Innovative program turns stress into health
(The case management process has always included a holistic approach. The next two articles in this issue feature programs to help chronically or terminally ill patients use their minds to reduce stress and pain.)
Chronic and terminal illnesses and the roller coaster of emotions that accompany them cause patients stress that often leads to depression. The Seattle Cancer Treatment Center offers cancer patients programs that help them turn that stress into hope for the future.
"It's a medical fact that stress interferes with health. Cancer patients can enhance their health and chances for recovery by making choices that are in sync with their priorities," says Joy A. Carey, PhD, counseling psychologist and health educator at the center.
"The programs encourage patients to look at what is important to them and what gives meaning to their lives. And we encourage them to move from automatic pilot to purposeful living," Carey says. (See charts on p. 69 and above. Also, see words for purposeful living, p. 71.)
The programs Carey develops focus on aspects of the body not normally discussed by physicians and other health care professionals. "Patients do hear at least a little information about diet and exercise. What they don't normally hear about is the stress of noise or pollution in their environment; how to use relaxing music to improve their mood," she says.
Sensory overload
Depression is a normal response to chronic or terminal illness. Yet many times, patients believe they are depressed when actually they are just overwhelmed, Carey says.
"Patients often think they are depressed when they are simply on overload. They often do too much without a basis for making wise decisions and setting limits based on their current energy levels," she notes. "Feelings and moods are not just psychological. They can be environmentally induced."
Carey gives the following examples of environmental issues:
· negative attitude in family and friends;
· lack of natural sunlight;
· lack of fresh air;
· lack of clean water;
· noise.
"When we are surrounded by unnatural noise, our bodies never relax," she explains. "I encourage patients to use that awareness and consciously choose music that will bring their energy levels up and reduce their stress."
Even her approach to nutritional counseling varies from those of other providers. "Others talk about food and nutrition. I talk about the chemical effect of food on our moods. I talk about how excess carbohydrates make women sleepy, and how we feel different emotionally when we eat different foods." Carey helped develop and teach a program called "Sources of Hope" for the center and another called "Turning Health into Health and Happiness" for MultiCARE Health System, a managed care organization in Tacoma, WA. In both programs, she teaches a simple, three-part model designed to help patients lead more fulfilled lives.
"The beauty of what I try to teach is that patients can do this whole course for themselves," she says. "The answers are within all of us. When patients receive the right type of education, they find they already know the answers, and all I do is guide and encourage them to trust themselves."
The three-part educational model includes the following:
1. Reactive living. "When patients live reactively, they are simply a function of their environment," Carey says. "If they like something, they are happy. If they don't like something, they are sad. Too many patients with terminal or chronic illness get stuck in this stage."
2. Ego-intentional living. This is a stage that many case managers help patients reach. "In this stage, patients set goals and try to accomplish them. They work on themselves and their relationships," she explains.
"The problem is that in our society this is considered the highest realm. You work to get what you want. The problem is that when patients are faced with a serious illness, achieving everything they want in a material realm is not satisfying."
3. Purposeful living. This third way of living brings life to a more spiritual level, Carey says. "Purposeful living is knowing what is important to us and what is not. It requires first understanding our values and then learning to incorporate those values into our daily decision making."
`Recognize the right' in your life
Carey suggests case managers help patients move forward from focusing on what's wrong with their health or their lives. "Encourage patients to focus on what is right with their lives instead of what is wrong. If they can recognize the right and work on that, they will continue to develop and move forward with hope," she says.
Case managers should help patients understand that disease can't prevent them from experiencing many positive and fulfilling aspects of life, Carey says. She gives patients who attend her programs a list of good things disease can't prevent people from having or being.
That list includes:
· self-respect;
· perseverance in working toward what is best;
· compassion for others;
· a sense of humor;
· gratitude for the many good things in our lives;
· hope that we will learn from difficulties and that easier times will come.
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