Academic journal article Journal of Cognitive Psychotherapy

Coping with Life-Threatening Illness: A Cognitive Therapy Perspective

Academic journal article Journal of Cognitive Psychotherapy

Coping with Life-Threatening Illness: A Cognitive Therapy Perspective

Article excerpt

For years, behavioral scientists have been examining the process of coping with life-threatening illnesses. In fact, much of the work in this area has been influenced by cognitive-behavioral theories (e.g., Lazarus & Folkman, 1984). The purpose of this article is to apply Beck's model of cognitive therapy to coping, to discuss specific cognitive processes related to life-threatening illnesses, and to suggest specific interventions appropriate for individuals diagnosed with life-threatening illnesses. AIDS, cancer, and myocardial infarction are discussed in terms of the emotional reactions they may produce (e.g., anxiety, depression, and anger). Cognitive processes related to these emotions are examined and cognitive therapy techniques are suggested for helping individuals with maladaptive emotional and behavioral coping responses.

A life-threatening illness can be defined as any disease or physiologic process that endangers an individual's biological existence. Multiple factors determine the life-threatening potential of an illness, including the type and stage of disease, the availability of effective treatment, compliance with treatment, and the patient's general health. While some illnesses are almost invariably lifethreatening (e.g., pancreatic cancer and AIDS), most serious illnesses vary greatly in their threat to life (e.g., myocardial infarction and prostate cancer).

In this article the cognitive processes involved in coping with life-threatening illnesses are discussed. Cognitive therapy is offered as an approach to counseling persons with life-threatening illnesses. Three specific diseases are highlighted: acquired immune deficiency syndrome (AIDS), cancer, and myocardial infarction. Heart disease and cancer are the leading causes of death in the United States, while AIDS is perceived by many to be the most frightening and deadly disease.

REVIEW OF LITERATURE

There is substantial variability across individuals in how they cope with lifethreatening illnesses. While some experience severe depression or anxiety in response to a life-threatening illness, most individuals ultimately adapt effectively. In fact, Stanton and Snider (1993) report that "the psychosocial functioning of cancer patients differs little from that of disease-free controls over the long run" (p. 16).

Lazarus and Folkman (1984) in their classic text explain that individuals' coping styles are determined by their cognitive appraisals. Negative appraisals might involve threat or loss, e.g., "I'm not ready to die." "My family will suffer without me." In contrast, positive appraisals might involve hope and determination e.g., "My time has come." "I'm ready for whatever comes next." "I'll fight this illness as best I can." Individuals' cognitive appraisals are influenced by personal and situational variables, e.g., age and family structure. For example, younger cancer patients experience significantly more emotional distress than older patients (Stanton & Snider, 1993).

Acquired Immune Deficiency Syndrome (AIDS)

An individual diagnosed with AIDS may be at risk for psychological problems and crises, including depression, suicidal ideation or attempts, anxiety, and somatic complaints (Kelly & Murphy, 1992). Cote, Biggar, and Dannenberg (1992) found that persons with AIDS had suicide rates that were "7.4-fold higher than among demographically similar men in the general population" (p. 2066). Catania, Turner, Choi, and Coates (1992) used the term "death anxiety" to describe the emotional discomfort associated with thoughts of death or dying from AIDS. These authors, like others, report that emotional responses to AIDS are related to premorbid psychological functioning, as well as the course and severity of the disease.

In a recent article, Liese (1993) described the process of coping with AIDS from the perspective of cognitive therapy. He suggested that a diagnosis of AIDS serves as a "critical incident" which activates the patient's basic beliefs about himself, his personal world, and his future. …

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