CBT Benefits Cancer Patients' Mental Health and Treatment Adherence
Sofia Chernoff, PsyD, MSEd, discussed how cognitive behavioral therapy helps cancer patients manage emotional challenges by modifying negative thoughts and behaviors.
Sofia Chernoff, PsyD, MSEd
Cognitive behavioral therapy (CBT) offers significant benefits for patients with cancer by addressing the emotional and psychological challenges that often accompany a diagnosis and its treatment. Unlike therapies that focus solely on emotions, CBT operates on the principle that thoughts and behaviors significantly influence feelings. By learning to identify and modify negative or unhelpful thought patterns and behaviors, patients can experience improvements in their emotional well-being.1,2
CBT can be delivered in individual therapy sessions, group therapy, or even through online platforms. The duration and intensity of therapy are tailored to the individual needs of the patient. Oncology professionals can integrate basic CBT principles into their practice or refer patients to licensed cognitive behavioral therapists or counselors with experience in working with cancer patients. The goal is to empower patients to become active managers of their emotional states throughout their cancer journey.
In an interview with Targeted OncologyTM, Sofia Chernoff, PsyD, MSEd, clinical health psychologist, educator, and supervisor overseeing training initiatives and clinical services as Beck Institute’s Director of CBT Programs, discussed CBT’s particular benefits for patients with cancer and how health care providers can help to improve patients’ quality of life with these principles.
Targeted OncologyTM: What is CBT, and how does it work?
Chernoff: The way that I think about this, it’s a type of talk therapy. There are so many different types of talk therapy out there, but we would consider it to be a specific modality of psychotherapy with its own theory and its own sort of practice.
CBT was developed in 1960s by Aaron T. Beck at University of Pennsylvania. It was really a groundbreaking sort of new therapy, and it became one of the most empirically studied therapies. At this point, is pretty much supported for any sort of condition that there is out there.
Cognitive behavior therapy is based on what we call the cognitive model. And if we really want simplify this, it's basically this idea that people's emotional and behavioral reactions—how we think, how we how we feel, and how we behave—is really based on our thoughts. If I were to put it in a different way, you will always understand why people feel the way that they do and how they act if you know what they're thinking.
When we’re thinking about cancer diagnosis and [patients] dealing with treatment, everybody who is going through this really difficult experience will have different sorts of reactions. Some of the [patients] will be shocked; they will be upset. But then they really overcome the challenges. They're optimistic. They connect with their care team; they are connecting with their loved ones and people in their community. They're thriving despite all of these difficult circumstances. And then there are some other [patients] that fall apart. They become depressed, they become anxious, they're extremely stressed out, and they're not coping well. From our perspective, the difference between these groups is how they're thinking about this, how they're processing this, and what they believe about themselves and their future.
In cognitive behavioral therapy, we will look at those patterns of thoughts and look at those patterns of emotions and behaviors, and we're going to try to teach folks to, first of all, pause, step back, evaluate what's happening, and see if any sort of adjustments might be helpful. And if so, we will teach them skills that will be specific to how to make those adjustments.
Where does CBT fall in the timeline of cancer treatment?
I’ve worked in interdisciplinary care for a very long time, in oncology settings, in teen settings, in primary care settings, and other medical settings where a psychologist was needed, and the initial reaction that providers might have is, “[Patient] got a diagnosis. Let's get them with a mental health provider or psychologist.” And I would actually argue that at that point in time, at the very beginning, the patient really just needs a supportive, validating person, right? Somebody to just listen to them and hold their hand for this, right? So that's not the right time for CBT, at least from my perspective.
Now, once they actually get into treatment? They really are starting to face so many different challenges. First of all, treatment can be so incredibly overwhelming to [patients] and so incredibly stressful, between the time management, the appointments, trying to understand things. Then when folks are starting to really grapple [with what the future] could look like. There's a lot of fear. There might be some traumatic responses. Once we start getting to that cancer care and beyond, this is where CBT can be incredibly helpful, both with emotional and psychological responses that [patients] might have that are not ideal, but also with some of the physical symptoms. There [can be] so much pain [with] cancer treatment, [and] insomnia, sleep difficulties, things like fatigue, sexual problems. Problems that [patients] will really encounter, and CBT is very well equipped, and it's actually very well studied to be helpful with those specific problems as well. What I would say is that starting CBT relatively early in treatment and continuing throughout the treatment in even in the months and years after treatment is where really the sweet spot lies.
Do you see CBT working in conjunction with any other forms of psychological support throughout the treatment and posttreatment phases?
Absolutely. My personal experience as a professional in the field is that the more interdisciplinary approaches that we have, the more attention that we give to the [patient], the better individualized it is, the better it's going to be. When we're thinking about specific other approaches, most of my patients are treated with medication, whether they are medications for stress, SSRIs for depression or anxiety—there are certainly a lot of things that medication can help with. There are fantastic support groups out there that create a sense of community and provides that validation and sense of belonging.
What I would say, also, is that frequently those medications and support groups are simply not sufficient. You need some goal-oriented, evidence-based treatment to really make sure that [patients] are living a higher quality of life and addressing that clinical depression, clinical anxiety, insomnia, pain, fatigue, anger, whatever it may be. Some of my clients started using substances or alcohol to cope in their best way possible with a difficult situation. My point is that a lot of modalities that are out there and are critically used in [patients with cancer] and very much go well together with CBT, but they might not be sufficient.
What would be your advice or takeaways for health care providers?
First of all, what I would absolutely love is for health professionals to be a little bit more aware of CBT and some of the fantastic outcomes that it has that might be specific for their patients. I think that so many folks might have heard of CBT but really don't understand how applicable it can be and how it can really improve the lives of [patients] that they treat. So really having a basic understanding of what CBT is and what the research around CBT is might be helpful and being comfortable introducing it to their patients. They also might benefit from having a couple of good referrals up their sleeves, because once the patients are interested, they're going to say, “Well, where do I find this sort of treatment?”
Beyond that, I think that there's so much early-stage fantastic research out there that is popping up that says that not only mental health providers can deliver CBT, but really health care providers [in general] can deliver CBT, and with as much efficacy in a much briefer format. Maybe see how you can incorporate CBT principles in your own work. It might be a conversation that lasts 2 minutes but could be so incredibly beneficial to the patients specific to how they're thinking about their diagnosis and their treatment. That can be incredibly helpful in improving adherence to treatment and diagnosing these barriers that the patients might be struggling with but have difficulty talking about or revealing to their health care providers.
If I were to summarize this a couple of key points: know about CBT, don't be afraid to get trained and deliver a little bit of treatment on your own, and make sure that you continue working with the interdisciplinary team as much as possible for in order to provide really good treatment for patients.
Training in CBT doesn't have to be this thing. You don't have to get a different degree. It can be quick, as much as 1 or 2 hours [of training]. And CBT tools that our health care providers can use are very much adjusted for their specific setting and role, so they don't have to take on the role of a therapist or psychologist to deliver good care.
