Coping with the “Roller Coaster” Emotions of the Cancer Experience, by Leah

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January 17, 2008 - 10:37 pm email to a friend printer friendly view / write comments

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Dr. West

Hello again! After my first column Lola’s daughter asked me to discuss what is helpful in negotiating the emotional roller coaster she and her mother, and every other cancer patient and loved one experiences during the cancer journey. I thought it was a question that is very relevant to any reader of this website, so here goes!

First and foremost, acknowledge that these ups and downs are very normal. Although denial can be functional and helpful, it is impossible to remain in denial when one is visiting cancer treatment centers frequently; experiencing the side effects of treatment, feeling ill, feeling exhausted most of the time, being anxious when test results are due, and constantly being reminded that one is dealing with the big “C”. So, I think the question really is, how can we keep the negative emotions to a minimum so that we are not overwhelmed by them?

Some suggestions:

1. Rather than allowing random worrisome thoughts to keep circling through your mind all day, play Scarlett O’Hara. No, I don’t mean think about it tomorrow, but try to designate a certain time when you might be able to sit down and actually focus on those thoughts. This is a technique that can work well for many people. By pushing the negative thoughts out of your mind each time they appear and telling yourself that you will think about them, say, at 4:00PM and then doing exactly that, your ability to control the nagging thoughts will increase and you will find that the time you spend on them will decrease. When you are thinking about them, prepare some self-talk that is both accurate and supportive. Statements like: “We have a great medical team, doing everything they can!” “The treatment is state of the art, no matter where we went it couldn’t be better! ” ” Its’ OK to feel scared and worried once in a while, but we can handle this!” “Nothing so far has been as bad as we thought it would be!” So many patients tell me that the unknown is always worse than the known. Remember that what you tell yourself must be true: you cannot lie to yourself — your brain will simply reject the statement, and the technique will not work for you.

2. Join a cancer support group. I know, I know, you’re not a groupie kind of person, but giving it a try may surprise you. We have in our community (Seattle) several wonderful cancer support organizations, Gilda’s Club, and Cancer Lifeline, and Team Survivor Northwest, a combination group/sports cancer organization, and they all offer many groups that are bound to appeal one way or the other. At most of these organizations, a full range of classes that allow other forms of connecting with each other are offered. Yoga, Mindfullness Meditation, Pilates, Tai Chi, QI Gong, are only a few of the classes offered in our community. All are “soft” classes, meant for people on treatment who are easily fatigued.

Here at the Swedish Cancer Institute, we have several breast cancer groups, a general cancer group, a caregivers group, an ovarian cancer group, a prostate cancer group, and an advanced cancer group for people with any kind of cancer. Some folks believe that they need a group that specializes in the type of cancer that they have, but I have never found that to be necessary or even advisable. You would be amazed at the dynamics that takes place among people facing a common enemy! Even though a person is not getting the exact type of chemo you are, chemo is chemo, and who knows maybe the next chemo you face will be the same. This is also true of radiation therapy, though the side effects vary with which part of the body is being radiated. But everyone is concerned about whether whatever treatment they are getting will work, about how their family is coping, and lots of other issues they all face, and a cancer support group is one place where the patient or the caregiver does not have to put on a cheerful face for the benefit of others, they can just let themselves feel or say whatever they are comfortable with! Generally speaking, I believe that the patient and the caregiver should not go to the same group: their issues are not the same, and neither will be comfortable speaking out if the other is there. My other bias is that whatever group you choose to attend, it should be professionally facilitated. Peer facilitation may work for lots of other types of groups like AA, but a cancer support group really needs a professional. Sometimes without one, a group member may monopolize the group, complain a lot, not be supportive to another group member, or simply may have a personality that does not mesh well with the others in the group. A well trained group leader can skillfully deal with all of these issues and keep the group on balance. People should leave a cancer support group feeling understood, supported, and comfortable having learned something about how others are coping with similar issues. Try it; try several if you have access to them, as each one will have a different personality, since the groups reflect the group members as well as the group leader! That’s why there is Baskin and Robbins, not all of us like the same flavor!

3. Finally, a last suggestion for now, though not the last by any means! Find a way to truly relax: whether you call it relaxation training, or meditation, the net effect will be the same. You will find yourself more centered, with increased inner peace, less anxiety, and more confidence in your ability to cope. Years ago, after my son was killed, a clergyman who I loved and trusted, he always looked like my idea of what Moses must have looked like, told me to trust him and learn to meditate. So I did, because he said it would help and it did. I learned TM, which was a fad at the time, and I did it exactly the way I was taught, twice a day for 20 minutes at a time, and it was very effective. Now although I know all the benefits, I don’t do it as consistently, but I still use it as a coping skill, and it still helps, though not as much as it did before. Meditation is a skill, that once learned is not forgotten, but unless it is practiced, it is not as much help! You do not need to learn any fancy form of meditation, did you know that prayer is the oldest form of meditation? The use of the rosary or of worry beads in cultures that utilize them can create an altered state of consciousness and an inner peace by simply thinking well known prayers over and over again for 15 or so minutes. You can do the same thing without either a rosary or worry beads — simply sit in a comfortable chair, take a few deep breaths, relax and begin to think a favorite prayer you have memorized. One of my favorites is the prayer of Saint Francis, the 23rd psalm, and other psalms, and even the Lord’s Prayer. What is helpful is the consistency. The technique must be practiced on a daily basis so that the skill of relaxing becomes second nature.

Dr. Herbert Benson has developed a Westernized version of TM that he used to teach cardiac patients. The technique is printed on one page of his book “The Relaxation Response” and is so simple you can’t believe it! I have taught many patients this meditation technique using simple words like Peace, Jesus, Shalom, and One. The word you choose must not have too much meaning, we don’t want you thinking about the word itself, just think the word. I really like the word One because somehow it connotes a connection to the universe and that can be very comforting. Just sit in a comfortable chair, close your eyes, breathe deeply 3-5 times and then begin to think the word. If your mind wanders, and it will, just simply return effortlessly to the word. A word of caution: Americans are by nature a very impatient people, and sitting still does not come easily to us, so most people will start to fidget at the beginning of any meditation exercise, and many stop trying because they find it so difficult to sit still. Don’t worry about it. If you can manage 2 minutes, that’s OK — try for 3 minutes the next time and gradually increase it as you can tolerate it. Practice is the most important thing. Don’t worry about how long you are able to do it.

For some folks, using a relaxation CD is more helpful. There are some wonderful relaxation-guided imagery tapes and CDs made especially for cancer patients. Again in our institution, in the Cancer Education Library, there are many such CDs, a favorite is one by Carolyn McManus, titled “Relaxation for Cancer Patients”; Bellruth Naperstek, has several CDs out, including Radiation Therapy for Cancer Patients, Chemotherapy for Cancer Patients, and Relaxation and Healing for Cancer Patients. Many of these can also be found in local bookstores under Relaxation and Meditation books and CDs. There is a trick to finding the right one for you, and many stores that sell these tapes and CDs will let you listen before you buy. I suggest you do that, since you really have to agree with whatever is being said by the person narrating the exercise, you have to like the background music, and you have to find the voice of the person soothing. If any of these things don’t jibe for you, the tape won’t work. So, listen and try, there should be just the right CD or tape out there for you!

Don’t forget the healing energy of Pet therapy! Sometimes for me, just sitting in my recliner with my dog or cat on my lap, and stroking them is as relaxing and meditative as I need. It has been proven to lower blood pressure too! Listening to classical music can also help you to reduce stress and anxiety. One of my favorites is Pachelbel’s Canon or anything by Rachmaninoff. The Canon, in particular is very soothing, because of the repetitive nature of the chords and the slow beat, I have one CD that plays 4 variations of it, and whenever I listen I can feel my heart rate and my breathing slow down. Combine listening with stroking a soft or silky animal, and the next thing you know you may be dozing! Lovely!

So try some of these ideas, and please report back on your experiences! Here’s to less stress in the New Year!

-Leah

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