Managing worry and living with uncertainty
Clinical Psychologists Dr Laura Baker, Dr Louise Brown and Dr Bec Mulholland share some information and tips to help you manage worry and anxiety during cancer.
Feeling worried or anxious is understandable, especially when you’re experiencing something difficult like cancer. But sometimes you might feel overwhelmed by worry if you don’t feel in control. Here are some tips to help you manage those feelings.
This information is taken from a session that Clinical Psychologists Dr Laura Baker, Dr Louise Brown and Dr Bec Mulholland ran for our virtual Find Your Sense of Tumour event in 2020. You can watch the full workshop here.
Before you start
Learning new techniques for handling anything to do with your mental wellbeing can feel difficult or might trigger difficult feelings.
That’s totally ok, and actually very normal.
Make sure to read this at your own pace, taking a break if you need to, and also taking some time out afterwards to relax and reset.
Why do we worry?
You might find this four minute video helpful in explaining why humans worry.
We’ve evolved over millions of years to survive. We’ve also been designed to feel and need and want certain things.
Because of that, we have automatic threat responses that kick in.
These responses are our brain’s way of trying to protect us from harm by making sure we are prepared to deal with the threat we are facing in whatever way we need to.
These automatic responses are:
- Fight: That’s when we physically respond to the danger by facing it.
- Flight: That’s when we run from danger.
- Freeze: This is when we don’t do anything, as a way of avoiding the danger.
- Appease: This is when we try to do what is desired of us to avoid the danger.
When these responses start, they trigger the release of stress hormones, called adrenaline and cortisol. They make lots of changes happen in our bodies that can make us feel anxious, like:
- our heart rate and breathing rate getting faster, which gives us more energy and oxygen
- tense and trembling muscles, which is helpful if we need to physically fight the threat
- feeling sick and butterflies in the stomach, because any excess blood gets sent from the stomach to the brain and muscles, where it’s most needed
So, what’s the problem with worrying?
Our brains are amazing. We can be creative, we can imagine all sorts of things, we can plan ahead, and we have memories we can learn from. And we’ve also developed a sense of self. That means we’re able to think about who we are, our relationships and how we impact those around us.
But we’ve almost got too good at imagining things. We can also imagine awful things which might or might not happen. We can think so much about the future that we get stuck in loops of worry. We can bring up memories that feel painful or traumatic. And we can also judge ourselves based on what other people will think.
When we feel overwhelmed by worry, sometimes the automatic threat responses can kick in as our body tries to keep us safe and protected, even if we don’t need those responses.
This isn’t our fault. Our brains are designed this way to keep us safe.
An example could be worrying about an idea from the past or the future, like cancer coming back. The fight, flight, freeze, appease responses won’t help with that worry, because there isn’t anything we can do about that threat in the moment.
But sometimes just knowing how our body creates automatic stress responses can really help in managing how overwhelmed we feel.
What effect does a cancer diagnosis have on feeling worried and anxious?
It’s very normal to feel anger, anxiety, sadness and fear when you are diagnosed with cancer. Hearing this news means that you have a lot of uncertainty to deal with, and that is very hard.
As a result, you might not feel as motivated as usual. That can be caused by feeling very tired from treatment or even feeling tired from lots of worry.
It might feel really difficult to feel calm and relaxed, as you may feel like you’re constantly on high alert for danger.
It’s important to remember again that it’s completely understandable to feel this way and it’s not your fault. It’s your brain’s way of keeping you safe from harm.
But that doesn’t mean you have to just put up with it. Feeling lots of worry and anxiety can get in the way of life, making it harder to connect with people, or do things you enjoy or which have meaning for you.
Why do we struggle with uncertainty?
The problem with being able to look into the future and plan is that it’s always a guess – we don’t know for sure what’s going to happen. And our brains hate that.
This is where patterns of worry can start. We often assume the worst-case scenario is the most likely, and that we won’t be able to cope with that worst-case it if it does happen. And our brains often replace a possibility (like ‘my cancer could come back’) with the worst-case scenario possibility (‘my cancer will come back’).
When you were diagnosed with cancer, this probably added a big new uncertainty into your life. And now coronavirus is likely to have added even more unknowns to that pile too. So you might have found that your feelings of worry have felt more intense lately.
And things don’t always feel certain after cancer treatment, either. You might have worries about your future and how your experience of cancer might affect you in years to come.
That’s why it can be helpful to practice how to live with uncertainty. We know that this isn’t as easy as it sounds so we have included some ideas below.
How do you live with uncertainty?
1. Think of the best-case scenario as well as the worst
When you notice yourself thinking about the worst-case scenario, try thinking, ‘What’s the most likely thing to happen?’
Try and think of all the possibilities of things that could happen, not just the worst or most scary ones. And then try and think of all the additional information around each scenario too.
For example, if you’re worried about your cancer coming back, instead of believing the thought that it definitely will, try asking what other things could happen. Try saying to yourself something like:
‘The cancer might not come back. Or it could, but if it does, I already know the team, and they’ll be in a really good place to help me face it again if I need to’.
2. Try the worry tree
Worry can help us solve problems if it’s something that’s very likely to happen, if it’s certain and not too far in the future.
But worry doesn’t help us when the problem is out of our control.
So next time you find yourself stuck in a cycle of worry, try following these steps to see if worrying is helping you right now.
Notice the worry
↓
Ask yourself, ‘What am I worrying about?’
↓
Ask yourself, ‘Can I do something about it?’
↓
Yes or No
If the answer is yes, then you might be able to take some practical steps to help solve the issue. Try searching online for ‘problem solving action plans’ for some good guides.
If the answer is no, then you can’t problem-solve this issue, and it’s best to try and let the worry go. That can be really hard, especially when it’s about your health. But practicing mindfulness techniques can help.
3. Mindfulness
You might have heard of this technique, but you might not know about how it can help with worry.
Mindfulness is where we learn to direct our awareness and attention on to what is happening right now. This is sometimes also described as being ‘in the moment’.
With mindfulness, we’re not trying to change anything, and we’re not trying to focus on things that have already happened or things that might happen. That can be really hard, as our brains are very good at wandering and taking us to future possibilities or memories of the past.
There are a few different ways to practice mindfulness. A good place to start is a three-minute breathing space. For instructions on how to do this, fast forward to the 25.40 time mark on the main workshop video at the top of this page.
We also shared some great tips on mindfulness in our blog post from Merry Gibbons, a Macmillan teenage and young adult wellbeing specialist and psychotherapist.
Or you can search online for other mindfulness meditations from websites and apps like Headspace.
4. Worry time
Feeling anxious can take up a lot of our time. So try choosing a time of day that you dedicate to worrying. It should be the same time every day (ideally not right before bedtime), and should last for no more than 20 minutes.
When you notice a worry during the day, jot it down in a notepad or on your phone, and try to remind yourself that you’ll worry about that later.
Then, when you come to worry time, pop a timer on your phone and allow yourself to worry about the worries you wrote down for all of that time.
This might sound a bit odd, but it can really help you to manage worry and how much time it’s taking out of your day.
5. Being kind to yourself
We are often very harsh on ourselves, and that can make worry and anxiety worse. As much as possible, try not to be hard on yourself for worrying. It’s normal, and it’s your brain trying to help.
6. Get more support for your mental health
Your clinical care team, including people like your Teenage Cancer Trust Nurse or Youth Support Coordinator, can help you find more support if you’re struggling with worry and anxiety. There may be support they can offer you directly, or they may refer you to a different health professional.
It’s important to give yourself permission to ask for help if you’re struggling with worry. Your mental wellbeing is just as important as, and closely connected to, your physical health and you deserve to access advice and support around it.
If you’re a young person going through cancer and you feel you’re struggling with your mental health, please do speak to your clinical team, Teenage Cancer Trust Nurse or Youth Support Coordinator. They’ll do whatever they can to help you, which may include referring you to specialist support.