‘Choosing the Path Less Traveled….’
Resilience, Optimism and Hope in Cancer Survivorship
Mark D. Gilbert, MD,
Director, Mind-Body Medicine Skills Group Program,
University Arizona Health Network,
Associate Director, Psychosocial Oncology and Director of Professional
Development, Arizona Cancer Center;
Associate Professor of Clinical Psychiatry,
University of Arizona
Compassion means to be intensely together
with those who suffer.
The point of this attentive presence with a
patient is not on curing or fixing a problem –
instead, it is simply being in the moment.
Compassion welcomes and provides
sanctuary for all that is unpredictable,
imperfect, incomplete, awkward, pinched and
unspoken.
Burnout
A debilitating psychological condition brought
about by unrelieved work stress, resulting in:
• Depleted energy and emotional exhaustion
• Lowered resistance to illness
• Increased depersonalization in interpersonal
relationships (patients become numbers)
• Increased dissatisfaction and pessimism
 Increased absenteeism and work inefficiency
Education
Relaxation Techniques
Autogenic Training
Meditation
Resilience in the Eye
Responsibility – Attitude – Awareness
Purpose – Empowerment- Connection
- Illness
- MBM
-Stress
- focusing
- Imagery
- mindfulness
- Spirituality
- movement
- Forgiveness
Biofeedback
- Hope
Guided Imagery
- Nutrition
Music and Sound
- Humor
Genograms
- Cognitive
Life Maps
Restructuring
Spirit Boxes
- Emotional
CBT exercises
Journaling
Eating Meditation
Yoga
Awareness
Facilitator lead Talking Circle
- Sleep Hygiene
- Movement
Awareness
- CAM
PNI of Resilience, Optimism and Hope
strong social bonds
DHEA
Cortisol
Hb1ac
Hardiness
Positive Emotional Granularity
Switching Cognitive Set
Hippocampal Volume and HPA axis
Childhood trauma
Stress Inoculation
CRH 1 and CRH 2
Locus Ceruleus and NE
NPY
COMT
Galanin
Serotonin
Dopamine
Neural Reward Circuitry
Actin-Polymerization Protein (APP)
cAMP response element binding protein
Brain-derived neurotropic actor (BDNF)
Fear=learning and extinction of amygdala response
Emotional
Development
Resilience, Optimism and Hope
Optimism
 optimists believe that discrepancies
between their goals and their current
attainment will be resolved- minimizing
depression, anger and shame
PNI of Resilience, Optimism and Hope
Hope
 Hope as a noun (there is always hope), a verb (I
hope) an adjective (hopeful) and an adverb (hopefully)
 With cancer hope of a cure or prolonged survival, and
in terminal illness hope defined as a struggle to come to
terms with the multiple losses in a changing reality
 hiding or distorting the truth is not hope-engendering;
hope best engineered through honesty and empathy by
framing hope in a wider context (relationships, belief,
control, dignity, inner peace, humor, meaningful events,
achievable treatment goals - Clayton)
Emotional Life as a Cancer Survivor
 FEAR (RECURRENCE AND FUTURE TESTS AND TREATMENTS e.g. THE AVASTIN STORY)
 SEPARATION
 RE-ENTRY
 FEELING REMNANTS
 ROLE CHANGE
 NEW PERSPECTIVES
 RENEWED RELATIONSHIPS
 RENEWED PURPOSE
 SYMPTOMS (PAIN, FATIGUE, BRAIN FOG, INFERTILITY, SEX)
Living as a Cancer Survivor
The 10 Choices that will Determine
Which Road The Survivor Will Take