Emotion-focused perspective on breast cancer patients’ experiences of comorbid anxiety and depression: a qualitative case analysis of three clients’ in-session presentations

ABSTRACT

The current study is a qualitative, descriptive-interpretative study that utilizes an emotion-focused therapy (EFT) theoretical framework as the basis of interpretation of clients’ experiences of co-morbid anxiety and depression among three women with breast cancer. The study consists of analysis into the clients’ in-session presentation of their difficulties. The study uses a multiple case study observational qualitative design. In total, 18 video-recorded therapy sessions from 3 clients were used for analysis. Sessions were analyzed utilizing an EFT case conceptualization framework. Findings illustrate common themes across cases, organized within EFT conceptualization domains; these include triggers of emotional pain, such as hurtful relationships with close ones and cancer diagnosis/treatment; problematic self-treatment like self-blame and/or excessive worrying; global distress evidenced in the form of anxiety and depression symptoms; emotional and behavioral avoidance strategies such as interruption of emotions, self-distraction and avoidance of activities potentially triggering of painful emotions. The underlying core pain takes the form of sadness/loneliness, shame and fear, and points to corresponding unmet needs (e.g. to be loved, to be recognized, to be protected). The discussion focuses on presenting the findings in the context of psycho-oncology and EFT theory.

Point de vue axé sur les émotions au sujet d’expériences d’anxiété et de dépressions associées chez les patientes atteintes d’un cancer du sein : Analyze qualitative de cas de de trois clientes en séance thérapeutique.

L’étude présentée est une une-étude qualitative, descriptive et interprétative qui repose sur le cadre théorique de la thérapie centrée sur l’émotion (TCE) comme base d’interprétation des expériences d’anxiété et de dépression associées de trois clientes atteintes de cancer du sein. L’étude analyze la manière dont les clientes présentent leurs difficultés en cours de séance. L’étude utilize un schéma d’observation qualitatif de cas multiples. Au total, ce sont dix-huit séances thérapeutiques filmées qui ont servi de matériel à l’analyze. Les séances ont été analysées sur base du cadre conceptuel de la TCE. Les résultats font ressortir des thèmes, repris au sein de domaines de conceptualization de la TCE, que l’on retrouve dans toutes les situations et qui englobent les déclencheurs de douleur émotionnelle, tels que: les relations blessantes avec les proches et l’impact du diagnostic/traitement du cancer; la gestion personnelle problématique telle que l’auto-culpabilité/ou l’excès d’inquiétude; la détresse générale manifestée sous la forme de symptômes d’anxiété et de dépression; les stratégies d’évitement émotionnel et comportemental telles que la coupure des émotions, la diversion de soi et l’évitement d’activités susceptibles de déclencher des émotions douloureuses. La douleur fondamentale sous-jacente prend la forme de tristesse/solitude, de honte et de peur en correspondance avec des besoins non satisfaits (par. ex. être aimé, être reconnu; être protégé). La discussion se concenter sur la présentation des résultats dans le contexte de la psycho-oncologie et de la théorie de la TCE.

Emotionsfokussierte Perspektive zu den Erfahrungen von Brustkrebs-Patientinnen mit Komorbidität von Angst und Depression: eine qualitative Fallstudie dreier Klientinnen anhand von Sitzungen

Die vorliegende Studie ist eine qualitative beschreibend-interpretative Studie, die den theoretischen Rahmen der Emotionsfokussierten Therapie (EFT) nutzt. Dies ist die Basis, um die Erfahrungen von Klientinnen mit Komorbidität von Angst und Depression am Beispiel dreier Frauen mit Brustkrebs aufzuzeigen. Die Studie besteht aus einer Analyse dessen, was Klientinnen während der Sitzung über ihre Schwierigkeiten berichten. Die Studie verwendet ein vielschichtiges qualitatives Beobachtungsdesign. Insgesamt waren 18 per Video aufgezeichnete Therapiesitzungen von drei Klientinnen das Analysematerial. Die Sitzungen wurden mithilfe einer EFT-Fall-Konzept Realisierung als Rahmen analysiert. Die Befunde illustrieren allgemeine Themen über die einzelnen Fälle hinweg, innerhalb von EFT- Konzeptualisierungsbereichen; diese beinhalten Auslöser für emotionalen Schmerz, z.B. verletzende Beziehungen mit Nahestehenden und die Krebsdiagnose / Behandlung; ein problematischer Umgang mit sich selbst, wie z.B. sich selbst beschuldigen und / oder übermässiges Sich-Ängstigen ; globaler Stress, wie er sich in der Form von Angst und Depressionssymptomen zeigt; emotionale und Verhaltens-Vermeidungsstrategien wie z.B. das Unterbrechen von Emotionen, Selbst-Ablenkung und das Vermeiden von Aktivitäten, welche potentiell schmerzhafte Emotionen auslösen könnten. Der zugrundeliegende zentrale Schmerz nimmt die Form an von Trauer/Einsamkeit, von Scham und Angst und verweist auf damit zusammenhängende, nicht gestillte Bedürfnisse (z.B. geliebt werden, anerkannt werden, beschützt werden). Die Diskussion konzentriert sich auf die Darstellung der Befunde im Kontext von Psychoonkologie und EFT-Theorie.

Perspetiva focada na emoção na vivência das comorbilidades de ansiedade e depressão em pacientes com cancro da mama: uma análise qualitativa das sessões dos casos de três clientes

O presente estudo é uma investigação qualitativa e descritivo-interpretativa que recorre a um enquadramento teórico da Terapia Focada na Emoção (TFE) como base para a interpretação das vivências dos clientes das comorbilidades de ansiedade e depressão em três mulheres com cancro da mama. O estudo consiste na análise de como as clientes expuseram as suas dificuldades no âmbito das sessões de psicoterapia. Recorreu-se a um design experimental de observação qualitativa de vários casos. Foram sujeitas a análise um total de 18 sessões de terapia gravadas em vídeo, das 3 clientes. As sessões foram analisadas recorrendo a um enquadramento conceptual de casos da TFE. Os resultados ilustram temas comuns aos vários casos, organizados por domínios conceptuais da TFE, os quais incluem: desencadeadores de sofrimento emocional, tais como relações penosas com pessoas próximas e o diagnóstico e tratamento do cancro; tratamento de si problemático, como culpabilizar-se ou preocupar-se em demasia; inquietação generalizada, evidenciado em sintomas de ansiedade e depressão; estratégias de comportamento evitante, tal como interrupção de emoções, auto-distração e evitamento de atividades potencialmente desencadeadoras de emoções dolorosas. A principal dor subjacente assume a forma de tristeza/solidão, vergonha e medo e aponta para necessidades não satisfeitas correspondentes (como por exemplo, ser amado, ser reconhecido ou ser protegido). A discussão centra-se em apresentar os resultados no contexto da psicologia oncológica e da teoria da TFE.

Perspectiva centrada en la emoción sobre las experiencias de ansiedad y depresión comórbidas de pacientes con cáncer de mama: un análisis de caso cualitativo de las presentaciones en sesión de tres clientes

El estudio actual es un estudio cualitativo, descriptivo-interpretativo que utiliza un marco teórico de terapia centrada en las emociones (TCE) como base para la interpretación de las experiencias de ansiedad y depresión comórbida de las clientas entre tres mujeres con cáncer de seno. El estudio consiste en el análisis de la presentación de sus dificultades en la sesión de los clientes. El estudio utiliza un diseño cualitativo observacional de estudio de caso múltiple. En total, se utilizaron 18 sesiones de terapia grabadas en video de 3 clientes para el análisis. Las sesiones se analizaron utilizando un marco de conceptualización de casos de TCE. Los resultados ilustran temas comunes en todos los casos, organizados dentro de los dominios de conceptualización de TCE; estos incluyen factores desencadenantes del dolor emocional, como las relaciones hirientes con personas cercanas y el diagnóstico/tratamiento del cáncer; auto tratamiento problemático como autoculpa y/o preocupación excesiva; angustia global evidenciada en forma de síntomas de ansiedad y depresión; Estrategias de evitación emocional y conductual, como la interrupción de las emociones, la distracción y la evitación de actividades que pueden desencadenar emociones dolorosas. El dolor central subyacente toma forma de tristeza/soledad, vergüenza y miedo y señala las necesidades insatisfechas correspondientes (por ejemplo, ser amado, ser reconocido, ser protegido). La discusión se centra en presentar los hallazgos en el contexto de la psicooncología y la teoría TCE.

KEYWORDS:

• EFT
• psycho-oncology
• breast cancer
• co-morbid anxiety and depression
• qualitative research
• theoretically-informed research

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Joana Hissa

Joana Hissa is a counseling psychologist presently in clinical practice in the UK. She received her bachelor’s degree in International Relations and Psychology at the University of St Andrews, her master’s degree from New York University and completed her psychology doctoral studies at Trinity College Dublin. She currently works in a child and adolescent mental health service in London, UK.

Allison Connolly

Allison Connolly is the lead psychologist in chronic pain at Nanaimo Regional General Hospital in B.C., Canada. Her clinical background involves working with adults with mental health and physical health comorbidities, depression, anxiety, adjustment disorders, posttraumatic stress disorder (PTSD), complex trauma, and interpersonal difficulties. Dr. Connolly has extensive training and experience working with individuals with medical conditions including cancer and chronic pain. She has lectured at the postgraduate level, supervised research, presented research internationally and produced a number of publications. She has supervised doctoral trainees in clinical supervision, and participates in ongoing research in the area of emotionally focused therapy. Dr. Connolly completed her original training with the founder of EFT, Dr. Les Greenberg and she is a certified EFT therapist. Dr. Connolly's academic qualifications include an M.Sc. in Counselling Psychology and a Ph.D. in Counselling Psychology (Trinity College Dublin).

Ladislav Timulak

Ladislav Timulak, PhD is Associate Professor at Trinity College Dublin, Ireland. He is Course Director of the Doctorate in Counseling Psychology. His main research interest is psychotherapy research, particularly the development of emotion focused therapy. He has written six books, over 70 peer reviewed papers and various chapters in both his native language, Slovak, and in English. His most recent books include Transforming Emotional Pain in Psychotherapy: An Emotion‐Focused Approach (Routledge, 2015) and Transforming Generalized Anxiety: An Emotion‐Focused Approach (Routledge, 2017). He previously co‐edited Counselling Psychology Quarterly. He maintains a part‐time private practice.

Natalie Hession

Natalie Hession is Principal Psychology Manager/Head of Psycho-oncology Services in Psycho-Oncology Services at St. Luke’s Radiation Oncology Network. She has worked in the area of Psycho-oncology for 15 years, where she manages the service and provides clinical assessment and therapeutic intervention for individuals and families in relation to all aspects of the psychological impact of cancer. She regularly uses emotion focused therapy (EFT) as a psychotherapeutic approach to bring about change whilst working with the emotional difficulties faced by cancer patients common to many other patient cohorts. Dr. Hession has a track record for being committed to the development of psycho-oncology in Ireland and has contributed by way of national policy development, as well as publishing widely in the area. She has lectured, supervised research, made many professional presentations nationally and internationally, as well as ongoing research in the area of EFT.  Dr. Hession completed her original training with the founder of EFT, Dr. Les Greenberg and is now an EFT supervisor. Dr. Hession’s academic qualifications include Doctorate in Counseling Psychology (University of Surrey); MSc Leadership and Healthcare Management (RCSI) and Post Grad Diploma in Clinical Supervision (TCD).