Stress/Anxiety

How Not to Worry About Being Worried all the Time

You feel stressed and anxious. That’s normal, especially with cancer. We’ll help you understand why you feel this way—and help you manage stress and cancer better.

What is stress?

Stress is a reaction to demanding circumstances (stressors). Some stress encourages growth, but other stress can take a toll on our health.

Our bodies don’t distinguish between stressors that are physical and those that are mental. Our stress response systems activate no matter what—whether we’re running away from a lion, struggling to meet a work deadline or getting news of a cancer diagnosis.

When we come face to face with something stressful, our stress hormones trigger a release of energy. Our heart rate and breathing speeds up, our muscles tense up and we may start sweating. In the short term, this reaction is helpful but when it happens over and over again it’s not.

What is anxiety—and how is anxiety different from stress?

Anxiety is a normal part of life. We all experience it. Like stress, it can become excessive and affect our lives.

Anxiety is different than stress because it involves anticipation of future difficulties. It evolved to help us avoid dangerous situations that could happen in the future. Worry, a common feature of anxiety, is a series of negative thoughts about future threats. Worry is different than fear, which is a response to a real, immediate threat that’s right in front of you.

Symptoms of anxiety include:

  • difficulty sleeping or racing thoughts
  • headaches and muscle tension
  • irritability
  • heart palpitations, sweating or trembling
  • chest pain or discomfort
  • nausea
  • numbness
  • lightheadedness
  • feelings of unreality or detachment from yourself
  • fear of losing control or going crazy
  • chills or hot flashes

We often avoid situations that make us feel anxious. Finding ways to actively cope with a cancer diagnosis, rather than avoiding things, is the best bet to combat stress and anxiety.

What causes stress and anxiety?

Your stress and anxiety levels may fluctuate at different points in your cancer journey. This is also normal. Generally, as we cope with our cancer diagnosis, stress and anxiety begin to lessen. Research suggests that if cancer recurs, we tend to experience similar levels to when we were first diagnosed. But they go down more quickly than the first time.

Many of us feel particularly stressed and anxious during these times:

  • At the time of cancer diagnosis
  • When we have side effects from cancer treatment
  • At the start or end of treatments
  • When we’re told cancer is in remission
  • When we go back to work, school or “everyday life” and have fewer follow-ups with our medical team
  • At follow-up scans
  • At anniversaries, like the one-year anniversary after diagnosis

Many of us feel particularly stressed and anxious about:

  • Body changes related to cancer and cancer treatment
  • Side effects of cancer treatment, like nausea, pain or low energy
  • Changes in relationships with loved ones, self-identity or roles
  • Uncertainty about the future or changes in goals and values
  • Financial difficulties or challenges with health insurance
  • Believing loved ones are impacted by the cancer diagnosis
  • Communicating with children about a cancer diagnosis
  • Fear of dying or facing a foreshortened future

Why is managing stress and anxiety important?

If stress and anxiety aren’t managed well, they can become debilitating. According to the National Institute of Mental Health, chronic stress can compromise our immune, digestive, sleep and reproductive systems. It can lead to headaches, sleeplessness, sadness, anger and irritability, and make us more susceptible to getting a cold or the flu.

With chronic stress, our ability to be resilient in the face of stress weakens. It affects our behavior, emotions and thoughts. It can also affect our relationships. When we have stress and cancer, it’s especially important to find ways to cope because it can take a toll on our immune system.

How can I manage stress and anxiety?

Try incorporating these techniques into your daily routine.

  1. Distract your mind. Our minds can race during activities that allow us to think and do something at the same time. Reading or going to a movie force your mind to focus and blocks it from ruminating on unpleasant thoughts.
  2. Try progressive muscle relaxation. Stress and anxiety are incompatible with relaxation, so when our bodies relax, stress and anxiety start to dissipate. Progressive muscle relaxation is a technique that involves gradually tensing and relaxing different muscle groups. Other powerful relaxation techniques include guided imagery, deep breathing and listening to calming music.
  3. Reframe negative thinking. Research shows that reframing the way we think about a situation can help with stress and anxiety—especially if we’re thinking about the situation unrealistically. For example: It is easy to get into a negative spiral when thinking about our diagnosis and the road ahead. Identify which of your negative expectation you may be imagining which may not come to fruition at all. Rather than focusing on feelings of helplessness or lack of control, ty focusing on the power you do have. Think of steps you can make to toward your recovery. Explore inspiring stories of others that have overcome similar diagnosis or read about new therapies that make you feel inspired.
  4. Approach rather than avoid. Approaching and dealing with stressful and anxiety-provoking situations instead of avoiding them is called active coping. Research suggests active coping has the best long-term outcome.Avoidance only helps you feel better temporarily. If you find yourself avoiding something—maybe it’s a call with your sister, an MRI scan or your medication—ask yourself what steps you can take to approach rather than avoid the situation. Of course, as you’re going through treatment and recovery, it’s OK to mindfully avoid some situations (like that PTA meeting) to give yourself time to heal.
  5. Practice mindfulness. Being present in the current moment, without making judgments or trying to change anything, is called mindfulness. Mindfulness strategies include observing your breath or paying attention to sounds or sights around you, like noticing every sensation on your feet as you walk from one room to another or every sensation in your mouth as you suck on a peppermint. Your mind will wander. It helps us tune into the way things currently are, instead of worrying about the future. Scientific studies suggest mindfulness is an effective way to lower stress and anxiety, especially in cancer.
  6. Social support. Make time for activities with a wide variety of family and friends, if your energy allows. If you’re interested (not everyone is, and that’s OK), ask your medical team if they can recommend support groups for people diagnosed with cancer.
  7. Prioritize movementExercise releases endorphins, which make us feel more positive, and offers a distraction from our pervasive thoughts. What’s the best exercise? An exercise you enjoy doing. (It can also be helpful to exercise with someone else.)
  8. Enjoy positive physical touch. Hug your partner or pet a dog or cat. Touching is a means of communication that can be highly effective in reducing stress.
  9. Make time for prayer or meditation. Those of us who are not religious may find comfort in daily meditations. One daily meditation resource that may be helpful for Christians is the book Jesus Calling.
  10. Change your bedroom scenery. Our bedroom environments can trigger a stress response if we have come to associate our surroundings with illness. If you are fully into recovery, consider repainting your room, buying new sheets, or getting new sleepwear. Indulge in new ideas with decorating books.
  11. Start a journal or try art therapy. Expressing thoughts and using our left brain can help take the pressure off.
  12. Explore talk therapy. Remember, stress and anxiety after a cancer diagnosis is normal. However, if stress or anxiety persists, interferes with your life or feels debilitating, consider talk therapy. The type of therapy with the most scientific support for treating anxiety is cognitive behavioral therapy (CBT). CBT is an umbrella term for many variations of time-limited therapy that focus on helping you reframe your thinking and engage in active coping strategies. You may also consider a therapist trained in EMDR (Eye Movement Desensitization and Reprocessing)which is an especially effective treatment for people who’ve been through trauma.
  13. Share your worries with others—with limits. It can be a relief to confide in a friend but going over issues over and over can make things feel more overwhelming. Experiment with talking about your cancer for 10-20 minutes to see if shorter time frames help.
  14. Bird watching. When we have stress and cancer but don’t have the energy to read or watch TV, birdwatching can offer a relaxing change of scenery. Set up a birdfeeder in your yard or window and enjoy a bit of nature therapy.
  15. Yoga. The benefits of yoga are not limited to the physical body. Yoga can be an excellent tool for managing stress and negative emotion. Two helpful books are Yoga for Cancer and Relax and Renew: Restful Yoga.

How can friends, family and colleagues help?

Friends and loved ones can help someone with cancer manage stress and anxiety. Here’s how:

  1. Read a progressive muscle relaxation script aloud to your friend or loved one. Remind him or her to listen to a guided imagery CD.
  2. Plan fun, time-limited social activities to match his or her energy level. Understand your friend may need to cancel sometimes—and that’s OK. Ideas:
    • coffee at a fun, new spot
    • a walk along a favorite rout
    • a movie or show
    • brunch
    • tai chi class, yoga session or gentle bike ride
    • cooking dinner together
    • phone or video chats
    • volunteer work
  3. If your loved one’s medical facility offers education about side effects or recovery suggest going together.
  4. Help your friend cope with things he or she is avoiding but really needs to do, like scheduling a follow-up MRI or helping with shots.
  5. Create a calendar to keep track of who, when and how others will pitch in. Online calendars are free and make it easy to spread the word and keep everyone on the same page. Work with your friend to come up with ideas, like:
    • bringing meals
    • babysitting, taking children to school or pet walks
    • doing laundry, washing dishes, housecleaning and grocery shopping
    • driving to medical appointments
    • taking care of healthcare paperwork
    • mowing the lawn, weeding the garden or shoveling snow
  6. If your loved one has a hard time asking for help, try an “angel jar,” where loved ones draw chores from a jar so she or he doesn’t have to ask.

If you’re an ongoing caregiver, take good care of yourself. The stress and anxiety management strategies above are good for you, too.

Figure out what works for you

For those struggling with anxiety or stress and cancer, it’s important to find what’s most effective for you. We hope these tips can reduce the anxiety in your life right now. We will never be able to eliminate stress from our life entirely, but we don’t need to feel powerless to its effects.

 

Tammy Phillip has a PhD in Clinical Psychology from Ohio State and is a former Clinical Research Psycho-Oncology Fellow at Memorial Sloan Kettering Cancer Center.
Lisa Lefebvre is the Founder of Mend After Cancer.  She has experience recovering from 8 cancer-related surgeries, chemotherapy treatments, radiation protocols and hormone suppressiontherapy.

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