Licensed Clinical Social Worker & Therapist Vivian Acosta Cedeño specializes in women’s health and life transitions. Leveraging her deep experience, she offers Breasties a guide to seeking mental health support and the importance of doing so, to navigate their cancer journey from diagnosis through survivorship, and how self-advocacy guides our care.
Vivian Acosta Cedeño, LCSW, is a clinical therapist with deep experience specializing in women’s health, specifically in fertility and life transitions. Earlier in her career, she worked as a Psychotherapist and Clinical Social Worker. Acosta Cedeño earned a Master’s in Social Work from New York University.
This interview has been edited for clarity and length.
The Peak (TP): When your schedule is already overloaded with medical appointments, adding another appointment can feel like too much. Can you please share actionable tips for a Breastie who is looking to get started addressing and supporting their own mental health?
Vivian Acosta Cedeño (VAC): Given the cancer journey is often very difficult to talk about, part of the avoidance of seeking support is not wanting to talk about these things. I think the first step is understanding that it’s okay to talk about these hard things. Exploring vulnerability is a huge topic that we don’t want to dive into a lot of times, whether it is because of social conditioning, core beliefs, or because of thoughts that we have to be strong. There is a lot of strength in vulnerability and in exploring the things that make us uncomfortable.
To find a therapist, I think it is important to use trusted directories and sources:
- Psychology Today
- Cancer Mental Health Professionals at Inclusive Therapists
- At the hospital or cancer care center where you are receiving treatment, you can speak with an oncology social worker, or ask for a referral list
[You can also] call your insurance carrier at the phone number on the back of your card and ask about behavioral health. They will tell you what’s in network and then what’s out of network. Always ask about out of network benefits in the event there may be a therapist you may like to explore, but they’re not in network. If that is the case, there are therapists that will allow you to pay upfront and then give you a bill so that you can request reimbursement if you have out-of-network benefits.
Culturally responsive care is also an important part of finding the right mental health provider. Feeling understood in your cultural background, values, and lived experiences can significantly impact how safe and supported you feel in therapy.
It’s okay to seek a provider who not only has clinical expertise but who also respects and understands the cultural lens through which you experience your journey.
TP: What are CBT and ACT?
VAC: CBT is Cognitive Behavioral Therapy and ACT, called “act”, is Acceptance and Commitment Therapy. CBT and ACT are both evidence-based approaches and have been around for years. ACT is a little bit newer; it came out in the 1980s. Although both methods tell us to manage our emotions, our thoughts and our feelings, they have different approaches.
CBT focuses on identifying and restructuring unhelpful thought patterns, especially when thoughts are distorted or not fully aligned with reality.
ACT focuses less on changing thoughts and more on changing our relationship to them. It tells us that it’s okay to create space for these thoughts and feelings, without becoming overwhelmed by them, while still moving toward what matters most to us. We don’t have to judge them, we don’t have to label them. We can just allow them to be and see those thoughts from a distance in order for us to create a meaningful life and really create and do things that are valuable for us.
TP: Is one of these approaches more helpful for people affected by cancer?
VAC: ACT can be particularly helpful for individuals impacted by cancer because many of the thoughts and fears that arise—such as fear of recurrence, grief, or uncertainty—are not irrational. They are very real and grounded in lived experience.
In those cases, constantly trying to challenge or reframe those thoughts may not always feel validating. ACT allows space for those emotions to exist while helping individuals stay connected to their values and continue engaging in meaningful parts of life.
That said, both CBT and ACT have strong research support in oncology settings, and the most effective approach often depends on the individual and where they are in their journey
TP: Can we talk a little bit about discomfort?
VAC: The other wonderful thing about ACT is learning how to build tolerance for discomfort.
When we have these fears, when we have thoughts that aren’t so great—they feel not so pleasant—we will try to push them away. To avoid these feelings, some people will engage in unpleasant or unhealthy things, so avoidance is a big piece. While avoidance can bring short-term relief, avoidance is linked to increased distress over time.
ACT tells us to challenge the avoidance, to actually sit with that discomfort, which can be really helpful for someone impacted by cancer. But starting is really hard. When difficult thoughts or emotions arise, the natural instinct is often to avoid or suppress them.
ACT gently guides individuals to approach discomfort with openness, which can reduce its intensity and help people feel more grounded as they move through their experience.
TP: When it comes to finding a mental health professional to work with, would someone who is newly diagnosed want to look for something different from someone who’s in survivorship, or might they look for very similar characteristics?
VAC: Both someone who is recently diagnosed with cancer and someone who is a survivor of cancer are navigating significant transitions. While their experiences may look different, both are adjusting to a new reality.
It’s a new journey for both newly diagnosed and survivors. So, I would say it’s the same thing. You need the support to go through this new adjustment, to go through this new life transition because there will be a grieving process that occurs when you find out about this new diagnosis, and then there’s another grieving process that happens when you find out that you have survived cancer.
Support during these stages can help individuals process what they’re going through, while also adapting to what life looks like moving forward.
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TP: What is that grieving process like for survivors?
VAC: The grieving process can be complex and deeply personal. It often includes emotions like sadness, anger, fear, and uncertainty about the future, especially when reflecting on the life that was expected, versus the life that is now unfolding. I have some clients that will say that they live quarter by quarter as they are not sure what’s going to happen next. There’s a lot of uncertainty. The grieving process can be very sad.
Someone grieving the loss of the life they envisioned is going through the same stages as someone who is grieving the loss of a loved one.
Traditionally, there are five stages of grief: denial, bargaining, anger, depression, and acceptance. However we understand that grief is not linear and does not happen in any order. It just happens as it comes; there is absolutely no order. And sometimes you can go through all five stages and then start all over again or not follow a predictable sequence
Having the support of a therapist during this process can help individuals make sense of these emotions and feel less alone in navigating them.
TP: Are there any other challenges other than grief that might arise for someone navigating survivorship?
VAC: Other challenges that may come up other than grief may be body changes. A new identity may arise, fear of recurrence, and or there may be financial worries. The impact of treatment on relationships and daily functioning can also be significant.
TP: What is one way that you think Breasties can and should feel empowered to advocate for themselves when it comes to finding that mental health support?
VAC: Your voice shapes your care. I think self-advocacy is so important. Speak up about what you need. You know your body best, so speaking to your providers about what you need, how you feel that can really be helpful. It is okay to ask for time to ask clarifying questions.
TP: Does the Breastie who is new to therapy need to know what their goals are they first time they sit across from a therapist?
VAC: I think clients think that they must come prepared for therapy, and this is not the case. This is the only appointment that you can come as you are, and you don’t have to prepare for. It is my job to guide you, to support you.
I’ve had clients that don’t want to say anything because they don’t know what they need, what they want or how they feel about what’s happening. They are simply trying to understand all these things, and that’s okay too. It’s my job to guide you and allow all these feelings to exist in you. It’s okay for a Breastie to know that what they need is support at that moment.
TP: What is one low-lift option you would suggest to Breasties If they want to start therapy, but they feel so bogged down by the pressure of just getting through the day-to-day?
VAC: I’ve said this to grieving patients – you don’t have to take it day by day. Sometimes, a whole day is too long, so take it hour by hour. Even minute by minute. So, in this minute or these next 30 minutes, I’m going to focus on enjoying this meal that’s in front of me.
And that’s another wonderful thing that I love about ACT. It allows us to be in the present moment. So, at this moment, I want to eat this meal, and I want to enjoy it. What colors do I see? What do I smell? What do I hear around me? And that really grounds you and allows you to live with more purpose, with more meaning, and to feel some joy. I think a lot of times, because we’re thinking so much about cancer, it robs us of some of the joy that we’re allowed to feel.
TP: What does Breasties having the power mean to you?
VAC: Having power means re-reclaiming ownership to your story.
You don’t need permission to feel what you feel. Your worth is not tied to your diagnosis.
I think it’s also thinking about reclaiming what you can control. Start by focusing on your nutrition, focusing on movement. Movement is medicine, even if it’s a little walk, even if it’s stretching. Spending time with loved ones, if that’s important to you.
Focus on the things that are in your control: What are the things that you have the power to do?
