La Ansiedad

Artículo Publicado en la Revista: Bitácora Médica. 

Clasificado en: Bitácora del día

Llamamos ansiedad normal a un conjunto de emociones y manifestaciones físicas, que se producen de forma automática y sin control voluntario, cuando nos enfrentamos a situaciones nuevas, o de exigencia. La “ansiedad normal” nos ayuda a adaptarnos a estas situaciones de manera tal que podamos obtener la respuesta más adecuada para las mismas. En este sentido, es beneficiosa, ya que nos permite alcanzar mejor los objetivos que nos planteamos en la vida.
De esta manera, esta respuesta al estrés en sí misma no es nociva, pero sin embargo, cuando los síntomas ansiosos se vuelven excesivos y difíciles de controlar, pueden llegar al punto de interferir seriamente en nuestras actividades diarias (trabajo, vida social, de pareja, etc.). En este caso estamos en presencia de un cuadro de “ansiedad patológica”, que suele necesitar tratamiento médico y psicológico para su resolución.

En la ansiedad encontramos síntomas a cuatro niveles:
1.- Cognitivo: miedo, irritabilidad, agobio, insomnio, etc…
2.- Motor: temblor, tensión muscular, etc…
3.- Vegetativo: palpitaciones, sudoración, nauseas, etc.
4.- Conductual: evitación de determinadas situaciones o soportar la situación sin hacer nada.

Al hablar de ansiedad, no solo debemos tomar en cuenta el estímulo que la genera, sino también otras variables personales, con respecto a la emisión de respuestas inadecuadas ante la situación de demanda, por:
1. Bien porque no se posee de un repertorio de estrategias,
2. Bien porque estas estrategias son inhibidas por las emociones,
3.  Bien porque existen obstáculos en la emisión de estas conductas,
4.  Bien porque aún disponiendo de las estrategias, no las ponemos en marcha en el momento adecuado.

De esta manera, presentamos un cuadro resumen con la finalidad de diferenciar los tipos de ansiedad:

	Ansiedad Normal	Ansiedad Patológica
Características generales	Episodios poco frecuentes.  Intensidad leve o media. Duración limitada.	Episodios repetidos.  Intensidad alta. Duración prolongada.
Situación o estímulo causante	Reacción esperable y común a la de otras personas.	Reacción desproporcionada.
Grado de sufrimiento	Limitado  y transitorio	Alto y duradero
Grado de interferencia en la vida cotidiana.	Ausente o ligero	Profundo.

Es importante entender la ansiedad como un sentimiento normal ante deter­minadas situaciones y que solo cuando sobrepasa ciertos límites o la capaci­dad adaptativa del individuo es cuando se convierte en patológica.

La situación de enfermedad, las hospitalizaciones, las intervenciones quirúrgicas; así como determinados problemas de la vida diaria, generan en la persona un estado  de ansiedad.

La ansiedad con respecto a condiciones médicas, puede influir en los siguientes aspectos:
1. Interfiriendo en el curso de la enfermedad (en su curso, desarrollo, agravamiento o en la recuperación),
2. Interfiriendo en el tratamiento médico,
3. Incrementando respuestas que afectan negativamente el estado de salud (fumar, consumir alcohol, disminuir práctica de ejercicio),
4.  Siendo un factor de riesgo adicional para la salud (por ejemplo, enfermedades cardiovasculares).

De forma general, las técnicas y recursos psicológicos que se expondrán tiene como finalidad, proveer recursos para hacer frente a las situaciones que nos generan ansiedad, entrenando en habilidades que nos permitan manejarla adecuadamente.
Entre las técnicas para manejar la ansiedad tenemos:
1.- Relajación muscular progresiva.
2.- Respiración abdominal lenta.
3.- Terapia por visualización.
Dra. Liana Pérez

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Coping with Grief and Loss: Support for Grieving and Bereavement

Coping with Grief and Loss: Support for Grieving and Bereavement

Coping with Grief and Loss

Support for Grieving and Bereavement

Losing someone or something you love is very painful. After a significant loss, you may experience all kinds of difficult and surprising emotions, such as shock, anger, and guilt. Sometimes it may feel like the sadness will never let up. While these feelings can be frightening and overwhelming, they are normal reactions to loss. Accepting them as part of the grieving process and allowing yourself to feel what you feel is necessary for healing.

There is no right or wrong way to grieve — but there are healthy ways to cope with the pain. You can get through it! Grief that is expressed and experienced has a potential for healing that eventually can strengthen and enrich life.

In This Article:

• What is grief?
• Are there stages of grief?
• Common symptoms of grief
• Get support
• Take care of yourself
• When grief doesn’t go away
• Professional help
• Related links

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What is grief?

Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. You may associate grief with the death of a loved one – and this type of loss does often cause the most intense grief. But any loss can cause grief, including:

A relationship breakup Loss of health Losing a job Loss of financial stability A miscarriage

Death of a pet Loss of a cherished dream A loved one’s serious illness Loss of a friendship Loss of safety after a trauma

The more significant the loss, the more intense the grief. However, even subtle losses can lead to grief. For example, you might experience grief after moving away from home, graduating from college, changing jobs, selling your family home, or retiring from a career you loved.

Everyone grieves differently

Grieving is a personal and highly individual experience. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and the nature of the loss. The grieving process takes time. Healing happens gradually; it can’t be forced or hurried – and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

Myths and Facts About Grief

MYTH: The pain will go away faster if you ignore it.

Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run. For real healing it is necessary to face your grief and actively deal with it.

MYTH: It’s important to be “be strong” in the face of loss.

Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Crying doesn’t mean you are weak. You don’t need to “protect” your family or friends by putting on a brave front. Showing your true feelings can help them and you.

MYTH: If you don’t cry, it means you aren’t sorry about the loss.

Fact: Crying is a normal response to sadness, but it’s not the only one. Those who don’t cry may feel the pain just as deeply as others. They may simply have other ways of showing it.

MYTH: Grief should last about a year.

Fact: There is no right or wrong time frame for grieving. How long it takes can differ from person to person.

Source: Center for Grief and Healing

Are there stages of grief?

In 1969, psychiatrist Elisabeth Kübler-Ross introduced what became known as the “five stages of grief.” These stages of grief were based on her studies of the feelings of patients facing terminal illness, but many people have generalized them to other types of negative life changes and losses, such as the death of a loved one or a break-up.

The five stages of grief:

• Denial: “This can’t be happening to me.”

• Anger: “Why is this happening? Who is to blame?”

• Bargaining: “Make this not happen, and in return I will ____.”

• Depression: “I’m too sad to do anything.”

• Acceptance: “I’m at peace with what happened.”

If you are experiencing any of these emotions following a loss, it may help to know that your reaction is natural and that you’ll heal in time. However, not everyone who is grieving goes through all of these stages – and that’s okay. Contrary to popular belief, you do not have to go through each stage in order to heal. In fact, some people resolve their grief without going through any of these stages. And if you do go through these stages of grief, you probably won’t experience them in a neat, sequential order, so don’t worry about what you “should” be feeling or which stage you’re supposed to be in.

Kübler-Ross herself never intended for these stages to be a rigid framework that applies to everyone who mourns. In her last book before her death in 2004, she said of the five stages of grief, “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives.”

Grief is a roller coaster, not a series of stages

It is best not to think of grief as a series of stages. Rather, we might think of the grieving process as a roller coaster, full of ups and downs, highs and lows. Like many roller coasters, the ride tends to be rougher in the beginning, the lows may be deeper and longer. The difficult periods should become less intense and shorter as time goes by, but it takes time to work through a loss. Even years after a loss, especially at special events such as a family wedding or the birth of a child, we may still experience a strong sense of grief.

Source: Hospice Foundation of America

Common symptoms of grief

While loss affects people in different ways, many people experience the following symptoms when they’re grieving. Just remember that almost anything that you experience in the early stages of grief is normal – including feeling like you’re going crazy, feeling like you’re in a bad dream, or questioning your religious beliefs.

• Shock and disbelief – Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting them to show up, even though you know they’re gone.

• Sadness – Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.

• Guilt – You may regret or feel guilty about things you did or didn’t say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.

• Anger – Even if the loss was nobody’s fault, you may feel angry and resentful. If you lost a loved one, you may be angry at yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.

• Fear – A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.

• Physical symptoms – We often think of grief as a strictly emotional process, but grief often involves physical problems, including fatigue, nausea, lowered immunity, weight loss or weight gain, aches and pains, and insomnia.

Coping with grief and loss tip 1: Get support

The single most important factor in healing from loss is having the support of other people. Even if you aren’t comfortable talking about your feelings under normal circumstances, it’s important to express them when you’re grieving. Sharing your loss makes the burden of grief easier to carry. Wherever the support comes from, accept it and do not grieve alone. Connecting to others will help you heal.

Finding support after a loss

• Turn to friends and family members – Now is the time to lean on the people who care about you, even if you take pride in being strong and self-sufficient. Draw loved ones close, rather than avoiding them, and accept the assistance that’s offered. Oftentimes, people want to help but don’t know how, so tell them what you need – whether it’s a shoulder to cry on or help with funeral arrangements.

• Draw comfort from your faith – If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you – such as praying, meditating, or going to church – can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or others in your religious community.

• Join a support group – Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers.

• Talk to a therapist or grief counselor – If your grief feels like too much to bear, call a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.

How to support a grieving person

If someone you care about has suffered a loss, you can help them heal by asking about their feelings, spending time just being with them, and listening when they want to talk.

Read: Helping and Supporting Someone Who Is Grieving

Coping with grief and loss tip 2: Take care of yourself

When you’re grieving, it’s more important than ever to take care of yourself. The stress of a major loss can quickly deplete your energy and emotional reserves. Looking after your physical and emotional needs will help you get through this difficult time.

• Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.

• Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organization that was important to him or her.

• Look after your physical health. The mind and body are connected. When you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don’t use alcohol or drugs to numb the pain of grief or lift your mood artificially.

• Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.

• Plan ahead for grief “triggers”. Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional wallop, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honor the person you loved.

When grief doesn’t go away

It’s normal to feel sad, numb, or angry following a loss. But as time passes, these emotions should become less intense as you accept the loss and start to move forward. If you aren’t feeling better over time, or your grief is getting worse, it may be a sign that your grief has developed into a more serious problem, such as complicated grief or major depression.

Complicated grief

The sadness of losing someone you love never goes away completely, but it shouldn’t remain center stage. If the pain of the loss is so constant and severe that it keeps you from resuming your life, you may be suffering from a condition known as complicated grief. Complicated grief is like being stuck in an intense state of mourning. You may have trouble accepting the death long after it has occurred or be so preoccupied with the person who died that it disrupts your daily routine and undermines your other relationships.

Symptoms of complicated grief include:

Intense longing and yearning for the deceased Intrusive thoughts or images of your loved one Denial of the death or sense of disbelief Imagining that your loved one is alive

Searching for the person in familiar places Avoiding things that remind you of your loved one Extreme anger or bitterness over the loss Feeling that life is empty or meaningless

The difference between grief and depression

Distinguishing between grief and clinical depression isn’t always easy, since they share many symptoms. However, there are ways to tell the difference. Remember, grief is a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

Other symptoms that suggest depression, not just grief:

Intense, pervasive sense of guilt. Thoughts of suicide or a preoccupation with dying. Feelings of hopelessness or worthlessness.

Slow speech and body movements Inability to function at work, home, and/or school. Seeing or hearing things that aren’t there.

To learn more about the signs and symptoms of clinical depression, see Understanding Depression.

Can antidepressants help grief?

As a general rule, normal grief does not warrant the use of antidepressants. While medication may relieve some of the symptoms of grief, it cannot treat the cause, which is the loss itself. Furthermore, by numbing the pain that must be worked through eventually, antidepressants delay the mourning process.

When to seek professional help for grief

If you recognize any of the above symptoms of complicated grief or clinical depression, talk to a mental health professional right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. But treatment can help you get better.

Contact a grief counselor or professional therapist if you:

• Feel like life isn’t worth living
• Wish you had died with your loved one
• Blame yourself for the loss or for failing to prevent it
• Feel numb and disconnected from others for more than a few weeks
• Are having difficulty trusting others since your loss
• Are unable to perform your normal daily activities

Related articles

Supporting a Grieving Person
Helping Others Through Grief, Loss, and Bereavement

Understanding Depression
Signs, Symptoms, Causes, and Help

More Helpguide Articles:

• Healing Emotional and Psychological Trauma: Symptoms, Treatment, and Recovery
• Coping with a Breakup or Divorce: Moving on After a Relationship Ends
• Grieving the Loss of a Pet: Understanding and Coping with the Grief of Losing a Pet
• Improving Emotional Health: Strategies and Tips for Good Mental Health

Need More Help?

Bring Your Life Into Balance: Emotional Skills Toolkit

Feeling overwhelmed by sadness, anger, loneliness, guilt, or other painful emotions? This toolkit can help you get through the grieving process and regain your emotional balance. Go to Toolkit »

Related links for coping with grief and loss

General information about grief and loss

The Grieving Process – Provides helpful handouts on the grieving process, including the stages of grief, how to take care of yourself, and the different ways people react to loss. (Hospice of the North Shore)

Life after Loss: Dealing with Grief – Guide to coping with grief and loss, including normal grief reactions to expect. (University of Texas Counseling and Mental Health Center)

Grief Support – Provides insights into grieving and the grief process. A companion page contains detailed information about children’s grief. (Australian Centre for Grief and Bereavement)

Death and Grief – Article for teens on how to cope with grief and loss. Includes tips for dealing with the pain and taking care of yourself during the grieving process. (Nemours Foundation)

Death of a loved one

Grief: Coping With Reminders After a Loss – Tips for coping with the grief that can resurface even years after you’ve lost a loved one. (Mayo Clinic)

Healing Steps – Advice on how to heal after the death of a loved one, including the rituals that can help and things you can do to keep memories alive. (California Home Care & Hospice, Inc.)

On Being Alone: A Guide for the Newly Widowed – A comprehensive series of articles on grief and loss offering practical, as well as psychological advice. (AARP)

Support for grief and loss

GriefNet.org – Online support community for people dealing with grief, death, and major loss, with over fifty monitored support groups for both kids and adults.

Compassionate Friends - National, self-help organization for those grieving the loss of a child. Includes a Chapter Locator and supportive online brochures on various aspects of grief.

Stages of grief

The Kübler-Ross grief cycle – Details each stage as it applies to persons facing death or other negative life change. Note that the cycle as presented includes seven stages, including initial shock. (ChangingMinds.org)

What is Grief? – Lays out general stages of grief with tips for helping someone who is grieving. (University of Illinois Counseling Center)

Complicated grief and depression

Major Depression and Complicated Grief – Lists the warning signs and symptoms that suggest grief has progressed to major depression or complicated grief. (American Cancer Society)

Complicated Grief – Learn the difference between the normal grief reaction and complicated grief. Includes information about symptoms, risk factors, and treatment. (Harvard Medical School Family Health Guide)

Grief after suicide

Grief after Suicide - Survivors of suicide and their friends can help each other and themselves by gaining an understanding of grief after suicide. (Canadian Mental Health Association)

Grief after Suicide Understanding your emotions, as well as suicide in general, may ease your grieving after suicide. (Buddha Dharma Education Association)

Melinda Smith, M.A., Ellen Jaffe–Gill, M.A., and Jeanne Segal, Ph.D., contributed to this article. Last modified: November 2010

Finding Balance as a Cancer Caregiver

Finding Balance as a Cancer Caregiver

by Steve Keir, DrHP, MPH

We can only estimate the number of familial cancer caregivers in the United States, as there is no formal system designed to capture this data. However, we do know the number of people living with a history of cancer. If each person living with cancer had just one caregiver, a conservative estimate would approximate that there are at least 10.5 million people who have either provided care or continue to provide care for a loved one with cancer.

As caregivers provide physical and emotional support, they often put their lives on hold and do not fully attend to their own needs. In addition, most caregivers undertake this difficult task with little or no formal training, leaving them tremendously unprepared for this complicated and multifaceted role. As a result, caregivers often experience what is called caregiver stress at some point in the caregiving trajectory. To date, numerous studies have documented that caregiver stress can negatively affect one’s physical and psychological health.

Dr. Steve Keir

When Is Stress Not Good for Us?
Stress is the physical and/or psychological response that occurs whenever one must adapt to changing conditions, whether those conditions be real or perceived, positive or negative. Although everyone has stress in their lives, people respond to stress in very different ways. Stress is commonly perceived to be bad when, in fact, there are two very different types of stress: eustress, which is defined as pleasant or health-giving stress, and distress, which is defined as an unpleasant or disease-producing stress. Eustress, or “good stress,” can be thought of as providing you with an extra burst of energy to perform at your best, while distress, or “bad stress,” can drain your energy and impair your ability to perform well. Providing care to a loved one with cancer can produce both types of stress, so it is important to understand what triggers these different types of stress for you as a caregiver. Here are some signs of bad stress that you should watch out for:

• changes in eating or sleeping patterns
• becoming emotionally strained
• decline in physical health
• feeling tired or lacking energy
• feeling depressed, lonely, or isolated
• becoming easily distracted, experiencing problems concentrating, or forgetfulness
• changes in your behaviors and responses, including being easily irritated, angered, or saddened.

Self-Care Strategies for Caregivers
Providing care for a loved one can be a physically and emotionally draining experience, but as a caregiver, you need to remember that you are important, too. By taking care of yourself, you will be better able to handle the everchanging demands of caregiving. The following are tips to help reduce or address caregiver stress through self-care:

• Stay physically fit and eat a balanced diet.
• Try to get enough sleep and rest.
• Consult your doctor, maintain regular check-ups, and inform your healthcare providers of your role as a caregiver.
• Stay in touch with friends and family; social activities can help you feel connected and may reduce stress.
• Take time out for yourself, either to relax or to take part in hobbies.
• Look to faith or community groups for support and assistance.
• Join a local or online support group.
• Assess your support network of family and friends.
• Learn about community caregiving resources.
• Get organized – prioritize and make lists to establish daily, weekly, and monthly routines.
• Create a long-term caregiving plan.
• Don’t be afraid to ask for help or respite.

On your caregiving journey, remember to focus on the positive aspects of caregiving. These may include spending time with your loved one, connectedness or an improved relationship with your loved one, personal and spiritual growth, satisfaction from learning and doing a good job, and a heightened sense of value and self-esteem. Relishing the good times can help you through the difficult ones.

♦ ♦ ♦ ♦ ♦

Dr. Steve Keir is an associate professor at Duke University in Durham, NC, and works at The Preston Robert Tisch Brain Tumor Center. He has studied and written about the stress experienced by brain tumor survivors and their caregivers.

November is National Family Caregivers month. Learn more at www.thefamilycaregiver.org/national_family_caregiver_month.

For additional resources for caregivers, click here.

This article was originally published in Coping® with Cancer magazine, November/December 2010.

El cuidado emocional ante la enfermedad oncológica

El cuidado emocional ante la enfermedad oncológica

Bitácora Médica
Tu salud es nuestra misión

El cuidado emocional ante la enfermedad oncológica

febrero 4, 2011

Hablar de cáncer es hablar de incertidumbre, posibles pérdidas, y ajustes como crisis vital tanto a nivel individual como familiar. Por fortuna, son cada vez más los avances médicos y tecnológicos que ofrece la ciencia para el tratamiento de esta enfermedad en los que se procura, no solo obtener resultados positivos y de curación, sino que a su vez, busca que la persona mantenga una “buena” calidad de vida, es decir, que le permita continuar realizando sus actividades y funciones como antes de recibir el diagnostico, o lo más parecido posible.
Por Lic. Liana Pérez Rodríguez (*)
Asimismo, el mantenimiento de dicha calidad de vida apunta hacia el cuidado integral lo cual no sólo incluye aspectos médicos, sino también el apoyo emocional, recordando que la esencia del ser humano va más allá de la biología. El nuevo paradigma de atención integral incluye la promoción de educación ante la enfermedad, el fortalecimiento de los recursos de afrontamiento y las redes de apoyo social. El objetivo final de la intervención emocional es lograr incrementar la sensación de control, disminuyendo la incertidumbre y potenciando la autoeficacia del paciente y de sus cuidadores frente a esta situación crítica.
Durante cada una de las fases de la enfermedad existen retos propios que con la ayuda del apoyo psicológico es posible superar.
Es innegable que no podemos escapar del sufrimiento, pero sí podemos prepararnos para afrontarlo. Moos y Shaefer (1986) nos proponen algunas tareas que pueden favorecer la adaptación en situaciones de crisis vital:
- Establecer y comprender el significado de la situación real y sus consecuencias, lo que favorece la conciencia y el establecimiento de metas a corto plazo.
- Continuar el contacto con las redes de apoyo, entre ellos familiares, amigos, compañeros de trabajo. Evitando el aislamiento, la sensación de soledad y facilitando la posibilidad de delegar y pedir ayuda.
- Escuchar, entender y canalizar las propias emociones, con el fin de mantener la esperanza.
- Afrontar la realidad, respetando los miedos, preocupaciones y otras emociones. Lo cual ayudará a reconocer los motivos relacionados y trabajar en los mismos.
- Fortalecer la autoestima y la sensación de autovalía. Desarrollando nuevos valores, amistades, actividades y formas de ver la vida.
El apoyo psicológico es un recurso más en el cuidado integral tanto paciente como su familia, no es signo de debilidad, sino sinónimo de auto-reflexión, conciencia y flexibilidad.
Bibliografía:
- Moos, R. H. & Schaefer, J. A. (1986). Life transactions and crises: a conceptual overview. En: R. H. Moos (ed.). Coping with life crises: an integrated approach. Nueva York: Plenum Press.
- Flórez, J.A. La comunicación y compresión del enfermo oncológico. Manual de Psicooncología. Madrid: Aula Médica; 1999.
(*) Magister en Psicooncología. Universidad Complutense de Madrid.

The Resilient, Adaptable Human Spirit

The Resilient, Adaptable Human Spirit

by Tamara Barto

The dictionary defines “resilience” as the ability to recover rapidly. Although you may not feel like you’ve actually recovered, you will somehow adapt to your changing circumstances. There is nothing like a serious illness or loss to change your “normal” life. In the middle of the chaos of appointments, procedures, and more appointments, you may feel out of control and helpless to establish a new routine. Little by little, you will find that a “new normal” evolves.
Gradually, your body and mind begin to adapt. Things that were significant before your diagnosis may no longer seem so important. If you used to push yourself to get everything done before allowing yourself to rest, then you might find that a new routine of a little work followed by a lot of rest works best for you now. Surgery and treatment can make dramatic physical changes to your body. But people who become disabled or disfigured due to an accident or illness do manage to carry on.

Little by little, you will find that a “new normal” evolves.

Tamara Barto

When minor things happen to your body, like a cut on your thumb or blister on your heel, you adjust the way you move to protect it and to keep it from causing you pain. Surgery, recovery, and learning to function with new limitations are major adjustments that require much more time to adapt. You may grieve for the life you lived before, but that doesn’t change your current situation. Slowly, with support from your healthcare team, friends, and family, a “new normal” life will evolve, and it will be worth living.
The human spirit is amazingly resilient. So many people have overcome extremely difficult circumstances to live a life full of purpose. You can and will carry on. Your body, by its very nature, is designed to repair itself and to heal. It takes time, but you will heal.
Embrace the life you are living and realize no one can live it exactly like you. Strive for wellness, no matter what form that takes, and give your spirit time to adapt to the new you.

♦ ♦ ♦ ♦ ♦

Tamara Barto has worked at Pomona Valley Hospital’s Robert and Beverly Lewis Family Cancer Care Center in Pomona, CA, since 1993. Her husband is a kidney cancer survivor, and she has had to adjust to multiple health problems.

This article was originally published in Coping® with Cancer magazine, January/February 2011.

Advanced Cancer Care Planning | Cancer.Net

Advanced Cancer Care Planning | Cancer.Net

Apoyo integral al paciente con linfoma y leucemia

Apoyo integral al paciente con linfoma y leucemia

Dr. Herman van Grieken y MSc. Liana Pérez.

Fundación Bascopé van Grieken.

Caracas – Venezuela.

bascopedaniela@yahoo.com

RESUMEN

Esta ponencia ofrece de manera breve los conceptos y técnicas fundamentales en la atención integral al  paciente diagnosticado de una enfermedad oncohematológica, desde el marco de la psicooncología, tomando en cuenta que el cáncer es un padecimiento complejo, que genera gran impacto tanto físico como psicológico a nivel individual, en el entorno familiar y social de quienes lo padecen. Se realiza un esquema de los factores físicos y de las fases que con mayor frecuencia han sido atendidas en la institución. Nuestro objetivo principal es promover el conocimiento de la Psicooncología y el proyecto de atención psicooncológica que propone la Fundación.

Palabras claves: Leucemia, linfoma, psico-oncología, apoyo integral, calidad de vida.

ABSTRACT

This lecture has two goals; one is to expose the main concepts and techniques on integral support to the  haematological malignancy patient from a psycho-oncologic approach, knowing that cancer is a complex  disease with both physical and psychological impact over the family and social environment of the patient. The second purpose of the lecture is to promote the project that, based on the psycho-oncology knowledge, is proposed by Bascopé Van Grieken Foundation.

Key Words: Leukaemia, lymphoma, psycho-oncology, integral support, quality of life.

En la Fundación Bascopé van Grieken hemos venido desarrollando un programa de responsabilidad social e  intervención psicosocial que busca brindar atención integral al paciente y su familia, con el fin de  proporcionarles bienestar, contribuir al desarrollo de estrategias que les permita mantenerse adheridos al tratamiento, mantener una actitud positiva y de compromiso frente a este, mejorar su calidad y, condición de vida y desarrollar herramientas de afrontamiento que les permita mantenerse bien en su proceso.

Se considera pertinente el desarrollo de programas enfocados a la atención integral del paciente oncológico y su familia, pues estos no se pueden mirar solo desde lo médico; como seres humanos se ven afectados por un sin fin de variables relacionadas con su dinámica familiar, con su estado general, con su estado psicológico, social, educativo y/o laboral que si son abordados desde una perspectiva interdisciplinaria llevan a que estos se beneficien integralmente.

De igual manera se considera un proyecto novedoso e interesante ya que en la actualidad no tenemos conocimiento de instituciones que presten atención de forma integral y que brinden ésta como valor agregado a su atención médica dando nuevamente importancia al concepto de SER HUMANO y brindar servicios de salud con humanidad.

Así, la Fundación Bascopé van Grieken se crea con el firme compromiso de ayudar a todas aquellas personas que hoy luchan contra una de las enfermedades más agresivas en la actualidad, como lo es el cáncer, en dos de sus variantes: Leucemias y Linfomas. Nuestro propósito es guiar el camino y gestionar las ayudas necesarias para los pacientes y sus familiares.

Esta organización no lucrativa presta sus servicios desde el año 2007, bajo la Dirección General de Daniela Bascopé, actriz y paciente sobreviviente de esta enfermedad, y del Dr. Herman van Grieken H., Médico Pediatra y abuelo de Daniela. Cuenta además con un grupo de profesionales que, por decisión propia y de manera desinteresada, aceptan trabajar bajo los lineamientos de una organización formalmente constituida, dedicando parte de su tiempo de modo continuo y de manera responsable, a una acción solidaria en beneficio de las personas y de intereses sociales colectivos.

Adentrándonos en el tema del cáncer, el diagnóstico de una enfermedad oncohematológica y sus tratamientos conllevan a múltiples cambios en la vida del paciente y de su familia, tal interrupción en la trayectoria de vida es una fuente significativa de estrés y puede causar graves consecuencias físicas, emocionales y trastornos psicológicos (Fawzy y Fawzy, 1994).

Actualmente, dados los avances en el conocimiento de las repercusiones del diagnóstico de cáncer a nivel emocional, familiar e interpersonal surge una sub-especialidad de la oncología, llamada Psicooncología que se ocupa de estudiar:

(a) Las respuestas emocionales de los pacientes en cada etapa de la enfermedad oncológica, de sus familiares y del personal sanitario;

(b) Los factores psicológicos, sociales y comportamentales que afectan el desarrollo y la evolución en la enfermedad (Holland, 1992).

De esta manera, para prestar una atención eficaz al paciente es necesario que nuestro enfoque se caracterice por ser:

(a) Multidimensional, se refiere al modelo de atención biopsicosocial que procura una atención integral con una visión globalizada, comprendiendo a la persona enferma en su realidad total;

(b) Interdisciplinar, consiste en lograr una atención donde concurran diferentes profesionales, con diferentes modelos teóricos de intervención y desde diferentes perspectivas de la realidad, con la finalidad de lograr un enfoque holístico de la situación del paciente y su familia. Por ejemplo, Médico Oncólogo, Trabajador Social, Psicooncólogo, Docente de Aula, entre otros.

(c) Individualizado, por lo que es relevante la evaluación de la calidad de vida, concepto que se refiere a la valoración que realizan los pacientes sobre la satisfacción con su nivel de funcionamiento actual comparándolo con el que ellos creían como posible o ideal (Cella, Tulsky, Gray,. et al., 1993). Dicha evaluación incluye factores psicológicos, sociales, físicos y de sintomatología asociada a la enfermedad y los tratamientos.

Asimismo, y tomando en cuenta las características de la calidad de vida como son la subjetividad, ya que cada individuo la valorará de acuerdo a sus expectativas y experiencias pasadas; y la temporalidad, que hace referencia a que la estimación de la misma cambiará a medida que cambie la situación del individuo. Por ello, es necesaria su evaluación continua durante todas las fases de la enfermedad y de esta manera conocer las necesidades reales del paciente.

Continuando con la atención integral se propone un cambio en el modelo de atención, tomando en cuenta todas las fases de la enfermedad oncológica cubriendo desde el diagnóstico, abarcando el tratamiento y llegando a los cuidados paliativos del enfermo al final de la vida. Por lo tanto, los cuidados continuos son aplicables a lo largo de todo el proceso evolutivo del tratamiento y sus diferentes etapas.

Durante la etapa de diagnóstico, es de importancia conocer que la incertidumbre se ve agravada por un pronóstico incierto, por lo que el primer objetivo es recuperar el equilibrio emocional. Para ello es necesaria la preparación de una entrevista de “Acogida”, en la cual se invita al paciente y a la familia, se evalúa la presencia o no de “conspiración al silencio”, proporcionarle un entorno de confianza, preguntar lo que sabe la de situación y lo que ha entendido, y proporcionar información adaptada al ritmo del paciente, identificando temores y preocupaciones (Arranz, Ulla y Coca, 2003).

La conspiración al silencio se define como una alteración de la información con acuerdo implícito o explícito de negar la situación del enfermo al propio enfermo, existiendo dos tipo una adaptativa en donde el paciente evita la información o la niega y otra desadaptativa, en la que el paciente quiere conocer su situación, pero la familia no quiere que se le proporcione (Arranz, Barbero, Barreto y Bayés, 2005). Es de importancia que el docente conozca esta posible reacción en la familia, ya que debe respetar el tiempo de la misma como del paciente en el manejo de la información y de esta manera caminar al mismo compás y evitar estresores adicionales.

Posterior a ello, el paciente ingresa a la etapa de tratamiento en donde debe enfrentarse a otros estresores como son los efectos físicos y los psicológicos que repercuten en su calidad de vida.

Entre los tratamientos clásicos tenemos:

-Quimioterapia (tratamiento sistémico): Náuseas y vómitos (náuseas anticipatorias), mucositis, trastornos del ritmo intestinal (diarrea - estreñimiento), anemia, alopecia, astenia, trastornos de pigmentación, toxicidad gustatoria y olfativa.

-Cirugía: Mutilación, dificultades con la imagen corporal, autoestima, pérdida de la libido, rechazo de la pareja (Díaz- Rubio y García Sáenz, 2007).

Debido a los múltiples efectos secundarios y a las características agresivas del tratamiento oncológico, una de nuestras funciones en esta fase es tratar de disminuir los niveles de ansiedad determinados, tanto por el significado cultural que se le otorgan a estos tratamientos o debido a experiencias anteriores relacionadas con el cáncer, como a la constante incertidumbre causada por el cuestionamiento permanente acerca de la efectividad del tratamiento.

En esta misma línea, se trata de evaluar y promover mecanismos de afrontamiento adecuados a los cambios a los que se deberán enfrentar el paciente y su familia, buscar redes de apoyo, promover la ventilación emocional, trabajar la autoestima, autoconcepto, autoimagen y la adaptación a la situación actual, utilizando recursos, como los educativos, normalizando y evitando una ruptura brusca en la vida cotidiana. Es claro que el tratamiento produce cambios en la apariencia física de la persona que resultan, en ocasiones, difíciles de aceptar debido a la importancia de la estética en la sociedad.

El papel del psicólogo a este nivel es relevante ya que el sistema sanitario, centrado en el análisis de costos-beneficios, se centra en la recuperación física del enfermo oncológico, ofreciendo escasas oportunidades para comprender junto al paciente el significado que la enfermedad impuso en sus cuerpos.

En conclusión, se enfatiza en el afrontamiento a los tratamientos oncológicos (cirugía, quimioterapia, trasplante de médula ósea y hormonales) y los efectos colaterales de los mismos (miedos, fatiga, disnea, nauseas y vómitos, anorexia, dolor y otros), la falta de adherencia y cooperación del paciente y la familia con el personal sanitario. Así como el tratamiento de los trastornos asociados al cambio en la imagen corporal y la integración de pautas para la solución de problemas, planificación de actividades y adaptación a la situación actual (Cruzado y Olivares, 2001).

Tanto en esta etapa como en la anterior es necesario trabajar los conflictos familiares generados o exacerbados por la enfermedad o sus tratamientos, lo que resulta en un cambio en los roles familiares.

Aunque en un primer momento la intención del personal médico oncólogo es curar, lo cierto es que por diversas variables, este objetivo muchas veces no es posible. Así, cuando la curación no es el objetivo se trata de dilatar los intervalos libres de enfermedad, mejorar la calidad de vida y aliviar los síntomas. En este caso el papel del psicooncólogo se centra en detectar y suplir las necesidades psicológicas de la persona cuya condición física no admite ser curada y proporcionar tratamiento de soporte a nivel afectivo, emocional, desarrollando y manteniendo habilidades que le permitan trabajar por un buen vivir y eventualmente, por un buen morir a través de la elaboración del duelo tanto a nivel del paciente como de sus familiares y allegados.

En general, entre los tratamientos psicológicos con mayor frecuencia utilizados en todas las fases de la enfermedad es posible mencionar:

- Psicoeducación, consejo psicológico y orientación sobre estrategias para superar problemas de información y necesidades de comunicación y emocionales. Imprescindible la técnicas del counselling.

-Control de los estados de ánimo negativos: ansiedad, depresión, hostilidad, sentimientos de culpa, aislamiento, negación. Identificar emociones negativas, expresarlas. Estrategias para afrontarlas.

- Tratamiento de trastornos asociados al cambio en la imagen corporal.

- Solución de problemas y planificación de actividades.

- Tratamiento grupal, tanto para los familiares como para los pacientes. Esta modalidad permite compartir experiencias, disminuir la sensación de indefensión y explorar recursos.

- Intervención familiar: psicoeducación, información sobre el estado sanitario y psicológico del paciente. Estrategias de ayuda y comunicación con el paciente. 

Afrontamiento de estados emocionales negativos. Resolución de problemas de la vida diaria.

Es de importancia mencionar que, en primer lugar, para realizar cualquier tipo de intervención con el paciente tanto educativa como emocional, se deben controlar los síntomas físicos, como primordial el dolor y una vez realizado esto es cuando el paciente se encuentra en posición de involucrarse en la intervención e identificar los asuntos que desea mejorar, así como asumir los temores más profundos y tratar de enfrentarlos, promoviendo una manera más adaptativa de confrontar la situación actual.

Por último, creemos que es de suma relevancia la interrelación entre el docente y el personal sanitario, como el psicooncólogo, intercambiando estrategias pedagógicas y emocional, ya que ambos aspectos se ven afectados entre sí, brindando también apoyo emocional como equipo de trabajo para la prevención del burnout (síndrome de estar quemado) en el grupo interdisciplinar.

Actualmente, la Fundación Bascopé van Grieken se encuentra consolidando un proyecto de atención psicooncológica para los pacientes diagnosticados con leucemia y linfoma, esperamos contar con su apoyo.

Bibliografía

-Arranz, P., Barbero, J., Barreto, P. y Bayés, R. (2005) Intervención Emocional en Cuidados Paliativos. Modelo y Protocolos. Barcelona: Ariel Ciencias Médicas.

-Arranz, P., Ulla, S. y Coca, C. (2003) Leucemias, linfomas y mielomas. En M. Die Trill (Ed.), Psico-Oncología. Madrid: ADES.

-Cella, D.F., Tulsky, D.S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., Silberman, M., Yellen, S.B., Winicor, P. y Brannon, J. (1993). The Functional assessment of cancer therapy scale. Journal of Clinical Oncology, 11: 570.

-Cruzado, J.A. y Olivares, M.E. (2001) Evaluación y Tratamiento psicológico del Cáncer. En J.M. Buceta, A.M. Bueno y B. Mas (Eds.), Intervención psicológica en trastornos de la salud. Madrid: Dykinson.

- Díaz Rubio, E. y García Sáenz, J.A. (2007) Enfermedades Oncológicas: Consejo para pacientes. Barcelona: Permanyer.

- Fawzy I. y Fawzy, M.D. (1994) General Hospital Psychiatric, 16; 149-192.

- Holland, J. (1992) Psycho-Oncology: Overview, obstacles and opportunities. Psycho-Oncology, 1, 1-13.

El Libro de la Felicidad

Este video me encantó y quería compartirlo con todos ustedes, aunque la vida puede ser muy dura la esperanza y capacidad de apreciar lo bello que nos rodea y el amor de nuestros familiares y amigos, la hace hermosa y posible de enfrentar. Saludos!!!!