Conceituação cognitiva em paciente oncológico: estudo de caso

Abstract

Breast cancer is a public health problem in Brazil, the leading cause of death among women and a disease with stigmas due to its epistemology that causes intense emotional and physical suffering due to its subjective configuration experienced by the individual. Objective: To describe a case of a woman with breast cancer and evaluate the intervention in the cognitive-behavioral model and present the cognitive conceptualization of the case. Method: Participated in the study, a woman diagnosed with breast cancer, 51 years old, married, municipal civil servant. Materials: Sociodemographic questionnaire, Quality of life inventory (WHOQOL-Bref), Beck Anxiety Inventory - BAI, Beck Depression Inventory - BDI and Irrational Beliefs Questionnaire. The intervention lasted for a weekly session of up to 50 minutes each, performed in a private psychology clinic and previously scheduled totaling 20 sessions during the psychotherapeutic process. The Cognitive-Behavioral Intervention Model (CBT) included: Socratic Questioning, Record of dysfunctional thoughts, application of inventories and standardized tests, among others. The inventories were applied at the beginning of the interventions and at the end to perform the diagram of cognitive conceptualization of the Cognitive-Behavioral approach and follow-up after 30 days after the end of the interventions. Results: In the first evaluation, he obtained 35 points in BAI and 42 in BDI. The final evaluation showed a decrease in the symptoms of anxiety and depression (18 in BAI and 10 in BDI). Regarding quality of life, the first assessment showed low scores in all domains, indicating low quality of life, the highest score was in the “environment” domain; in the final assessment, scores rose in all domains indicating good quality of life. There was a restructuring of dysfunctional thoughts and although the central belief of devaluation is still present, the patient demonstrated during the process a greater ability to deal with everyday situations, increasing her self-confidence. As noted, spirituality and faith were present as a way of coping with the disease and adherence to psychotherapy. The cognitive conceptualization allowed to identify situations that occurred with the patient in a hospital, social and family context. To understand the case, the author identified the category “experiences of helplessness in the treatment of cancer”, based on the analysis of the narrative and content of the sessions and the Socratic questioning. In the “anger at negligence” subcategory, the patient revealed a very intense feeling transcribed in full during the interviews; in the subcategory “dependence on illness” he described a lot of anxiety and sadness and in the last subcategory “unconditional faith in healing and in the presence of God”, the confrontation during the sessions was constant. Religiosity and the belief that she would be cured after treatment were decisive in preventing relapses and total adherence to psychotherapy. CBT has shown effectiveness in the therapeutic process, reducing symptoms of anxiety and depression and cognitive conceptualization has provided a new functional repertoire along with protective factors of faith and religiosity. Conclusion: CBT has shown effectiveness in the therapeutic process, reducing symptoms of anxiety and depression and cognitive conceptualization has provided a new functional repertoire together with protective factors of faith and religiosity.