Behavioral Intervention in Comprehensive Cancer Care
William H. Redd
Ruttenberg Cancer Center, Mount Sinai Medical Center
Mofitt Cancer Center & Research Institute
Cancer and its treatment adversely affect almost every aspect of a person's life. Indeed, there are few things more dreaded than being diagnosed with cancer. Although severe psychiatric reactions are relatively infrequent among cancer patients, significant adjustment problems and disorders are common. Indeed, over one-half of those treated for the disease experience fear, pain, insomnia, and related anxiety disorders (Derogatis, Morrow, & Fetting, 1983). A major advance in efforts to reduce such cancer-related distress has been the application of behavioral principles.
In this chapter, we discuss the application of behavioral principles in the design of psychosocial interventions with adult and pediatric cancer patients. The chapter is presented in four distinct sections. The first section reviews basic principles of behavioral intervention in the context of cancer treatment. The aim of that overview is to lay the foundation for the discussion of specific interventions. The second and third sections examine behavioral intervention with adults and children, respectively. It is important to note that the foci of clinical research with each of these two groups are quite different, each reflecting the problems that are encountered most frequently. Intervention research with adult patients has focused on symptom control and psychological adjustment, whereas the pediatric work has been broader. That work has examined methods to reduce pain and distress as well as issues surrounding treatment compliance and parents' impact on children's adjustment. These differences are reflected in the specific organization used in the adult and pediatric sections. The final section of the chapter considers future directions for clinical research.
The cognitive-behavioral perspective is based on the postulate that patient reactions to cancer and its treatment are a function of the context (i.e., social setting) under which the individual is diagnosed and treated, the social contingencies that operate, as well as his/her prior history and his/her individual strengths and weaknesses. Cognitive factors (e.g., beliefs, attitudes, and expectations) are also seen as playing a role (Turk, Meichenbaum, & Genest, 1983). Each of these factors is considered in the design and implementation of psychosocial interventions. The aim of such cognitive- behavioral intervention (the term that is most frequently used to identify this approach to clinical care) is to identify and then modify those factors (i.e., social feelings, and behaviors) that contribute to the development and maintenance of symptom. As the name implies, the cognitive- behavioral perspective incorporates both behavioral and cognitive approaches to psychosocial change. Reflecting its behavioral origins, the cognitive-behavioral perspective uses techniques for behavior change derived from the principles of operant conditioning (Skinner, 1953) and respondent conditioning (Pavlov, 1927).