Charting Your Course : Seminar I - Taking Your Bearings : Stress, Fear, Anxiety, Depression, Anger

Stress

Cancer is an emotional roller coaster. At first you might not know how to think about your cancer, how to make decisions about your treatment, or even how to begin to imagine living with a disease like cancer. The most common emotions that accompany cancer are fear, anxiety, depression, and anger. As hard as it is to believe, you will adjust to your cancer, and you may live a full and productive life after cancer.

Fear

Accurate information is probably the best defense against fear. There are many myths about cancer. For example, it's a myth that a cancer diagnosis is an inexorable death sentence. There are more than 8 million cancer survivors alive today, and more than 51% have lived for five or more years since their diagnoses.

Anxiety

Feelings of anxiety are normal during the cancer experience. Most cancer survivors rank the diagnosis as the most upsetting and anxious time. A cancer diagnosis is a shock, and often people react with denial. You may not know how to think about your situation or how to plan for the future. Remember that eventually you will become an expert on your own illness and treatment and that you will develop the coping skills you need in times of crisis. The disbelief and anxiety you feel now will give way to adjusting to life with cancer. Common symptoms of anxiety:

nervousness
tension
panicky feeling
fear
forgetfulness

If anxiety persists, discuss it with your doctor. Anxiety is treatable. Your doctor may refer you to a counselor who can help you come to terms with the feelings causing your anxiety.

A guided imagery exercise for anxiety

In a quiet room free of distractions, spend some time thinking about a special place where you can feel happy and relaxed. It can be a place you have been or a place you make up. It might be a beach or a forest, a mountain, a lake, or any other place where you feel good. It should be a place where you can be wholly at peace. Have nothing disturbing in your special place. Think about the whole scene. Envision the details, the sounds, the smells. For instance, if your special place is a beach, imagine the the sounds of seagulls and breaking waves, the salt smell on the breeze, the gritty feel of sand underfoot. Visualize your scene in as much detail as possible.

This is a place you can visit in your mind to be completely relaxed. It is a place where you can always return. It is a place without worries-a place where nothing intrudes on your peace.

Depression

Depression is a common problem for people with cancer. The depression experienced by people newly diagnosed with cancer is called "reactive depression". It is different from chronic mental depression. Depression is a natural way to cope with shock, and it is usually relatively short-term. Sometimes it can be caused by either illness or treatments.

Understand that depression is quite normal. Allow yourself some time to get used to cancer-related losses such as the loss of control you may feel, loss of a body part or hair or the loss of self-image. Take an active role in your treatment plan and refuse to be helpless. You might also ask your health care team about speaking with a counselor or finding a support group to help you through this difficult time.

Common symptoms of depression:

hopelessness
change in appetite (increase or decrease)
change in sleep pattern (insomnia or excessive sleeping)
loss of interest in activities
excessive crying
preoccupation with death
feelings of guilt
loss of concentration
moving more slowly than usual
irritability

Depression is treatable. Some steps to take are:

Discuss your feelings with your doctor.
Review all your medications with your doctor. Some medicines can cause or increase depression.
Get plenty of rest
Exercise when you have the energy, as appropriate.
Eat healthfully. Consult with your nurse or nutritionist.
Avoid alcohol.
If your doctor prescribes antidepressant medication, take it as directed.
See a counselor. Your doctor can refer you to a reputable therapist.

Anger

You will be angry because you have cancer. Anger is a normal response to cancer and the impact that it has on your life. Cancer may require you to alter plans and change your dreams. It may interfere with your livelihood and with your relationships. It would be unusual not to feel anger. The key is to express your anger in a positive way. Some people find it helpful to talk to a counselor or support group or good friend. Other people find it helps to write about their anger or to paint or draw or use some type of creative expression to dissipate it. Guard against "misplaced anger". You are angry because you have cancer. Do not direct your anger at your family, friends, doctors, and others.

Self-Care

Ask for help when you need it. Getting assistance in tough times can reduce your feelings of frustration. Trying to do everything that needs to be done yourself can leave you with no energy for anything else.
Identify sources of strength that you can summon during moments of despair when the world looks bleak. For some people strength is found in religious faith. For others, in nature.
Find ways to feel useful and focus on interesting or pleasant activities. Distraction is a wonderful way to reduce stress. Music can be comforting, or a warm bath or shower.
Reduce your sense of isolation by finding a support group. Living with illness can be an isolating experience. Within a support group, you might discover friendship as well as sensitivity and understanding that are hard to find among people who haven't shared your sense of frustration, fear, and loss. Support groups allow you to share your thoughts and fears and provide a chance to hear how other people find strength. You can learn new ways of dealing with the changes in your life and give support to others.

- Joanne Lynn, M.D.