Managing Stress and Anxiety

| September 6, 2019

Manage Stress and AnxietyThere is growing recognition of the psycho social (the human side of cancer care) and increased attention to the whole person in cancer care. In 2008 the Institutes of Medicine published Cancer Care for the Whole Patient which summarized years of research findings that ​cancer care often provides state-of-the-science biomedical treatment, but falls short in addressing the psychological and social (psycho social) problems associated with the cancer and its treatments. This oversight can compromise the effectiveness of treatments and adversely impact the health of cancer patients, as well as their loved ones.

Psycho social problems caused by cancer treatments can include anxiety, depression, and behavioral, social and emotional conditions. In recent years, accredited cancer care programs have been charged with the requirement to screen all individuals diagnosed with cancer for Psycho social Distress.

Cancer care programs are also required to document the services, referrals, and recommendations that are made for individuals who demonstrate elevated signs of emotional, social, or spiritual distress. Even with these significant changes in the healthcare system and cultural understandings about cancer’s impact, many individuals suffer silently or feel they are weak for seeking support. Often times support groups and/or psychiatric medications are the primary offering given to women who express their emotional or social distress. These resources can be helpful in some circumstance, but decidedly not all psycho social needs can be addressed effectively in a group setting or by a pill.

Women diagnosed with breast cancer face some unique psycho social challenges and opportunities. Due to the size of the breast cancer survivor population, there are a wide array of diverse breast cancer related programs for social and emotional support, exercise, advocacy, education, etc. Many women find connection and motivation for meaningful engagement through their breast cancer experience. However, some women diagnosed with breast cancer would prefer “not to join the club” and feel guilt and shame for their lack of investment in the community. There is no right or wrong way to be a breast cancer survivor, but some women experience a sense of social or self-imposed pressure to identify themselves in a certain way following their diagnosis. This can add an additional layer of psycho social distress in some individuals.

Whether facing early stage or advanced stage breast cancer, there can be many effects on a woman’s emotional, social, physical, and spiritual-well being. How someone reacts to a stressful life situation is due to many different factors. Therefore, there is no “one size fits all” recommendation for managing the stressors of breast cancer treatments. Ultimately, a diagnosis of cancer results in a new relationship with the idea of uncertainty and understanding your own challenges of living in the unknown.

On the next page, you will find recommendations for evidence-based tools for addressing common psycho social concerns.

If you are struggling with depression:

Physical Activity has consistently been proven to improve mood, sleep, immune system, as well as to reduce cancer recurrence risk.
Talk with a trusted loved one or a licensed professional counselor with medical expertise. If you seek a professional, find someone who specializes in Health Psychology or Medical Social Work and has experience treating individuals with chronic medical conditions.

A gratitude practice – such as writing down 3 things that went well or that you are grateful for each day. A regular gratitude practice has been shown to effectively reduce symptoms of anxiety and depression and result in increase spiritual connection.

Expressive therapy such as art or music therapy can be a powerful way to address distressing emotions.

Reducing time spent on social media sites is essential. Research is showing increased evidence of correlations between time spent on social media (Face Book, Twitter, Instagram, Snap Chat) and increased symptoms of depression and anxiety.

If you are struggling with anxiety:

Mindfulness-based stress reduction is a proven method for reducing worry and improving overall sense of peace, particularly when dealing with situations without clear solutions.

Guided imagery or meditation activities can help an individual relax and regain a sense of control over ruminating worries and the “noise” in your thoughts.

Many studies have shown that a pre-surgical guided imagery practice can result in reduced pain and improved healing post-surgery. Check out

Complementary therapies such as massage and acupuncture can have profound effects on anxiety.

Talking with a licensed professional therapist about underlying causes for worry and effective tools for reducing the impact of anxiety.
Refrain from web-searches regarding physical symptoms.

Develop a plan with your treatment team regarding time frame and contact individuals for addressing worrisome physical experiences.
Try to develop an understanding of situational triggers for stress responses or a panicky sensation. You may then develop skills for managing your stress reactions when you have a better sense of the triggers.

Physical activity with a focus on relaxation such as yoga and tai chi can be effective of active anxiety reduction.

If you are struggling with Social Stress:

If you are struggling to know how to describe your cancer experience or current health status with different groups of people, try to role play or practice a little “elevator speech” with a trusted loved one or a professional about what you want to express.

Read “The Human Side of Cancer” – Jimmie Holland, MD (2000). Although it is dated, it contains timeless insights about social pressures on the cancer survivor and regarding misunderstandings of popular culture regarding cancer resilience.

Surround yourself with people who energize you and accept you. Be strong in establishing clear boundaries with individuals or groups of people who you find a challenge or exhaust you.

No can read minds! Establish regular communication with those closest to you (partners, family, close friends) in order to touch base about needs and expectations.

Explain to others that you are more than your cancer diagnosis. Be open to talk with people about their lives, their joys, their worries; and be as open as you wish regarding your personal life.

Remember that everyone’s medical situation is different and everyone’s response — physically and emotionally — to treatment is different. Try not to compare yourself and your condition to anyone else, even someone with the same type or stage of breast cancer.

Volunteering can be very rewarding. You can volunteer with organizations that are meaningful to you or are consistent with your passions. These organizations ​may or ​may not have anything to do with your cancer diagnosis.

Psycho social oncology has made many great strides in the past decade to improve understanding of the emotional and social needs of the whole person in cancer care. However, women facing breast cancer often need to be their own vocal advocates for expressing their unique, personal psycho social stressors and needs. It is often surprising to people that feel most emotionally and socially distressed after the active phase of cancer treatment ends.

Whether you are on maintenance treatment or have concluded treatment; most people experience a significant spike in psycho social distress when the frequency of their appointments decreases and they expect things to “return to normal.” Anxiety, depression and severe stress reactions can have detrimental effects on your health and well-being. Be open and honest about your concerns with your healthcare team and trusted loved ones in order to access care that is able to meet your personal needs.

About the Author

Dr. Jana Bolduan Lomax, PsyD.
Dr. Jana Bolduan Lomax, PsyD is a Licensed Clinical Health Psychologist in Colorado. She received her Bachelor’s degree in Psychology from Miami University-Ohio and her Masters and Doctoral degrees in Clinical Psychology from the Illinois School of Professional Psychology-Chicago. Dr. Lomax completed a postdoctoral fellowship year at the University of Colorado Cancer Center in the Blood and Marrow Stem Cell Transplant program which was followed by four years as an Assistant Professors in the University of Colorado School of Medicine. During that time she provided clinical psycho social oncology assessment and interventions to individuals and their families being treated for hematologic malignancies. In 2010, Dr. Lomax accepted the position of Director of Psycho social Oncology at Saint Joseph Hospital in Denver. During her seven years with the organization, Dr. Lomax’s role expanded to develop psycho social oncology, survivorship, and cancer navigation programs across SCL Health Group.

Dr. Lomax has dedicated her 15 year career in healthcare and oncology to clinical care, research, program development, training, and community education. Her areas of expertise include Psycho social Oncology and Cancer Survivorship, as well as adaptive adjustment to chronic illness and caregiving stress. Throughout her career, Dr. Lomax has valued opportunities to train future health psychology clinicians about evidence-based psychology interventions in a variety of medical settings. Dr. Lomax is an Adjunct Assistant Professor at the University of Denver Graduate School for Professional Psychology where she teaches classes regarding the practice of clinical psychology in medical settings and she supervises doctoral psychology trainees. She has been an invited lecturer, advisor, and subject matter expert in the areas of cancer survivorship, psycho social oncology, caregiving stress, coping with chronic illness, and development of supportive cancer programs.

Dr. Lomax is the owner of Shift Healing, offering psychology services for adults, couples, and families facing chronic medical conditions and stressors of health changes in life. For relaxation and fun, Dr. Lomax enjoys attending music festivals and outdoor adventuring in the gorgeous environs of Colorado with her husband and three children.

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