by Sage Bolte, PhD, LCSW, OSW-C, CST, and Drucilla Brethwaite, MSW, LCSW, OSW-C
Lauren, a devoted mom of two young children, committed partner, competent professional, diagnosed with metastatic breast cancer, arrived in the office pleading, “I don’t want to feel like this anymore. This worry is taking too much of my time.” When faced with a cancer diagnosis, even the most resilient individuals can find themselves experiencing strong emotions resulting from distressing thoughts unlike any they have ever experienced before.
The worries and fears that creep into the mind can be difficult to control, and they can take up a lot of real estate in your brain. While you can’t eliminate these thoughts, you can get them under control.
Step One: Understanding Worry
Having worries and fears is common after a cancer diagnosis. Cancer is often an unpredictable experience. It can bring about many changes in your life, and, as humans, we typically don’t react well when changes in our circumstances are beyond our control. Moreover, the side effects of cancer treatment, such as fatigue or pain, can lower your threshold for tolerating distressing thoughts and lessen your ability to problem solve.
Unfortunately, your usual life stressors don’t get put on hold when you are diagnosed with cancer. These daily stressors can amplify your worries and fears. Well-intended questions and suggestions from loved ones can also contribute to worrisome thoughts.
It’s helpful to understand that your thoughts are often automatic. That is, you don’t really have much control over what thoughts creep up in your mind. Moreover, if the brain perceives a distressing thought as an actual threat, stress hormones immediately begin to flow, which is another thing you don’t have much control over. The brain acts quickly to assess a threat, and, therefore, the brain often gets it wrong, assigning real danger to what is at the moment, a distressing or scary thought.
Step Two: Your Brain Needs a Break – Give It Something to Do Besides Worry
Recognize that automatic thoughts of worry and fear are going to come. As you identify them, without judgment, notice how they make you feel. Ask yourself questions such as What am I thinking? What is the effect of continuing to have this thought? What could happen if I changed my thinking? What should I do next?
Anxious thoughts increase tension. However, positive thoughts promote a sense of well-being. To promote positive thinking, try some mindfulness or relaxation techniques. They really do work. Acknowledge that it’s okay to feel anxious or fearful at times. Then find an affirmation or mantra that works for you: I trust in life, or I am strong and competent. Repeating affirming thoughts can bring you a sense of calm.
Ground yourself. When you begin to feel anxious, take three slow deep breaths. Controlled breathing can help activate the relaxation response.
Train yourself to stay present; don’t get ahead of yourself. Ask yourself, At this moment, what is currently happening? Focus only on the current situation. Don’t jump to step 27. If you don’t quite understand something concerning your disease or your treatment, ask for more information. It is surprising how clarity alone can decrease fear.
Develop a meditation practice, use guided imagery, or visualize a safe place within your mind. All of these can activate the thinking part of the brain and decrease activity in the emotional part of the brain, which is where worry and anxiety originate. A spiritual practice can also help bring you comfort and peace.
It’s important to connect with others for support and to communicate your needs. Connect with people who ground you, those who can be with you in your fear, support you, and remind you of strategies you have found useful in controlling it. Then tell the people in your support network what they can do to help you, whether it’s sending you funny YouTube videos or telling you about their recent trip, a movie they saw, or a book they read.
When you begin to feel anxious, take three slow deep breaths. Controlled breathing can help activate the relaxation response.
Choose your connections (and ways of connecting) wisely. Excessive social media, email, and text messages may create worry. As can message boards and certain websites. Avoid websites that cause you distress, and don’t respond to distressing emails or messages. To protect yourself, consider blocking or setting boundaries with websites or people that intensify your distress. If you want, you can reconnect when you are in a better place.
Prioritize where you want to spend your mental and emotional energy. Identifying what’s most important to you and setting small achievable goals can help you feel more in control.
Do things that are calming, or that are just plain fun. Listen to music, dance, laugh, meet a friend for coffee. Participating in activities that promote positive emotions will help limit the perception that cancer is taking over your life.
It may seem overwhelming at first, but you can get worry under control. For starters, choose three of the techniques above to really focus on, and then reassess where you are each week. If something isn’t working for you, try something else. With practice and with time, you should see a noticeable difference in the frequency and intensity of your worries and fears. But remember, always tell your doctor if you feel your worry or anxiety is too overwhelming or is interfering with your everyday life. It is OK to ask for help if you need it.
Dr. Sage Bolte (left), a licensed clinical social worker, is the executive director of Psychosocial Programs for the Inova Dwight and Martha Schar Cancer Institute and the director of Inova’s Life with Cancer program, which provides cancer survivors with information, support, and resources. Drucilla Brethwaite (right) is a licensed clinical social worker and manager of Oncology Navigation and Counseling at the Life with Cancer program.
This article was published in Coping® with Cancer magazine, March/April 2016.