Anxiety
Hi, I've been NED for 14 years and have been a therapist for 17 years, so I have a lot of varied experience dealing with anxiety. Anxiety is just awful and can not only be debilitating, but can keep us from being able to take in and process information just when we need to be at our best. Too little stress can leave us bored, but too much stress/anxiety can leave us with panic, unusual amounts of anger and/or the inability to "perform" at our best. In the "not diagnosed but worried" category, anxiety can mean that we aren't able to hear our medical providers when they give us good news, or we aren't able to rationally discern what information is good and credible scientific evidence and what information is unscientific and only inflames our anxiety. It may impair our ability to listen, remember, read and comprehend our personal risks, our treatment options and our ability to calm ourselves, even if we have been found to have no evidence of disease.
So how do you know if you are too anxious? Look at the stress curve above. Do you feel fatigued or exhausted? Are you sleeping well? Can you turn your mind to something else when you need to focus on another task? Or is your anxiety all you can think about. Are you eating properly? Or have you lost your appetite. Are you able to engage in activities that reduce your feeling of anxiety/stress? If you are able to concentrate on something else for periods of time, and utilize good coping skills to reduce your feelings of stress, then you'd fall in the optimal performance stage. If your normal patterns of sleep, energy and appetite have been disrupted, then you would fall in the distress stage.
I am going to suggest some strategies for each category, and am hoping that others will chime in with what works for them. What I'd like to see is a thread where anyone who is new to the experience of breast cancer or other breast health issues, has a place to refer to for concrete suggestions for managing their anxiety. There is no judgment here, as we've all experienced anxiety (to some extent) in our own journeys.
Stress occurs when perceived pressure on a person is greater than their ability to sustain resilience. The following skills can be used to improve and maintain your resilience:
- Practice distraction: deep clean something; do a home project that you've been wanting to do but haven't gotten around to; binge watch netflix; if you like to cook or bake, make a complicated recipe that takes your full concentration.
- Exercise: studies have shown that at little as 20 minutes of walking can bring down your stress response and walking in nature has a more robust response
- Regular relaxation: listen to a relaxation cd or use an app, try guided imagery, practice counting your breathe, practice yoga, try mindfulness or meditation, take a hot shower or bath, get a massage
- Use good self-care: make sure you are getting good nutrition and good sleep
For those of you who find that the above strategies aren't enough to reduce you anxiety to a tolerable level or for those of you who have pre-existing anxiety issues.
- Talk to your primary care provider (or psychiatrist if you have one) about medication options, both long term and short term; for both anxiety and sleep
- Think about getting into therapy and learn cognitive behavioral techniques to address your anxiety
- Find a group that lets you connect to others who have experienced similar levels of anxiety and who may be able to share ideas about what has been effective for them.
For those who are here who have been diagnosed, there was a study recently released that found a statistically significant improvement in the recurrence anxiety of breast cancer survivors. See a summary here: https://community.breastcancer.org/forum/105/topics/855472?page=1#idx_1
I may review and revise this post at will without defining why, unless saying why is integral to the work. I would like to be able to add links and additional information as I find it.
Comments
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MTWoman - great post.
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thanks! I hope it will keep folks from having to repeat the same things to people who are struggling
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MTw I agree with MT. Hahahah try and write that fast three times.
MTw thank you, for bringing your solid counseling background and offering assistance. You are a blessing sorely needed here
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Great post
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thanks sas and MelissaDallas. I'm hoping folks will add to the list. In fact, a got a pm from someone reminding me of 2 other important things to help reduce anxiety, so I'm adding:1) being in nature - whether it is a walk, run, hike or just sitting on a park bench. Breathe the clean air and notice your surroundings. Listen to the wind, watch a bird (I've heard from another poster that hummingbirds have magical powers to mesmerize and bring peace to their watchers) or sit by some moving water and just watch. Try to slow your breathing and just be present. The Japanese call this "forest bathing" and studies have shown that it can reduce the physical signs of stress. 2) Animals/pets - spending time with your favorite animals/pets can also reduce the feelings of anxiety. Pet them, brush them, play with them, hug them. They are therapy in fur (or feathers).I will be out of touch for about 10 days, so peace to you all!
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I have been in therapy for pre-existing anxiety for a couple of years, so I am well versed in the CBT techniques. I was actually feeling normal levels of anxiety (after having weaned from meds) and was about to cut the cord with my therapist when, oh surprise, you have cancer. So I continue going, but it's extremely helpful and I'm thankful I hadn't cut that cord.
What I've found the most helpful, for my anxiety, is what she calls "big picture," though re-framing might be the actual term, not sure. Spanning out in your mind, to look at a problem or event with a more global view, or to see it from another point of view. I also picture events as a big wave...it will crest and feel awful, but I will eventually be on the other side of it. I am also a christian, so we do a lot of "God is in control" point of view. That helps the most, honestly.
I also watch funny movies if I've had a really bad day. Get Smart makes me laugh like silly every time.
Great thread!!!
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Thanks so much for sharing what has been helpful to you gb2115! Looks like you've worked hard at managing anxiety and have learned some really useful strategies to increase your resilience. Well done!
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Read an article this week that surprised me but explains why so many people find gardening relaxing and satisfying. Turns out there is a bacteria (not the kind that makes you sick) in the soil that when inhaled or ingested causes the release of serotonin in the brain that calms anxiety and elevates the mood. It has also been shown in the lab that mice exposed to this bacteria learn mazes faster than those not exposed so it improves learning too.
So go play in the dirt !
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Awesome reminder DJMammo! There is actually a thread where we've been discussing this!
https://community.breastcancer.org/forum/73/topics/854729?page=3#idx_69
I have found weeding to not only be therapeutic, but meditative. All I have to keep in my mind is "plant" and "not plant" (i.e. what I planted and what I didn't=weed). I have been able to pass an hour at a time just weeding and breathing. I didn't even know about that bacteria at the time, but certainly experienced the calming effects of dirt.
Thanks for the lovely addition!
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Dirt is a wonderful thing! I play in it as much as I can!
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This is wonderful MTWoman - thank you! This month since being diagnosed with bc is the first time in my life I have felt like I might need professional help to overcome this anxiety. and indeed I was wondering "is this anxiety" -- your post is helpful.
I am taking daily walks and I love to cook and on my own found the "complicated recipe" idea also works. But I'm still anxious and can't distract myself for long, can't sleep well. Re your idea of talking to pcp or finding a psychiatrist.. do you think a medical oncologist could help as well? (I have a consult with one in a couple weeks, after my oncotype score is back)
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Probably wouldn't hurt to talk with your oncologist. They might prescribe something or send you on to someone in mental health (or both). Mental health isn't what an oncologist specializes in but anxiety is indeed common amongst cancer patients so they should be well versed in handling it, or at least have someone in mind to send you to.
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MT Woman - thanks for starting this thread and all the detailed information. I'll be recommending it to people who say they are anxious or paranoid.
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Hi everyone! Glad to be back here after a nice long vacation.
EpicSquirrel, Good for you for getting walking and trying to find some distraction techniques that work for you! I think that the more you practice distraction (and relaxation techniques) the more effective they become, keep it up! Also, I think that getting support for your anxiety is the key, whether it be from your MO or other provider. Some MOs may be good at this and others not as much. I don't see any problem bringing it up with your MO, who can then let you know about their ability/comfort level in helping you manage. And, as gb2115 mentioned, they may make a referral to someone who specializes in treating anxiety. Please let me know how it's going and if you need extra support.
Thanks MinusTwo! It does seem to be a pretty common experience for folks, so I was hoping this forum might help us help each other
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I've made an appointment to see a psychologist who specializes in anxiety and stress at a respected place here. Was able to get an appointment for tomorrow! I've never seen anyone like this before so I'm a little nervous, but I feel good about taking a step to try and help myself. Although I returned to work this week after being off for a week to recover from the surgery, I have had a hard time focusing on work.
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Good for you EpicSquirrel! Being nervous about meeting a new provider is normal
Anxiety really does respond to intervention (there are a variety of choices) so I am so glad you've decided to see someone with expertise! I have worked with so many folks with anxiety, and even used the techniques on myself, so have first hand knowledge about how much better you can feel. I'm so happy you could get in so soon and am sending you positive thoughts and gentle ((hugs))0 -
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Had the appointment today and I think this was such a good idea. I'm going to see her weekly for a few weeks. Although she specializes in anxiety, she seemed to know about bc, which helped the conversation. Gave me some good coping ideas for this week -- similar to your advice MT, about distractions etc. Asked me to keep anxiety notebook this week (She told me what and how to track it) Glad I took this step
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So glad to hear that Epic...I have been down that road before, and it really does help. I think it takes a lot of courage to make that first appointment and go, but it helps so much.
:-)
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So glad to hear it EpicSquirrel. Feeling empowered about your anxiety and getting help to manage it is a great first step. Keeping the notebook will give you and your therapist useful info, so you can not just deal in generalities about what causes anxiety in "most people", but what makes yours better or worse. I'm so happy to hear it went well and feels useful. Awesome job!!
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So, I was talking with a client about things to do when he has increasing anxiety, and I realized that I hadn't put in a few things herbal remedies that have been studied for anxiety:
chamomile tea - can soothe anxiety
edited to remove discussion of kava (see posts further down for clarification re: toxicity)
and if sleep is problematic, you could try Valerian root.
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There are many instances of liver toxicity with Kava. I wouldn't take it.
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MelissaDallas - I, too, have read about Kava and liver issues and should not be used with depression and several meds.
I have been told not to take Valerian by 2 of my Drs. (Never have - was just a warning in case I wanted to 'try' it.). Liver toxicity is a possibility and it interacts with several drugs.
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Thanks MelissaDallas,
For those interested in reading more about the potential for liver toxicity read the following from the NIH:
" Hepatotoxicity
The frequency of adverse reactions to kava, particularly liver injury, is not known. Based upon reported cases, the estimated frequency of clinically apparent liver injury due to kava is less than 1:1,000,000 daily doses. However, spontaneous reporting is believed to capture less than 1% of severe adverse events from the use of dietary supplements. Between 50 and 100 cases of clinically apparent liver injury have been published or discussed in the literature. Advocates of the herbal have strongly rejected these numbers, disputing both their accuracy and the causality assessment process. Still, there seem to be convincing evidence in some cases of severe hepatitis ending in fulminant hepatic failure, requiring liver transplantation, and even leading to death. Patients typically present with fatigue, nausea, elevations in serum aminotransferase levels, and jaundice 2 to 24 weeks after starting use of the product. The pattern of enzyme elevations is hepatocellular with marked elevations in serum aminotransferase and minimal increases in alkaline phosphatase levels. In some cases, features of immunoallergic hepatitis (rash, fever, eosinophilia, and recurrence on reexposure) are present. Liver biopsy findings include focal hepatocellular necrosis, lobular inflammation and intrahepatic cholestasis. In more severe cases there is massive or submassive necrosis.
Mechanism of Injury
The cause of hepatotoxicity from kava is unclear. In vitro studies suggest that the kavalactones are not intrinsically cytotoxic, although other components of kava preparations may be. Kava can also cause herb-drug interaction. Although in vitro studies suggest that kavalactones inhibit several cytochrome P450 isoenzymes, human studies suggest that it is a modest inhibitor only of CYP 2E1. Clinical cases of hepatotoxicity due to kava suggest an idiosyncratic or immunoallergic pathogenesis. The possibility of mislabeling or adulteration with hepatotoxic herbals is always an issue.
Outcome and Management
The severity of liver injury ranges from transient and moderate enzyme elevations to symptomatic acute hepatitis to acute liver failure. In most instances, the liver injury subsides within 1 to 3 months of discontinuing the herbal product, but if fulminant hepatitis develops, a liver transplant may be required. Rechallenge leads to prompt recurrence and should be avoided."
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Kicks,
2 different psychiatrists I've worked with (at 2 separate facilities) have encouraged the use of Valerian and I have taken it myself, with no problems. Again, from the NIH:
"Hepatotoxicity
Valerian has been implicated in a small number of cases of clinically apparent liver injury, but usually in combination with other botanicals such as skullcap or black cohosh. In view of its wide scale use, valerian has to be considered a very rare cause of hepatic injury. In published cases, the latency to onset ranged from 3 to 12 weeks and the pattern of enzyme elevations was usually hepatocellular or mixed hepatocellular-cholestatic. The liver injury was usually mild-to-moderate in severity with recovery within 2 to 4 months of stopping. Immunoallergic and autoimmune features were not present. Severe cases with features of hepatic failure have been described, but usually in association with other potentially hepatotoxic herbals.
Mechanism of Injury
The cause of the liver injury associated with valerian use is not known. Valerian extracts contain multiple ingredients, but none have been shown to be specifically hepatotoxic.
Outcome and Management
Hepatotoxicity from valerian is usually mild-to-moderate in severity and self-limiting. Only a small number of cases of liver injury attributed to valerian have been published, and there have been no instances of chronic hepatitis, cirrhosis or vanishing bile duct syndrome attributed to its use, and no convincing case of acute liver failure."
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One of the 2 Drs who warned me of Valerian happened to be my Psychiatrist.
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don't know what to tell you, different providers have different approaches. NIH information above indicates it's possible, typically in combination with other hepatotoxic herbals. Also " The interaction potential of valerian preparations therefore seems to be low and thereby without clinical relevance. We conclude that there is no specific evidence questioning their safety, also in cancer patients." from the following PubMed journal article: https://www.ncbi.nlm.nih.gov/pubmed/25093031 .
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From Memorial Sloan Kettering's Herbal website:
"Although kava may provide short-term relief for anxiety, the risk of liver damage outweighs any benefits."
https://www.mskcc.org/cancer-care/integrative-medi...
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