Weekly Discussion Summary ~ Chemo Brain

Summary of our weekly group discussion ~ 17^th December 2016

CHEMO-BRAIN' - WHAT IS IT AND HOW DOES IT IMPACT ON US?

Chemo-brain is a common term used to describe the thinking, attention and memory problems that occur during and following cancer treatments.

Though chemo-brain is a widely used term, it is somewhat misleading because even those of us who had not received chemotherapy reported a notable impairment in our thinking abilities. However, Naz told us it is widely recognised that the trauma of a breast cancer diagnosis plays a significant role and that hormonal treatments also contribute to a reduction in our cognitive abilities.

Although there were exceptions, the overwhelming majority of us described experiencing significant difficulties in relation to thinking and retaining information, particularly our short-term memory and working memory ie holding one task/piece of information in mind while completing another task. Sometimes our errors were small, and we could laugh off our lapses in memory, but at other times, we felt our thinking problems were much more significant, undermining both our confidence and our ability to function in our everyday lives, for instance at work, in social settings and our relationships with our friends and families.

Naz explained that it is clear that the brain networks involved in processing (cognitive) information efficiently are heavily impaired in women with a breast cancer diagnosis. Both the attached paper and our own experiences highlight that these difficulties continue to impact on us to a varying degree, sometimes over many years.

Naz told us that there is also solid evidence to show that brain grey and white matter is reduced as a result of a breast cancer diagnosis and chemotherapy treatment. The mechanisms in our brains which are involved in cognitive function have to work harder to achieve similar outcomes to those which individuals without a breast cancer diagnosis (matched controls) achieve with less effort which explains why some of us experienced mental as well as physical fatigue.

Psychological interventions focus on our depression and anxiety, yet our symptoms and experiences only served to highlight how little support and understanding is available to us. We need the medical world to take 'chemo-brain' and the consequences of it seriously as well as interventions which improve the brain’s attention and memory and in turn our overall psychological well-being.

http://www.curetoday.com/community/barbara-tako/2016/12/chemo-brain-it-doesnt-always-go-away

#ResilienceDiscussion

Weekly Discussion Summary ~ Cancer and Anti-Depressant Use

This week's discussion was triggered by this article posted by one of our members highlighting that the use of anti-depressants amongst those diagnosed with cancer is double that of the general population (1 in 5 compared to 1 in 10).

Some of us shared that we'd found anti-depressants a great help, others were adamant that we don't wish to use them, although even those who have abstained so far were clear they would consider them. Experiences of taking anti-depressants varied, from providing clarity at one end of the spectrum, to masking reality and numbness at the other. The difficulty of coming off medication due to withdrawal side effects was also highlighted.

What is clear from our members' contributions is the immense psychological challenges that accompany a cancer diagnosis. Many of us have sought help for low mood and anxiety, others have experienced fatigue and long term pain, many had been given anti-depressants - sometimes because they felt that there was little alternative. The end of treatments like chemotherapy/radiotherapy/surgery was identified as a vulnerable time, accompanied by and a sense of feeling lost and being cast adrift. We also wondered about the psychological needs of those living with secondary breast cancer.

Though we would never want to take away any strategies for coping, we think it is important to highlight the contradictions, and controversies in relation to anti-depressants, including the lack of understanding about the mechanisms by which they 'work'.

While we need to cope as effectively as we can, and we need to survive, Naz told us that the longitudinal 'effects' (or lack of) in these drugs are problematic - we expect the brain to take over after a course of antidepressants, but what happens? Many people need to go back on them again. We also don't know how they affect cognitive function.

We all feel that more holistic and longer term support is required to help us with the breadth and depth of the psychological adjustments required and identified the importance of our group as a safe place to share our feelings.

http://www.everydayhealth.com/cancer/living-with/high-rate-antidepressant-use-after-cancer/

#ResilienceDiscussion

Weekly Discussion Summary ~ Repression (Avoiding)

In this week's discussion, we thought about repression - or avoiding - as a common way of coping with anxiety and stressful situations.

Naz told us about some work she had previously done to try and understand the brain and physiological mechanisms behind repressive coping, a coping style used by people who believe that they are not anxious, but physiologically, they still may show signs of anxiety, especially in stressful situations.

We thought about how this way of coping can perhaps work for us in the short term, and when we need it on the spot, in a highly threatening encounter for instance, but as a longer term way of coping, might serve us less well and impact negatively on our emotional and physical health.

#ResilienceDiscussion

Can Training Cognition Enhance Psychological Wellbeing? ~ Jessica Swainston ~ *GUEST BLOG*

I was recently shocked to discover that the world health organisation has estimated that 50 million years of work, an annual global loss of £651bn, will be lost to anxious and depressive disorders between now and 2030. Although I was aware that emotional disorders such as anxiety and depression are on the increase, I found this figure particularly alarming not only for the state of the economy, but more importantly for the future psychological well-being of individuals, their families, and the society we live in. 

As it stands, current pharmacological and psychotherapeutic treatments have been shown to be only modestly effective in both the treatment and prevention of emotional disorder. To me, it seems critical then that more research is carried out in order to better understand the underlying mechanisms involved in these conditions. 

By achieving this, there is hope that we can develop effective interventions to not only treat emotional vulnerability, but further to build resilience against its onset and recurrence.   

So, how do we become more resilient? How do we continue to cope with the ever demanding stresses that society and life place upon us? 

It is these questions that motivated me to embark upon a PhD exploring how we can develop appropriate interventions to build resilience in vulnerable populations. Luckily, Professor Nazanin Derakshan at Birkbeck University of London, Director of the Laboratory for the study of Risk and Resilience in Mental Well-Being, and Director of the Centre for Building Psychological Resilience in Breast Cancer, is of a similar mind-set, and agreed to supervise me throughout this journey. 

For many years Derakshan has investigated the cognitive mechanisms that are involved in emotional disorder.  Derakshan is of the mind that our ability to flexibly direct where we place our attention, is the key mechanism in regulating our emotions and boosting our psychological resilience. In other words, the better we are at paying attention to our current goal (e.g. Writing this blog post), the less distracted we are at the expense of irrelevant intrusions and worrisome and ruminative thoughts that can quickly lead to cognitive and emotional fatigue (e.g. 'What if I fail my PhD?!'). We can refer to this ability as 'attentional control'. 

Backing up this claim, research has shown that people with high anxiety and depression are poor at exercising attentional control, they find it difficult to focus, concentrate, and get easily distracted. Research shows that when there are possible faulty brain connections between 'emotional' and 'cognitive' systems they can lead to problems in regulating attentional control and using it more effectively when we need it.  

If then attentional control is the key mechanism by which emotional vulnerability can be moderated, how then can this process be targeted? 

It was many years ago that I first became aware of online 'cognitive training' games in psychological science, at the time being investigated for its reversal effects on cognitive degeneration through ageing. However, it is only recently that I have discovered a line of research investigating the effects of these games on emotional disorder, led by Derakshan. Can training our attentional control through cognitive training games better our ability to stop intruding and ruminative thoughts from occupying brain space? Further, is the training applicable to other circumstances, such as improving anxious states that can interrupt sports performance? Preliminary findings show great promise.  As yet, compared to control groups, a course of adaptive attentional control training has shown to reduce anxiety, increase cognitive efficiency leading to better performance and improve sports performance under high pressure. 

I am a firm believer in always considering the potential directions and clinical relevance of new interventions for emotional disorder. So, what is the future for cognitive training in psychological health?  I think it is fair to say that a number of current psychological therapies such as mindfulness and cognitive behavioural therapy are of varied success. Yes, for many patients they have wonderful effects, however many others fail to engage at all. This may in part be due to the lack of attentional resources that severely depressed and anxious individuals possess. If one's attention is poor, how can one easily engage in a 10 week course of psychological therapy which requires focus and concentration? It can often be problematic. 

Therefore, cognitive training may be beneficial as a complimentary treatment to current therapies. If attentional control processes are improved through training, individuals will be better enabled to pay attention and gain the most value from their treatment. 

So improving our cognitive flexibility and ability to adaptively pay attention to our current goals may, in effect, help to our build resilience and protect against emotional vulnerability. This research is in its infancy and there is a long journey ahead, but I am excited by our initial findings and am keen to build developing cognitive interventions that may help alleviate and prevent emotional distress.

Jessica Swainston

PhD candidate in the Department of Psychological Sciences, Birkbeck University of London

Laboratory for Risk and Resilience in Psychopathology and Mental Well-Being

Centre for Building Psychological Resilience in Breast Cancer