Learning To Cope With The Emotional Challenges Of The Cancer Experience

By Dr. Kevin Stein

The cancer journey, from the point of diagnosis to survivorship, and at every point along the way, can be stressful and may present challenges to maintaining positive mental health and emotional well-being. Learning stress management skills and, if necessary, talking to a mental health professional, are important strategies to being able to deal effectively with these challenges. The first step in managing stress associated with cancer is to pay attention to your own body and being willing to seek out help when you need it. This “self-awareness” includes recognizing signs of stress in yourself, including feelings of irritability, anger, sadness, fear, excessive crying, and lack of interest in things that once brought you pleasure. Your body may also exhibit physical signs of stress, including racing heart, poor appetite, decreased libido, headaches, difficulty sleeping, restlessness, and weight loss or gain. Finally, you may have cognitive symptoms such as problems with memory, attention, and concentration.

It is important to acknowledge that all of these signs of stress are normal reactions to a challenging situation. In other words, anyone going through the cancer experience may experience these symptoms. The idea is to learn some basic techniques that you can use on your own, often called stress management strategies, but to also recognize when things get bad enough that you might need help from a mental health professional. For example, mild-to-moderate feelings of worry or sadness can be self-managed using stress management strategies – see below for a list of a few techniques you can try. However, when these strategies are not enough and you experience more severe or persistent feelings of anxiety or depression, it is time to seek out the support of a mental health professional.

Some mental health professionals, like psychiatrists, can prescribe medications, such as anti-depressants, anti-anxiety medications, and sleep aids. Other mental health professionals, such as counselors and psychologists, focus more on talking to you about your issues and identifying non-pharmacological approaches. This approach is called psychotherapy. The best outcome for many mental health issues, such as a severe episode of depression, is achieved when the treatment plan includes a combination of psychotherapy provided by a mental health counselor along with psychotropic medications prescribed by a psychiatrists or primary care physician.

Before seeking out a mental health professional, it is worthwhile to try some basic self-help stress management strategies that are easy to learn and use. Here are a few examples:

Deep Breathing (aka Diaphragmatic Breathing) – to practice deep breathing, begin in a relaxed seated position or lie down on a bed. Allow the body to settle so that the breath can slow into its natural quiet state. Once the body has settled, slowly move the abdomen out, drawing down the diaphragm, which will draw air into the lungs. Counting to 3 or 4 while you breathe in can help you ensure you are taking a nice deep breath. To exhale, pull the abdomen in, which will expel air from the lungs. Again, count to 3 or 4 while you exhale. The pace of deep breathing should be slow and rhythmic so that the inhale length matches that of the exhale. You can do this for several minutes, and you should feel a sense of calmness come over your body. The great thing about deep breathing is that you can do this almost anywhere, anytime, and usually get relief from feelings of anxiety, nausea, or pain.

Guided Imagery (aka Visualization) -

Guided imagery is a relaxation technique that involves dwelling on a positive mental image or scene. This technique is sometimes called visualization, or guided meditation. The practice involves closing your eyes and intentionally visualizing a peaceful scenario or image. While one person might choose to visualize a pleasant scene, others use healing imagery, such as picturing white blood cells fighting illness and imagining the desired outcome. I often tell patients to pick their favorite place – it could be the beach, a garden, or the view from the top of a mountain - wherever you feel safe and calm. I then instruct them to go through each of the five senses and really attempt to experience what it would be like to be in that safe, calm place – imagine the sights you see, the sounds, the smells, the physical touch, even the tastes that you would experience if you were physically in that place. You can linger in the scene for as long as you like – the point is to really experience the calmness and sense of relaxation you achieve by being in that place.

Progressive Muscle Relaxation – this technique involves going through each major muscle group in your body, progressing from one to the next, first tensing that muscle group, holding it for a few seconds, recognizing what it feels like to have tension, and then releasing that tension, paying attention to what it feels like to have relaxation in that muscle group. I often tell patients to start with one leg, first tensing and relaxing the toes and feet, then move to the calf, then to the thigh, always tensing and relaxing each muscle group as you progress throughout your body. Moving from your legs, to your torso, to your shoulders, arms, and hands, and finally to your neck, face, and head. It should take 5-10 minutes to progress through all the muscle groups in your body. At the end, you should be able to experience an overall sense of relaxation in your body.

Positive Thinking – This technique involves focusing your mind on happy, uplifting, and hopeful thoughts, and avoid letting negative, fearful, or sad thoughts dominate your active mind. This can be difficult to do, especially when you feel sad, anxious, or is in physical pain. So, I often instruct my patients to keep a running list of positive thoughts, either in a notebook or on an electronic tool, such as your phone, tablet, or computer. The important point is to PRACTICE positive thinking by reading and stating these positive statements to yourself over and over, several times a day or whenever you feel down and out. The repeating reading or saying of positive thoughts can lead to a more hopeful outlook on life.

Cognitive Re-Framing – like positive thinking, cognitive re-framing involves using positive thoughts, but in this case, it is used in response to a negative, sad, or fearful thought and to reframe a negative into a positive. This method involves being able to monitor one’s own thoughts and to recognize when one is engaging in a negative or fearful thought. I often tell my patients to use a 3-step process whereby they actively say STOP to themselves when they recognize a negative thought, LABEL that thought as negative, and then REPLACE the negative thought with a more positive thought.

For example, you might notice yourself thinking, “I am not strong enough to face this challenge.” When you hear that thought in your head, immediately stay STOP, then LABEL that thought as negative, and REPLACE that thought with something like “I am a strong person with a lot of support and love from others. I can and I will overcome this challenge!”

Mindfulness-Based Meditation – this technique involves the practice of bringing your attention to the present moment, focusing on what is happening right here and right now. By doing so, you avoid focusing on the past or the future, neither of which can you control. By actively focusing on the present, you can begin to appreciate what is happening right now, not what has happened in the past or what may happen in the future. Mindfulness-based meditation is not easy to master, and may be best learned by reading a book on the topic or by working with a trained therapist or joining a meditation group. Each of these approaches will provide support and encouragement. Like all of the stress management strategies discussed above, the most important part of a mindfulness-based meditation is to PRACTICE. Keep working on it and it will become easier over time, and you will reap the benefits.

Healthy Behaviors – this final recommendation is not so much a stress management strategy, but is more so a lifestyle approach, which involves eating healthy foods, exercising regularly, and maintaining a healthy weight. Doing all of these things can not only improve your physical health, but they can also manage stress and improve your mental health as well. I often encourage my patients to talk to a dietician and a cancer rehabilitation specialist to help you design a diet and exercise regimen that is right for you, and to run this plan past your doctor to ensure that it is both safe and achievable.

Summary: One of the most important things to highlight is that while these strategies may provide immediate relief, they work best when used early and often. Have you ever heard someone say “I practice a specific religion”? The operative word in that sentence is PRACTICE. These strategies work best when you PRACTICE, PRACTICE, PRACTICE them every day, at least once a day, for several weeks, until you become comfortable using them and they become part of your daily routine. I often tell my patients to set aside at least 30 minutes a day to practice stress management, at a time that you will not be disturbed and can focus on practicing the strategies. Setting aside time each day does several things: First, it allows you to become proficient at using these strategies, so that when you need them, you feel competent and confident in putting them to work. Second, it communicates to yourself and your loved ones that learning and using these strategies is a PRIORITY in your life. By taking this time each day to practice stress management, you are saying that my mental health is important! Third and finally, setting time aside to practice stress management can have a preventative effect –that is, over time you will begin to notice that your daily stress management practice may reduce the frequency and/or severity of the negative feelings and may ultimately make you feel like a happier, more fulfilled person. I therefore invite you to being your stress management practice TODAY and build it into your daily routine! And remember, if these strategies don’t seem to be working, it’s time to seek out a mental health professional.

Dr. Stein is a clinical psychologist and the Director of MaineHealth’s Center for Center for Interdisciplinary Population & Health Research