Emotional suffering is often stronger than physical pain - patients experience intense fear, helplessness, lack of a clear perspective

Author: Center for Psychological Support at Lozenets University Hospital

Breast cancer is the most common oncological disease among women, and an oncological diagnosis is a powerful source of distress and is perceived as a message of death. The emotional state of those diagnosed covers a wide range of experiences - from the usual feelings of sadness and vulnerability to depression, anxiety and social isolation and many others, and this interferes with treatment, coping with physical symptoms and the traumatic aspects of the disease. Accepting the diagnosis is a complex process that includes many conscious and unconscious reactions. Some of them are forms of psychological defense that hinder the process of not only grieving, but also awareness.

Although distress is considered understandable, it often remains hidden and unaffected by medical teams. To a large extent, the reason is related to the strictly individual way in which each person shows their emotions or has access to them themselves. Numerous significant studies in recent years confirm that individual coping models during treatment affect not only the patient's quality of life, but also the prognosis of the disease.

In this regard, psychological counseling is of key importance for the rational and emotional integration of the disease. It helps patients express their fears, grieve for the loss of health and restore their emotional balance. For over 20 years, Lozenets University Hospital has been applying an effective comprehensive approach to the treatment of patients, combining psychological care and support. The hospital has established a procedure for referring patients with breast cancer for consultation with a psychologist upon admission. The medical staff is informed and appreciates the role and importance of psychological support, along with drug treatment.

Consultation with a clinical psychologist in life-threatening operations and conditions is considered an equal part of the care and treatment of every patient at Lozenets Hospital. The clinical psychologist takes care of psychological support and emotional coping with the disease and provides a protected space for sharing difficult-to-name experiences, fears and expectations that cannot be spoken in front of loved ones.

Usually, patients understand the disease, but they feel strong fear and experience a sense of loss of control associated with the threat to life, immense helplessness and lack of a clear perspective. Breast cancer and the effects of medical treatment have a traumatic effect on the psyche, negatively affecting the usual stereotype and quality of life. In most patients, surgical interventions provoke fears of losing femininity, disrupting interactions with the partner and sexual relations. Cancer treatment affects fertility and may cause premature menopause.

All these consequences are perceived ambiguously by the psyche. On the one hand, they are life-saving interventions, and on the other, they change the appearance and affect the self-image. Patients begin to experience lowered self-esteem, a feeling of disability and an inability to return to their usual life. There is a fear of regret or concerns that they will not be accepted for work. Some share a strong sense of guilt that they are a burden to their loved ones. Their anxiety increases and they often develop depressive states, which affect the motivation to cope and the successful outcome of the disease.

Emotional suffering is often stronger than physical pain and is partly independent of the stage and prognosis of the disease. It is unconsciously associated with all old traumatic experiences, with unsurpassed losses and the feeling of loneliness. The role of the psychologist is to help ventilate, react and share current worries and fears, as well as everything traumatic in the personal history.

Some patients have the idea that cancer is a driving force to rearrange their life priorities in a new way. Promises of significant change and focus on better self-care are often shared.

Clinical experience shows us that patients go through different phases of motivation regarding psychological counseling. Initially, it helps patients to move through fears and negative emotions of anger and denial. It plays the role of a safe space in which some of the automatic mental barriers can retreat.

Some patients refuse consultation due to very intense fears. Others demonstrate cheerfulness and a positive attitude. They face the unknown seemingly calmly and deny fears by emphasizing control and strict adherence to medical recommendations. This refusal to comment on fears and the diagnosis is a defense that can serve the patient well if it protects against anxiety or depression without interfering with the implementation of treatment. For others, the denial of the topic of the disease is an obstacle to the implementation of subsequent treatment, and some of them do not even perceive themselves as sick.

In women with metastases, a tendency to focus on different topics is noticeable. They often embark on researching periods of their lives in order to discover the reasons for the return of the disease. A tendency to self-blame and fixation on some specific reason, which is interpreted as the main problem, is noted. Excessive psychologization in a large number of cases is an expression of depressive suffering and non-acceptance of a number of facts from external reality. A key point at this stage of the disease is to monitor the patient for suicidal risk.

Monitoring the patient's affective state by the clinical psychologist is of utmost importance for effective partnership in the treatment process. An interdisciplinary approach is a necessary condition for planning interventions that are beneficial to the patients in the long term. Depending on the personality characteristics, the specifics of the disease and the stage of the disease, it is precisely psychological and consultative work that is an essential element of the overall care for the patients. Working with a psychologist supports and enables the integrated acceptance of the diagnosis and therapy, the naming of the most painful aspects related to cancer, the processing of traumatic contents and the building of balanced expectations and plans for the future.