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شخص يمسك حبلا مطاطيا للدلالة على المرونة النفسية

How Can We Learn to Practice Psychological Resilience?

Article: Dr. Zena Marwan Al Sharbati –  Senior Specialist (A) Clinical Psychology

Management of Gynaecological Cancers across the continuum of care – Part 6

This is the sixth of a series of several articles intended to increase awareness about cancers of the female genital tract and their management. Management of cancer can be seen across the continuum of care, from prevention, early detection, diagnosis, treatment and symptom management through survivorship. This article deals with the management of symptom related to Gynaecological Cancers using psychological resilience

Gynecological cancers have been increasingly seen as a public health concern due to several factors which are linked to the global rise in the incidence rates, the late presentation of the disease, and the high number of relapses.  Additionally, the unique nature of the disease itself involving the most intimate female organs put an additional psychological burden on these women. This, in itself, could be perceived by many women as extremely overwhelming and traumatic (Beesley et al., 2019; Grassi et al., 2000)1. Some authors have suggested that having cancer in female organs is socially stigmatized as it is most likely associated with negative public perceptions in how they got the disease (i.e., unsafe sexual practices). Additionally, there exist negative public perceptions of the consequences of cancer treatment which includes sexual dysfunction (Korean Society of Gynecologic Oncology, 20202; Holland, Kelly & Weinberger, 2010)3. Thus, women with gynecologic cancer suffer from the cancer stigma (see article on “Cancer is not a Stigma” in the SQCCCRC Website), and the stigma of being diagnosed with a female cancer (Korean Society of Gynecologic Oncology, 2020; Holland et al., 2010).

Consequently, more clinical attention has been shed on the concept of resilience, its psychological applications, and mechanisms in influencing the psychological and behavioural outcomes of women with gynecologic cancers. Psychological resilience is a complex concept and has heterogenous definitions and conceptualizations. However, the American Psychological Association (APA) has defined psychological resilience as the “process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors” (APA, 2014)4.  Therefore, it is pivotal that we remind ourselves that resilience is a process which takes time and resources to build within us. Moreover, it is critical that we take a mental note that resilience does NOT mean that we do not experience unhelpful feelings or that we do not go through hard times.  On the contrary, going through challenging times is key to developing resilience and new meanings to stressful experiences.

Some studies have been conducted to explore how resilience can help in the psychological adaptation of women with gynecological cancers (Gu et al., 2020; Manne et al.,2015)5. For example, Manne et al. (2015)6 explored the ways in which resilience can positively affect the quality of life among women with cancer. Main study findings indicated that it was through three main mechanisms that resilience improved these women’s quality of life: the expression of positive emotions, sense of meaning of life, and finally the cognitive restructuring of the cancer experience itself. Gu et al., (2020)7 also explored whether the relationship between the Fear of Progression of the disease and quality of life can be influenced by resilience. He and colleagues found that resilience mediates the relationship between these two variables.

According to what has been discussed earlier, the burning question is how can we learn to practice resilience and how we can hone this skill? Dr. Amit Sood suggested that we need to pay attention to our mindset. He specifically highlighted five mindsets that are important to develop the skill of resilience. These mindsets include gratitude, compassion, acceptance, meaning, and forgiveness. Gratitude could also be considered a skill that we need to practice on a daily basis. How? Try to write one thing that you are grateful for every day, and then compile those things and put them in a gratitude jar. Compassion refers to an attitude of kindness that you will have towards yourself and others. It could be a kind way in looking at people, or as simple as reassuring yourself that things will be okay at the end. You can even try to give yourself a hug. Yes, it can be funny, but it is an effective tool to increase self-compassion. Acceptance is a process in which you engage in a self-reflective process to accept situations that you have no control of (you do not have to agree or approve these situations). Meaning, another powerful mindset in which you try to utilize your spiritual and religious background to add meaning to events in your life which do not make (human) sense. You do not necessarily have to come up with the meaning of all events in your life! The last mindset that will be discussed in this article is forgiveness. As with other psychological skills, this is also a process which may take some time for people to develop. It is about letting go of your shoulders and other cognitive rules and accepting that the event had happened, and it is in the past now. What could be helpful in this process is to remind yourself that you need to be peaceful, calm, and to have fun, which could be mainly achieved by letting go of grudges. Think about it, life is too short.

References:

  1. American Psychological Association. The road to resilience. Washington, DC: American Psychological Association; 2014. Retrieved from http://www.apa.org/helpcenter/road-resilience.aspx.
  2. Beesley, V. L., Alemayehu, C., & Webb, P. M. (2019). A systematic literature review of trials of survivorship interventions for women with gynecological cancer and their caregivers. European journal of cancer care, 28(3), e13057. https://doi.org/10.1111/ecc.13057
  3. Holland JC, Kelly BJ, Weinberger MI. Why psychosocial care is difficult to integrate into routine cancer care: stigma is the elephant in the room. J Nat Compr Cancer Netw. 2010;8:362–366.
  4. Korean Society of Gynecologic Oncology . Gynecologic Oncology. Seoul: KOONJA; 2020.
  5. Mayo Clinic Guide to Stress-Free Living; Mayo Clinic Handbook for Happiness; Immerse – A 52-Week Course in Resilient Living.
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