Teresa, a 24-year-old who was just diagnosed with breast cancer, was stunned. She immediately began to worry, felt uneasy, became nervous, and was overwhelmed with a sense of dread – all normal feelings of anxiety.

Teresa’s reaction to her cancer diagnosis is not surprising. Anxiety is a normal emotion alerting your body to respond to a new threat that can serve a helpful purpose. Anxiety related to an immediate threat can help you take an action. However, longer-term and intense anxiety can get in the way of daily life and your relationships with others. 

Anxiety when coping with cancer is particularly powerful because of worry about test results, treatment side effects, whether treatment is working, fear of recurrence, loss of independence, or living with the unknowns that come with cancer. Other people coping with cancer might worry about needle sticks, procedures, or scans.

If you’ve never had anxiety before and you experience symptoms of anxiety, you may think you’re having a heart problem, or you’ve contracted some other illness that is affecting your nerves. There are several symptoms that you may be experiencing that can be related to anxiety:

• Restlessness or the feeling of being “on edge” 

• Easily fatigued 

• Sweating 

• Nausea 

• Muscle tension 

• Disturbed sleep 

• Trembling or shaking 

• Rapid heartbeat 

The challenge is that some of these symptoms can also be related to the side effect of medications, or other medical issues. It is always important to speak with your doctor about any concerning side effects. Over time, however, you may recognize a symptom pattern that goes along with anxiety.

Your thoughts and the way you speak to yourself (self-talk) can impact how you feel. Thoughts are not always factual but there are many “factual” thoughts related to cancer that cause worry. However, thoughts can also be biased in some way.

For example, one type of biased thought that is common for cancer patients is the thought that you SHOULD have control over everything in your life. Even though rationally you understand that this is not true, this can be one way of understanding or coping with what you can’t know or control. While it is a very human response to try to control what you can’t, it often creates worry and cancer-related distress. Identifying this kind of biased thinking is a skill. It takes time to learn but starts with curiosity about our thoughts.

Another type of distressing cancer-related thought involves the mind jumping to conclusions. Instead of waiting for an answer or accepting that there is no definitive answer at this time, you may try to control a situation by finding an answer that might only be one of the possibilities.

Your thoughts, behaviors, and physical symptoms interact to influence your anxiety. For example, you may experience shortness of breath while climbing stairs (physical symptoms). This symptom may trigger thoughts about the vulnerability or limitations of your body (thoughts). These thoughts may make you anxious about your health (anxiety) and may lead you to spend more time on the couch (behaviors). However, spending more time on the couch (behaviors) gives you more time to think about your health (thoughts), which just makes you more anxious (anxiety). In addition, being more anxious causes muscle tension, which makes it harder for you to breathe (physical symptoms) which triggers more thoughts, which makes you more anxious!

It is easy to see in this example how the thoughts, behaviors, and physical symptoms work together to increase your anxiety.

While anxiety is frequently part of your cancer experience, there are various interventions to treat anxiety that you can use – individually or together – to help cope with the intensity. 

• Counseling Interventions where you will learn coping strategies and ways to recognize unhelpful thoughts and behaviors that may be contributing to the anxiety.  

• Medication for clinical anxiety can help manage mood, which can be particularly helpful with the stress of coping with cancer. 

• Relaxation strategies include specific types of breathing, progressive muscle relaxation, meditation, and guided imagery among others to help regulate and calm the nervous system.  

Identifying, examining, and mitigating your “go-to” self-talk traps can also help you cope with cancer anxiety. For example:

• Do you jump to conclusions when you don't have all the information?  

• Are you someone who moves quickly to black-and-white thinking when you are stressed? 

• Do you take one small part of a situation and conclude it tells the whole story? 

• Do you see only the negative and disqualify the positive? 

• Do you see a single negative event as a never-ending pattern of negativity? 

• Do you assume that if you feel bad it must be that bad? 

• Do you sometimes take on all the responsibility for something, like it was your fault when it was much more complicated than that? 

Recognizing these self-talk traps is the first step in challenging them. To help relieve your anxiety, ask yourself instead: Is there another way to see this? Am I seeing all sides of it? These questions can often help you to evaluate your thoughts and move them in a direction that is more in line with the facts. With cancer, it is common to ruminate about the worst-case scenario. If you find yourself doing this, ask yourself what the best case and worst case are…. then try to find a middle-ground thought that can soften the distress you experience by ruminating on the worst case.

Cancer can be overwhelming and may lead to opportunities to feel worried. Working to use these strategies can help you not only identify anxiety but also enable you to deal with your anxiety with curiosity and flexibility rather than with avoidance. For example:

• Approach your thoughts with curiosity and pay attention to the way you speak to yourself.

• Recognize that thoughts originate from many places in our minds- some of which are about the present but also many are about the past or an expectation about the future.

• Focus on your self-talk so it is more balanced and flexible – Are there other ways to look at this situation?

• Strive to change some of the language to minimize your worry.

With Iris, you are not alone in facing cancer. If you want individualized help recognizing and dealing with cancer-related anxiety, schedule an appointment with an Iris mental health therapist.