‘Choosing the Path Less Traveled….’ Resilience, Optimism and Hope in Cancer Survivorship Mark D. Gilbert, MD, Director, Mind-Body Medicine Skills Group Program, University Arizona Health Network, Associate Director, Psychosocial Oncology and Director of Professional Development, Arizona Cancer Center; Associate Professor of Clinical Psychiatry, University of Arizona

Compassion means to be intensely together with those who suffer. The point of this attentive presence with a patient is not on curing or fixing a problem – instead, it is simply being in the moment. Compassion welcomes and provides sanctuary for all that is unpredictable, imperfect, incomplete, awkward, pinched and unspoken.

Burnout A debilitating psychological condition brought about by unrelieved work stress, resulting in: Depleted energy and emotional exhaustion Lowered resistance to illness Increased depersonalization in interpersonal relationships (patients become numbers) Increased dissatisfaction and pessimism Increased absenteeism and work inefficiency

Facilitator lead Talking Circle Relaxation Techniques Autogenic Training Meditation - focusing - mindfulness - movement Biofeedback Guided Imagery Music and Sound Genograms Life Maps Spirit Boxes CBT exercises Journaling Eating Meditation Yoga Education - Illness - MBM -Stress - Imagery - Spirituality - Forgiveness - Hope - Nutrition - Humor - Cognitive Restructuring - Emotional Awareness - Sleep Hygiene - Movement - CAM Resilience in the Eye Responsibility – Attitude – Awareness Purpose – Empowerment- Connection Facilitator lead Talking Circle

PNI of Resilience, Optimism and Hope strong social bonds DHEA Cortisol Hb1ac Hardiness Positive Emotional Granularity Switching Cognitive Set Hippocampal Volume and HPA axis Childhood trauma Stress Inoculation CRH 1 and CRH 2 Locus Ceruleus and NE NPY COMT Galanin Serotonin Dopamine Neural Reward Circuitry Actin-Polymerization Protein (APP) cAMP response element binding protein Brain-derived neurotropic actor (BDNF) Fear=learning and extinction of amygdala response Emotional Development The Tree on Resilience Mountain –Other Contributions

Resilience, Optimism and Hope optimists believe that discrepancies between their goals and their current attainment will be resolved- minimizing depression, anger and shame

PNI of Resilience, Optimism and Hope Hope as a noun (there is always hope), a verb (I hope) an adjective (hopeful) and an adverb (hopefully) With cancer hope of a cure or prolonged survival, and in terminal illness hope defined as a struggle to come to terms with the multiple losses in a changing reality hiding or distorting the truth is not hope-engendering; hope best engineered through honesty and empathy by framing hope in a wider context (relationships, belief, control, dignity, inner peace, humor, meaningful events, achievable treatment goals - Clayton)

Emotional Life as a Cancer Survivor FEAR (RECURRENCE AND FUTURE TESTS AND TREATMENTS e.g. THE AVASTIN STORY) SEPARATION RE-ENTRY FEELING REMNANTS ROLE CHANGE NEW PERSPECTIVES RENEWED RELATIONSHIPS RENEWED PURPOSE SYMPTOMS (PAIN, FATIGUE, BRAIN FOG, INFERTILITY, SEX)

Living as a Cancer Survivor The 10 Choices that will Determine Which Road The Survivor Will Take