Anxiety Q&A with Emily Hodge, MSc Health Psychology, Accredited Coach and Therapist

Insights is a Q&A series where members of our Network put forward any questions they may have to experts in a respective field. If when reading this you have any additional questions around anxiety, please leave a comment in the feedback below and we will get an answer for you.

1. What are you top tips on coping with anxiety? 

• Anxiety can be viewed as something not to cure and get rid of but rather to understand and to know how and when it impacts you and to know what and when you might need to take action.
• Though there are lots of strategies to support anxiety, not everyone is ready to take action and use those strategies. It’s easy to want to blame yourself for not being ‘normal’ and not being able to get rid of your anxiety. Conversely if you can bring kindness, compassion and patience to yourself, you’re more likely to think clearly about what’s best for you to act on.
• Have a think about what good mental wellbeing means for you – this can help you to know when you’re experiencing it or not. Is it about having space in your life to feel joy? Is it experiencing a range or emotions when you need to? Check in with your own expectations and try to find your own definition so you know your own baseline.
• Have things in your life that you love and can do - what is it about these things that gives you happiness? Why does it make you feel this way? This kind of thinking will enable you to start to see what gives you energy and how you might get more of it when you’re ready to.
• Anxiety can impact any area of your life and you might need professional support to work through it. There is no shame in this and it doesn’t make you weaker for needing support - it makes you stronger for seeking help. Speak to professionals – you don’t have to cope with this alone – your GP, nurse practitioner, a licensed therapist or coach and trusted websites are all good places to start

2. I get very nervous before social situations because I feel like people don’t know what to say to a person with cancer. How can I explain my illness to others in a way that won’t make a social situation uncomfortable?

The first time you’re asked to talk about it your illness, it might be scary to know what to say.

Plan beforehand what you might say if you’re asked a question like ‘how are you’ or ‘what do you do’. It’s completely up to you what you let people know about your health, and what detail you go into. It may be helpful to imagine what you’d like to hear from someone else if they were going through it.

Try and surround yourself with the people and groups who you feel great around for the moment so you have less to worry about whilst you’re feeling vulnerable.

Also, it is helpful to be aware of how you’re feeling beforehand– have you had a good day and are you feeling confident? Or are you feeling tired and a little low? Ask yourself if you’re ready to be in a social situation just yet, because it’s okay to try again another time if it’s too much today.

If you’re avoiding social situations because of not knowing how to explain your cancer, consider who it is you’re planning on seeing. Do you feel comfortable around them and enjoy their company?

3. Since I’ve been diagnosed, I feel like my life has been revolved around cancer and people don’t know what else to talk to me about. What can I do to bring back normality to relationships I had prior to my diagnosis?

A way to bring back normality is to remember things you love doing that have nothing to do with cancer. What makes you feel good? Can you get more of this in your life at the moment? You can ask friends and family to do things that are completely unrelated to your cancer – the cinema, going for a drive, going to a pub; whatever it is you’d like to do again, ask someone to go with you or to meet you there.

If conversations are indeed cancer heavy and you’d rather they weren’t, you can steer the conversation on to the things you love, which equally reminds you that you are not defined only by your cancer. You’ll start to feel more in control, and having control in your life—even in small ways—is an important element of recovery.

Sometimes you may want people to ask about your experience, other times you don’t. The tricky thing is that others don’t always know which one it is you want!

4. I’ve started experiencing panic attacks since starting chemo and I’ve never had any previous anxiety. Leading up to my treatment days, I get very anxious. How can I cope with this?

Speak to a member of your medical team about your panic attacks. They may have specific support they provide on the ward whilst you’re having treatment or they may provide some good strategies appropriate for your case.

Don’t be afraid to reach out for support. Identifying with the fact that you are experiencing anxiety is a really important step. Do you recognise that the panic is about the whole situation or about a specific part of it? It is useful to pinpoint where the anxiety stems from as it can inform you which area you may want to adjust or change or work on.

Try out some calming techniques and see which for you. This might be meditation, massage, reflexology, walking, therapy or counselling. Taking some control might help reduce your feelings of anxiety, and may provide calm and support during the days leading up to and during your treatment.

Prepare for your next treatment. Do you have a plan of what to do in the days leading up to it? Make sure you give yourself the rest you need, see the people you would like to see and put together the things you would like to take with you.

5. I have been experiencing anxiety with my treatment. Does this side effect fade away as my treatment ends?

It is important to remember that anxiety is a mental health issue and has a broad range of symptoms – it can range from mild worry to ongoing, crippling nervousness and avoidance of people, places, things, situations and also severe physical symptoms. Regardless of cancer treatment, we shouldn’t ignore the symptoms that we are experiencing.

Side effects from chemotherapy do often decrease as the drugs leave your body. It is important to acknowledge that once these drugs are out of your system, emotions such as low mood or increased anxiety might still be present. Everyone is different so this isn’t a given, but you’ll likely go through some emotional changes as things move on, and this is perfectly okay.

A common issue when treatment ends is the pressure either you or those around you put on yourself to be ‘normal’ again. This can bring about anxiety as you start to want to go back to who you were despite having been through so much in the meantime. Try and be patient with yourself to accept whatever your ‘new normal’ may be and know that this is not something you have to go through alone.

Anxiety is a known side effect of chemotherapy, radiotherapy and other cancer related treatments. These treatments, along with the fact that you’ll be processing your diagnosis, can put you through a range of emotions and increase your anxiety.

6. I normally feel fine but the feeling of anxiety can suddenly come over me and make me feel very overwhelmed. Why is this and what can I do when I feel it coming on?

Telling those close to you that you feel overwhelmed and letting your medical team know that you may need help with decisions or processing things can be useful. Small tasks can feel huge, so allowing yourself to focus on one thing at a time, however small, can bring you back to the present. Grounding activities such as being in nature are useful to stop the over-thinking from taking over. Try balancing your diary with all the things you have to do, with things that you want to do, so you have space and time to feel in control.

Feeling overwhelmed is completely normal – there’s so much to think about and processing your anxiety can be confusing, challenging and tiring. When that feeling starts to come on, it’s easy to want to run from it because it feels like too much – which it might be!

7. When I speak with my consultant and tell them how I feel, they suggest anti-anxiety medication but I really don’t want to take it. How can I better express to my consultant what I am going through?

Ask yourself – what is it that you’re trying to express to him or her? What is it you want them to hear? How can you articulate it so it feels honest and will be useful for you? Ask yourself whether your consultant is the right person to talk to about anxiety– they may be brilliant at oncology or surgery but are they going to be able to help with mental and emotional side of cancer? They may be, but if not, find the person in your medical team who is able to help.

Do you have a clinical nurse specialist or can you ask for a counsellor or therapist linked to the hospital? Maybe there’s a charity that works with your hospital that help patients to get access to mental health services or other types of support.

If anti-anxiety medication is indeed suggested by a professional regarding your anxiety, you should have the opportunity to understand the benefits and side-effects and make an informed decision that’s right for you.

8. Since I’ve been in remission, I get crushing chest pains and shortness of breath. I get anxiety type pains, then worry it is the cancer coming back (my tumour was in my chest) and then I get more anxious and it is a vicious cycle. How can I break this cycle?

Keeping up with your scans and appointments is important as it can provide peace of mind. Of course, the monitoring can also cause anxiety (scanxiety), but knowing that you are on top of your appointments is a good way to take control.

The cycle described shows how connected your mind and body really are. The physical symptoms can start the negative whirring in your mind about all of the things that could be bad. Your mind and body have a way of working together, so by relieving those physical symptoms, you may reduce some of the anxiety in your mind. It may not be a cure, but it might start to break that cycle. To reduce physical symptoms, very simply breathing techniques can be used, as well as distraction exercises and other body work.

Triggers of anxiety, specifically panic-type symptoms, come in many forms so breaking the cycle will be a very personal solution to you. There is no one size fits all approach to anxiety, just techniques, tools and combinations of them, that you can experiment with to find what works for you. Most importantly you don’t have to find them on your own – help from professionals, family and friends will aid your understanding and support with anxiety enormously.

9. I have found plenty of information on what to do when things were really bad, but very little on managing to get on with normal life. What are some day to day tips or techniques to help when I am having a bit of a slump?

A slump suggests that it’s something that is unpleasant but perhaps more manageable. Although it’s obvious to say it, cancer or not, everyone has low periods, and understanding how to live with the normal ebb and flow of life can be an important part your wellbeing.

Work out when your slumps happen – are they hourly, daily, weekly or do they last much longer? What happened just before that may have triggered it? How low do your slumps take you? Have you worked out any pattern in them that you can start to change? Is it mental or physical – for example, have you eaten well that day or had enough water? This can be a factor in mood changes.

Keep space in your diary to give yourself a treat or rest. Give yourself something good to look forward to or something you can plan that makes you happy.

10.When I was initially diagnosed, I was aware of the physical side effects of cancer but much less regarding mental health. Are there helpful resources out there for this?

• Talk with the professionals in your hospital or health centre will be a resource. They will have your details and understand the combination of medications, treatments or particular stresses you are under.
• Find the person who you can trust and talk to and ask them for time to talk about your particular mental health issues. Although sometimes difficult, reaching out and being honest is more likely to be beneficial than staying silent.
• Look at the side effects of the drugs you might be taking which helps to remind yourself that this is likely temporary
• Use charity support to find other people in similar situations, who talk about their mental health and what it’s like for them and what’s helped them
• Check out post-cancer bloggers and see what they’re saying – it’s more than likely they’ll be talking about the mental wellbeing impact of cancer and treatment and what helps them.
• Find cancer specific support such a coaches, therapists, counsellors who have understanding of the cancer journey and the impact on mental health and wellbeing
• Have a look at some trustworthy charity and government sites: Mind, NoPanic, Anxiety UK, NHS Life After Cancer, Bupa Mental Health and Cancer