Table Of ContentOxford Guide to CBT for
People with Cancer
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Oxford Guide to
CBT for People
with Cancer
SECOND EDITION
Stirling Moorey,
MB BS, BSc, FRCPsych
Consultant Medical Psychotherapist, South London and
Maudsley NHS Foundation Trust, and Honorary Senior
Lecturer, Institute of Psychiatry, London, UK
Steven Greer,
MD, FRCPsych, FRANZCP
Consultant Psychiatrist, St Raphael's Hospice, Sutton, Surrey,
and Emeritus Reader in Psychological Medicine, Institute of
Cancer Research, University of London, London, UK
1
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1
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Foreword
L ike many others, I view my time on airplanes as an opportunity to catch
up on reading. No e-mail, no phone calls, no conversations with colleagues,
friends, and family; just a stretch of time that is all mine. However, my expec-
tations often prove to be overly optimistic, especially when my reading mate-
rial contains the words ‘stress’ or ‘coping’ in the title. In such instances, my
seatmate is likely to glance at whatever it is that I’m reading and then, leaning
towards me and speaking in a slightly conspiratorial voice, either offer to tell
me about the stress in his or her life or ask me to share the secrets of successful
coping, of course, to be summarized in just a few words. Usually I listen to the
stories about stress not just to be polite, but because I find such stories interest-
ing and often quite moving. But when I am asked to share the secrets of suc-
cessful coping, I reveal that I am a psychologist who does research and not a
psychologist who sees patients. Usually that response precipitates an immedi-
ate loss of interest and I am left, once again, with the promise of uninterrupted
time in which to work.
M y seatmates probably assume that as a researcher I am good with data but
ill-equipped to speak about the meaning of the data in relation to helping peo-
ple get through difficult days. This assumption is in fact deeply embedded in
the cultures of the social and behavioral sciences on the one hand and clinical
practice on the other. Historically, the two cultures have evolved separately;
they have spoken different languages and have had different objectives. The
social and behavioral sciences, for example, have focused on explaining and
even predicting behavior, while clinical practice has focused on diagnosing and
treating adjustment problems and mental illness. In recent years, however,
each discipline is finding reasons to reach across the chasm to the other, to
build bridges that permit flow of knowledge and promote multidisciplinary
collaboration.
One concept in particular has played a key role in bridging the chasm: stress.
On the clinical side, stress is recognized as a cause of behaviors such as
smoking, drinking, overeating, and use of illegal drugs that can cause disease
and even death. The study of such behaviors has resided primarily with the
social and behavioral scientists, which means clinicians need to reach out to
the researchers. On the other hand, social and behavioral scientists are increas-
ingly interested in how psychological processes associated with stress adversely
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vi FOREWORD
affect organ systems and eventuate in disease. Advances in technology are
making it possible to pursue such questions, so now the researchers want to
connect with clinicians and their patient populations.
S tirling Moorey and Steven Greer illustrate the bridge-building process.
Moorey and Greer developed Adjuvant Psychological Therapy to support the
well-being of patients with cancer. Then they conducted clinical research to
determine, among other objectives, the effects of their treatment and the rep-
licability of their earlier findings. At the same time, and possibly influenced by
Moorey and Greer’s pioneering work, others developed and tested variations
of cognitive behavioral therapy designed for cancer patients. By the late 1990s,
sufficient numbers of studies had been conducted to allow a meta analysis. The
benefits as well as the limitations of cognitive behavioral treatments in general
and Adjuvant Psychological Therapy in particular were identified.
The current edition shows a deepened understanding of the patient popula-
tions for which cognitive behavioral treatments can be most effective and for
issues faced by diverse patient groups. The authors’ experience also informs
the discussion of how the therapist should engage the patient at various phases
not only of illness, but also of therapy such as entry, mid-way and exit.
A t the time of Moorey and Greer’s first edition, the field of psycho-oncology
was in its infancy. The dramatic expansion in the intervening decades includes
the development of evidence-based treatments to support the quality of life
and well-being of patients with chronic illness or the prospect of imminent
death. The work of Moorey and Greer has continued throughout this period of
expansion. The process through which they have developed their treatment,
using their first-hand experience with cancer patients tempered with their own
research as well as the research of others, illustrates the way research and prac-
tice can be mutually beneficial.
As for my airplane conundrum, next time I will place Moorey and Greer’s
book on top of my reading pile, thereby eliciting interest primarily from those
with a specific interest in cancer. I will offer my seatmate the Moorey and Greer
book for the duration of the flight. This act has two purposes: it will provide the
opportunity for my seatmate to begin learning about the complexity of coping
with cancer while also protecting my precious airplane reading time.
Susan Folkman
San Mateo, CA
July, 2011
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As no two persons are alike in health, so no two are alike in disease: and no diagnosis
is complete or exact which does not include an estimate of the character or constitu-
tion of the patient … for to treat a sick man rightly requires diagnosis not only of the
disease but the manner and degrees in which its supposed essential characteristics are
modified by his personal qualities, by the inheritances that converge in him, by the
changes wrought in him by the conditions of his past life, and many things besides.
James Paget (1885)
Address to Abernethian Society
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Preface
When the first incarnation of this book was published in 1989, Professor Tim
McElwain, one of Britain’s most eminent oncologists, wrote in the Preface:
‘ Of course what we have here is very much a work in progress, and clearly there will be
more to be done to refine, augment and validate the treatments advocated; but I feel
certain that this important book will be of immediate value to everyone concerned
with the management of cancer patients.’
I n the 20 years since this was written, cognitive therapy has established itself
as the psychological therapy with the strongest evidence base, and psycho-
oncology has firmly established itself as a branch of health psychology. Our
own work has moved from the area of early-stage, curable cancer to the field of
palliative care, and this change is reflected in an expansion of the chapter on
advanced disease and a new chapter on working with grief. Interventions in
psycho-oncology are becoming more sophisticated, and we now give more
attention to the adaptation of cognitive behaviour therapy (CBT) for specific
cancer problems and symptoms. CBT has also increased its understanding of
psychological processes such as selective attention, safety behaviours, and the
role of worry and rumination in maintaining disorders, and we have incorpo-
rated some of these insights into our treatment. Readers of the previous edi-
tions have valued the clarity of the text, and we have not sought to change it
substantially, but rather to update it in the light of recent research and clinical
developments. We have retained the two-part structure. Part One describes
some of the key clinical, theoretical, and empirical aspects of the psychology of
cancer. It begins with an account of the experiences of people with cancer and
the common emotional reactions to the disease. In Chapter 2 these reactions
are put into a cognitive behavioural context, with an updated cognitive model
of adjustment to cancer. Chapters 3 and 4 review the evidence both for the
effectiveness of cognitive behavioural interventions in people with cancer, and
for the impact of therapy on the disease process itself. Part Two is a description
of our version of CBT for people with cancer, namely adjuvant psychological
therapy. It begins with an overview of adjuvant psychological therapy in
Chapter 5, followed by a description of the structure and nature of the thera-
peutic relationship in Chapter 6. Chapters 7, 8, and 9 present the basic emo-
tional, behavioural, and cognitive techniques that are used in therapy. These
remain unchanged from the last edition, except for some updating of Chapter 7
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