Episode 84: Managing Insomnia and Mental Health in Cancer Care with Dr. Cara Bohon

In this episode of The Patient From Hell, host Samira Daswani sits down with Dr. Cara Bohon, a clinical psychologist and researcher, to explore the unique mental health challenges faced by cancer patients and survivors. They discuss the role of cognitive behavioral therapy (CBT) in cancer care, the complexities of treating cancer-related insomnia, and the shortage of mental health professionals trained in oncology.

Dr. Bohon and Samira also review a PCORI-funded study led by Dr. Jun J. Mao, comparing the effectiveness of CBT-I (cognitive behavioral therapy for insomnia) versus acupuncture for cancer-related insomnia. Dr. Bohon breaks down step-by-step sleep strategies for cancer patients, offering practical tools to improve sleep, emotional well-being, and cancer-related anxiety—even for those without access to therapy.

This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features this PCORI study by Jun J Mao, MD.

Check out the free mental health resources mentioned in this episode from Veterans of America here.

Your Cancer GPS is here! Step-by-step breast cancer maps based on what others have gone through and what oncologists recommend.

Key Highlights:
Insomnia is a major issue for cancer patients and survivors alike – beyond just trouble sleeping, it exacerbates pain, fatigue, cognitive impairment, and emotional distress, making cancer treatment even more challenging.  

The clinical trial covered in this episode found that cognitive behavioral therapy for insomnia (CBT-I) led to better sleep improvements compared to acupuncture, with lasting effects even after treatment ended. While acupuncture may not be as effective as CBT-I for sleep, it showed short-term benefits for managing cancer-related pain, which can still be valuable for your mental health as well.

The problem with therapy today is not just accessibility, but also the fact that many therapists aren't trained in psycho-oncology, making it difficult for cancer patients to find mental health support tailored to their unique challenges.

Techniques from CBT-I, such as sleep restriction, stimulus control, cognitive restructuring, and relaxation exercises, can significantly improve sleep quality—even for those who can't afford professional therapy.

About our guest: 

Dr. Cara Bohon is a clinical psychologist and researcher from Stanford University with experience scaling delivery of evidence-based mental health treatments to meet the huge needs of patients across the United States. She led clinical programs and research at Equip Health, which addressed the demand for effective eating disorder treatment by providing training and virtual delivery of evidence-based eating disorder treatment across the country and is passionate about expanding her work in oncology in the future.

Dr. Cara Bohon is a clinical psychologist and researcher from Stanford University with experience scaling delivery of evidence-based mental health treatments to meet the huge needs of patients across the United States. She is the Co-Founder and Chief Clinical Officer of Protocol Behavioral Health, focused on creating access to expert emotional and behavioral health support for patients with a cancer diagnosis. Prior to Protocol, she led clinical programs and research at Equip Health, which addressed the demand for effective eating disorder treatment by providing training and virtual delivery of evidence-based eating disorder treatment across the country.

Key Moments:

At 5 minutes 53 seconds “One of the main treatments that is out there for depression, for example, is cognitive behavioral therapy. There's a lot of variations of cognitive behavioral therapy. The idea behind cognitive behavioral therapy is you have thoughts in your mind and they pop up and sometimes they are rational and make sense and sometimes they are irrational and don't make sense, but they absolutely can impact how you feel about yourself or feel about a situation. Behaviors can also affect how you feel about yourself, so in the context of depression, when we're doing CBT or cognitive behavioral therapy, we end up looking at ways we can restructure thoughts, so part of it is restructuring where the evidence is, where the facts are, and being able to change that so that you change how you're feeling about yourself. Now, switch in and have in the presence of cancer where the thoughts that go through your mind are. “Oh my gosh, this treatment is really painful. I'm in a lot of pain... My gosh, I'm so scared of how my loved ones are going to react to my diagnosis.” It's really tricky to restructure those thoughts when a lot of those things are just true. You can't say, if you only thought differently about it, then your cancer diagnosis would feel fine.”

At 20 minutes 28 seconds “Authors of the study designed this thinking about access to treatments as well. CBT-I has a lot of research and evidence backing it up to support its use for treating insomnia, yet the data shows that maybe 15% of oncologists would be referring someone to get CBT-I, even though we know that it's an established treatment, whereas acupuncture was actually readily available and referred often in some of the data. Now, some of that in this is me projecting, making conjectures, no idea if this is true, but I imagine that part of the reason that acupuncture is much more readily referred to is because there is a lot of evidence that acupuncture is used for pain and fatigue. If you think about the whole package, if I can kind of hit a bunch of birds with one stone, let's send them to acupuncture. There are points for acupuncture to put the needles in the body that target sleep. There's additional points that you can place the needles to target anxiety. There's additional points that you can target for pain, et cetera.”

At 23 minutes 6 seconds “I want integrated care so much. I really want us to have [this]: you get your oncologist, your oncologist gives you your cancer diagnosis, and then boom, here's your behavioral health specialist to help you think through what’s next and what else might be available to help you in a billion different ways that that you might be affected. That's my dream situation is to have that just be hand in hand so that you're not sitting there saying, let me figure out who exactly my insurance covers for X, Y, and Z.”

Disclaimer:
All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

This episode was supported by an award from the Patient-Centered Outcomes Research Institute.