December 19, 2011

In these days of promising cancer vaccines, we may want to start thinking of resiliency as a vaccine against chronic posttraumatic stress disorder (PTSD) in our patients.

Defined by respected psychologist Donald Meichenbaum as "the capacity of people to effectively cope… adjust… [and] recover from stress or adversity," resiliency is the personality’s shock absorber, offering strength and perspective even in the face of profoundly challenging life events.

Dr. Meichenbaum, a prominent cognitive behavioralist and PTSD specialist, frequently quotes Helen Keller on resiliency: "Although the world is full of suffering, it is also full of overcoming it."

In a recent webinar sponsored by the Glendon Association, Dr. Meichenbaum and Dr. Lisa Firestone spoke of the vast human capacity for resiliency, but also signs of its absence in vulnerable individuals.

Oncologists and other professionals who work with cancer patients are in an excellent position to identify such signals very early on, identifying and referring patients in need of a resiliency booster to thwart PTSD before it takes hold.  

As mentioned in last week’s Vitality Signs column, cancer patients commonly exhibit signs and symptoms of posttraumatic stress disorder (PTSD), even if they do not meet full DSM-IV diagnostic criteria for the condition. A sizeable group of survivors – conservatively estimated at 4% to 6% – do not resiliently "bounce back." Their PTSD becomes chronic, with important ramifications for their adherence, restoration of function and emotional well-being, and will to live.

My sense is that the psychological characteristics of resilient individuals come through in their narrative stories, even as they answer the proverbial, "How’s it going?" question asked during brief medical visits.

Dr. Meichenbaum, research director and cofounder of the Melissa Institute for Violence Prevention and Treatment identifies signs of resiliency as:

• The ability to hold on to positive emotions (realistic optimism, humor, self confidence) to regulate strong negative emotions.

• Adoption of a task-oriented coping style. Resilient patients actively seek social support. They find role models and control their environments as best they can, based on the circumstances.

• Cognitive flexibility, including use of adaptive problem-solving skills and the ability to identify benefits in one’s situation.

• Desire to find meaning, purpose, and a "mission" arising from one’s experience.

• Evidence of self-care. Resilient people exercise, follow routines, and avoid behaviors that confer risk or undermine physical health.

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