Academic journal article International Journal of Clinical and Health Psychology

Positive Psychotherapy for Distressed Cancer Survivors: Posttraumatic Growth Facilitation Reduces Posttraumatic Stress

Academic journal article International Journal of Clinical and Health Psychology

Positive Psychotherapy for Distressed Cancer Survivors: Posttraumatic Growth Facilitation Reduces Posttraumatic Stress

Article excerpt

Severe illnesses like cancer are adverse life experiences that have a high psychological impact. Many investigations have explored the negative psychological consequences of cancer, which include fatigue, distress, depression, and posttraumatic stress (Haberkorn et al., 2013; Sheppard, Llanos, Hurtado-de-Mendoza, Tailor, & Adams-Campbell, 2013). In fact, 35%-38% of patients develop distress when diagnosed with cancer (Carlson, Waller, & Mitchell, 2012). There is also a considerable body of evidence associating this distress with poorer quality of life, less adherence to cancer treatments, and worse overall survival, as well as poorer self-care and a less healthy lifestyle (Antoni, 2012; Spiegel, 2012).

In addition to distress, a cancer diagnosis can trigger positive life changes in survivors (Ochoa, Castejon, Sumalla, & Blanco, 2013; Sawyer, Ayers, & Field, 2010; Sumalla, Ochoa, & Blanco, 2009). These positive changes have been conceptualized as posttraumatic growth (PTG) in the literature. PTG refers to positive cognitive and behavioral changes after adversity and trauma. According to the influential model of Tedeschi and Calhoun (1996), positive changes can be observed in several domains: a) self-concept (e.g., new valuation of one's own strength and resilience); b) appreciation of new possibilities in life; c) social relationships (e.g., feeling emotionally closer to others, especially family and friends); d) life philosophies (e.g., reordering of values and priorities); and e) spiritually (e.g., increased participation in religious activities).

The results of meta-analyses show that those patients with cancer who experience PTG tend to adapt to their illness more successfully, reporting better subjective physical and mental health, lower symptoms of distress and posttraumatic stress, as well as healthier behaviors and higher adherence to oncological treatments (Helgeson, Reynolds, & Tomich, 2006; Sawyer et al., 2010).

Traditionally, the focus of psychotherapy in cancer has been on stress reduction and on restoring the emotional state prior to illness. However, over the last two decades, psychology has placed greater emphasis on the positive aspects of human functioning, such as positive emotions, personal meanings, growth and strengths, which has led to the proposal of a number of successful positive psychology interventions in cancer to enhance quality of life and reduce distress (Casellas-Grau, Font, & Vives, 2014). A recent meta-analysis showed that those psychological treatments, which tend to reduce the most cancer participants' depressive symptoms were, in turn, the ones which resulted in greater benefits on their quality of life (De la Torre-Luque, Gambara, López, & Cruzado, 2016). Moreover, positive psychology interventions showed their important effects in increasing affect (Woodworth, O'Brien-Malone, Diamond, & Schüz, 2016).

In this study, we applied a program of Positive Psychotherapy for Cancer (PPC) survivors that was developed through extensive research and a review of the literature on trauma and PTG (Ochoa et al., 2013; Sumalla et al., 2009; Vázquez, Pérez-Sales, & Ochoa, 2014). The basic aim of PPC is to facilitate PTG in cancer survivors, and it was designed to complement and enhance traditional psychological treatments, such as stress management (Antoni, 2003). Therefore, PPC focuses closely on a patient's positive resources, such as positive emotions, strengths, and personal meanings (Ochoa et al., 2010; Rashid & Seligman, 2013) because its assumption is that individuals have an inherent desire for growth, fulfillment, and happiness, rather than merely seeking to avoid misery, worry, or anxiety. A substantial portion of suffering, emotional distress, and psychopathology in cancer is related to the enormous and urgent need to make positive life changes (growth), which arises after the total or partial awareness of their mortality (Ochoa & CasellasGrau, 2015). …

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