Psychosocial Interventions: A Cognitive Behavioral Approach

IntroductionChildhood cancer in the family is an obviously stressfulsituation. A great deal of research has been conductedto investigate the emotional reactions and coping strate-gies of children with cancer and their parents. Differentﬁndings are reported for both children with cancer andtheir parents. Several studies that investigated the psy-chological and social adaptation of children with cancerfound that they did not differ signiﬁcantly from healthycontrols, but subsets of more vulnerable children havebeen identiﬁed [1]. In a review on young childhood can-cer survivors it is also shown that overall emotionaladjustment of the survivors as a group was within nor-mal limits [2]. However, one-third of the adolescent sur-vivors met the criteria for lifetime posttraumatic stressdisorder (PTSD), which is a higher percentage than inthe general population [3,4]. Moreover, research on spe-ciﬁc areas of psychosocial adjustment has found thatabout one-third of survivors and their family membershave experienced personal, family or social difﬁcultiesthat have affected their academic achievement, employ-ment, interpersonal relationships or self-esteem [5]. Many studies have been conducted among parents ofchildren with cancer and different reactions have beenreported for different periods of treatment [6]. Research-ers who focused on parents of newly diagnosed childrenwith cancer, or children who are in treatment, reportincreased emotional distress such as anxiety or depres-sion, when compared to parents of healthy children.Some studies have found that parents continue to expe-rience psychological distress over time [7], while othershave found that the elevated levels of distress decline,within a few years to comparable levels in the generalpopulation [8,9]. Contradictory ﬁndings among children and parentscan partly be attributed to the inappropriateness ofinstruments to measure the impact of childhood can-cer. Studies focusing on illness-related psychosocialconsequences instead of depression and anxiety, foundthat problems for parents concerned uncertainty andloneliness [10,11], or anxiety about the child’s future,health and relapse [12]. Other explanations for thescarcity of serious adjustment problems are children’sand parents’ capacities to develop strengths and abili-ties to “bounce back” [13]. Another possible explana-tion could be “response shift,” which means that theexperience with cancer has changed the children’s con-ceptualization of problems. As a result of this responseshift, problems are being underreported. Responseshift has also been described in adults with cancer [14]. In other words, the reliance on different coping strate-gies such as avoidance, social support, and open com-munication play an important role in the emotionaladjustment of children with cancer and their parents.Several intervention studies showed the possibilitiesof improving coping strategies and reducing feelings ofdistress in children with cancer [15]. Empirical evalua-tions of intervention programs for parents are, how-ever, rare and report limited signiﬁcant effects onadjustment [16]. The aim of this chapter is to providean understanding of the emotions and coping strate-gies, and behavioral reactions of children with cancerand their parents. First, the cognitive approach will beoutlined, with the theoretical background of cognitionsand emotions. This will include a description of emo-tions in the light of different situational meaning struc-tures which determine the appraisal of the situation forchildren with cancer and their parents. Situational