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What Is Emotional Judo?

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Published on October 13, 2016

What are the emotional challenges for men with prostate cancer?  How do you overcome these emotions?  Dr. Andrew Roth is a psychiatrist at Memorial Sloan Kettering Cancer Center where he dedicates his practice to helping prostate cancer patients understand anxiety, worry, depression, and anger with his five steps of Emotional Judo, known as DRAFT:  Detection, Recognition, Acknowledgement, Flip and Transformation.



AACR/Cancer Today

Transcript | What Is Emotional Judo?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello and welcome to Patient Power. I’m Andrew Schorr. For men with prostate cancer, there can certainly be for many, heavy-duty emotional issues. How do you cope? What are these emotional issues? Here to join us now is a leading expert in the field. That’s psychiatrist Andrew Roth. Dr. Roth is at Memorial Sloan Kettering Cancer Center in New York City. Dr Roth, thanks for joining us. Dr. Roth, what are the emotional issues that men with prostate cancer face?

Dr. Roth:               

The emotional issues that men with prostate cancer experience can be quite varied. Prostate cancer is a very common cancer with over 200,000 men being diagnosed every year. And it’s possible even that one in every six men can develop prostate cancer. But each man is unique. And each man is individual. And we have to take into account their genetic and their physiological differences. We have to take into account their psychological differences as well. There are some men who come into their prostate cancer experience having had psychiatric help, psychological help, psychotherapy in the past.

And there are some men who have never thought or dreamed of having psychiatric help.

And so I think the things that men are most concerned about is how they react to a new diagnosis, how they react if there’s a recurrence of their tumor, how they react to making a treatment decision when they’re trying to figure out what complications might they get? Are they going to be cured? And if they get complications, which ones might they get, and how are their lives going to be changed? This can all bring up a lot of anxiety, worry, a sense of sadness, depression. It can bring up a lot of anger as well, because a man’s life has just taken a turn and is now on a very different road than he and his family thought was going to be there for him.            

I think the challenges that men face when they feel these uncomfortable thoughts, emotions, behaviors, or their friends or family are telling them they’re not coping well is to figure out what’s going on. Some of these men have never felt some of these emotions before, and they think they’re going crazy. And one of the challenges is to help them understand that these emotions might be quite valid and quite human and quite appropriate. But they may not necessarily be very comfortable. And they might, actually, get in the way of their getting good care for their cancer.

So we like to have the physicians be able to hear what the men are experiencing and, actually, invite them to talk about how they’re feeling.

In a busy medical clinic or urology clinic, there isn’t that much time to hear all the issues that are going on. So some physicians are a little hesitant to ask how are you feeling? However, if they don’t ask these questions, a lot of men are not going to complain. And their spouses or partners or families may be the ones who are complaining to the doctors for them. Sometimes, these emotional reactions can be confused, because of some of the treatments that they’re getting, maybe it’s hormonal treatment or steroid treatment or treatment for pain. They might be feeling fatigued. They might be feeling nervous from these medications. 

They might have a loss of appetite. And they may not feel like doing the things they usually want to do.

And to family members, it looks, for all of the world, that these men are depressed. So being able to decipher how much of this is related to the physician symptom, how much of this is related to a reaction to the physical symptom, and how much of this might be a real psychiatric symptom takes some expertise. And it takes some time to be able to talk with a man and let him know that it’s okay to describe what he’s feeling.

Andrew Schorr:                  

Dr. Roth, what is emotional Judo, and how can this technique help?

Dr. Roth:               

Emotional Judo is a term that I use to describe an active type of psychotherapy that I do with men who have prostate cancer. It’s a combined approach of a number of different psychotherapies, cognitive behavioral-oriented therapy, acceptance and commitment therapy, some supportive therapy, maybe even some inside-oriented therapy. But I take a visual of a man who thinks that his cancer is a real opponent. 

And it’s not just the cancer. But it’s now the emotions, and it’s the thoughts and the behaviors that are coming up where he’s more irritable. Or he’s not doing the things that he usually would like to do. Or he’s getting stuck in some thought traps where he’s just become very pessimistic about the future. Or he’s so focused on his PSA test or his CAT scan that’s coming up in another month and so worried about what those tests may show that he stops living his life in the present. So Emotional Judo has five aspects to it where I teach men how to understand or recognize their emotions and what to do about them.

And I call this a DRAFT process. So DRAFT stands for detect, to detect the emotions that are going up or to detect the behaviors that they’re doing. 

They’re yelling at their spouse more. Maybe they’re not going out as much. Maybe they’re just feeling quite worried. And then, to recognize, that’s the R, to recognize what are some of the rational aspects of those emotions and those behaviors, and what are some of the irrational aspects of those behaviors. If someone is worried about the PSA test, there’s some rationale to a PSA that might go up that might be indicative that there’s either more testing to do or a different treatment to consider. However, if the man’s idea of a PSA going up a little bit triggers a thought in his head that he could die or he will die, that then is not a very helpful way of thinking about it. 

But it’s an all or none, very magnified, scary proposition. So if he can understand some of that rational aspect and some of the irrational aspects of where these emotions are coming from, and to be able to acknowledge that some of what’s going on in his life right now is good, even though he has cancer, then, we’ve moved from detection and recognition and acknowledgement to the next phase that is the flip.

That is the F. And then, transform. And the flip is really to be able to get someone out of the future where they’re so pessimistic or maybe out of the past where they’re thinking about the idealized past. Everything was so great before the cancer. Everything was so great before I had this surgery or this radiation. A lot of men are worried when they have complications from their treatment. They’re worried about erection problems. They’re worried about urinary problems. They worry about bowel problems, depending on which treatment they get. And if they get those complications, they’re wondering how the heck can they live their regular life? 

And how can they transform? How can they accept this and be able to move on and enjoy things? And I think, at this point, when I want someone to flip from all of this overload and flood of emotion or thoughts that are just not really helping them out, I want them to flip into the present. And that usually comes with a word like “however.” Yes, I am worried about this PSA, or yes, I am worried about my next MRI scan. Yes, I’m worried about dying and how difficult this is on my family. I feel like a burden. However, there are some good things going on in my life right now. I’ve got such a really supportive family. My doctor has been with me through this whole thing.

And she or he has been very supportive. My PSA has actually been kind of flat for the last six months. And so I want them to be able to find the balance between some of the uncomfortable and some of the more comfortable thoughts about what is happening realistically.

I don’t want to make a panacea or an unreal vision for them. But if they can flip back to some of what`s going on well now, then, we can get them to transform. And to transform into the present might take a little bit of preparation. So I ask men to have four or five go-to things that they can use when they’re feeling very anxious or very angry. And that will help them distract from the uncomfortable thoughts or emotions and back into today. Whether it’s a Sudoku puzzle, whether it’s taking a walk, whether it’s calling a friend, maybe it’s going over and giving a kiss to their spouse, maybe it’s calling one of their kids, maybe it’s picking up a book, or it`s putting on some music.

But I want them to pick a few things that might be easy for them to go to and not to have to think, in the midst of a difficult moment, what should I do to get out of this uncomfortable thought process? Let them have a go-to list and then do that. And I think a lot of men find that very useful, because when they’re feeling a flood of emotion, very often, anxiety comes from our fight-or-flight mechanisms. Fight-or-flight mechanism is I see that opponent, and either I feel like running the heck out of there, or I better be very good to get that lion in the jungle with the spear. With cancer, that’s what we have to give our oncologists and urologists the proxy to do.

They’re the ones who have to have the spear. They’re the ones—even if they’re deciding that the treatment is going to be active surveillance. Active surveillance is seen, sometimes, as not a very active treatment.

But we’re following PSAs, or the urologists are following PSAs over time. And it might mean that a man doesn’t have to have treatment and the threat of those complications for quite a while. So we want to help someone deal with the anxiety that might crop up if they’re wondering I’m not doing anything to fight the cancer. There’s still a cancer in my body. But I have hope that the cancer is going to stay in a minimal state. And if it does start to progress or get worse, my doctor is watching. And we’re going to take care of it at that point. So, in that fight-or-flight mechanism, neither one really resolves the issues for them. 

And so I want them to be able to slow down a little bit to be able to acknowledge and validate some of the emotions that are cropping up and some of those thoughts. 

But I want them to re-tool and be able to focus on these emotions and behaviors in a better way so maybe they’re able to do more life-enhancing lifestyle behaviors. So for those guys who used to be in great condition, but they got the cancer, so what was the point of being in great condition? Maybe their cancer was not as advanced, because they were in great condition. Maybe their bodies are in better shape to deal with whatever treatment comes along, because they’re in better condition. So a part of this is trying to activate men and get them to be more activated where, in some ways, something is better than nothing.

It doesn’t mean they all have to be in the gym for an hour. We know now that men can be doing 20 or 30 minutes of aerobic activity and maybe some strength training that’s very easy to do. And after four or five weeks, their mood is better. 

Their energy is better. Their sleep is better. They have less anxiety. And they’re focusing better. Their concentration is better. So getting them more activated is very important. And it’s a very important corollary to their cancer treatment. 

Andrew Schorr:

Dr. Andrew Roth from Memorial Sloan Kettering Cancer Center in New York City, thank you so much for being with us to share your insight. Be sure to join our community on Patient Power, so you always know whenever we post an interview like this in something new. I’m Andrew Schorr. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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