2015 World Congress of Psycho-Oncology

Meaning Centered Psychotherapy for Cancer Patients

Speakers: Allison Applebaum MD, William Breitbart MD

This one day experiential workshop provides an overview of a novel counseling intervention for patients with advanced cancer, entitled “Meaning Centered Psychotherapy”. Participants will be introduced to the topics of meaning and spirituality as they relate to cancer care and the experience of patients with cancer. The basic concepts of Meaning Centered Psychotherapy will then be described. Meaning Centered Psychotherapy is based on the concepts of meaning as derived from the work of Viktor Frankl, M.D. and adapted for use in cancer populations by our team at Memorial Sloan-Kettering Cancer Center. Two forms of Meaning Centered Psychotherapy have been developed: Meaning Centered Group Psychotherapy (8 weekly 1 ½ hour sessions; Individual Meaning Centered Psychotherapy (7 weekly 1 hour sessions). Both interventions are manualized and randomized controlled trials are currently being conducted. Preliminary data from these studies will be presented as well. During the workshop participants will have the opportunity to participate in experiential exercises utilized in Meaning Centered Psychotherapy. In addition, a detailed description of the intervention and the content of each session will be provided. Newer adaptations of Meaning-Centered Psychotherapy for breast cancer survivors, Caregivers, bereavement, and cultural adaptation for Chines and Spanish speaking populations will be discussed.

1. The attendees will become familiar with the concept of spirituality as a construct composed of faith and/or meaning.
2. The attendees will become familiar with the importance of meaning, as a component of spiritual well-being, and its relationship to depression, hopelessness and desire for death
3. The attendees will become familiar with a structured, didactic and experiential 8 session intervention for advanced cancer patients aimed at sustaining or enhancing a sense of meaning in the face of terminal illness.
4. The attendees will participate in experiential exercises that are components of 4 of the sessions in Meaning Centered Psychotherapy.

Psychoneuroimmunology Across the Life Span

Speakers: Elisabeth Andritsch and Miri Cohen

Health psychology is based on the „bio-psycho-social model“, that includes effects of psychological and social factors on disease risk, prevention, treatment compliance, quality of life and many other essential aspects connected with wellbeing and self-efficacy. Psychoneuroimmunology provides an understanding of fundamental mechanism involved in the bio-psycho-social model meaning that psychological and social factors influence disease processes via two main mechanisms: psychosocial processes (individual differences like optimism, depression or resources concerning coping and social support…) and health behaviors (sleep, alcohol, sports, relaxation exercises…). In the last decades the knowledge about the complexity of the relationship between psychosocial distress and immune regulation in the context of the cancer disease has increased and therefore the integration of the psycho-neuro-immunological concept in psychological interventions for patients with cancer has great potential.

This workshop will be split into two parts: the first part of this workshop will provide an overview (basics) of the concept of psychoneuroimmunology and the mind-body connection. 

The second part will go deeper into the main elements of methods relating to the PNI concepts integrated in psychosocial interventions for cancer patients and in research questions.

The workshop is open to clinicians from all professions caring for cancer patients and young researchers, who are interested or working in the field of Psychoneuroimmunology and who consider researching in this area.

In the first part of the workshop (morning session):

• The attendee will get acquainted with the basic knowledge of PNI and will understand the bi-directional connections between emotions and body and the processes that mediate these connections.
• The attendee shall be able to understand principles of PNI research.

In the second part of the workshop (afternoon session):

• The attendee shall be able to understand the specific aspects of Psychoneuroimmunology in Cancer
• The attendee shall be able to practice research projects
• The attendee shall be able to connect his or her own experiences with the PNI knowledge
• The attendee shall be able to identify the effects of specific interventions on the immune system and physical health

Managing Cancer and Living Meaningfully (CALM): An Individual and Couple Based Supportive-Expressive Intervention

Speakers: Gary Rodin MD and Sarah Hales MD

This interactive workshop provides a theoretical and clinical framework for the CALM intervention and will build skills in in its delivery. Through the use of videotaped treatment sessions, participants will learn how to integrate the four content domains of CALM with the process of this intervention. They will consider how to engage sensitively with individuals and their partners at this stage of life, and to help them face the threats of physical decline, dependency and mortality. The workshop will help participants to make creative use of their own experience within the structure of CALM and to engage with the practical and profound problems that individuals face at this stage of their life. It will help participants to build and apply therapeutic skills in empathic engagement, mentalization and in intersubjective relatedness in the therapeutic setting. Finally, it will address the clinical structure in which CALM can be delivered, the ongoing supervisory process that supports it and the evaluation of treatment outcomes. The attendee will be able to:

1. Understand and apply the theoretical framework of the CALM intervention
2. More effectively engage with patients and their primary caregivers living with metastatic and advanced cancer.
3. Integrate the four domains of CALM with the treatment process
4. Create a clinical structure for CALM and evaluate CALM treatment outcomes

Models of Family-Centered Care During Cancer Care & Bereavement

Speaker: David Kissane MD, Peter Steinglass MD, Marta Porebiak PhD, Talia Zaider PhD and Wendy Lichtenthal PhD

An experiential workshop utilizing exemplary videos and role-plays to train clinicians in the conduct of family-centered interventions across the trajectory of cancer care:

1. Family-Focused Grief Therapy, a model of family care that targets those of risk of complicated grief by delivering continuity of family support through the phase of advanced cancer into bereavement; 
2. Meaning-Centered Grief Therapy for parents who have lost a child to cancer to support parents in finding meaning in their loss, in their child’s life, and in their own life; 
3. The Ackerman Multiple Family Discussion Groups, a psycho-educational family therapy model designed for families dealing with chronic illnesses, including cancer; and
4.  Responding to challenges in discussing death and dying, optimizing open family communication, containing conflict and maintaining safe therapy, drawing relevant family members into sessions and sustaining a focus on the meaning and value of life. 

Strategies in framing circular questions, providing integrative summaries to deepen family members’ understanding, and the promotion of empathic exchanges between family members to optimize their mutual support and cohesion illustrate key therapist skills.

1. To acquire skills in family assessment during palliative care that transfer into sustained work in bereavement; 
2. To incorporate meaning-centered dimensions into working with parents bereaved of a child to cancer; 
3. To respond to conflictual families promoting safety through circularity; 
4. To understand how to use a model of Multiple Family Discussion Groups in cancer care;
5. To practice the conduct of family meetings through role-play. 

Communication and Challenging Discussions at the End of Life

Speakers: Darius Razavi MD PhD

This one day experiential workshop provides an overview of common clinical challenges in end-of-life care and an introduction to the issue of improving health care professionals communication skills in this area of clinical practice. Useful basic communication skills will be briefly recalled. Participants will be introduced to the main components of advanced communication skills, which may be used in the highly emotional contexts of end of life care and in addressing common difficult clinical encounters. Teaching methods designed to improve communication skills will then be described: techniques (learner-centered, skills-focused, practice-oriented) will be discussed. The usefulness of role-play and immediate feed-back will be emphasized. Effective manualized training programs that have been tested in randomized controlled studies conducted in Brussels for physicians and nurses will be presented. During the workshop participants will have the opportunity to test the type of role-playing exercises utilized in these studies. In addition, a detailed description of these studies and the content of training sessions tested will be provided.

Workshop Objectives:

1. The attendees will become familiar with end of life discussion and communication.
2. The attendees will become familiar with the importance of communication skills, as a component of end of life care, and its relationship to patients and family satisfaction, concerns and distress.
3. The attendees will become familiar with the communication skills, which may improve health care professionals end of life care and the management of difficult end of life decisions;
4. Attendees will become familiar with strategies to address frequently challenging clinical communication (eg conflict regarding treatment goals with family or within clinical team; responding to requests to hasten death; assessing and responding to existential concerns and other forms of distress)
5. Attendees will become familiar with the potential impact on clinicians themselves in caring for a dying patient and the consequences for patients, including strategies to minimize this impact.
6. The attendees will participate in role-playing exercises with direct feed-backs and in case discussions.

Fear of Recurrence: A Novel Framework and Therapy Model

Speakers: Prof Phyllis Butow, Prof Louise Sharpe and Prof Jane Turner

This workshop will focus on the most common and severe cancer survivorship issue – fear of cancer recurrence (FCR). FCR is seen in all people who survive cancer, but many find that it diminishes over time. However, for a substantial number of people (up to 60%), FCR continues to be high and disabling, preventing them from making future plans, causing over-screening and over-use of medical services and compromising quality of life. This workshop will provide a review of frameworks for understanding FCR, and will present a novel framework combining elements of the Self-Regulatory Executive Function (S-REF) model, Relational Frame Theory and Self Regulation Theory. A therapy based on this model, including elements of metacognitive therapy, acceptance and commitment therapy and psycho-education, will be outlined. Practical strategies to implement this therapy will be demonstrated and practiced in the workshop. Patient handouts, relevant papers and a framework will be provided to workshop attendees. Workshop Objectives:

1. The attendee shall be able to describe several theoretical frameworks for fear of cancer recurrence
2. The attendee shall be able to describe and deliver methods to reduce attentional focus on cancer, including attention training
3. The attendee shall be able to describe and deliver methods to teach mindfulness training in the context of fear of cancer recurrence
4. The attendee shall be able to describe and deliver methods to provide education and encourage appropriate levels of screening and monitoring for cancer recurrence