The Field of Psycho-Oncology

November 29, 2021

Information

November 21, 2021

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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00:00Funding for Yale Cancer Answers is provided
00:04by Smilow Cancer Hospital and AstraZeneca.
00:08Welcome to Yale Cancer Answers with your
00:10host doctor Anees Chagpar. Yale Cancer
00:13Answers features the latest information
00:14on cancer care by welcoming oncologists
00:17and specialists who are in the forefront
00:19of the battle to fight cancer. This week,
00:22it's a conversation about Psycho-
00:24Oncology with Doctor Jennifer Kilkus.
00:26Dr Kilkus is an assistant professor of
00:28psychiatry at the Yale School of Medicine,
00:30where Dr Chagpar is a professor
00:33of surgical oncology.
00:35Maybe we can start off by you telling us a
00:37little bit about yourself and what you do.
00:40Sure, I am a clinical health psychologist.
00:44I've been in practice since about
00:462014 and primarily worked in large
00:49health systems helping to improve
00:51behavioral health and psychological
00:53services for cancer patients.
00:55So when we talk about
00:58psychological services,
01:00I think a lot of people get a bit
01:03confused about all of the different
01:05types of people that we talk about,
01:07so we talk about social workers
01:10we talk about psychologists,
01:12psychiatrists.
01:13Can you break it down for us and help
01:16us to understand the differences and
01:17the nuances between all of those?
01:20Absolutely, and that's
01:21a great point.
01:23I often have to explain to people
01:25what's different from what I do versus
01:27what a psychiatrist does versus what
01:29a clinical social worker does.
01:30So a psychologist is someone with
01:33a doctoral degree
01:35in psychology.
01:38What I tell people is I went to school for a very
01:40long time to help learn strategies
01:42and tools to assist people in
01:44managing their emotional and their
01:46physical symptoms more effectively.
01:48I don't prescribe medication,
01:50so that's a big difference between what
01:52I do versus what a psychiatrist does,
01:55and a psychologist can do
01:57many different things.
01:58Our degree is pretty versatile,
02:00but what I use my degree to do is to focus
02:03on intervention therapy.
02:06I mainly provide therapy
02:09services for cancer patients using
02:11my degree and a social worker is pretty
02:13similar as far as what they do.
02:16They also have a lot of variability
02:19in what they can do with their degree.
02:21Clinical social workers may provide
02:23psychotherapy services as well.
02:25They may also,
02:26for example,
02:27we have clinical social workers who provide
02:31navigation services for our patients.
02:33Help get them connected to
02:35resources and their degree
02:36is just not quite as long as a PhD,
02:38so their degree usually runs between
02:41around three years or so versus
02:43I believe I wrapped up finally about
02:45seven years in to my doctoral program.
02:48And so when people also refer to counselors,
02:52are those psychologists?
02:55Are those social workers?
02:57Is that a different group
02:59of people altogether?
03:00Or is that just a term that's used
03:03interchangeably for people who
03:04provide counseling services as
03:06part of their scope of care?
03:09It's generally used interchangeably with
03:11psychotherapy or therapy counseling,
03:14but there are folks that have a specific
03:16degree and they're called licensed
03:18Professional counselors and those
03:20degrees tend to be around two to three
03:22years as well before they can be licensed
03:24independently to provide counseling.
03:26But it seems to be that people use the term
03:29counseling interchangeable with therapy.
03:32And here at Yale Cancer Answers,
03:35we're often talking about cancer
03:37patients in their journey.
03:39So talk a little bit about how
03:43mental health, which seems to
03:46be a really big topic right now,
03:48kind of plays into the
03:50cancer patients journey.
03:51At the top of the show,
03:52we kind of talked about
03:55we were going to
03:56talk about Psycho Oncology,
03:58so maybe you can give us a
04:00definition of what that is and
04:02how mental health plays
04:04into a cancer patients journey?
04:06Sure, psycho Oncology is a subspecialty
04:09of the field of health psychology,
04:13which is applying biological, physiological,
04:18social and psychological understanding
04:20of disease to help understand how
04:24people cope and also how we can use
04:27understanding of those processes
04:29to help people change behaviors.
04:32For example, smoking cessation
04:35or helping people adhere to screening
04:38recommendations and psycho oncology
04:40specifically is applying those behavioral
04:44and social science ideas to the
04:46challenges that cancer patients face,
04:48specifically, which are many,
04:50the treatments for cancer.
04:52It can be so challenging in harsh
04:55and taxing on the body that those
04:57things can trigger some symptoms that
05:00we would classify as mental health.
05:02Or vice versa,
05:03mental health symptoms could worsen
05:05some of the challenges that come along
05:08with cancer treatments alongside just
05:10the general idea of of being diagnosed
05:13with the Big C, such
05:16a life threatening and scary disease,
05:18which as you could imagine,
05:20would make anybody feel fearful.
05:22But the treatments also tend to
05:25compound those things and make that
05:27struggle a little bit more challenging.
05:29And so psycho oncologists really
05:31focus on helping patients
05:33manage both the emotional and the
05:35physical side of cancer treatments
05:37and well into survivorship as well.
05:39You know when you were talking,
05:41it seemed to me that there's really different
05:44groups of patients that I could see
05:47your services being useful for,
05:50so they're the patients
05:53who are well who have not yet
05:55been diagnosed with the big C,
05:57but who may be at risk.
05:59So when you were talking
06:02about behavior modification,
06:03smoking cessation we know that smoking
06:05is a key driver of many cancers.
06:08A patient may not have been
06:10diagnosed with cancer yet
06:12but your services would still be
06:15helpful in helping patients to
06:17quit smoking or other
06:20lifestyle modifications.
06:21We've talked on this show about obesity,
06:24for example,
06:25and getting people into the right
06:28mindset to to adopt those healthy behaviors.
06:32So that's one group of patients.
06:33And then there's the cancer patients.
06:35And then there's the survivors.
06:36So in talking about these three
06:38categories of patients, I guess,
06:40can you dive a little bit more into
06:43the strategies that you would use in
06:46helping the first group of patients?
06:48The patients who,
06:49and I'm sure many of our listeners
06:51right now are thinking,
06:53especially with the new
06:54year just around the corner,
06:56I really ought to develop
06:58some healthier habits.
06:59I know that these habits that I currently
07:01have, over eating, not exercising,
07:04smoking, drinking,
07:04and so on and so forth increase
07:07my risk of cancer.
07:08But how can I
07:12help myself to set some resolutions
07:15and behavior modification that can help?
07:18Can you give people some tips and
07:20also tell us when they should
07:22start seeking out professional
07:24help to make those behavior
07:27lifestyle modifications?
07:29We are lucky in that we have
07:31a very robust tool in our tool belt
07:35called cognitive behavioral therapy
07:36which some may have heard of that is
07:39really considered the gold standard in
07:42managing depression and anxiety symptoms,
07:45but has been more studied in recent years
07:48on how we can use CBT to help manage
07:51both those behavioral changes you're
07:54mentioning as well as emotional issues
07:57moving forward. Whether
07:59you're talking about a cancer patient
08:01or someone who just wants to make
08:03some changes because behavior is not
08:05something that exists in isolation.
08:08Behavior also exists in response
08:10to how we think about things and
08:13how we feel about things and so
08:15CBT focuses on the relationship
08:18between our thoughts, our behaviors,
08:21our emotions, and more recently,
08:23research has focused on the
08:25physical sensations as well.
08:27An example,
08:28maybe if you're feeling anxious,
08:30people tend to have changes in their body.
08:33Their heart may race.
08:34They may have difficulty
08:36with hyperventilation,
08:37which is something that
08:38when it's intense enough,
08:40could actually bring someone to the
08:42emergency room because they think that
08:44they may be having a heart attack and
08:46so CBT looks at those four components,
08:48and prioritizes which of these things
08:50seems to be the biggest barrier for making
08:54the changes that you want to change.
08:57So one thing that I notice a lot in practice
09:00when folks want to make some
09:02kind of behavior change as they
09:03tend to go really big at first,
09:05and then they inevitably end up not
09:08getting where they want to go because
09:11they may have set those goals too
09:13high in the beginning instead of
09:15maybe starting slow and just
09:17taking some time to reach their goal.
09:20And you could imagine if you've
09:22done that over and over again,
09:24you may start to have thoughts like Oh well,
09:26what's the point? Why even bother?
09:27I can't do this,
09:28and then you may throw in the towel.
09:30And so when you're
09:32meeting with someone like myself,
09:35to focus on those issues,
09:37we want to know what has been
09:39difficult about getting to the place
09:40where you want to go in the past.
09:42And usually it follows in one of those
09:44categories of thoughts, behaviors,
09:46emotions or physical sensations.
09:49And I would suggest for someone if
09:51they're thinking about whether or not
09:53they need to work with a professional,
09:55is how successful have you
09:57been in the past,
09:58and are you able to identify where
10:00you might have gotten off the
10:02path of where you wanted to go?
10:04And if you're not sure, if it feels
10:05like you need someone to help work
10:07with you to set some clear goals
10:09and have some accountability and
10:11work with you on building momentum,
10:12then that might be a time to reach
10:14out to a professional for some help.
10:17And so in order to do that,
10:20how do people access
10:22Psychological services?
10:23Do they go through their family doctor
10:25or do people come to you just straight
10:28off the street and say, you know,
10:30I'm interested in
10:33quitting smoking.
10:34I'm interested in losing weight.
10:36How do people generally find
10:39psychologists and psychiatrists
10:40and counselors and social workers
10:43to help them with these with
10:45these behavioral modifications?
10:46If they haven't been diagnosed
10:48with cancer yet?
10:50There are a lot of different avenues for
10:52that, but oftentimes people may find
10:54a provider through their insurance,
10:56as insurance will list what services
10:58are covered and who are the
11:00providers that take your insurance.
11:02People also find me through word of mouth,
11:04so they might have a friend or a family
11:07member who had spoken to me at one point,
11:08or they may have heard me speak at a
11:11group and people can also search different
11:15websites that host different
11:18platforms for finding a provider.
11:20For someone like myself,
11:22I'm a board certified clinical
11:24health psychologist,
11:25so I have a specialty in health and
11:27you can search specifically for that.
11:29A board certified clinical health
11:31psychologist through the American Board
11:33of Professional Psychology to find
11:35folks in your state that have that
11:37designation and would likely be more
11:39able to help in the realm of health change.
11:43Great information, all right.
11:45Let's look at the second category
11:49so the newly diagnosed cancer
11:51patient, you can imagine,
11:54when you've
11:55been given that diagnosis,
11:57your world kind of turns upside down,
11:59and it's not uncommon for people
12:03to a have anxiety, but
12:06it may also turn into,
12:10you know, depression.
12:11Some people may turn to substance abuse.
12:15They may have issues in terms of
12:18relationships, especially because
12:19it's not just the patient
12:21going through that diagnosis,
12:23it also affects family,
12:25workplaces, and so on and so forth.
12:28How do you manage dealing with
12:31all of that when patients are
12:34newly diagnosed with cancer?
12:37It is a lot, and if you think about it,
12:39it really does affect almost
12:41every aspect of someone's life.
12:43Maybe not everyone all of the time,
12:45but even things like work.
12:47If somebody is so sick that they
12:48can't make it to work anymore,
12:50then they might start having
12:52financial problems.
12:52Maybe they can't perform the same
12:54roles that they did in their
12:56household and that might lead to
12:58some relationship conflict.
13:00Not to mention the physiological aspects
13:02of the cancer treatment itself.
13:04So there are a lot of different
13:06ways folks can struggle through this
13:10process and I keep coming
13:12back to CBT because it's just such
13:13a handy tool because it's such a
13:15big umbrella and there's so many
13:16different things that we can do with that.
13:19But again,
13:20we can breakdown what are the challenges?
13:22Are they controllable or uncontrollable?
13:25If they're controllable,
13:25we might problem solve or help
13:27resolve some of the barriers and that
13:29way of looking at what are concrete
13:31steps that someone could take,
13:32or if it's uncontrollable then
13:34we look at managing the emotion
13:36and maybe helping choose
13:37coping strategies that are more
13:39helpful. Things like substance abuse,
13:41those kinds of things tend to help
13:42really well in the short term,
13:44and that's why people do them.
13:45But they're not the best for long
13:47term coping or for long term health,
13:49and so we can help someone
13:50get the big picture of
13:52what are the biggest issues and
13:54prioritizing the ones that are
13:56most important.
13:57Starting with that controllable,
13:59uncontrollable framework and then
14:01using the tools that CBT provides
14:03us to help get more specific.
14:05We'll talk a lot more about what
14:07things people can do from
14:09a practical standpoint,
14:10right after we take a short
14:12break for a medical minute.
14:13Please stay tuned to learn more
14:15about The Field of Psycho-Oncology with my
14:17guest doctor Jennifer Kilkus.
14:19Funding for Yale Cancer Answers
14:21comes from Smilow Cancer Hospital,
14:23where physicians collaborate with
14:25diagnostic and interventional
14:27radiologists, gastroenterologists,
14:28and pathologists to provide expert care
14:31for patients with pancreatic cancer.
14:36yalecancercenter.org/GI.
14:39Breast cancer is one of the most common cancers
14:41in women. In Connecticut alone,
14:43approximately 3500 women will be
14:45diagnosed with breast cancer this year,
14:48but there is hope,
14:49thanks to earlier detection,
14:50noninvasive treatments and the
14:52development of novel therapies
14:54to fight breast cancer.
14:55Women should schedule a baseline
14:57mammogram beginning at age 40 or
14:59earlier if they have risk factors
15:01associated with the disease.
15:03With screening, early detection,
15:05and a healthy lifestyle,
15:06breast cancer can be defeated.
15:09Clinical trials are currently
15:11underway at federally designated
15:13Comprehensive cancer centers such
15:14as Yale Cancer Center and at Smilow
15:16Cancer Hospital to make innovative
15:19new treatments available to patients.
15:21Digital breast tomosynthesis or 3D
15:23mammography is also transforming breast
15:26cancer screening by significantly
15:28reducing unnecessary procedures
15:30while picking up more cancers.
15:32More information is available at
15:35yalecancercenter.org. You're listening
15:36to Connecticut Public Radio.
15:39Welcome back to Yale Cancer Answers.
15:42This is doctor Anees Chagpar
15:44and I'm joined tonight by my
15:45guest Doctor Jennifer Kilkus.
15:47We're learning about her work
15:48in the field of Psycho oncology
15:50and right before the break
15:52Jennifer, you were telling us about
15:54the role that Psycho oncology
15:56can play for a cancer patient whose
15:59world may have been just shattered with a
16:01new diagnosis who may be facing anxiety,
16:04who may be facing issues of
16:07depression or substance abuse,
16:08who may have issues in their work,
16:10in their relationships,
16:13and I'm just wondering a few things.
16:15So first of all, does every patient,
16:18every cancer patient,
16:19need a Psycho oncologist?
16:21Is that something that they should be
16:23talking to their oncologist about?
16:24Or is it only the patients who are
16:27really struggling with that diagnosis
16:29that should be asking for that service?
16:32I would say that no,
16:34it's actually surprising that many
16:36cancer patients are able to cope just
16:38fine with the resources that they
16:40have available in their community.
16:42So they might have a really
16:44strong social support network,
16:45or they may already have a provider in
16:50the community and we estimate somewhere
16:53around 30 to 40% of patients may
16:56meet criteria for a major depressive
16:58disorder and anxiety disorder at some
17:00point throughout their diagnosis
17:02and their treatment,
17:03depending on which measures we're using
17:05and which researcher we're asking.
17:06But for the most part,
17:08many patients tend to cope very well
17:11despite how challenging this can be.
17:13So I would say for patients who
17:16really feel like these symptoms are
17:18persisting and they're really finding
17:20it hard to get by with their day-to-day
17:23activities because of their symptoms,
17:25that would be a good time to talk
17:27to your oncologist about connecting
17:28with someone for some help.
17:30The other thing that strikes me
17:32is that very much like we've seen
17:35with mental health in general,
17:38it seems to be something that a lot
17:40of people don't want to talk about.
17:41They don't want to admit they oftentimes
17:44feel like they may be perceived
17:47as being quote weak if they admit
17:50that they're struggling to cope.
17:53And how do you get over that?
17:55What advice do you have for people to
17:58broach that subject with their physician
18:00so that they can start getting some help?
18:03I am so glad that you brought that up
18:05because if I had a number one soapbox issue,
18:08it would be the messaging that we get not
18:10just with cancer but in our culture as a
18:13whole about those narratives of having
18:15to be strong and struggle through things.
18:17And those types of narratives really
18:20make it difficult for people to
18:22acknowledge that they may be struggling
18:25and reach out for help,
18:26because the message that they get everywhere
18:29that they look at is that is somehow wrong,
18:31or that you're failing in some way.
18:33But the reality is,
18:35that most people struggle with this,
18:38and that's what's more normal.
18:39It's more normal to struggle
18:41and to have difficulty with
18:43challenging situations in our lives,
18:45and we don't often give people an
18:48opportunity to have that witness.
18:50And so if there are folks listening
18:52who have struggled with that,
18:54I would just encourage you to
18:58question where that came from,
19:00and if you would have the same
19:02types of expectations
19:04if somebody that you cared about in your
19:05life thought that.
19:07Because oftentimes
19:09we're very hard on ourselves in a way
19:11that we wouldn't be for other people,
19:13and I think that of course,
19:16as a psychologist,
19:16this is easy for me to say,
19:18but I think that asking for help is
19:20the biggest sign of strength because
19:22you're acknowledging that this is
19:24something that you can't manage on your own,
19:26and that's risky.
19:27It's vulnerable,
19:28and so it's possible to feel that
19:31and still ask for help.
19:33It's possible to
19:34push through that and in speaking
19:36with an oncologist,
19:37all of them have seen people struggling
19:39at different points of their diagnosis.
19:43And so it's not a surprise if you do
19:46even just a little bit of research,
19:48if you just Google,
19:49say cancer and anxiety or cancer and stress,
19:52you'll see how common it is and
19:54how common it is to ask for help
19:56and how many different avenues
19:57there may be out there for support.
20:00I think that one key message for
20:03people whether you've been diagnosed with
20:06cancer or not is that it's OK to not be OK.
20:09And it's OK to say I'm not OK and I
20:12could really use some help and the
20:15good news is that help is out there,
20:19but sometimes that help needs to be asked
20:22for because people don't have ESP, right?
20:24So you need to kind of take that
20:27step and I agree with you, it's a
20:29vulnerable step, right?
20:30But it's OK to say I'm not OK,
20:34and I think more and more people
20:36now are realizing that,
20:38and so I hope that that message gets across.
20:42But the other thing I think that is
20:46really helpful is for people to understand
20:49in a practical and pragmatic way,
20:51what is the benefit of seeing
20:54a mental health provider,
20:55whether it's a psychologist, a psychiatrist,
20:58a counselor or social worker,.
20:59Can you provide us
21:02some tangible benefits that you get
21:04because some people may be thinking OK,
21:07what are
21:08they gonna do?
21:10I mean,
21:10we're going to talk about my
21:11childhood or something,
21:13and I think that there's a lot of
21:16misperceptions about what exactly you
21:18do and what are the tangible benefits
21:21of working with a counselor or mental
21:24health professional to kind of cope
21:27with either the physical symptoms
21:29or the psychological symptoms.
21:32Or simply to get through the day
21:34and cope with all of the peripheral
21:36things that are happening with you
21:39in terms of relationships at home,
21:41at work, and so on.
21:44And I've heard all
21:45of those things and more when I
21:47meet someone for the first time,
21:49so they have gotten over that hump of OK,
21:52I'm going to make an appointment.
21:53I'm going to go to the appointment,
21:54but what do we do now?
21:56There is a lot of misinformation and
21:59misunderstanding about what psychologists
22:01and counselors and social workers do.
22:03There are some that focus on understanding
22:06how your childhood shaped who you are today.
22:08When we're dealing with something like cancer
22:11and something that's very here and now,
22:13we're focused on what tools are the most
22:16useful for helping improve your symptoms
22:18and helping improve your quality of life.
22:21And so to use an example that I see often,
22:24fatigue is one of the biggest challenges
22:27that cancer patients experience as they're
22:29going through their treatment and well
22:32beyond when their treatment is completed
22:34and if we're using looking at how CBT
22:37skills vary based and a present moment
22:39focused approach could help with that.
22:42I would work with someone on
22:45identifying what behaviors might be
22:47continuing that cycle of fatigue,
22:49and oftentimes with fatigue comes
22:50depression and when we feel
22:52depressed or when we feel like we
22:54can't do the things we used to do,
22:56a lot of people tend
22:57to withdraw and so they may struggle
22:59to do the activities that used to bring
23:02them pleasure or feel meaningful to them,
23:04or they may be spending a lot of
23:06time in bed or on the couch and those
23:09things unfortunately tend to make
23:10both fatigue and depression worse.
23:12So we might focus on how can we gradually
23:16increase activity overtime and in a way
23:19that balances both energy and mood.
23:22So paying attention to what things
23:24have the biggest bang for the buck
23:26for improving mood and energy.
23:28And building up slowly over time
23:29again so we don't get into a cycle
23:31where we're doing too much
23:32and then the bottom drops out and and we
23:35just give up because it's too difficult.
23:38And so you can see how
23:41in that scenario,
23:42I'm not providing advice.
23:43I'm also not talking about anybody's
23:45childhood.
23:46I'm suggesting skills and strategies
23:48that are focused on the problem at hand.
23:51And what could actually be done
23:53to help improve things overtime.
23:56Yeah, I think that's
23:57so important.
23:59And it really is, you know,
24:00kind of tangible advice like guidance.
24:03Just like a coach.
24:05You know when you're a kid and
24:07you're playing Little League or
24:09or you're learning the piano.
24:11You always have a teacher or a
24:13coach who's trying to make you
24:14better and and give you those tips.
24:16Those skills that will help
24:18you in improving whatever it
24:20is you're trying to improve.
24:22And I think working with a mental
24:26health professional in that way may
24:29provide you those same kinds of skill
24:31sets that will help you to overcome
24:34the challenges that come with that.
24:37I think the other piece though is
24:40the emotional piece and you know,
24:42dealing with just the huge array of emotions
24:46that you get with a cancer diagnosis.
24:49And for some people I think that so
24:52much can compound one thing on top of
24:55another thing on top of another thing.
24:58And there are cases where
25:01people can actually get
25:04suicidal with all of the things
25:07building up leading to outcomes
25:09that really didn't need to happen.
25:12So talk a little bit about how people
25:15can overcome some of the emotional
25:17baggage and all of the things that
25:20just seem to layer on when they're
25:23going through a cancer journey where
25:26you know sometimes it just feels like
25:29there's a tiny straw that can
25:31break the camels back.
25:33And I think that's
25:34exactly what happens,
25:35and I often talk to people about
25:38that these aren't as if we were
25:40dealing with each stressor individually.
25:42They do become something different
25:44when they compound like that and
25:46and they become something bigger
25:47and more more difficult to manage,
25:49but I think the strategy is the
25:51same as teasing apart all those
25:53different pieces that are tangled up
25:55and looking at them one by one and
25:57how they interact with each other.
25:59And so it may be that someone,
26:02like the example that I mentioned,
26:04comes with more behaviorally
26:07motivated symptoms where they're
26:09having a hard time connecting
26:11with people or they've withdrawn,
26:13and it may be that somebody is coming
26:15to me with more symptoms that are more
26:17driven by the thoughts that they have like,
26:19this is hopeless,
26:20or I'm never going to get past this,
26:23and so we would just take those pieces one
26:25at a time and address them as they come,
26:28and oftentimes they have a downstream effect.
26:31So once you can start
26:32getting some distance from
26:34thoughts and thinking about them in
26:36a more objective or balanced way,
26:38then it may become easier to do some
26:40of the things behaviorally that might
26:42also help you feel better and vice versa.
26:45And so it's not
26:47I wouldn't say a simple process or
26:49or maybe it is a simple process,
26:51but not an easy one,
26:53but that's why it's helpful
26:55to have someone like a coach.
26:56And that's why I often think of
26:58myself like a coach or like a teacher
27:00to help observe those things.
27:02And help point out where can we start
27:04so that we can have the most success
27:07the quickest and then go from there.
27:10I think that that's so key, is
27:13that oftentimes when you're feeling
27:14overwhelmed like it's just one thing
27:16on top of another thing on top of
27:19another thing on top of another thing,
27:21it's sometimes helpful to have an
27:24objective lens and outside person
27:26to kind of break things down for you
27:29into little pieces and to give you
27:32some skills to understand how you can
27:34deal with each of the little pieces.
27:37It might be more manageable
27:39than trying to deal with
27:40the overwhelm of many things
27:43all compounded at once.
27:45And actually if we look at what happens
27:48physiologically and neurologically
27:49when we become overwhelmed,
27:51it's actually really difficult to
27:53do that for ourselves because our
27:55frontal lobe is really what helps
27:57us think through things clearly and
27:59problem solve and to sort through
28:02things and organize for ourselves.
28:04And when we're feeling very emotional,
28:06that part of our brain isn't
28:08activated as much. Instead,
28:09the part of our brain,
28:11our amygdala, is really on
28:13overdrive in our sympathetic nervous system.
28:16That's our fight or flight response.
28:17That's what our body does when
28:19we're in danger.
28:20When it thinks we're in danger, it
28:22really takes over,
28:23and it becomes very challenging
28:24to think clearly,
28:25and that's part of the reason why
28:27it's so helpful to have someone
28:29outside to be able to objectively
28:30help guide you through those things.
28:33Doctor Jennifer Kilkus is an
28:34assistant professor of psychiatry
28:36at the Yale School of Medicine.
28:38If you have questions,
28:40the address is cancer answers at
28:42Yale.edu and past editions of the
28:44program are available in audio and
28:47written form at yalecancercenter.org.
28:48We hope you'll join us next week to
28:51learn more about the fight against
28:53cancer here on Connecticut Public Radio.
28:54Funding for Yale Cancer
28:56Answers is provided by Smilow
28:57Cancer Hospital and AstraZeneca.