Lepage Associates Newsletter
Mental Health Matters
October 2010
Lepage Associates
Call: (919) 572-0000
In This Issue
The Emotional Side of Cancer
Posttraumatic Growth
Please click on each group for a flier with complete information to include description,


The Emotional Side of Cancer

Although being educated about breast cancer, including its treatment and outcomes are important steps when diagnosed, it is equally important to recognize the emotional side of cancer. It is common to overlook this aspect of cancer since the diagnosis itself demands that you rapidly learn an overwhelming amount of medical information. However, since a diagnosis of cancer is perceived by the body and mind as a significant negative change, emotional distress is, in fact, the most common mental health issue.

This is actually an adaptive coping mechanism that the body has designed to protect itself from harm or disequilibrium. Therefore, it is normal, and quite frankly natural, to feel worried, sad, confused, depressed and even angry that you have cancer. It is also normal and natural to want a way out of these feelings since the cancer itself is enough to deal with. The good news is that none of us want to deal with these feelings on top of having cancer. However, most of us are unaware that we can learn to choose a different response to something that we perceive as negative.

In other words, though it is normal to react with emotional distress, you can choose to respond differently, and ultimately lessen the chances of suffering even more because of emotional distress. This will not only give you more energy to cope with what lies ahead, but it will also encourage you to live your life no matter what it throws at you.

Take notice of the idea that you have the choice to respond differently. This is the key in helping you feel empowered in your journey, instead of a victim of your circumstances. It will also help you to see cancer as a part of you instead of something that is you. But, how can I learn to cope differently when my body and mind naturally react this way?

First, you will need to believe that you can learn a new way to respond to cancer, and your life in general. This novel way of responding to cancer (and life, in general) comes from a place of kindness, softness, flexibility, courage, and compassion. It is a way that your loved one might have responded to you when you told them you have cancer.

You can respond to your fears, your pain, your suffering with this same kindness, and compassion. This may seem impossible at this moment in time because of the power of our biological makeup. However, these simple tools will help you to change the way you feel about having cancer and ultimately, help you to see cancer as a catalyst into a journey of change, growth, discovery, and transformation.

  1. Surround yourself with people who mirror this way of living. You probably know some people in your life who believe that they have the choice to respond to life instead of falling victim to it. Make it a point to spend time with them and learn how they decided to approach life in this way. Social support is crucial during stressful times, but the type of social support is even more important. 
  2. Spend some time in nature. Nature helps us to feel connected to our surroundings, and with ourselves. Research shows that our automatic stress response naturally reduces when we spend just 15 minutes a day with nature. 
  3. Connect with your breath and be completely in the moment. You can do this simple practice throughout your day. Sit quietly for five minutes, clear your mind and focus on your own breathing. Be aware of any physical sensations and thoughts that come up. Notice them, but try not to get attached to them and gently bring yourself back to your breath. Focusing on the air expelling from your nostrils, or the movement of your stomach expanding when you inhale, and contracting when you exhale will help you to remain completely in the moment where only kindness and compassion exist. 
  4. Practice acceptance; that is, come to peace with the fact that some things are out of your control. Use your breath as your guide and while you practice connecting with it slowly try and let go of what is not in your control. The peace you will experience is something you can turn to for comfort. It is something you can cultivate even when life feels unfair, and out of your control. 
  5. Seek support. Sometimes emotional distress may be too severe to try and cope with on your own, let alone try and practice the techniques mentioned above. There is no shame in asking for help during these times. Professional help, such as individual counseling and/or support groups can help facilitate this process. Psychologists, for example, can help you to cope with the difficult emotions cancer elicit so that you can restore some feeling of control over your emotional experience, and give way to achieving real calmness and acceptance of yourself and your life.

Our Health Psychologist is experienced in working with people who have chronic health conditions. A number of our psychologists have conducted research and training in the application of yoga, mindfulness, and meditation to therapy and in the treatment of health disorders. 



October is Breast Cancer awareness month so we've included an article on how mindfulness practice can be applied to cancer treatment.


We've also included an article to help explain how even traumatic experiences can be a chance for positive growth.


Post-Traumatic Growth


Suffering Meaningfully


Almost everyone has heard of post-traumatic stress and PTSD (post-traumatic stress disorder), but a related and new area of research has been on post traumatic growth. The idea of post traumatic growth is a more recent phenomenon that offers a positive approach to dealing with traumatic events. It is both a process that people undergo after experiencing trauma and an outcome where positive changes are experienced in response to struggling and making sense of that major crisis or traumatic event. It is a new, optimistic perspective on suffering and transforms a person into someone significantly different than who they were before. The struggle, not the trauma, engenders these changes. Researchers have found when questioned about trauma, more people report growth experiences as long term effects rather than stress disorders.


Post traumatic growth appears to develop in five broad areas: new possibilities, change in relationships, personal strength, philosophy on life, and spiritual or religious change. People may be more open to opportunities, find that they are more resilient, and appreciate the preciousness of life. The advocates for post traumatic growth emphasize that while changes or growth can be beneficial, all problems or stress are not dissolved. Rather, post traumatic growth occurs in the context of suffering. In addition, post traumatic growth is not universal.


Dr. Talya Rabina is a psychologist who researched the experiences of the Hurricane Katrina helper population. There have been numerous studies conducted on the negative effects of participating in relief efforts, but less research on positive effects such as learning and feeling rewarded for voluntary efforts. Dr. Rabina explains that post traumatic growth involves finding meaning out of an experience that throws one's whole understanding of the world on its head. In her experience, she found that changes in relationships and adjustments of philosophies were the most transparent. People needed other people who had the same experience to reflect and understand that event. In addition, people redefined their values and goals and thus revised their perspective on life; this especially related to developmental stages. People who were in their twenties considered how they were going to proceed in their career. An older generation who already had an established career pondered more deeply the way in which they performed their work. Traumas, such as Hurricane Katrina, instigate post traumatic growth.


How intense does a trauma need to be in order to experience post traumatic growth?


Does it have to be a natural disaster or war, or can it be divorce or something similarly common? In order for post traumatic growth to develop, the trauma needs to threaten one's mental security and how one perceives the world. Dr. Rabina notes that trauma needs to cause a significant amount of distress and dissonance, and this dissonance leads one to a psychological process of working through and sorting out this trauma: "the brain wants to feel even and good, and when something like trauma occurs, the brain is thrown off and needs to reformulate" which generates a new understanding of the self in relation to what's happened. Dr. Rabina also mentions that people witness violence every day, whether in direct or indirect settings. These exposures to violence are all sort of mini traumas and our capacity for post traumatic growth depends on how we approach these traumas. Essentially, what constitutes trauma depends on the person who experiences it.


Influencing Psychologists, Individuals, and Society


Dr. Rabina finds the post traumatic growth concept useful in her clinical work. She explains that it's easy to get pulled towards focusing on the negative because people typically enter therapy with problems. While value lies in dissecting the negative, exploring the positive side is necessary and broadens the perspective: "As a therapist we have power in the way we ask questions. If you're asking only about the pathology and not about the potential for growth and strength then you're not seeing the whole picture. What [post traumatic growth] has done for me is allow me to see the strength in my clients in a different way and maybe help them see it in themselves. I'm grateful for that." She also describes that she knows the potential for growth is there in her patients but that this post traumatic growth model has provided her with a way to understand and capitalize on eliciting that growth.


The implications of post traumatic growth for individuals and society can be extremely constructive and stimulate positive change in our culture. There is a certain social transformation of trauma, where the results of trauma on individuals can produce collective social change. The founding of organizations such as Mothers Against Drunk Driving (MADD) and Alcoholics Anonymous are indicative of this. Even closer to home, the Eve Marie Carson Scholarship (which is awarded to students who have grown significantly in areas related to academics, social justice, and leadership) was established in response to the senseless murder of Eve Carson, UNC's Student Body President.


Ultimately, post traumatic growth allows for an alternate, more optimistic view on life despite suffering through traumatic experiences. This is not to suggest PTSD and post traumatic stress are not real as well, and people experiencing this deserve empathy and help. Post traumatic growth work can be one way to move through the stress of the trauma and regain a sense of well-being.

Love, Sex and Relationships
November 12th at noon at Lepage Associates
Presented by: Dr. Nicole Imbraguglio
Improving Your Marriage Without Talking About It  

Believe it or not, talking is not the only thing you can do to improve your marriage, and in fact sometimes talking is not beneficial! Come learn the secrets to what's behind your partner's behavior and the best ways to react that will increase your bond.



Monthly Reader

Each month we will recommend a book that someone at our practice has found useful.

This month's book is:
When Things Fall Apart:

Heart Advice for Difficult Times


Pema Chodron

Quick Links
Read Archived Newsletters
Listen to Podcasts
Read Articles
Review Books and DVDs  

 Live more intentionally

Something to Ponder
Our new weekly area to visit for thought provoking ideas and tips to live life to the fullest.