{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:08:36Z","timestamp":1778764116371,"version":"3.51.4"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Chemotherapy-related cognitive impairment (CRCI) is typically conceptualized as a neurocognitive side effect of cancer treatment, with emotional distress framed as a secondary or reactive consequence. This paper aimed to reconceptualize CRCI from a psycho-oncological perspective by examining how acquired cognitive unreliability disrupts self-experience, identity, and continuity of being, using Donald W. Winnicott\u2019s theory of the self and environment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This theoretical paper synthesized Winnicottian concepts\u2014including the True Self, False Self, holding, and play\u2014to develop a conceptual model of CRCI that links cognitive dysfunction to disruptions in selfhood and relational safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CRCI is conceptualized as a potential disruption of the continuity of the True Self in a subset of survivors, particularly those whose premorbid identity was strongly organized around cognitive functioning. Within this framework, cognitive unreliability is interpreted as threatening self-continuity, with adaptive responses taking the form of intensified False Self functioning, including vigilance, over-adaptation, and concealment. While these strategies may preserve external functioning, they constrain spontaneity, vitality, and the capacity for play. Recovery is therefore reframed not as cognitive restoration alone, but as the re-establishment of a holding environment that supports the gradual re-emergence of authentic self-experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Within this framework, addressing CRCI is not limited to cognitive remediation, but extends to the relational conditions that support the continuity of the self and the possibility of authentic lived experience in a subset of survivors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1811745","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:20:23Z","timestamp":1778761223000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Chemotherapy-related cognitive impairment as a crisis of the self: a Winnicottian psycho-oncological perspective"],"prefix":"10.3389","volume":"17","author":[{"given":"Sun Mie","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Literature and Arts Psychotherapy, Graduate School, Konkuk University","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin Su","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Applied RI, Korea Institute of Radiological and Medical Sciences (KIRAMS)","place":["Seoul, Republic of Korea"]},{"name":"Radiological and Medical Sciences, University of Science and Technology (UST)","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1186\/s40478-025-02102-z","article-title":"Deciphering transcriptomic changes in chemobrain: a comprehensive review","volume":"13","author":"Acharya","year":"2025","journal-title":"Acta Neuropathol. 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Med."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1111\/1467-9566.ep11339939","article-title":"Chronic illness as biographical disruption","volume":"4","author":"Bury","year":"1982","journal-title":"Sociol. Health Illn."},{"key":"ref8","doi-asserted-by":"crossref","DOI":"10.4324\/9781315197999","volume-title":"Illness: The Cry of the Flesh","author":"Carel","year":"2018"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1002\/pon.5844","article-title":"Exploring primary breast cancer survivors' self-management of sustained cancer-related cognitive impairment in the workplace","volume":"31","author":"Chapman","year":"2022","journal-title":"Psychooncology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"736003","DOI":"10.3389\/fnbeh.2021.736003","article-title":"Pharmacological Neurorescue in a paclitaxel-induced Chemobrain model","volume":"15","author":"Chen","year":"2021","journal-title":"Front. Behav. Neurosci."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"15248380261429511","DOI":"10.1177\/15248380261429511","article-title":"Family-inclusive and relational approaches to trauma recovery: literature review and narrative synthesis","author":"Cloud","year":"2026","journal-title":"Trauma Violence Abuse"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.pedhc.2026.01.003","article-title":"From trauma to recovery: a phenomenological insight into pediatric fasciotomy and caregiver experiences after an earthquake","volume":"40","author":"Dag","year":"2026","journal-title":"J. Pediatr. Health Care"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2983","DOI":"10.1177\/15248380221120836","article-title":"Trauma-informed approaches in the context of Cancer Care in Canada and the United States: a scoping review","volume":"24","author":"Davidson","year":"2023","journal-title":"Trauma Violence Abuse"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"4231","DOI":"10.1007\/s00520-021-06783-9","article-title":"Transitional self-disappear: the journey of cancer survivors to self re-coherence in a Middle East society","volume":"30","author":"Dehghan","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1177\/1088868315597841","article-title":"The nature of self-regulatory fatigue and \"Ego depletion\": lessons from physical fatigue","volume":"20","author":"Evans","year":"2016","journal-title":"Personal. Soc. Psychol. 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Nurs."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"35765","DOI":"10.1038\/s41598-025-95380-5","article-title":"The chemobrain in breast cancer patients: a systematic review and meta-analysis","volume":"15","author":"Godaert","year":"2025","journal-title":"Sci. Rep."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e89","DOI":"10.1017\/S2045796019000829","article-title":"Psychiatric and psychosocial implications in cancer care: the agenda of psycho-oncology","volume":"29","author":"Grassi","year":"2020","journal-title":"Epidemiol. Psychiatr. 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Rev."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.1038\/nn.4113","article-title":"Neuroimmune mechanisms of depression","volume":"18","author":"Hodes","year":"2015","journal-title":"Nat. Neurosci."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1007\/s10608-012-9476-1","article-title":"The efficacy of cognitive behavioral therapy: a review of Meta-analyses","volume":"36","author":"Hofmann","year":"2012","journal-title":"Cognit Ther Res"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1111\/j.2044-8287.2012.02082.x","article-title":"Investigating the cognitive precursors of emotional response to cancer stress: re-testing Lazarus's transactional model","volume":"18","author":"Hulbert-Williams","year":"2013","journal-title":"Br. J. Health Psychol."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"11600","DOI":"10.1073\/pnas.1214551110","article-title":"Default mode network connectivity distinguishes chemotherapy-treated breast cancer survivors from controls","volume":"110","author":"Kesler","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"118581","DOI":"10.1016\/j.biopha.2025.118581","article-title":"Cognitive dysfunction in chemobrain: molecular mechanisms and therapeutic implications","volume":"192","author":"Kim","year":"2025","journal-title":"Biomed. Pharmacother."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"234.1","DOI":"10.3390\/jcm8020234","article-title":"Trastuzumab induced Chemobrain, atorvastatin rescued Chemobrain with enhanced anticancer effect and without hair loss-side effect","volume":"8","author":"Lee","year":"2019","journal-title":"J. Clin. 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Med."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"19","DOI":"10.4040\/jkan.2016.46.1.19","article-title":"Chemotherapy-related cognitive impairment and quality of life in people with Colon Cancer: the mediating effect of psychological distress","volume":"46","author":"Oh","year":"2016","journal-title":"J. Korean Acad. Nurs."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1188\/24.ONF.263-274","article-title":"Self-reported Cancer-related cognitive impairment in patients with breast Cancer is associated with Potassium Channel gene polymorphisms","volume":"51","author":"Oppegaard","year":"2024","journal-title":"Oncol. Nurs. Forum"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"13","DOI":"10.2190\/EUFN-RV1K-Y3TR-FK0L","article-title":"Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses","volume":"36","author":"Osborn","year":"2006","journal-title":"Int. J. Psychiatry Med."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"11806","DOI":"10.1002\/cam4.5847","article-title":"Psychological distress is involved in CRCI in breast cancer survivors via mediating cytokine levels","volume":"12","author":"Pang","year":"2023","journal-title":"Cancer Med."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"4797","DOI":"10.1007\/s00520-022-06880-3","article-title":"Cognitive appraisal of the disease and stress level in lung cancer patients. The mediating role of coping styles","volume":"30","author":"Poreba-Chabros","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"e71383","DOI":"10.1002\/cam4.71383","article-title":"Chemobrain and Cancer survivorship: a scoping review of the literature","volume":"14","author":"Rovito","year":"2025","journal-title":"Cancer Med."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"5593","DOI":"10.3390\/curroncol30060422","article-title":"Young adults' lived experiences with Cancer-related cognitive impairment: an exploratory qualitative study","volume":"30","author":"Sharma","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1080\/13803395.2025.2526647","article-title":"Neuroimaging studies of cognitive dysfunction following cancer and treatment","volume":"47","author":"Silverman","year":"2025","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e35","DOI":"10.1097\/RLU.0b013e318292aa81","article-title":"Adverse functional effects of chemotherapy on whole-brain metabolism: a PET\/CT quantitative analysis of FDG metabolic pattern of the \"chemo-brain\"","volume":"39","author":"Sorokin","year":"2014","journal-title":"Clin. Nucl. Med."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1662935","DOI":"10.3389\/fneur.2025.1662935","article-title":"Mapping self-awareness of cancer-related cognitive impairment: a scoping review of evidence, methods, and neurobiological correlates","volume":"16","author":"Spinetti","year":"2025","journal-title":"Front. Neurol."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"9944","DOI":"10.1073\/pnas.1301119110","article-title":"Heightened emotional contagion in mild cognitive impairment and Alzheimer's disease is associated with temporal lobe degeneration","volume":"110","author":"Sturm","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"40.1","DOI":"10.1186\/s43556-026-00439-y","article-title":"Astrocytes in neuroinflammation and brain cancer","volume":"7","author":"Sun","year":"2026","journal-title":"Mol Biomed"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"69","DOI":"10.2176\/jns-nmc.2025-0258","article-title":"Cerebral hemodynamics in pediatric abusive head trauma: 3 severe cases with preserved motor cortex, Hyperperfusion, and recovery of mild paralysis","volume":"13","author":"Tamura","year":"2026","journal-title":"NMC Case Rep J"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/BF00489413","article-title":"Illness and the paradigm of lived body","volume":"9","author":"Toombs","year":"1988","journal-title":"Theor. Med."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1038\/nrn2647","article-title":"Neural regulation of endocrine and autonomic stress responses","volume":"10","author":"Ulrich-Lai","year":"2009","journal-title":"Nat. Rev. Neurosci."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"104956","DOI":"10.1016\/j.ajp.2026.104956","article-title":"Between trauma and recovery: understanding the mental health of ISIS-affiliated children","volume":"119","author":"Uzun","year":"2026","journal-title":"Asian J. Psychiatr."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"123","DOI":"10.3322\/caac.21258","article-title":"Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer-related cognitive impairment in adults","volume":"65","author":"Wefel","year":"2015","journal-title":"CA Cancer J. Clin."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1015573","DOI":"10.3389\/fpsyg.2022.1015573","article-title":"Impact of psychosocial, behavioral and lifestyle factors on subjective cognitive complaints and perceived quality of life in a large cohort of Italian breast cancer patients","volume":"13","author":"West","year":"2022","journal-title":"Front. Psychol."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1111\/1467-9566.00191","article-title":"Chronic illness as biographical disruption or biographical disruption as chronic illness? Reflections on a core concept","volume":"22","author":"Williams","year":"2021","journal-title":"Sociol. Health Illn."},{"key":"ref56","first-page":"89","article-title":"Transitional objects and transitional phenomena; a study of the first not-me possession","volume":"34","author":"Winnicott","year":"1953","journal-title":"Int. J. Psychoanal."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1111\/j.2044-8341.1954.tb00864.x","article-title":"Mind and its relation to the psyche-soma","volume":"27","author":"Winnicott","year":"1954","journal-title":"Br. J. Med. Psychol."},{"key":"ref58","first-page":"140","volume-title":"The Maturational Processes and the Facilitating Environment","author":"Winnicott","year":""},{"key":"ref59","first-page":"585","article-title":"The theory of the parent-infant relationship","volume":"41","author":"Winnicott","year":"","journal-title":"Int. J. Psychoanal."},{"key":"ref60","first-page":"238","article-title":"The theory of the parent-infant relationship","volume":"43","author":"Winnicott","year":"1962","journal-title":"Int. J. Psychoanal."},{"key":"ref61","first-page":"591","article-title":"Playing: its theoretical status in the clinical situation","volume":"49","author":"Winnicott","year":"1968","journal-title":"Int. J. Psychoanal."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"1237005","DOI":"10.3389\/fpsyt.2023.1237005","article-title":"Pragmatism or idealism: a systematic review and visual analysis of Winnicott's psychoanalytical treatment views","volume":"14","author":"Xie","year":"2023","journal-title":"Front. Psych."},{"key":"ref63","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.bbi.2010.10.015","article-title":"Immune modulation of learning, memory, neural plasticity and neurogenesis","volume":"25","author":"Yirmiya","year":"2011","journal-title":"Brain Behav. 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