Chapter I

Introduction
Resilience:

American Psychological Association (APA) has explained resilience as the process of adapting
well in the face of adversity, trauma, tragedy, threats, or significant sources of stress such as family
and serious health problems, relationship problems, , or workplace and financial stressors. So it
actually means 'bouncing back' from difficult experiences.

According to APA research has also shown that resilience is ordinary, not extraordinary. People
commonly show resilience. So there is one of the example that is response of many Americans to
the September 11, 2001 terrorist attacks and individuals' efforts to rebuild their lives.

If a person is resilient it does not mean that they do not experience difficulty or distress. Emotional
pain and sadness are common in those who have suffered major adversity or trauma in their lives.
In fact, the road to resilience involves considerable emotional distress but resilience is not a trait
that people either have or not. It involves thoughts, behaviors and actions that can be learned and
developed in anyone. (APA)

Resilience is the term which is taken from physics of materials, and it is the property of a material
that enables it to resume its original position or shape after being bent, stretched, or compressed. In
psychiatry, resilience stands for one's capacity to recover from trauma and stress. It is attributes of
some people who manage to endure and recover fully, despite suffering significant traumatic
conditions of extreme deprivation, serious threat, and major stress. Resilience in a person shows a
dynamic union of factors that encourages positive adaptation despite exposure to adverse life
experiences. Resilience is associated with mental health and considered to be essential as a
component of successful psychosocial adjustment. Increasing attention is drawn in recent years to
the potential role that personality and neurobiology might play in determining resilience. In case of
children; resilience may stand for successful adaptation to extreme events such as maltreatment or
poverty. It may be more evident in all stressful situations in form of how these children respond to
the everyday social, physical, and intellectual challenges faced by them. By Priyvadan Chandrakant
Shastri

Factors in Resilience

There are combination of factors contributes to resilience. Many studies are there which show that
the primary factor in resilience is having supportive and relationships within and outside the family.
Relationships that create trust and love provide role models and offer encouragement and
reassurance help bolster a person's resilience.

some additional factors are associated with resilience, including:

 The ability to make original plans and take actions to carry them out.
 A positive view of yourself and confidence in your abilities and strengths
 Skills in problem and solving communication
 The ability to manage your strong feelings

Factors in Resilience

There are combination of factors contributes to resilience. Many studies are there which show that
the primary factor in resilience is having supportive and relationships within and outside the family.
Relationships that create trust and love provide role models and provide encouragement and
reassurance that also help bolster a person's resilience.

Some additional factors are associated with resilience, including:

 The ability to make realistic plans and take steps to carry them out.
 A positive view of yourself and confidence in your abilities and strengths
 Skills in problem and solving communication
 The ability to manage strong impulses and feelings.

All of these are some factors that people can develop in them.
.

Strategies for Building Resilience

Developing resilience is a self decision journey. All people do not react the same to traumatic or
stressful life events. An approach to building resilience that works for one person is not necessary
to work for other person in a same way. People use different strategies.

Some variation may show some cultural differences. A person's culture can get impact on how they
communicates feelings and deals with adverse situation — for example, how a person connects
with significant others, including their extended family members or community resources. With the
increasing cultural diversity, each individual has greater access to a number of different approaches
to building resilience.

Ways to build resilience:

You should make connections.

Make good relationships with close family members, friends or others those are important. Accept
the help and support from those who really care about you and who will listen to you to strengthens
your resilience. Some people also find that being active in civic groups or trust-based organizations,
or any other local groups which provides social support and who can help with reclaiming hope.
Assisting others in their time can benefit the helper.
Avoid seeing crises as insurmountable problems.
People cannot change the reality that highly stressful events happen, but they can do is change how
they interpret and respond to such events. They should try to look beyond the present to know how
future circumstances may be a good. They can also note any subtle ways in which they might
already feel better as they deal with difficult situations.

Accept that change is a part of living.

Some goals may no longer be attainable as a result of adverse situations. Accepting the
circumstances that cannot be changed can really help people focusing on circumstances that they
can alter.

Move toward your goals.

Person can develop some realistic goals. They should do something regularly — even if it seems
like a small accomplishment — that enables them to move toward their goals. Instead of focusing
on tasks that seem unachievable, on should ask themselves, "What's one thing I know I can
accomplish today that helps me move in the direction I want to go?"

Take decisive actions.

Person should act on adverse situations as much as they can. Take some decisive actions, rather
than detaching completely from problems and stresses and wishing that fine day they would just go
away.

Look for opportunities for self-discovery.

People sometimes learn something about themselves and they may find that they have grown in
some respect as a result of their struggle with loss. Many people who have experienced some
tragedies or hardship have reported better relationships, greater sense of strength even while feeling
vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation
for life.

By Abby R. Rosenberg, for many cancer survivors, the aftermath of treatment can have a
profound and lasting impact not only on their body but on their mind as well. For some, it’s
natural to develop a positive outlook on life during and after treatment, while others struggle to
find any positive meaning in their difficult cancer journey.
Studies have shown that survivors who can establish their stressors, manage their stress, and
derive strength from their experience with cancer have more resilience and, there fore, a better
overall quality of life. Resilience in cancer survivors might embrace an absence of
psychological distress or a positive outcome like post-traumatic growth, or finding which
means from traumatic experiences. Researchers have found that resilience can moderate the
effects of medical stress and improve life satisfaction among cancer survivors. So how does
one go about developing resilience? For some survivors, resilience seems to be a personality
trait. Others work to improve their outlook on life through support and practice. For many, the
following tips have proven helpful in strengthening resilience.

 Realize some things in life are out of your control.

 Find strength in what you can control, such as lessons you can take away from your
life.
  Outlook on life.
 Identify what causes you stress and anxiety and implement strategies to manage your
stress when thinking back on your experience, reflect on what you learned about
yourself and your own strength.

Coping with cancer is no easy task, but learning to manage stress can help make the journey a
little easier. Stress can present itself in a variety of ways, including sleeping difficulties,
irritability, headaches, poor concentration, and depression. It is important to recognize these
warning signs and work to reduce your stress. For many, surrounding yourself with a support
team, talking with other cancer survivors, exercising, and eating a healthy diet help reduce
stress and anxiety

Resilience involves maintaining flexibility and balance in your life as you deal with stressful
circumstances and traumatic events. This happens in several ways, including:

 Letting yourself experience strong emotions, and also realizing when you may need to avoid
experiencing them at times in order to continue functioning.
 Stepping forward and taking action to deal with your problems and meet the demands of daily
living, and also stepping back to rest and reenergize yourself.
 Spending time with loved ones to gain support and encouragement, and also nurturing yourself.
 Relying on others, and also relying on yourself.

Coping Mechanism:

Coping mechanisms are ways to which external or internal stress is managed, adapted to or acted
upon. Susan Folkman and Richard Lazarus define coping as "constantly changing cognitive and
behavioral efforts to manage specific external and/or internal demands that are appraised as taxing".

Defining Coping Mechanisms

Psychologists Richard Lazarus and Susan Folkman scientifically defined coping as the sum of
cognitive and behavioural efforts, which are constantly changing, that aim to handle particular
demands, whether internal or external, that are viewed as taxing or demanding. Simply put, coping
is an activity we do to seek and apply solutions to stressful situations or problems that emerge
because of our stressors. Actually, the term "coping" is more associated with "reactive coping",
because in general, we see coping as a response to a stressor. On the other hand, there's also what
 we call "proactive coping", wherein the coping response is aimed at preventing a possible encounter
with a future stressor.
While coping mechanisms are brought about by a person's conscious minds, it doesn't mean that all
of them bring about positive coping; there are some types of coping mechanisms which are
maladaptive. Other psychologists say that maladaptive coping is also synonymous to "non-coping",
since a person who responds to a stressor using a coping mechanism but isn't able to positively
ward off the stressor or solve the stressful situation hasn't coped with the stress at all.

Types of Coping Strategies

Over the years, psychologists and researchers have identified about 400 to 600 coping strategies,
and yet there are so many other potential coping strategies that are still under research. Because of
this, the classifications of coping strategies vary from textbook to textbook.

One of the recognized groupings of coping strategies is that which was written in the psychology
textbook by Weiten, which includes the appraisal-focused or adaptive cognitive, the problem-
focused or adaptive behavioural, and the emotion-focused.

1. the appraisal-focused strategies are those coping mechanisms which involve the change of
mindset or a revision of thoughts. Denial is the most common coping mechanism under this
category.
2. the problem-focused strategies are those that modify the behaviour of the person. A good
example of this is learning how to cook a family dinner upon knowing that your spouse's family
would come over your house this weekend.
3. the emotion-focused strategies include the alteration of one's emotions to tolerate or eliminate the
stress. Examples include distraction, meditation, and relaxation techniques.

Cancer :( National Cancer Institute)

Cancer is a genetic disease—that is, it is caused by changes to genes that control the way our cells
function, especially how they grow and divide.

Genetic changes that cause cancer can be inherited from our parents. They can also arise during a
person’s lifetime as a result of errors that occur as cells divide or because of damage
to DNA caused by certain environmental exposures. Cancer-causing environmental exposures
include substances, such as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays
from the sun.

Each person’s cancer has a unique combination of genetic changes. As the cancer continues to
grow, additional changes will occur. Even within the same tumor, different cells may have different
genetic changes.

In general, cancer cells have more genetic changes, such as mutations in DNA, than normal cells.
Some of these changes may have nothing to do with the cancer; they may be the result of the
cancer, rather than its cause.
Causes and Prevention

Cancer prevention is action taken to lower the risk of getting cancer. This can include maintaining a
healthy lifestyle, avoiding exposure to known cancer-causing substances, and taking medicines or
vaccines that can prevent cancer from developing.

Breast Cancer (American Cancer Society).

Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a
tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancer) if the
cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body.
Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

Where breast cancer starts

Breast cancers can start from different parts of the breast. Most breast cancers begin in the ducts
that carry milk to the nipple (ductal cancers). Some start in the glands that make breast milk
(lobular cancers). There are also other types of breast cancer that are less common.

A small number of cancers start in other tissues in the breast. These cancers
are called sarcomas and lymphomas and are not really thought of as breast cancers.

Although many types of breast cancer can cause a lump in the breast, not all do. Many breast
cancers are found on screening mammograms which can detect cancers at an earlier stage, often
before they can be felt, and before symptoms develop. There are other symptoms of breast cancer
you should watch for and report to a health care provider.

It’s also important to understand that most breast lumps are benign and not cancer
(malignant). Non-cancerous breast tumors are abnormal growths, but they do not spread outside of
the breast and they are not life threatening. But some benign breast lumps can increase a woman's
risk of getting breast cancer. Any breast lump or change needs to be checked by a health care
professional to determine if it is benign or malignant (cancer) and if it might affect your future
cancer risk.

How breast cancer spreads

Breast cancer can spread when the cancer cells get into the blood or lymph system and are carried
to other parts of the body.

The lymph system is a network of lymph (or lymphatic) vessels found throughout the body that
connects lymph nodes (small bean-shaped collections of immune system cells). The clear fluid
inside the lymph vessels, called lymph, contains tissue by-products and waste material, as well as
immune system cells. The lymph vessels carry lymph fluid away from the breast. In the case of
breast cancer, cancer cells can enter those lymph vessels and start to grow in lymph nodes. Most of
the lymph vessels of the breast drain into:

 Lymph nodes under the arm (axillary nodes)

 Lymph nodes around the collar bone (supraclavicular [above the collar bone] and
infraclavicular [below the collar bone] lymph nodes)
 Lymph nodes inside the chest near the breast bone (internal mammary lymph nodes)

If cancer cells have spread to your lymph nodes, there is a higher chance that the cells could have
traveled through the lymph system and spread (metastasized) to other parts of your body. The more
lymph nodes with breast cancer cells, the more likely it is that the cancer may be found in other
organs. Because of this, finding cancer in one or more lymph nodes often affects your treatment
plan. Usually, you will need surgery to remove one or more lymph nodes to know whether the
cancer has spread.
Still, not all women with cancer cells in their lymph nodes develop metastases, and some women
with no cancer cells in their lymph nodes develop metastases later.

Chapter IV
Methodology

Aim:
To study Resilience and coping strategies in women Survivor of Breast Cancer.

Objectives:
1. To assess the coping abilities among females with breast cancer survivors.

2. To assess the resilience among patients with breast cancer survivors.

3. To know about what is their meaning of life.

4. Do they face body shaming?

5. Does age matters to cope up.

Sample-

The sample will consist of few female breast cancer survivors.

The number of breast cancer survivors has increased since 1990 due to
advances in biomedical technology that lead to an increase in early diagnosis
and treatment. Research on survivorship has focused on the psychological and
treatment aspects of the disease. The goal of this study was focused on
exploring the lived experiences of breast cancer survivors from diagnosis,
treatment and beyond.

https://onlinelibrary.wiley.com/doi/full/10.1111/hex.12372

While breast cancer is the leading cause of cancer in American women and ranks second among cancer
deaths in women, mortality rates declined significantly between 1992 and 1998. The five-year survival rate
for women of all stages now is 86%, and 96% for women with local stage disease (American Cancer Society,
2002). This medical progress requires examining psychosocial quality of life issues among breast cancer
survivors. Women who developed breast cancer were more likely than women who remained free of
breast carcinoma to experience reduced physical function, role function, vitality, and social function
(Michael et al., 2000).
https://onlinelibrary.wiley.com/doi/pdf/10.1002/pon.991

References

American Cancer Society. (n.d.). What Is Breast Cancer? Retrieved from

https://www.cancer.org/cancer/breast-cancer/about/what-is-breast-cancer.html

American Psychological Association. (n.d.). The road to resilience. Retrieved from

https://www.apa.org/helpcenter/road-resilience

Berkeley International Office. (n.d.). Learn More About The Resilience Project. Retrieved from

https://internationaloffice.berkeley.edu/students/academics/resilience/LearnMore

Body image and sexual problems in young women with breast cancer - Fobair - 2006 - Psycho-

Oncology. (2005). Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/pon.991

Cancer Causes and Prevention. (n.d.). Retrieved from https://www.cancer.gov/about-

cancer/causes-prevention

PMC, E. (n.d.). Breast cancer survivors: concerns and coping. - Abstract. Retrieved from

https://europepmc.org/abstract/med/7866975

Psychological resilience contributes to low emotional distress in cancer patients. (n.d.). Retrieved

from https://link.springer.com/article/10.1007/s00520-013-1807-6
SL, F. (n.d.). Breast cancer survivors: concerns and coping. - PubMed - NCBI. Retrieved from

https://www.ncbi.nlm.nih.gov/pubmed/7866975

Stress and Coping Mechanisms. (n.d.). Retrieved from https://explorable.com/stress-and-coping-

mechanisms

Stress Management and Resilience Training (SMART) Program to Decrease Stress and Enhance

Resilience Among Breast Cancer Survivors: A Pilot Randomized Clinical Trial. (n.d.).

Retrieved from https://www.sciencedirect.com/science/article/pii/S1526820911001145

Taking positive changes seriously - Aspinwall - 2005 - Cancer. (2005). Retrieved from

https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.21244

Then and now: quality of life of young breast cancer survivors - Bloom - 2004 - Psycho-Oncology.

(2004). Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/pon.794

What Is Cancer? (2015, February 9). Retrieved from https://www.cancer.gov/about-

cancer/understanding/what-is-cancer