Psychological Model of Adjustment to Cancer

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When someone first receives the news that they have cancer, the greatest concern is usually survival. Patients often ask "am I going to die?" In younger people particularly, there is likely to be a period of shock and disbelief as implicit assumptions about invincibility are shattered. The individual then goes through a process of appraisal which will greatly influence their adjustment to the disease. As individuals make sense of their diagnosis they address three key questions: How great is the threat? What can be done about it? What is the prognosis? Moorey and Greer [9] have identified four different conclusions that people may come to about their diagnosis. These are outlined in Figure 6.1.

A person perceiving cancer as a challenge is likely to feel relatively optimistic and be more likely to engage in treatment. A perception of threat is likely to lead to anxiety. A perception that harm has already occurred may lead to hopelessness and lack of engagement in treatment. Denial of any threat may enable an individual to feel better but, if too great, could prevent engagement in treatment.

At some point after the initial threat to survival has been appraised, the wider implications of cancer and its treatment are likely to be considered and may become significant sources of

Diagnosis of cancer

Diagnosis of cancer

Challenge Threat

Harm, loss or defect Denial

Figure 6.1 The appraisal of the diagnosis of cancer. (From Cognitive Behaviour Therapy for People with Cancer (2002) by Stirling Moorey and Steven Greer, p. 12. By permission of Oxford University Press.)

Challenge Threat

Harm, loss or defect Denial

Figure 6.1 The appraisal of the diagnosis of cancer. (From Cognitive Behaviour Therapy for People with Cancer (2002) by Stirling Moorey and Steven Greer, p. 12. By permission of Oxford University Press.)

distress. Moorey and Greer have labeled the morbidity associated with disease and treatment "the threat to the self," in which they include: debilitating physical symptoms; inability to carry out former work, leisure or family roles; and disfigurement (Figure 6.2).

According to Moorey and Greer's cognitive model of adjustment, the "personal meaning of cancer," based on an idiosyncratic appraisal of the threat to survival and the threat to the self, is an important determinant of an individual's adaptation to their disease. Moorey and Greer's model helps to explain why any two individuals with the same disease may react very differently to a diagnosis of cancer. For someone who has relied heavily on their appearance for self-esteem, treatment associated with hair loss or scarring may be devastating. Someone else who

Inauthor Stirling Moorey
Figure 6.2 Negative consequences of the diagnosis of cancer. (From Cognitive Behaviour Therapy for People with Cancer (2002) by Stirling Moorey and Steven Greer, p. 15. By permission of Oxford University Press.)

has always perceived themselves to be in control of their life, may be unfazed by disfiguring surgery but find it extremely hard to live with uncertainty about potential relapse.

Psychological adjustment, based on an individual's appraisal of cancer, is associated with emotional response. Greer and Watson [10] have described five distinct styles of adjustment: fighting spirit; avoidance or denial; fatalism; helplessness and hopelessness; and anxious preoccupation. Fighting spirit is characterized by a perception that cancer is a threat to be actively challenged. It is associated with less risk of developing anxiety and depression. The helpless and hopeless adjustment style, characterized by a perception of major loss and a lack of active coping behaviors, is associated with clinical depression. An anxiously preoccupied adjustment style characterized by excessive worrying and compulsively seeking reassurance is associated with clinical anxiety [9].

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