One of the urgent problems of contemporary psychological practice is assistance to patients in overcoming the traumatic situation associated with the statement of an oncological diagnosis. As a disease, cancer does not threaten the psyche or personality of a person, but the adoption of the diagnosis entails the onset of a personal crisis, can become a serious stress load, and lead to post-traumatic stress disorder. An uncertain or unfavourable prognosis of the course of cancer aggravates the patient’s condition. Factors affecting the degree of injury to cancer patients were identified as follows: age, nature of tumors localization, disease stages, used methods of treatment, somatic state, degree of psychological compensation, and personality traits. Experiences of physical and psychological discomfort during the crisis inevitably lead to changes in the personality of the cancer patient. The main objective and subjective manifestations of this kind of change were determined: asthenia, anxiety-depressive states, fears, character and pathological reactions, deprivation of goal setting, change in self-esteem, decrease in personality activity, the frustration of basic human needs and meaning of life, leading to an existential crisis, violation of social contacts and change of behavioral stereotypes.
Keywords. Psychotrauma, oncopsychological study, cancer, cancer patient, personality crisis
The review of contemporary studies in the field of oncopsychology confirms the existence of specific conditions for preventing (overcoming) psychodrama during oncodiagnosis statement, which allows for establishing target guidelines for overcoming the traumatic situation in cancer patients (Balatskayaa, 2020; Gapova & Danchenko, 2020).
The number of people with cancer grows annually, and their average life expectancy rises due to the development of contemporary medical care in the field of oncology; therefore, attention to this category of people increases on the part of not only the professional medical community but society as a whole (Ulybina & Volkova, 2021).
Scientists have established that cancer itself does not threaten the psyche of a person or personality, but the adoption of the diagnosis and attitude toward it entails the onset of a personal crisis (Kolosova, 2017). Diagnosis and cancer treatment can significantly impact the patient's physical, psychological, social, and existential well-being. Cancer in clinical psychology is considered an example of an extreme and crisis situation: the detection of oncopathology in a patient can become a serious stress load and lead to post-traumatic stress disorder (Zagoskina et al., 2017; Balatskaya, 2020). Moreover, in the case of an oncological disease, not only the cancer patient suffers but also his closest social environment.
When studying the consequences of cancer on the human psyche, most scientists are based on the theory of post-traumatic stress disorder (Frolova, 2007; Gapova & Danchenko, 2020; Ivashkina et al., 2020). The cancer patient's life is characterized by a sharp change in the social situation of development, restriction of the type of activity leading to age, social deprivation and isolation, changes in the family structure, and frustration with the need for independence. Prolonged hospitalization is associated with a change in psychological indicators, such as anxiety, self-esteem, level of claims, motives and reactions, and ways of experiencing communicative and emotional difficulties (Shchepanovskaya, 2018).
Experiencing physical and psychological discomfort and the course of a life crisis in a person with cancer inevitably leads to personal changes (Vagaitseva, 2015; Yankova, 2015). Personal traumatization of a patient with cancer has the following specific objective and subjective manifestations:
Difficulties or deprivation of a person’s long-term goals, a decrease in personality activity, and frustration with basic human needs and the meaning of life (Gapova & Danchenko, 2020; Holt, 2015).
Existential crisis: solving existential problems can lead to both positive (spiritual growth) and negative (spiritual decline) personality transformations (Bourdon, 2017).
Various fears: fear of amputation, disability, loss of social connections, fear of neglect by society, social isolation (Gapova & Danchenko, 2020), fears of cancer recurrence and spread (Mehnert et al., 2013; Holt, 2015), fear of death; the appearance of these fears can cause a significant disruption of social functioning and affect the well-being and quality of life.
Distortion of microsocial and behavioral stereotypes due to the patient’s long stay in medical institutions (Gapova & Danchenko, 2020).
Pessimism, asthenia, depression, somaticized, aggressive reactions, and high risk of suicide after diagnosis statement.
A change in self-esteem and attitude towards own effectiveness reflects the subjective idea about oneself in a situation of changing opportunities (Shiryaev & Vasilyeva, 2016).
Scientists distinguish risk factors that greatly affect the degree of traumatization among patients having an oncological diagnosis.
It was noted that young age is a factor that increases the risk of personal injuries. In comparison with adults, children do not have enough experience to constructively express emotions; in addition, they do not understand what is happening to them, do not always have enough information about the disease, and cannot describe the spectrum of their own feelings and experiences, do not have enough resources to cope with feelings, caused by the disease, with emotional tension, overcome the sense of mental discomfort - their traumatization will occur to a greater extent (Dmitrieva, 2022).
Tumor Localization Pattern
In patients with non-localized diseases (for example, malignant lymphomas), the acceptance of the disease is increased in duration, and the denial of the disease is also more pronounced compared to patients with localized tumors (Poroshina et al., 2017).
The Stage of the Course of the Disease
The lower the spread stage of the disease, the higher the likelihood of partial or complete rehabilitation, a prognosis is more favorable, and a lesser degree of personal trauma occurs (Gapova & Danchenko, 2020). The regularities of the psychological trauma degree by stages of treatment are also highlighted: the strongest - at the diagnostic stage, post-operative stage: asthenia, resource exhaustion, hypochondria, the formation of an inferiority complex during a crippling operation - all this leads to psychological trauma (Shiryaev, 2016).
For example, with chemotherapy treatment, patients have a lower level of emotional stress and anxiety than with the transplant method (Hain, 2015). The level of psychological trauma is lower in patients who have the option of choosing a treatment method (therapeutic, surgical).
The level of experiencing trauma is higher in patients feeling physiological manifestations of the disease. The determining role in the trauma caused by the disease is the presence of postoperative stoma in the patient (Khain, 2015), emotional instability forms in this category of persons; there is a decrease in self-esteem, an increase in the level of auto-aggression, social maladaptation (Semke et al., 2008). Due to the increase in the duration of emotional acceptance of the disease in patients with non-localized diseases (for example, malignant lymphomas), they have a greater degree of disease denial compared to patients with localized tumors, which entails an increased risk of injury (Poroshina et al., 2017).
The Degree of Psychological Compensation and the Use of Constructive Coping Strategies
Among the coping strategies, the following can be distinguished as situationally used: Flight-avoidance, positive reassessment, planning a solution to the problem, distancing; and strategies not correlated with the situation: Self-control, search for social support, confrontation, and taking responsibility (Alexandrova, 2019).
Awareness of the Disease and the Depth and Validity of Knowledge about the Disease
The degree of traumatization of the personality is determined by the oncopatient’s assessment of the disease severity. In this case, the severity must be considered in two aspects - objective and subjective. Objective severity (due to the complexity of quantifying the severity of the disease, scientists are invited to give an objective assessment based on the criteria of mortality, probability of disability, and loss of ability to continue usual life). Subjective severity is an “internal picture of the disease” the concept of the disease, nosology, reflects the patient’s ideas about the disease at three levels: cognitive - knowledge about the disease, methods of treatment, forecasts of recovery, etc., relational - processing information regarding their unique situation, awareness of own emotions; and behavioral - formation based on the above behavioral patterns reflecting coping behavior (Zinchenko et al., 2014).
The Characteristic Features, Personality Traits, and the Actual Personality Type of the Patient
These are highlighted on the basis of studying the accentuations of his character (Grigorieva & Chalov, 2015). Patients of an anxiety type (according to the classification of A.E. Lichko) are extremely vulnerable; they show excessive suspicion and concern about the course of the disease, methods of treatment, the competence of the attending physician, and the adequacy of his effects. Patients with cycloid accentuation respond most adequately to the disease. Psychasthenics demonstrate the greatest intensity of experiences, which affects the appearance of secondary somatic symptoms. Persons with schizoid accentuation are most susceptible to self-isolation; those with epileptoid accentuation are more likely than others to manifest aggression and suicidal behavior (Gnezdilov, 1996).
The attitude of Personality to Disease
At the same time, a maladaptive type of response to the disease and, accordingly, a high degree of trauma is recorded in the presence of semantic emptiness, a negative assessment of the present moment of life, a narrowing of the future perspective, as well as a violation of the goal-setting function of the self-determination process (Sotnikov, 2015).
Relation to Disease in the Reference Group (social factor)
A high level of psychological stress is associated with such characteristics of the cancer patient as disability (due to the narrowing of the spectrum of social ties of the patient, deterioration of the financial situation), the absence of a spouse/spouse (the partner often encourages the patient to seek medical or psychological assistance) (Holm et al., 2013).
When adapting to a difficult life situation, both subjective assessments (how the patient perceives it) and objective circumstances that help or prevent adaptation are important. The purpose of psychological support for the oncopatient in adapting to the disease is to improve the quality of life (at any stage of the disease): ensuring physical and psychological comfort, overcoming deprivation of communication, and satisfying the spiritual needs of the patient (Alexandrova, 2019).
A review of contemporary studies in the field of oncopsychology confirms the existence of current conditions for preventing (overcoming) psychotrauma during oncodiagnosis. They are as follows.
Orientation to personal merits and positive personal resources of the patient. Important is the system of the patient’s ideas about cancer, reactions to the disease throughout the entire period of the disease, and the possibilities of adaptation to the disease (Sharova, 2017). The situation of cancer is associated with a personal crisis; when effectively overcoming it, life priorities, goals, and existential problems are reassessed, positive personal changes entail the emergence of new meanings, and positive changes in the patient’s personality can also cause, for example, post-traumatic growth (Costa et al., 2016).
Optimization of disease response types, change in non-constructive attitude to disease, maladaptive type of disease response, adaptation to disease, and increased motivation for treatment and recovery (Zinchenko et al., 2014).
Inclusion in communication with the patient in a social environment, which consists in expressing sympathy, being close by, support from family and friends, from the staff manifested in honesty, presentation of available information, positivity and sympathy, participation of the patient in meetings of support groups (Richardson et al., 2019).
Changes in society in attitudes towards cancer and social stereotypes regarding malignant tumors are broadcast by society, and attitudes toward oncological diseases have developed in specific socio-cultural conditions (Ulybina & Volkova, 2021).
Honest accessibility informs the patient about the diagnosis, disease, and prognosis of recovery already at the diagnostic stage, finding opportunities for the patient to actively discuss the effectiveness of treatment (Vagaitseva, 2015). At the same time, it is important to determine the strategy for informing the patient about the diagnosis - solving the ethical issue (Usmanova et al., 2015).
Training patients in the use of constructive coping strategies and decreasing the level of alexithymia, the situation associated with cancer is a manifestation of extreme stress level, and personal resources are activated, which helps the patient reorient himself in the application of coping strategies (Sharova, 2017).
Reducing the level of social frustration, maintaining the patient’s integration into family and social life, realizing the need to maintain social status and professional functions, and returning to the usual way of life (Balatskaya, 2020).
Taking into account correctional and preventive goals, it is possible to outline the main guidelines for overcoming the traumatic situation by means of psychological assistance to cancer patients:
Ensuring the collaboration of medical structures, psychological services, and society, in the course of support of cancer patients, from the diagnostic stage.
Individualization of psychological support routes for cancer patients.
Popularization among the population of modern scientific studies on effective methods of treating cancer, and progressive developments in this area.
Overcoming social stigma toward cancer patients by eradicating stereotypes about personal guilt in the occurrence of the disease, its infectiousness, and social and personal inferiority of cancer patients.
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