Originally posted on the University of Colorado (CU) Department of Psychiatry website. Tips from Joanna Arch, PhD, associate professor in the Department of Psychology and Neuroscience and CU Cancer Center member.
Joanna Arch, PhD
Fear and anxiety keep us safe from harm – they prevent us from running into the street when a car comes racing toward us, and motivate us to prepare well for a presentation we’re nervous to give. But fear and anxiety can also spiral into uncontrollable worry, endless internet searching, and avoiding valued life activities that connect us with the people we love. How do we harness the positive features of fear and anxiety without becoming trapped by their risks?
Feeling anxious or stressed about the COVID-19 pandemic, on top of feeling anxious and stressed about cancer? You’re not alone. We’ve heard from many individuals dealing with cancer that they feel like they’ve been hit with a double whammy.
Here are a few tips on ways to cope:
1. Keep Doing What You Love Doing
Take a moment to reflect on what you typically do to manage anxiety and stress. Identify which actions or mindsets are healthy for you over the long term. It’s important to keep using your healthy coping mechanisms during the COVID-19 era. Self-care is more important now than ever before. Some ways of coping, like walking in nature or journaling, are perhaps easier than others to do during the pandemic. Maintaining social connection is also more important now than ever before, but more challenging. Talking on the phone or connecting online may not be as satisfying as getting together in person, but they are important for our mental health and well-being.
What about the ways of dealing with anxiety and stress that are difficult or impossible to do now, like enjoying a dinner out with family or friends, or going to see a movie, show or sporting event? Take a moment to reflect on what it is you enjoy most about your favorite activities. Laughing or connecting with friends or family? Getting a break from cooking and appreciating good food? Enjoying a good story or music? The excitement of watching great athletes compete? Identify what you most enjoy about the activity. Then ask: Is there a safe way I can get this need met during the pandemic? Order out and enjoy a meal together with family sitting 6 feet apart outside? Watch a game, show or movie with a friend online, while maintaining social distance? Get creative. COVID-19 caused my parents to cancel a cruise they had booked to celebrate their fiftieth wedding anniversary. My sister and I had a troupe of local comedians come to their front yard and perform outside from a distance, to give them a taste of cruise entertainment. It wasn’t the same, but it helped my parents connect to what they enjoy about cruising.
Feeling unmotivated to do much? Try inviting yourself to take one small step every day to move in a meaningful direction. Maybe it’s texting a friend or family member, or stepping outside for 15 minutes each morning. Tiny steps add up quickly. If you try something and it doesn’t work out, try being forgiving with yourself. We’re all doing our best, and you can try again tomorrow.
2. Respond Skillfully to Anxious Thoughts
Anxious thoughts and beliefs abound during the experience of cancer and the pandemic. Some degree of anxiety can be helpful for ensuring that you follow the COVID-19-recommended social distancing and safety guidelines. Adhering to these guidelines is important for everyone, but is absolutely critical if you’re undergoing any form of cancer treatment that suppresses the immune system, or if you’ve undergone such treatment in the past six to 12 months.
That said, if you’re following recommended social distancing and safety guidelines, and you still find that anxious thoughts are leading your mind and mood to spiral in negative ways, consider the following.
First, catch your mind in the act. The earlier we catch anxious thoughts, the easier it is to “unhook” from them. Though we cannot control whether anxious thoughts appear or how often they repeat themselves, we can control how we respond to them. Notice your mind veering into anxiety as early as possible, and respond skillfully to manage your response to them.
- Thought labeling: Say to yourself “I’m having the thought that ___________________” This helps us respond to thoughts as simply thoughts, nothing more, no matter how scary the content.
- Use humor: Respond to anxious thoughts with dry humor, “That’s a nice one, mind!”, “Good one!”, “What a helpful thought!” Use whatever phrase speaks to you to create some distance and perspective on the thought.
- Weigh the consequences: Ask yourself, “How helpful would it be if I responded to this belief/thought/story as if it were true? Where would my life end up?” Reflect. “Is that where I want to go?” Take control of how you respond.
- Do the opposite (assuming it’s safe during COVID-19): Anxiety is like a bodyguard, protecting us from trying new things or taking risks. If you do everything the bodyguard demands, life shrinks and shuts out the good stuff. Try doing the opposite of what the anxiety bodyguard demands. If the bodyguard says “Don’t text your friend and set up a Zoom call – she might not be interested!” then do the opposite – text your friend. If the bodyguard says: “You have to search endlessly on the internet about your cancer or you won’t be prepared!” then try not searching beyond the very basics. The bodyguard may continue to chatter away. But the more you practice doing the opposite, the quieter the bodyguard will become, and the bigger your life will become.
- Check the facts: The anxious mind hones in on threats and worst-case scenarios. But the worst-case scenario is often unlikely. And even if it does occur, you’d still have options. So when anxiety is present, know that your mind tends to overestimate threat. You will have more difficulty accessing your full problem-solving and perspective-taking abilities. Use the skills outlined above, and check out the facts with your doctor.
If anxious thoughts, beliefs and feelings completely overwhelm you no matter which of these skills you try, please don’t be afraid to reach out for professional support.
Get your physical symptoms treated
There is an association between physical and mental well-being among cancer survivors. Since mental well-being is taxed for many people during COVID-19, it’s particularly important to take good care of your physical health. Thus, if you don’t like to bother your oncologist or oncology care team with the symptoms or side effects you’re experiencing, now is an important time to speak up. Your oncology team can offer tips for how to address symptoms. The intense fatigue or sleep difficulties your treatment may be triggering? Ask your oncology team for recommendations on how to manage it. That neuropathy in your feet that makes it harder to walk? Check with your provider about seeing a physical therapist.
Palliative care providers are another resource for symptom management. Many people mistake palliative care as something that we only need at the end of life – but these doctors and nurses specialize in treating the very symptoms that cancer survivors commonly experience – pain, fatigue, constipation/diarrhea, shortness of breath, depression and more. The University of Colorado is fortunate to have a world-class palliative care team. Receiving palliative care early in cancer treatment is associated with living longer, lower depression and better quality of life. So what are you waiting for? Ask your oncology team if it’s a good idea to meet with a palliative care provider.
Keep up on your cancer or survivorship care plan
COVID-19 may make you hesitant to follow through on surveillance scans or attend follow-up appointments. However, it is critical to stay up to date on your treatment and survivorship care plan, take your prescribed medications, and keep your cancer in check. Though it may be tempting to skip a follow-up scan, screening or blood test, skipping can mean that a cancer recurrence or progression goes undetected, and isn’t treated in time. If you’re hesitant to attend an appointment in person, now is a good time to ask about virtual medicine, which involves meeting with your provider online.
Taking care of yourself during COVID-19 means doing what you enjoy, responding skillfully to anxious thoughts, seeking treatment for physical symptoms and side effects, and staying on track with your cancer treatment or survivorship plan. Taking care of yourself is always important as a cancer survivor, and during COVID-19, it is more important than ever.