Gain Control of Your Anxiety and Depression
Helpful Coping Strategies for Cancer Survivors
by Pragati Chaudhary, BS and Katherine N. DuHamel, PhD
Following treatment, most cancer survivors do quite well. Some, however, experience anxiety and depression, which is normal and common, but at the extreme, anxiety and depressive disorders can cause prolonged distress. Symptoms of anxiety and depressive disorders may include excessive worrying, anxiety about upcoming scans, difficulty concentrating, muscle tension, being easily fatigued, depressed mood, diminished interest or pleasure in previously enjoyed activities, and irritability. These symptoms all can interfere with daily activities at home and at work.
A Helpful Coping Strategy For many cancer survivors, cognitive behavioral therapy, or CBT, is a helpful and effective coping strategy for managing symptoms of anxiety and depression and improving quality of life. CBT is an evidence-based therapeutic approach based on the belief that how we think, our actions, and our behaviors can shape the quality of our lives. CBT is designed to reduce distress through a combination of techniques meant to help cancer survivors modify unhelpful thoughts, beliefs, and learned responses.
Cancer survivors can seek CBT treatment from a licensed clinician, and you absolutely should if your symptoms are severe or are affecting your daily life. However, there are some techniques that survivors can employ on their own. The two we’ll discuss here are cognitive coping strategies and social support. Using these and other strategies, cancer survivors can create their own toolbox of coping techniques and customize it through trial and error based on what works best for them.
• All-or-nothing thinking: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.
• Mental filter: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
• Disqualifying the positive: You reject positive experiences by insisting they “don’t count.” You maintain a negative belief that is contradicted by everyday experiences.
• Magnification or minimization: You exaggerate the importance of things (such as your goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or others’ imperfections).
• Emotional reasoning: You assume that your negative emotions necessarily reflect the way things are: “I feel it; therefore, it must be true.”
• Should statements: You try to motivate yourself with shoulds and shouldn’ts, as if you had to be whipped and punished before you could be expected to do anything. The emotional consequence is guilt or anger.
• Labeling: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself: “I’m a loser.”
• Maladaptive thinking: You focus your thoughts on something that may be true but is not helpful to focus on.
• Catastrophizing: You focus on the worst possible outcome, however unlikely, or think that a situation is unbearable or impossible when it is really just uncomfortable.
• Jumping to conclusions: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion.
• Mind reading: You arbitrarily conclude that someone is reacting negatively to you and don’t bother to check it out.
• Fortune telling: You anticipate that things will turn out badly and feel convinced that your prediction is an already-established fact.
Cognitive Coping Strategies Cognitive coping strategies are characterized by coping statements, cognitive restructuring, and reframing. For example, if a cancer survivor thinks, “I’ll never stop being haunted by the memories of my medical procedure,” or “My friend from the transplant unit died; I shouldn’t have lived,” then CBT would have them come up with alternative thoughts. Examples of these are, “If I can get through cancer treatment, I can get through this,” and “Although others did not survive cancer treatment, I am fortunate to be alive and will make the best of my life.”
The process looks like this:
1. Identify automatic thoughts that drive the symptoms of anxiety and depression. For example, “This remission will not last. I’m sure my cancer has already returned.”
2. Categorize the thought into one or more of the unhelpful thought patterns, sometimes called cognitive distortions, created by psychiatrist Dr. David Burns (listed in the sidebar on the opposite page) that best describes the thought. Our example – “This remission will not last” – could be classified as fortune telling, emotional reasoning, and jumping to conclusions.
3. Challenge the thought by weighing the evidence for and against it. When weighing the evidence, keep in mind that neither feelings nor a sense of foreboding is considered valid evidence. Neither are views from sources that are not credible. Continuing with our example, evidence in support of the troubling thought may include previous short remissions, recent thoughts about dying, and negative statistics provided by your doctor. Evidence against the troubling thought that remission will not last include encouraging statistics from the doctor, a history of sustained remissions, and the recognition that feelings are not facts.
4. Create a rational response that is believable, supported by evidence, helpful, and realistic. For example, “There are many possible reasons why my doctor may have called, and unwelcome news is not the only one.”
Survivors can also use positive self-statements, which some people refer to as affirmations. They are simple and can be applied quickly. With repeated use, they can become lasting, are easier to remember, and can even become automatic. Some examples of positive self-statements are I know I can do this; I may not be perfect, but I’m really good at the things that are most important in my life, like being a father; I’m glad I have my family to lean on; and I am a likeable, pleasant, and resilient person who has overcome a lot. Some people like to write these statements on index cards and carry them around, or they can be posted anywhere you have easy access to, such as your phone or computer screensaver, inside the medicine cabinet door, or on a nightstand.
Social Support Engaging in social support is especially important for cancer survivors. Many survivors feel shy when asking for help. But when you can accept that it is OK to ask for and receive help, not only do you build up your social support systems but you also give others the opportunity to be helpful.
When communicating with others and asking for help, or asking someone to change an unhelpful behavior, it is important to have clear communication and avoid making the other person feel attacked. When people feel attacked, they often react defensively or just shut down. You can do this by focusing on using “I” statements, avoiding an angry or critical tone, and using a neutral tone of concern.
One way you can become good at this type of communication is by using a communication strategy called the XYZ technique, which was created by psychologist Dr. John Gottman and his colleagues. This technique allows you to organize your thoughts, express how you feel, ask for something, and encourage others to change. Here is the formula:
X: I feel/felt (feeling/emotion)
Y: when you say/said/do/did (specific situation)
Z: because (explanation).
This technique can be used to communicate a variety of positive emotions, such as love and gratitude, as well as negative emotions, such as anger and sadness. Here’s what the XYZ technique looks like in practice:
• (X) I feel really good (Y) when you give me a hug (Z) because it enables me to cope better, and I wish you would do it more often.
• (X) I felt sad (Y) when you said I was pointlessly worrying about my cancer returning (Z) because I am struggling to cope with the emotions my treatment has caused, and I need you to be more understanding about the fact that it helps me cope when I can voice my concerns to you.
Through regular practice, these techniques can become automatic and can provide relief from anxiety and depression symptoms. Try them out to see what works for you. The goal is to have a better quality of life without anxiety and depression getting in the way of you enjoying what matters most to you. If you are still struggling with anxiety or depression, call your doctor without hesitation. Your doctor can help you develop a treatment plan to manage your symptoms.
Pragati Chaudhary and Dr. Katherine DuHamel work together at Memorial Sloan Kettering Cancer Center in New York, NY. Pragati (left) enjoys speaking with cancer survivors and helping them make their journey a little bit easier.
Dr. DuHamel (right) is an attending psychologist at MSKCC and a professor in the Department of Psychiatry at Weill Cornell Medical College. She has experience with helping people cope with chronic illness and stressful life events and with using cognitive behavioral therapy (including hypnosis) to reduce anxiety and depression and improve quality of life.
This article was published in Coping® with Cancer magazine, January/February 2019.