The Doctor Gave Me Bad News! What do I do now?
ADJUSTING TO ILLNESS AND ACCEPTING TREATMENT
The diagnosis of a disease involves a complex set of emotional and behavioural reactions.
Being given an unexpected bad diagnosis can give rise to many questions and doubts, which are associated with several emotional reactions such as fear, anxiety, sadness, anger, among others. Some people are shocked, others have a crisis reaction. In both cases, these reactions translate into an inability to adapt to this unusual situation.
These reactions are transient. After receiving bad news, people are expected to adapt to this new reality and to a new health condition (disease) in a relatively short period of time and subsequently deal with the situation in order to normalise their emotional reactions.
However, in many cases, when there is the need to adjust to acute illness, e.g. the need for surgery and, in particular, adapting psychologically to chronic disease such as autoimmune or rheumatologic diseases, chronic pain, among others, psychological difficulties arise.
These difficulties may also depend, among other factors, on the severity and consequences of the disease as is the case with cancer and neurological diseases.
In these circumstances, the patient may have difficulty in adapting to the changes that the disease might entail; routine, work or family, among others. These difficulties can manifest themselves through a set of emotional and behavioural symptoms (the same emotional reactions previously mentioned, which are recurrent and with greater intensity) and end up interfering in the most diverse ways with the patient’s daily activities.
Over time, when these difficulties persist, particularly when there is previous vulnerability, they end up becoming worse and may even evolve into other illnesses, such as depression or anxiety and even post-traumatic stress disorder, which coexisting with the original disease, can amplify it and, in this way, compromise the patient’s psychological adjustment.
Scientific evidence has proven that the use of adaptive strategies in dealing with the psychological difficulties that may arise during and after a bad diagnosis, as well as during the treatment period, will contribute significantly to a better psychological adjustment to the disease. Therefore, providing the patient with a set of tools that will enable him/her to deal with the disease as well as the necessary treatment (medication and other procedures) will further promote the process of psychological adjustment and will have a positive impact on his wellbeing and quality of life.
Nowadays, the role of contextual psychotherapeutic intervention based on mindfulness, acceptance and commitment, including health coaching, is very important. Psychotherapy aims to facilitate the patient’s adaption to his illness through a process of acceptance and facing the situation, while focusing on the present, improving his/her health and fighting the disease.
In summary, the difficulties that arise related to the need of adjusting psychologically to illness depends on many factors, is expected and a consequence of the need to adapt to a new situation, whether it is expected or not. However, the process of adapting can be facilitated with the help of a psychoanalyst and thus patients can be helped to become more resilient in the face of adversity.
By Dr Marina Carvalho
Dr Marina Carvalho, PhD, is a specialist psychologist at Hospital de São Gonçalo, Lagos – HPA Health Group.