything is not peoples undercontrol. Something is uncontrollable its true but she has not to dwell with it. She is used activecoping strategy but she scored high on positive reframing subscale. After counseling she thoughtmost of things in optimistic way. She improved herself in post test condition. Many factors areresponsible for her improvement such as, she has very good family support, and she has formbelief in God, prayer and meditation.Case study7: Mrs. Kamlawati Devi, aged 62 years, illiterate, house wife, belongs to rural middleclass suffering from uterus cancer. The pre test results showed that the patient had low scored onoptimism, personal control and future orientation. She is very neutral about her future. She feelsthat future events are not in her hands. Then she attended the counseling sessions. She talkedvery freely with the counselor. She told that their family members were tired with her illness;they do not do-operate and not take care of all her needs. In counseling sessions she listened verycarefully to the counselor and tried to understand that how to change these things to make herhappy. She used adaptive coping strategy and she feels that most of the pain can be managed 18
  19. 19. with appropriate medication. In post test condition she improved on optimism and futureorientation.Case study 8: Mrs. Poonam Chauhan, 46 years, educated up to 8th, house wife, belongs to ruralmiddle class family suffering from ovary cancer. After baseline assessment the results showedthat even she scored low on all measures but she had scored lowest on coping. Her thought ispessimistic and she has no hope for her life. She lives with her problem, her illness and her pain.She doesn’t want to take any kind of support from others in stressful situations. She is usedacceptance coping strategy in the beginning of counseling sessions and she had not supported tothe counselor but after attending some counseling sessions she changed her attitude towardscounselor. She told that her Husband is unemployed and her economical condition is not good.She had regret about hospital management and staff. She feels very helpless and hopeless now.After attending counseling sessions she feel much better and in post test condition although sheimproved but because her social support system and economic condition is very weak and thiscreate hurdle in treatment.Case study 9: Mrs. Prabhawati Srivastva, aged48 years, belongs to rural middle class family,illiterate, suffering from uterus cancer. Baseline assessment data reported that the patient scoredlow on all measures but she scored lowest on optimism. She felt that her life is coming to an end.She accepted that her family supported her very much in illness, they take care of all her needseven that she feel that there is no ray of hope for her life. In stressful situation she is usingadaptive coping strategy. In post test condition she showed some changes in her way of thinking.She understood that even she is suffering from awesome disease but that is not an end of the life, 19
  20. 20. It can be managed by medication. In post test condition she showed certain changes in copingstrategies.Case study 10: Mrs. Poornima Devi, aged 50 years, house wife, illiterate and from ruralbackground suffering from uterus cancer. The pre test condition results showed that the patientwas low scored in optimism, coping, future orientation and personal control. She was notsatisfied with her life. She accepted that she don’t try to make situation better in stressfulcircumstances. She was used acceptance coping strategy. She thought that she can’t controlthings; everything in her life is uncontrollable. In counseling sessions she told that she was tiredof her illness and her family members don’t take care of her. The post test condition resultsshowed that she had not gained very much from counseling sessions but she said that she regainthe confidence that she can.Case study 11: Mrs. Gulshan Devi, 65 years, a house wife, illiterate and from urban middleclass family suffering from ovary cancer. The baseline assessment showed that the patients hadlow scores on optimism, personal control and future orientation. The patient is pessimistic andshe has no mental peace. She always felt herself in stressful mind-set and she was used adaptivecoping strategy. When she attended all counseling sessions she displayed much interest toimprove herself. In post test condition she improved because she wants so and she improved onfuture orientation.Case study 12: Mrs. Geeta Devi, 45 years, house wife, educated up to intermediate, belongs tourban middle class family suffering from uterus cancer. The baseline assessment indicated thatthe patient had low score on optimism, personal control and future orientation. She realizes that 20
  21. 21. she had not fulfilled her liabilities and this makes her restless. She felt very helpless anddependent. In the counseling sessions she catches every point very easily. In post test conditionshe restored hope.Case study 13: Mrs. Aarti Gupta, 52 years, illiterate, house wife, comes from rural upper middleclass suffering from uterus cancer. Baseline assessment showed that the patient was low scoreron optimism, personal control and future orientation. She doesn’t hope for the best in stressfulcircumstances. She felt that future events are not in her hands. Then she attended the counselingsessions and after that she showed contentment and she improved on optimism. Discussion Once a person is diagnosed as having cancer, the realization that now I haveto live with the disease, push him/her to make many compromises in life. After the diagnosis ofcancer, the patient experiences disorientation, anxiety, fear, loss of control etc. He/ she feel thatnow life is slipping of his/ her hands. At this moment many times the patient and their caretakersneed outside help to reconcile the life. Frankl (1963) argued that if illnesses were associated withthe lack of hope, then successful treatment must involve it, restoration. In the present investigation the researchers tried to restore the hope in thepatients that this is not an end of life. Although these patients do not have many years to love butthey are counseled to live their rest of life successfully, gracefully and with worth. 21
  22. 22. A substantial body of researches indicated that optimism is associatedwith psychological and physical well-being. Optimism helped to people to cope with stress andreduce risk of illness. (Carver etal, 1993; Horowitz, Adler&Kegeles, 1988; Scheier&Carver,1985). In the present study it was also observed that optimistic cancer patients think positivelyand tried to see positive aspects of the negative situation, as they also scored higher on thepositive reframing subscale of the cope questionnaire and their doctors also admitted that thesepatients co-operate in the treatment and had a better recovery. It was also found that housewomen caner patients, who scored higher on pessimism, denied the reality of the situation andreported feeling that the treatment was hopeless and their condition will not be going to improve.But when all these patients were counseled to look at the brighter side of the events, those whoalready thought of a little bit optimistically modified themselves more than those who werepessimistic. The findings of the study also showed that the support by different groups-family,friends, social groups and special support groups are important variable in fighting the diseaseslike cancer. Seligman (1991) had cited how social isolation may result in worsening of an illnessand hastening of death. During the counseling sessions, patients repeatedly said that supportfrom the family members is the key to successful recovery to the disease. The results of quantitative measures and case studies of counseling showedthat cancer patients who believe that they had control over at least some aspects of their illnesswere better adjusted to illness, use more active coping strategies and also plan something for nearor distant future than the patients who do not have such beliefs. When the illness condition wasperceived being modifiable and under one’s control, the recovery from myocardial infractionwas enhanced. (Bar-on, 1987). Having a sense of control make the patients to perceive quality in 22
  23. 23. life and judge their life satisfactory and less distress full. In the results it was also noted thatorientation towards future activities and goals was also increased. The motivational aspect offuture orientation is the anticipation of instrumental acts to attain positive and to avoid negativefuture developments. The intervention session indicated that those patients who enjoyed moresocial and psychological resources from their family or friends relied more on active coping suchas positive appraisal and seeking guidance and lesson avoidance coping, especially emotionaldischarge found that optimistic patients seem to cope in more active problem oriented way. It can be concluded on the basis of the findings of the study thatpsychological dispositions like having a sense of control, optimism and future oriented outlookalong with supportive and caring relationships enhances the tendency to effectively and activelymanage a deadly chronic disease like cancer. Although the cancer patient do not have 10 or 20years of life but an intervention programs me along with treatment regime may ensure a positivelife with quality and satisfaction and without grudge and regret. Although 10 sessions counselinghas made effective on the patients but there is a need for regular intermittent counseling of thesepatients and their family members. 23
  24. 24. References• Agarwal,A,,& Pandey,A. (1998). Coping with chronic disease: Role of Psychological Variables. Psychological Studies, 43, 58-64.• Bar-on,D. (1987). Causal attributions and the rehabilitation of myocardial infraction victims. Journal of Social and Clinical Psychology, 5, 114-122.• Chandrashekhar,C.R. (1999). A Manual on Counseling for lay counselor, Bangalore: Prasanna Counseling Center.• Dubey,A. (2003). Role of some Psychological variables in chronic illness. Unpublished doctoral dissertation. Department of psychology, D.D.U. Gorakhpur University, Gorakhpur. 24
  25. 25. • Frankl,V.E. (1963). Man’s search for meaning: An introduction to logo therapy. New York: Washington Square Press.• Horowitz, M.Adler,N.,&Kegeles,S.(1988). A scale for measuring the occurrence of Positive states of mind: A preliminary report. Psychosomatic Medicines, 50,477-483.• Kaplan,G.A.,&Reynolds,P.(1988). Depression and Cancer morality and morbidity: Prospective evidence from the Alameda County, Study. Journal of Behavioral Medicins, 11, 1-3.• Kapoor, N., Ahmed, H., &Ahmed, C.S91987). Psychological trait analysis of Cancer patients. Journal of Personality and Clinical Studies, 3, 75-80.• Lazarus, R.S. (1993), Coping Theory and Research Past, Present and Future. Psychosomatic Medicine, 55,234-237.• Mishra,M.&Agarwal,A.(2003).Coping and satisfaction with life in working women. In A.Agarwal&A.K.Saxena (Eds.) Psychological Perspective in Environmental and developmental issues. New Delhi: Concept.• Reed,G.m,.Kemeny,M.E.,Taylor,S.E.,Wang,H.V.J.,&Visscher,B.R. (1994). Realistic acceptance as a predictor of deceased survival time in gay man with AIDS. Health Psychology, 13, 299-307.• Scheier,M.F.,&Carver,C.S.(1985). Optimism, coping and health: Assessment and experiences, Health Psychology, 4,214-247.• World Health Organization (1968-69). Cancer around the world: World health statistics annual. Geneva: World Health Organization. 25
  26. 26. Table 1.1Scores of cancer patients on psychological measures before and after CBT interventions Measures Pre- Post Intervention t Intervention Optimism 24.7 (2.80) 28.3 (4.69) 2.12* Perceived Control 19.3 (1.84) 21.6 (2.91) 2.13* Future Orientation 7.51 (1.69) 10.89 (1.80) 2.12* My future 49.2 (1.41) 54.6 (1.73) 2.08* Symptom Reporting 9.3 (1.69) 9.6 (1.80) 1.64 26 Quality of life 22.5 (3.68) 26.7 (3.28) 2.27*
  27. 27. Table 1.2Means and SDs of scores on the measures of coping strategiesCoping Strategies Pre- Post-Intervention t 27
  28. 28. InterventionActive Coping 18.3 (3.60) 22.4 (3.74) 2.12*Acceptance Coping 17.2 (3.60) 22.8 (1.91) 2.07*Maladaptive Coping 16.3 (2.39) 12.3 (1.74) 2.12*Note: **p<.01, *p<.05. 28

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