Mental Health

Yes, everyone I've spoken with has a similar experience with chemo. I found that I could not concentrate and therefore reading was useless. Too bad, I love to read and learn - its exciting to learn by reading. Eating was not so hot either, my tasting ability was gone along with my appetite. So I ended up watching the clock tick, went for long slow walks. I improved physically as my body acclimated to the chemo. Then, I became much more active - reading, watching tv, walking, talking on the phone, checking out the internet, writing letters, and more. Getting by is definitely what you do. I did not try to attend everything with my girls. We would talk about what do you want Mom to be at and what can you go to with a friend. I took a lot of naps. We planned the meals for the week and ate really simple to prepare meals. Raw carrots and apples were a staple. Buy the cut up fruit or have a neighbor come wash and cut up your fruits and veggies for you. My husband did a lot of the cooking. To build strength, try to do a little bit more. At first I could not even walk around the block. So I would just go to the end of the driveway. I was in physical therapy for my arm and shoulder. The chemo messes with all your muscles. Try to move all your different muscle groups, even if you are lying down. Point and flex your toes 10 times, Raise and lower your arms 10 times, flex and relax your gluts, then your stomach. If you are watching TV, do a few reps of something during the ads. Drink a lot of water!

Give yourself lots of extra time. It took tons of energy to shower and get dressed. So I would get ready and then rest on the couch near the kitchen for 20 minutes. I could answer questions from everyone but not be tempted to do stuff for them. I did the same thing after school. I would be on the couch in the room that my girls play in. They would bring me a drink and I could help with homework or sign papers or talk. But I did not get up if I could avoid it. If someone else can do what you need done, then ask someone to do it. Only do what is important to you and will help you get better.

I would start a task and not be able to finish it. This gets really frustrating. And my husband would get frustrated at the mess I made that he had to clean up or finish. I had to acknowledge how weak I was and learn to ask for help and let go of things that do not really matter. Your priorities will change and your standards of what is acceptable. Decide what is important to you and let the rest go. You will get stronger but it is a very gradual process.

Post-traumatic stress syndrome (PTSD) may occur when an individual has been exposed to a traumatic event and responds with fear, helplessness, or horror. It is now recognized that a small percentage of patients being treated for cancer experience PTSD. The trauma-related symptoms in patients with cancer have been under increasing study. Individuals with a history of PTSD are at a substantial risk for continued emotional difficulties so it is encouraged that these patients receive timely and effective treatment for this syndrome.

It is difficult to recommend a “best therapy” approach for PTSD. Most clinicians recommend a multimodality approach, using components of therapy that meet the specific needs of each patient, taking into account any concurrent psychiatric disorders such as depression or substance abuse.

A crisis intervention approach is often recommended in order to facilitate the adjustment of patients experiencing cancer. In this approach, the therapist takes an active stance focusing on problem resolution, teaching specific coping skills, and providing a safe and supportive environment. Cognitive-behavioral approaches have proven very effective. This approach includes the former in addition to the use of relaxation techniques, restructuring cognitions or negative thoughts, and providing exposure to opportunities that provide systematic desensitization of the symptoms being experienced. Support groups have also been shown to benefit people who experience PTSD. In the group setting, patients can receive emotional support from others who have experienced similar symptoms, thereby validating their own feelings and learning coping strategies from others.

For patients with severe symptoms, psychopharmacology may prove effective. Antidepressants may be used when the symptoms of depression occur with PTSD. Antidepressants are also useful in decreasing the hyperarousal and intrusive symptoms that often accompany PTSD. Antipsychotic medications may reduce flashbacks and antianxiety medications may help reduce arousal and anxiety. Therefore, the best therapeutic approach to PTSD may be a combination of therapies tailored to the individual’s experiences and symptoms. Most importantly, therapeutic intervention is highly recommended for any person experiencing any of the symptoms associated with PTSD. Post-traumatic stress syndrome (PTSD) may occur when an individual has been exposed to a traumatic event and responds with fear, helplessness, or horror. It is now recognized that a small percentage of patients being treated for cancer experience PTSD. The trauma-related symptoms in patients with cancer have been under increasing study. Individuals with a history of PTSD are at a substantial risk for continued emotional difficulties so it is encouraged that these patients receive timely and effective treatment for this syndrome.

It is difficult to recommend a “best therapy” approach for PTSD. Most clinicians recommend a multimodality approach, using components of therapy that meet the specific needs of each patient, taking into account any concurrent psychiatric disorders such as depression or substance abuse.

A crisis intervention approach is often recommended in order to facilitate the adjustment of patients experiencing cancer. In this approach, the therapist takes an active stance focusing on problem resolution, teaching specific coping skills, and providing a safe and supportive environment. Cognitive-behavioral approaches have proven very effective. This approach includes the former in addition to the use of relaxation techniques, restructuring cognitions or negative thoughts, and providing exposure to opportunities that provide systematic desensitization of the symptoms being experienced. Support groups have also been shown to benefit people who experience PTSD. In the group setting, patients can receive emotional support from others who have experienced similar symptoms, thereby validating their own feelings and learning coping strategies from others.

For patients with severe symptoms, psychopharmacology may prove effective. Antidepressants may be used when the symptoms of depression occur with PTSD. Antidepressants are also useful in decreasing the hyperarousal and intrusive symptoms that often accompany PTSD. Antipsychotic medications may reduce flashbacks and antianxiety medications may help reduce arousal and anxiety. Therefore, the best therapeutic approach to PTSD may be a combination of therapies tailored to the individual’s experiences and symptoms. Most importantly, therapeutic intervention is highly recommended for any person experiencing any of the symptoms associated with PTSD.

I see now that you have answered the question I just posted about symptoms. When a patient also suffers from lymphedema, the psychosocial issues become compounded. Lymphedema is a daily reminder of the cancer, and causes embarrassment and social isolation. No one wants to look like a freak, and especially someone who's been through the trauma of cancer. There are many psychosocial issues that women need to be aware of when resuming their "normal" life after treatment. The diagnosis and treatment of cancer is a life-changing event like no other. Many times it changes a person's perspective of the world, changes their spirituality, changes their identity, and changes relationships. The personal meaning of cancer involves our intellect, emotions, body, and spirit. I believe that there is no part of one's life that is left untouched by the cancer experience. The journey even takes us into existential realms, transcending the present. Therefore, I don't think that a women can expect to return to the same "normal" life after their journey. Instead, I envision women integrating a "new-normal."

Many of the common psychosocial issues that women face are related to long-term side-effects of treatment. This can include side-effects such as fatigue and chemotherapy-induced menopause, body-image changes,alterations in sexuality, and cognitive dysfunction. Most of these side-effects are intertwined, fatigue affects the whole person, body and spirit, and menopause and body-image changes (mastectomy) affect sexuality.

The fatigue from treatment is a subjective sense of tiredness that often interferes with functioning and it typically is not relieved by sleep or rest. Fatigue has a detrimental effect on the woman's quality of life. In research studies, fatigue has been reported as the most distressing side-effect of cancer and its treatment. Closely associated with fatigue is a general lack of energy, difficulty concentrating, and depressed mood. A major psychosocial roadblock for a woman may be that she assumes she will quickly return to "normal" levels of energy soon after treatment has ended. It may take months to years for a woman to recapture pre-treatment energy depending upon the extent of treatment. Important for the woman is to recognize that fatigue is a normal, expected side-effect of treatment that can be treated in the following ways: delegate tasks, take time to rest (too much rest can decrease energy), stay as active as possible (exercise has been shown to increase energy and boost mood), eat a balanced and nutritious diet, drink plenty of fluids, and watch for signs of stress. Fatigue can also contribute to psychiatric disorders such as depression and anxiety and women should be astute to these symptoms and seek appropriate treatment from trained professionals.

Body-image changes range from weight loss to alopecia to loss of a body part. Our body-image makes up part of our identity; our sense of self and our sense of self-esteem. If a woman has incurred a mastectomy there will be significant changes in her body-image. Even a woman with a strong sense of self will grieve over a lost breast. Responses to body-image changes can include feelings that one's body has deceived them, feelings that one's body has been violated, feelings that one's body has betrayed them, or feelings of fear and vulnerability. The healthy self-image can be permanently damaged with treatment. Hopefully through interactions with the self, partner, and society, a woman can generate a new, positive body-image.

Changes in body-image can also include chemotherapy-induced menopause. Menopause can affect energy, mood, cognition, and impact sexuality. Drugs such as tamoxifen and the aromatase inhibitors (aromasin, arimidex) can also negatively affect healthy self-image due to their side-effect profile. Many women on aromatase inhibitors complain of arthritic type symptoms that interfere with their activities of daily living. Being on these agents also extends treatment for 5 years or more which some women find distressing. Side-effects of menopause and hormonal therapy may include decrease libido, and vaginal dryness, both interfering with sexual expression.

Sexuality is more than just sexual function. It includes feelings of intimacy, emotions, and fertility. It includes our image of our self, or body-image. Changes in sexuality occur with cancer treatment and many women do not seek medical attention for these changes. Permission should be given to women to discuss these concerns. Many women feel a loss of femininity following hormonal and body changes.

Menopause can contribute to cognitive dysfunction as well as chemotherapy. Chemotherapy-induced cognitive dysfunction is referred to as "chemo-brain" or "chemo fog." The symptoms are distressing and include memory loss, trouble concentrating, trouble finding the right words, trouble doing math, and trouble learning something new. Chemo-brain and menopause can also cause mood swings. Research continues to investigate the exact causes of chemo-brain and how long it lasts. It is important for women to know that certain things can exacerbate the symptoms including depression, anxiety, fatigue, insomnia, and certain medications. Although there is no definitive treatment it is also important for women to decrease stress levels, allow a quiet environment when needing to focus, and to try to not multi-task.

Lastly, it is not uncommon for women to suffer from anxiety or depressed mood after treatment ends. This is due to multiple factors including fatigue, changes in hormonal status, changes in body-image and sexuality, and changes in relationships. Women may also be at risk for post-traumatic stress syndrome (PTSD) that can be delayed for 6 or more months after treatment has ended. Any woman who finds herself experiencing symptoms of mood swings, overwhelming sadness, feelings of worthlessness, anxious mood, irritability, or feelings that she is reexperiencing the treatment through recollections or nightmares, should seek professional help.

One of the valuable lessons from the cancer journey is that it teaches one the value of being alive. Illness can restore a sense of living that is lost when we take life for granted. There are many psychosocial issues confronting the woman who has endured cancer and treatment. The hope is that the experience leads the woman on a path towards self-transcendence and a positive meaning for being alive.

Over the years, I went to maybe five, but only stayed with two.

They were genuine and I knew that I had their confidence as professionals, which is SO important, when you need to talk with someone about your mental state.

One was at a local "behavioral sciences" center, that also had an in-house psychiatrist. Because of money issues I was not able to go to this one for about 5 weeks, but he was so good, I made alot of positive progress in that time. He had me "journal", and actually gave me affirmation and praise in my hard work to try to improve myself, because it was me that called for help. That had a huge positive impact on my mental state.

The second place was the mental health facility based out of one of our hospitals. There I saw one young woman, who was absolutely fantastic. She was a very attentive listener. So I would write down anything that "shook my mental tree" inbetween visits, so that I could get her feedback. It was good system, and I saw her almost 3 yrs. Finally, she told me I had to leave (ha) that I was "highly functioning" and there were too many others that needed to see her! The co-dependent (ha) part of me wanted to hang onto her coat strings, but, alas, I knew it was time to stand on my own, and as she put it "put into practice what I've learned"! (Will I EVER grow up?)

I can now say that I've not had any more "emotional breakdowns" because of these two special people, and I'm still journaling when I have nightmares, or start having negative thought patterns, so can interrupt them, and MOVE ON!





Over the years, I went to maybe five, but only stayed with two.

They were genuine and I knew that I had their confidence as professionals, which is SO important, when you need to talk with someone about your mental state.

One was at a local "behavioral sciences" center, that also had an in-house psychiatrist. Because of money issues I was not able to go to this one for about 5 weeks, but he was so good, I made alot of positive progress in that time. He had me "journal", and actually gave me affirmation and praise in my hard work to try to improve myself, because it was me that called for help. That had a huge positive impact on my mental state.

The second place was the mental health facility based out of one of our hospitals. There I saw one young woman, who was absolutely fantastic. She was a very attentive listener. So I would write down anything that "shook my mental tree" inbetween visits, so that I could get her feedback. It was good system, and I saw her almost 3 yrs. Finally, she told me I had to leave (ha) that I was "highly functioning" and there were too many others that needed to see her! The co-dependent (ha) part of me wanted to hang onto her coat strings, but, alas, I knew it was time to stand on my own, and as she put it "put into practice what I've learned"! (Will I EVER grow up?)

I can now say that I've not had any more "emotional breakdowns" because of these two special people, and I'm still journaling when I have nightmares, or start having negative thought patterns, so can interrupt them, and MOVE ON!

Self hypnosis is a self induced form of hypnosis where a person in a calm, relaxed state makes self suggestions with the goal of making improvements in a specific area of their life. Self talk is the constant inner monologue or running commentary that goes on in our heads.

Awareness of these thoughts are very important in our healing. First in order to be aware of the incessant self talk a level of mindfulness must be achieved. Being present is an important part of mitigating mind made stressors, or stressors that arise from living in the past or in the future. Secondly, our bodies react to this self talk. If we have a chaotic mind, it creates a chaotic body. So we need to become aware of the thoughts and if they are inherently negative, they need to be changed. A good way to change our ideas about ourselves is through the practice of self hypnosis. Self hypnosis is a self induced form of hypnosis where a person in a calm, relaxed state makes self suggestions with the goal of making improvements in a specific area of their life. Self talk is the constant inner monologue or running commentary that goes on in our heads.

Awareness of these thoughts are very important in our healing. First in order to be aware of the incessant self talk a level of mindfulness must be achieved. Being present is an important part of mitigating mind made stressors, or stressors that arise from living in the past or in the future. Secondly, our bodies react to this self talk. If we have a chaotic mind, it creates a chaotic body. So we need to become aware of the thoughts and if they are inherently negative, they need to be changed. A good way to change our ideas about ourselves is through the practice of self hypnosis.

Up until recently, the “official” answer from NIH and others has been that there is not been any study that conclusively links stress as a direct cause of cancer. The National Cancer Institute fact sheet says,

“Although the results of some studies have indicated a link between various psychological factors and an increased risk of developing cancer, a direct cause-and-effect relationship has not been proven.” Here is a link to that source: http://www.cancer.gov/cancertopics/factsheet/Risk/stress

An article in the New York Times regarding the link between stress and cancer says,

“What has emerged is a tenuous connection between stress, the immune system and cancer, with a surprising new insight that is changing the direction of research: it now appears that cancer cells make proteins that actually tell the immune system to let them alone and even to help them grow. As for whether stress causes cancer, the question is still open.” Here is the link to this source: http://www.nytimes.com/2005/11/29/health/29canc.html?pagewanted=all

An article in PychCentral regarding this matter says,

“Currently, there is no evidence that stress is a direct cause of cancer. But evidence is accumulating that there is some link between stress and developing certain kinds of cancer, as well as how the disease progresses. Hundreds of studies have measured how stress impacts our immune systems and fights disease. At Ohio State University, researcher Dr. Ron Glaser, Ph.D., found that students under pressure had slower-healing wounds and took longer to produce immune system cells that kill invading organisms. Renowned researcher Dr. Dean Ornish, M.D., who has spent 20 years examining the effects of stress on the body, found that stress-reduction techniques could actually help reverse heart disease. And Dr. Barry Spiegel, M.D., a leader in the field of psychosomatic medicine, found that metastatic breast cancer patients lived longer when they participated in support groups.

Other studies have gone as far as to show those women who experienced traumatic life events or losses in previous years had significantly higher rates of breast cancer.

Still, the National Cancer Institute reports, “Although studies have shown that stress factors, such as death of a spouse, social isolation, and medical school examinations, alter the way the immune system functions, they have not provided scientific evidence of a direct cause-and-effect relationship between these immune system changes and the development of cancer.”

Nonetheless, some medical experts say therein lies the link between cancer and stress — if stress decreases the body’s ability to fight disease, it loses the ability to kill cancer cells.” Link to source: http://psychcentral.com/lib/2006/stress-a-cause-of-cancer/

However, a study in 2010 published in Nature was reported by Newsmaxhealth saying,

“Stress is a killer and is implicated in numerous deadly conditions including high blood pressure and heart attacks. Now scientists have biological evidence that common, everyday stress can trigger cancer.

A new study by Yale University School of Medicine and Fudan University in China shows that stress causes signals to be sent to mutant genes that make them turn cancerous.” Source: http://www.newsmaxhealth.com/headline_health/stress_cause_cancer/2010/01/28/312526.html

All the above being said regarding the “evidence” linking stress and cancer; my own experience is that I frequently see patients with cancer seeking help with hypnosis to boost their immune system, overcome side-effects of treatment, control pain, and make changes to a healthier lifestyle. And in the majority of these cases it is most common to see where prolonged and chronic stress (along with lifestyles with poor stress coping skills) have existed prior to the diagnosis of cancer. There are cases also where I have seen individuals experience ‘better healing’ responses by adding the mind-body tools available through hypnosis and lifestyle changes. I think that anyone diagnosed with cancer would benefit from learning many varieties of stress management, including hypnosis to access and use the mind-body connection for positive messages, images, and intentions for healing and stress-resiliency.
Up until recently, the “official” answer from NIH and others has been that there is not been any study that conclusively links stress as a direct cause of cancer. The National Cancer Institute fact sheet says,

“Although the results of some studies have indicated a link between various psychological factors and an increased risk of developing cancer, a direct cause-and-effect relationship has not been proven.” Here is a link to that source: http://www.cancer.gov/cancertopics/factsheet/Risk/stress

An article in the New York Times regarding the link between stress and cancer says,

“What has emerged is a tenuous connection between stress, the immune system and cancer, with a surprising new insight that is changing the direction of research: it now appears that cancer cells make proteins that actually tell the immune system to let them alone and even to help them grow. As for whether stress causes cancer, the question is still open.” Here is the link to this source: http://www.nytimes.com/2005/11/29/health/29canc.html?pagewanted=all

An article in PychCentral regarding this matter says,

“Currently, there is no evidence that stress is a direct cause of cancer. But evidence is accumulating that there is some link between stress and developing certain kinds of cancer, as well as how the disease progresses. Hundreds of studies have measured how stress impacts our immune systems and fights disease. At Ohio State University, researcher Dr. Ron Glaser, Ph.D., found that students under pressure had slower-healing wounds and took longer to produce immune system cells that kill invading organisms. Renowned researcher Dr. Dean Ornish, M.D., who has spent 20 years examining the effects of stress on the body, found that stress-reduction techniques could actually help reverse heart disease. And Dr. Barry Spiegel, M.D., a leader in the field of psychosomatic medicine, found that metastatic breast cancer patients lived longer when they participated in support groups.

Other studies have gone as far as to show those women who experienced traumatic life events or losses in previous years had significantly higher rates of breast cancer.

Still, the National Cancer Institute reports, “Although studies have shown that stress factors, such as death of a spouse, social isolation, and medical school examinations, alter the way the immune system functions, they have not provided scientific evidence of a direct cause-and-effect relationship between these immune system changes and the development of cancer.”

Nonetheless, some medical experts say therein lies the link between cancer and stress — if stress decreases the body’s ability to fight disease, it loses the ability to kill cancer cells.” Link to source: http://psychcentral.com/lib/2006/stress-a-cause-of-cancer/

However, a study in 2010 published in Nature was reported by Newsmaxhealth saying,

“Stress is a killer and is implicated in numerous deadly conditions including high blood pressure and heart attacks. Now scientists have biological evidence that common, everyday stress can trigger cancer.

A new study by Yale University School of Medicine and Fudan University in China shows that stress causes signals to be sent to mutant genes that make them turn cancerous.” Source: http://www.newsmaxhealth.com/headline_health/stress_cause_cancer/2010/01/28/312526.html

All the above being said regarding the “evidence” linking stress and cancer; my own experience is that I frequently see patients with cancer seeking help with hypnosis to boost their immune system, overcome side-effects of treatment, control pain, and make changes to a healthier lifestyle. And in the majority of these cases it is most common to see where prolonged and chronic stress (along with lifestyles with poor stress coping skills) have existed prior to the diagnosis of cancer. There are cases also where I have seen individuals experience ‘better healing’ responses by adding the mind-body tools available through hypnosis and lifestyle changes. I think that anyone diagnosed with cancer would benefit from learning many varieties of stress management, including hypnosis to access and use the mind-body connection for positive messages, images, and intentions for healing and stress-resiliency.

I love this question and I hope you do not mind a long answer.
After my mastectomy, I was very confused about the surgery itself. As a veterinarian, I wanted the gory details but really was not getting any. I did not understand where the expander was in relation to my muscle and chest wall and I also developed a large hard mass in my arm pit that my doctor did not seem to be able to explain. It was extremely uncomfortable and I had to keep my arm raised to minimize the discomfort. Communication was very poor with my surgeon and staff at this point. My drain was also pulled, to my surprise and I was given the pathology report on my way out the door. At a previous visit, my surgeon told me that he had gotten everything and the 3 sentinel nodes taken were clean. I read the report in tears on my way home. The report stated that the original mass (IDC) was nonviable scar tissue but it also reported another small mass, invasive lobular carcinoma, not previously detected, with 0 margin of clean tissue on the chest wall side of the tumor. Not good. It also reported that 11 nodes were taken, not just the 3 sentinel nodes. Fortunately, they were all clean. The real concern was the lack of clear margins. My understanding at that point was that radiation would be necessary but also not possible without removing the expander. I had no one to talk to and the weekend to survive until I could get more information. I was a mess. I saw my surgeon the following Monday and he allayed my concerns about the free margins (which were confirmed by my oncologist). The next day, however, I was in the ER with a 104 fever and an infection.

During my post surgical complications, I knew I could not continue healing at my best in my current state of mind. I was unhappy with the poor communication I was having with my surgeon and his staff and I just did not trust the conflicting information I had been getting. I was seriously considering changing surgeons/hospitals. I knew, at this point, that I could not change my surgeon and how he interacted with me nor could I change the culture of the hospital and staff. The only change I could create was in myself and how I chose to engage. With the help of author Caroline Myss, (Defy Gravity), I meditated and focused on reinventing my relationship with my surgeon (and my life). I surrendered to the situation and flipped my state of mind from one of fear and anger to love and trust. It required daily/hourly effort (or remembering) initially, but the benifits were so powerful and freeing, it literally had a momentum and staying power of its own. Simply put, a choice. I love this question and I hope you do not mind a long answer.
After my mastectomy, I was very confused about the surgery itself. As a veterinarian, I wanted the gory details but really was not getting any. I did not understand where the expander was in relation to my muscle and chest wall and I also developed a large hard mass in my arm pit that my doctor did not seem to be able to explain. It was extremely uncomfortable and I had to keep my arm raised to minimize the discomfort. Communication was very poor with my surgeon and staff at this point. My drain was also pulled, to my surprise and I was given the pathology report on my way out the door. At a previous visit, my surgeon told me that he had gotten everything and the 3 sentinel nodes taken were clean. I read the report in tears on my way home. The report stated that the original mass (IDC) was nonviable scar tissue but it also reported another small mass, invasive lobular carcinoma, not previously detected, with 0 margin of clean tissue on the chest wall side of the tumor. Not good. It also reported that 11 nodes were taken, not just the 3 sentinel nodes. Fortunately, they were all clean. The real concern was the lack of clear margins. My understanding at that point was that radiation would be necessary but also not possible without removing the expander. I had no one to talk to and the weekend to survive until I could get more information. I was a mess. I saw my surgeon the following Monday and he allayed my concerns about the free margins (which were confirmed by my oncologist). The next day, however, I was in the ER with a 104 fever and an infection.

During my post surgical complications, I knew I could not continue healing at my best in my current state of mind. I was unhappy with the poor communication I was having with my surgeon and his staff and I just did not trust the conflicting information I had been getting. I was seriously considering changing surgeons/hospitals. I knew, at this point, that I could not change my surgeon and how he interacted with me nor could I change the culture of the hospital and staff. The only change I could create was in myself and how I chose to engage. With the help of author Caroline Myss, (Defy Gravity), I meditated and focused on reinventing my relationship with my surgeon (and my life). I surrendered to the situation and flipped my state of mind from one of fear and anger to love and trust. It required daily/hourly effort (or remembering) initially, but the benifits were so powerful and freeing, it literally had a momentum and staying power of its own. Simply put, a choice.

This is a fair question. I do not usually recommend that people seek information about treatments on their own without consulting directly with a specialist to discuss treatment options for their individual care. Quite basically, what’s good or might work for one person may not be the case for another. Furthermore, I cannot say that there is much in the way of substantially novel approaches to managing depression or anxiety, as the mainstays of treatment consist of psychopharmacology or medication management which have been used for several decades.

That being said, there may be, and certainly is, ongoing refinements to and studies of the efficacy of the psychological therapies as well as establishment and evolution of varying approaches in the field; as well as continual research and development of drugs in the rapidly expanding and burgeoning field of psychopharmacology in which there continues to be refinement of the neurotransmitter receptor profiles, delivery systems, and formulations, in existing classes of medications – mainly the antidepressants which, you should know, are generally the first-line treatment for both depressive and many anxiety disorders, despite the potentially deceptive name – to achieve better tolerability (based on modifications to the molecule), ease of dosing (e.g. long-acting/ extended release versions) and administration (e.g. liquid or transdermal formulations for people who have difficulty with swallowing pills or cannot absorb them when taken by mouth) – all factors which are potentially important particularly for an individual with cancer who might, at a given point in the course of the illness, face a host of obstacles to quality of life including medication administration that may be eased with these options – as well as exploration of other targets for novel classes of drugs that no longer need directly involve the neurotransmitter systems.

There are also other major classes of both ‘biological’ – or what some might call “somatic” – approaches and other ‘non-medical’ interventions. With respect to the latter, these may include alternative therapies which, likewise, include approaches involving chemical consumption – such as herbal therapies – and those that do not – such as the variety of holistic and mind-body approaches. While such alternative approaches are not novel, per se, as they have typically existed for a long time, often long predating modern/ Western medical approaches, they are actively being studied to corroborate their efficacy. Particularly with respect to the holistic/ mind-body approaches, these may appeal to patients with medical illness as they would not necessarily subsume active effort or additional extrinsic compounds which may have the potential only to add to the burdensome medical list and potential risk of side effects to a condition which is already physically trying in its own right, and they may be most conducive to welcome measures of conserving, harnessing, and healing. But herbal therapies are also an area of active research with respect to both psychiatric conditions, including depression and anxiety, and cancer treatments. However, it must again be stressed that, for this reason, consultation with your oncologist and a psychiatrist is essential and is the most optimal source for information about the approaches being sought. Many herbal supplements also run the risk of side effects and deleterious drug interactions, like pharmaceuticals, compounded by the lack of careful standardization in their composition since they are not subject to the same restrictions by the Food and Drug Administration as prescription drugs. With respect to the former, a major field is that of the brain stimulation therapies. Traditionally, this included ECT – electroconvulsive therapy or what has commonly come to be known as “shock” therapy – still actually a highly effective approach which has had the misfortune of stigma through association in the popular media which has conveyed it as a less than humane treatment, and as a byproduct of it having withstood the test of time from its early days when, indeed, the approach was much cruder than the way it is currently conducted with refinements making it quite tolerable However, this is another approach that would not likely be pursued in a patient who has newly emergent depressive or anxiety symptoms in the context of grappling with cancer diagnosis and treatment. It is not that it subsumes potential logistical and medical complications in a patient with active medical comorbidity – as it may, indeed, be conducted safely, if necessary, as it is typically used and effective, for patients with a psychiatric condition that is of long-standing or has not responded well to other treatment approaches – but, rather, that many patients who experience depression or anxiety in the setting of cancer may not require such an approach. Their symptoms might be related simply to a normative adjustment process, or to transitory struggles with adapting to a dramatic life change. But even if a patient’s depression could benefit from a somatic approach, if you will, a first trial of an antidepressant medication will often be effective for someone who may not have experienced such symptoms in their past.

However, I mention the brain stimulation therapies not just because they continue to be a most fruitful field of study, and represent some of the most recent developments in treatment, in psychiatry but I think they represent a potentially appealing approach for people with cancer or other chronic medical conditions. Some of the approaches, such as Vagal Nerve Stimulation, or Cranial Electric Stimulation, have developed since ECT, have been around for a while, and have ultimately had less than appealing results. A more novel procedure, Deep Brain Stimulation – wherein an electrode is implanted in an area of the brain that is below the surface or “cortex” so must be accessed surgically – originally developed, to my awareness, for treating Parkinson’s Disease, is now being studied in a variety of medical conditions, including OCD and Depression. This invasive technique is not the one I would highlight, however. The most recent approach developed as been TMS or Transcranial Magnetic Stimulation. I am mentioning this both in response to the question and to indicate that it is potentially attractive as a very non-invasive and well-tolerated approach – a probe that generates a magnetic field on the surface of the brain to produce current that may either stimulate or inhibit certain areas of the brain – has been shown to be effective, and is FDA approved, for treating depression. It is quite feasibly better tolerated than psychiatric medication. Furthermore, there is evidence for is effectiveness as a treatment for pain, which many cancer patients do experience, (though studies in cancer pain are less robust and the treatment would be delivered with different settings and sites). For someone with cancer, with recent surgery possibly limiting one’s oral intake, this could perhaps be interesting to consider, at least hypothetically. That being said, it is fairly new, and the gains achieved in research were modest and inconsistent. Typically, one’s oral intake has been advanced at least to baseline following an operation before being discharged from the hospital, so that issue will likely be moot. It also does entail repeated frequent, albeit brief, visits for a period of a few weeks to receive the treatment each session, and this may not be feasible for someone who also has a grueling chemotherapy or radiation therapy schedule, or, even when an active phase of treatment is complete and such an intervention may be more doable, who still has a host of medical appointments to make and deferred or changing social issues that need attention. Finally, I will add that a related but newer brain stimulation technique, Transcranial Direct Current Stimulation -- involving direct electrical current, rather than a magnetic field -- may also have a similar good tolerability profile and be easily manpulated and performed, and is being studied as an intervention in both psychiatry, including depression amongst other disorders, as well as pain.

This is part of the reason why, with all of this, there is still no replacement for the mainstay approaches of psychopharmacology and/ or psychotherapy, at least to be considered first, and there is really no substitute, and no better resource that I can recommend for reviewing the current approaches to treatment of anxiety and depression, than going straight to the source – a psychiatrist. This is a fair question. I do not usually recommend that people seek information about treatments on their own without consulting directly with a specialist to discuss treatment options for their individual care. Quite basically, what’s good or might work for one person may not be the case for another. Furthermore, I cannot say that there is much in the way of substantially novel approaches to managing depression or anxiety, as the mainstays of treatment consist of psychopharmacology or medication management which have been used for several decades.

That being said, there may be, and certainly is, ongoing refinements to and studies of the efficacy of the psychological therapies as well as establishment and evolution of varying approaches in the field; as well as continual research and development of drugs in the rapidly expanding and burgeoning field of psychopharmacology in which there continues to be refinement of the neurotransmitter receptor profiles, delivery systems, and formulations, in existing classes of medications – mainly the antidepressants which, you should know, are generally the first-line treatment for both depressive and many anxiety disorders, despite the potentially deceptive name – to achieve better tolerability (based on modifications to the molecule), ease of dosing (e.g. long-acting/ extended release versions) and administration (e.g. liquid or transdermal formulations for people who have difficulty with swallowing pills or cannot absorb them when taken by mouth) – all factors which are potentially important particularly for an individual with cancer who might, at a given point in the course of the illness, face a host of obstacles to quality of life including medication administration that may be eased with these options – as well as exploration of other targets for novel classes of drugs that no longer need directly involve the neurotransmitter systems.

There are also other major classes of both ‘biological’ – or what some might call “somatic” – approaches and other ‘non-medical’ interventions. With respect to the latter, these may include alternative therapies which, likewise, include approaches involving chemical consumption – such as herbal therapies – and those that do not – such as the variety of holistic and mind-body approaches. While such alternative approaches are not novel, per se, as they have typically existed for a long time, often long predating modern/ Western medical approaches, they are actively being studied to corroborate their efficacy. Particularly with respect to the holistic/ mind-body approaches, these may appeal to patients with medical illness as they would not necessarily subsume active effort or additional extrinsic compounds which may have the potential only to add to the burdensome medical list and potential risk of side effects to a condition which is already physically trying in its own right, and they may be most conducive to welcome measures of conserving, harnessing, and healing. But herbal therapies are also an area of active research with respect to both psychiatric conditions, including depression and anxiety, and cancer treatments. However, it must again be stressed that, for this reason, consultation with your oncologist and a psychiatrist is essential and is the most optimal source for information about the approaches being sought. Many herbal supplements also run the risk of side effects and deleterious drug interactions, like pharmaceuticals, compounded by the lack of careful standardization in their composition since they are not subject to the same restrictions by the Food and Drug Administration as prescription drugs. With respect to the former, a major field is that of the brain stimulation therapies. Traditionally, this included ECT – electroconvulsive therapy or what has commonly come to be known as “shock” therapy – still actually a highly effective approach which has had the misfortune of stigma through association in the popular media which has conveyed it as a less than humane treatment, and as a byproduct of it having withstood the test of time from its early days when, indeed, the approach was much cruder than the way it is currently conducted with refinements making it quite tolerable However, this is another approach that would not likely be pursued in a patient who has newly emergent depressive or anxiety symptoms in the context of grappling with cancer diagnosis and treatment. It is not that it subsumes potential logistical and medical complications in a patient with active medical comorbidity – as it may, indeed, be conducted safely, if necessary, as it is typically used and effective, for patients with a psychiatric condition that is of long-standing or has not responded well to other treatment approaches – but, rather, that many patients who experience depression or anxiety in the setting of cancer may not require such an approach. Their symptoms might be related simply to a normative adjustment process, or to transitory struggles with adapting to a dramatic life change. But even if a patient’s depression could benefit from a somatic approach, if you will, a first trial of an antidepressant medication will often be effective for someone who may not have experienced such symptoms in their past.

However, I mention the brain stimulation therapies not just because they continue to be a most fruitful field of study, and represent some of the most recent developments in treatment, in psychiatry but I think they represent a potentially appealing approach for people with cancer or other chronic medical conditions. Some of the approaches, such as Vagal Nerve Stimulation, or Cranial Electric Stimulation, have developed since ECT, have been around for a while, and have ultimately had less than appealing results. A more novel procedure, Deep Brain Stimulation – wherein an electrode is implanted in an area of the brain that is below the surface or “cortex” so must be accessed surgically – originally developed, to my awareness, for treating Parkinson’s Disease, is now being studied in a variety of medical conditions, including OCD and Depression. This invasive technique is not the one I would highlight, however. The most recent approach developed as been TMS or Transcranial Magnetic Stimulation. I am mentioning this both in response to the question and to indicate that it is potentially attractive as a very non-invasive and well-tolerated approach – a probe that generates a magnetic field on the surface of the brain to produce current that may either stimulate or inhibit certain areas of the brain – has been shown to be effective, and is FDA approved, for treating depression. It is quite feasibly better tolerated than psychiatric medication. Furthermore, there is evidence for is effectiveness as a treatment for pain, which many cancer patients do experience, (though studies in cancer pain are less robust and the treatment would be delivered with different settings and sites). For someone with cancer, with recent surgery possibly limiting one’s oral intake, this could perhaps be interesting to consider, at least hypothetically. That being said, it is fairly new, and the gains achieved in research were modest and inconsistent. Typically, one’s oral intake has been advanced at least to baseline following an operation before being discharged from the hospital, so that issue will likely be moot. It also does entail repeated frequent, albeit brief, visits for a period of a few weeks to receive the treatment each session, and this may not be feasible for someone who also has a grueling chemotherapy or radiation therapy schedule, or, even when an active phase of treatment is complete and such an intervention may be more doable, who still has a host of medical appointments to make and deferred or changing social issues that need attention. Finally, I will add that a related but newer brain stimulation technique, Transcranial Direct Current Stimulation -- involving direct electrical current, rather than a magnetic field -- may also have a similar good tolerability profile and be easily manpulated and performed, and is being studied as an intervention in both psychiatry, including depression amongst other disorders, as well as pain.

This is part of the reason why, with all of this, there is still no replacement for the mainstay approaches of psychopharmacology and/ or psychotherapy, at least to be considered first, and there is really no substitute, and no better resource that I can recommend for reviewing the current approaches to treatment of anxiety and depression, than going straight to the source – a psychiatrist.

First off, most importantly, I would recommend that you seek evaluation and management by a psychiatrist. To find one, you can start by discussing referral with your surgeon, medical oncologist, and/ or current prescribing physician. A psychiatrist with specialization in palliative care or, more typically, psychosomatic medicine can be beneficial, since such training and practice is geared toward helping people with psychiatric problems – be they emotional concerns, behavioral difficulties, or problems with cognition or thinking, concentration, and memory – related to medical conditions, or addressing these issues as they emerge in the context of a serious chronic or advanced illness. A psycho-oncologist is a psychiatrist who works with cancer patients and has a specialty in psychosomatic medicine, also called consultation-liaison or C/L psychiatry because much of the work involves consultation for physicians in other fields and acting to facilitate complicated dynamics between patient, family, and provider within the medical setting. A psychiatrist with a specialty in palliative care is less common but specializes in dealing with the various psychiatric issues – e.g. mood or anxiety symptoms or emotional concerns – and their interaction with physical symptoms, along with social issues, and spiritual concerns that emerge for people dealing with a chronic advanced disease. On a practical level, such training subsumes developing additional skills in management of physical as well as emotional symptoms, and, for psychiatrists, provides a better understanding of their interaction within the patient who ought to be treated as a whole person rather than a manifestation of the consequences of a disease and a variety of associated symptoms. Less commonly, psychiatrists may have training in pain medicine given the complex interface of this physical symptom, in particular, with other elements within the psychiatric realm that are processed in the brain – such as mood, anxiety, and perception.

Regardless, a psychiatrist with expertise or experience dealing with patients and issues related to your medical problem is always helpful. There may be a psychiatrist within or closely affiliated with the practice of the physician who initially screened for depression, and specifically addressed the issue and prescribed a medication. Whatever the case may be, psychiatric evaluation and management in addressing problems with mood is essential and ought not be substituted or overlooked.

For one thing, clarifying and refining a diagnostic impression over time requires careful and ongoing assessment by an expert, in part to rule out and further assess the multitude of other factors which may potentially be contributing to the decline in mood – including related psychiatric conditions, other medical issues, and a host of distressing issues that may be at play in one’s social circumstances, with a variety of possibilities in each domain for which one is at risk, given a close association, after undergoing surgery or during chemotherapy treatment for cancer.

Pursuing a psychiatric evaluation is important for evaluation of psychopharmacologic – or medication management – options, as well as non-pharmacologic interventions for depression in cancer, including psychotherapy. Additionally, seeking counseling and support from a social worker, if on staff where you are being treated, be it at a cancer center, or in the practice of the oncologist providing your care, can be invaluable. Social workers providing clinical care in the oncology setting can help to provide counseling and emotional support as needed, as well as referral to community resources and practical assistance with the various stresses that emerge in the life of a someone with cancer or other medical illness – in relationships with family and friends, financially, and at work or school, etc.

There are a variety of medications to treat depression, with reasonable evidence to support their efficacy in cancer patients, including those in several classes of antidepressants, as well as other classes of medication which may be used adjunctively or alternatively. Choosing a medication to alleviate depressive symptoms requires careful consideration of a variety of factors which should be carefully assessed by a psychiatrist.

Conducted by psychiatrists, psychologists, social workers, or other types of therapists, various forms of psychotherapy and emotional or behavioral counseling, conducted supportively, are an important aspect of optimizing adaptive functioning when facing the challenges associated with a medical condition and associated mood changes. There are a variety of approaches, such as psychodynamically-oriented supportive or supportive-expressive psychotherapy, cognitive behavioral therapy, various existential therapies, and client-centered or humanistic approaches that may be used and have been shown to be beneficial – be it observationally or experimentally – and seem generally to be related in part to the establishment of a rapport between a patient and clinician to develop a working alliance in the service of improving one’s psychological well-being. This is routinely conducted on an individual or one-on-one basis, but work with families, couples, or in a group setting amongst peers, may also be valuable as a means of addressing emotional difficulties encountered, particularly in the setting of relationships affected by one’s illness. In addition to providing a safe and open space to engage in the task of processing one’s thoughts and feelings, psychotherapy in an individual and group setting involves an educational and informational component. Alternative therapies which may be beneficial and available in the medical setting include the creative arts therapy – such as art therapy, music therapy, and drama therapy – as well as other mind-body techniques, such as hypnosis or hypnotherapy, guided imagery, relaxation techniques, and mindfulness-based approaches – and may be incorporated to the approach of a given therapist. There are additional integrative therapy approaches provided by practitioners who are not just mental health providers. In general, when dealing with issues related to medical conditions, a supportive approach is employed to help the individual foster the use of pre-existing internal resources which may be challenged when confronted with mortality and the threat to one’s livelihood but can be harnessed or aided in providing assistance for coping with an otherwise overwhelming experience. In this vain, the individual is the agent of change with the support of the provider, such that approaches to helping oneself may be found within one’s own self, environment, and lifestyle, and, as such, may even include improving healthy behaviors such as exercise and diet and reducing harmful behaviors such as substance abuse. First off, most importantly, I would recommend that you seek evaluation and management by a psychiatrist. To find one, you can start by discussing referral with your surgeon, medical oncologist, and/ or current prescribing physician. A psychiatrist with specialization in palliative care or, more typically, psychosomatic medicine can be beneficial, since such training and practice is geared toward helping people with psychiatric problems – be they emotional concerns, behavioral difficulties, or problems with cognition or thinking, concentration, and memory – related to medical conditions, or addressing these issues as they emerge in the context of a serious chronic or advanced illness. A psycho-oncologist is a psychiatrist who works with cancer patients and has a specialty in psychosomatic medicine, also called consultation-liaison or C/L psychiatry because much of the work involves consultation for physicians in other fields and acting to facilitate complicated dynamics between patient, family, and provider within the medical setting. A psychiatrist with a specialty in palliative care is less common but specializes in dealing with the various psychiatric issues – e.g. mood or anxiety symptoms or emotional concerns – and their interaction with physical symptoms, along with social issues, and spiritual concerns that emerge for people dealing with a chronic advanced disease. On a practical level, such training subsumes developing additional skills in management of physical as well as emotional symptoms, and, for psychiatrists, provides a better understanding of their interaction within the patient who ought to be treated as a whole person rather than a manifestation of the consequences of a disease and a variety of associated symptoms. Less commonly, psychiatrists may have training in pain medicine given the complex interface of this physical symptom, in particular, with other elements within the psychiatric realm that are processed in the brain – such as mood, anxiety, and perception.

Regardless, a psychiatrist with expertise or experience dealing with patients and issues related to your medical problem is always helpful. There may be a psychiatrist within or closely affiliated with the practice of the physician who initially screened for depression, and specifically addressed the issue and prescribed a medication. Whatever the case may be, psychiatric evaluation and management in addressing problems with mood is essential and ought not be substituted or overlooked.

For one thing, clarifying and refining a diagnostic impression over time requires careful and ongoing assessment by an expert, in part to rule out and further assess the multitude of other factors which may potentially be contributing to the decline in mood – including related psychiatric conditions, other medical issues, and a host of distressing issues that may be at play in one’s social circumstances, with a variety of possibilities in each domain for which one is at risk, given a close association, after undergoing surgery or during chemotherapy treatment for cancer.

Pursuing a psychiatric evaluation is important for evaluation of psychopharmacologic – or medication management – options, as well as non-pharmacologic interventions for depression in cancer, including psychotherapy. Additionally, seeking counseling and support from a social worker, if on staff where you are being treated, be it at a cancer center, or in the practice of the oncologist providing your care, can be invaluable. Social workers providing clinical care in the oncology setting can help to provide counseling and emotional support as needed, as well as referral to community resources and practical assistance with the various stresses that emerge in the life of a someone with cancer or other medical illness – in relationships with family and friends, financially, and at work or school, etc.

There are a variety of medications to treat depression, with reasonable evidence to support their efficacy in cancer patients, including those in several classes of antidepressants, as well as other classes of medication which may be used adjunctively or alternatively. Choosing a medication to alleviate depressive symptoms requires careful consideration of a variety of factors which should be carefully assessed by a psychiatrist.

Conducted by psychiatrists, psychologists, social workers, or other types of therapists, various forms of psychotherapy and emotional or behavioral counseling, conducted supportively, are an important aspect of optimizing adaptive functioning when facing the challenges associated with a medical condition and associated mood changes. There are a variety of approaches, such as psychodynamically-oriented supportive or supportive-expressive psychotherapy, cognitive behavioral therapy, various existential therapies, and client-centered or humanistic approaches that may be used and have been shown to be beneficial – be it observationally or experimentally – and seem generally to be related in part to the establishment of a rapport between a patient and clinician to develop a working alliance in the service of improving one’s psychological well-being. This is routinely conducted on an individual or one-on-one basis, but work with families, couples, or in a group setting amongst peers, may also be valuable as a means of addressing emotional difficulties encountered, particularly in the setting of relationships affected by one’s illness. In addition to providing a safe and open space to engage in the task of processing one’s thoughts and feelings, psychotherapy in an individual and group setting involves an educational and informational component. Alternative therapies which may be beneficial and available in the medical setting include the creative arts therapy – such as art therapy, music therapy, and drama therapy – as well as other mind-body techniques, such as hypnosis or hypnotherapy, guided imagery, relaxation techniques, and mindfulness-based approaches – and may be incorporated to the approach of a given therapist. There are additional integrative therapy approaches provided by practitioners who are not just mental health providers. In general, when dealing with issues related to medical conditions, a supportive approach is employed to help the individual foster the use of pre-existing internal resources which may be challenged when confronted with mortality and the threat to one’s livelihood but can be harnessed or aided in providing assistance for coping with an otherwise overwhelming experience. In this vain, the individual is the agent of change with the support of the provider, such that approaches to helping oneself may be found within one’s own self, environment, and lifestyle, and, as such, may even include improving healthy behaviors such as exercise and diet and reducing harmful behaviors such as substance abuse.

I'm not sure that fear ever goes away. No matter how far out we get, no matter how many clean scans, it lurks in a closet waiting...

I agree with everything written: make the healthiest choices possible and embrace the moments we have. The only thing I might add is to give yourself permission for the rough days. For me it was often a scan or test that yanked the fears out of the closet and demanded I confront them. It's so very normal to be afraid, and the only way to deal with it sometimes is to walk through it. Remember there was a day when an initial diagnosis was your greatest fear, and you had the strength to manage it, overcome it, and move on. Trust in yourself that while it's okay to be afraid, should you ever need to, you have the inner stregnth to do it again. I am sure I am not alone in saying that my greatest fear is of recurrence. That is a reality we live with post diagnosis.

The way I deal with this is by identifying the factors which are in my control and being proactive in these areas. For example, I know that women who exercise have a statistically lower probability of recurrence. So I ensure that I exercise regularly. I swim daily before work and work out 2 - 3 times a week.

I also ensure that I have a sensible work life balance. While I am happy to work extra hours at times of extra need, I am clear that leisure time is not a luxury, it is critical to my physical and emotional well-being. I also highlight that of course this makes me more productive!

I make a point of doing things in my spare time which I enjoy. This enhances my leisure time but furthermore distracts my mind from fearful thoughts. Meditation also helps to channel my thoughts positively.

Additionally, it is important to be vigilant and educated about signs or symptoms which I should have checked by a Doctor. Connected with this is the reassurance (and inevitable stress) or regular and thorough monitoring checks and scans.

In summary, I believe that this is about taking control over those factors within my control.

Therapy, relaxing hobbies, guided imagery, exercise. All these are really vital to your spirit, mind, and body. You control one thing; your thoughts. So stop living in a future you fear due to your thoughts and visualize what you desire. Also use meditation, laughter and relationships to help you. Drugs and alcohol are helpful too when the previous items are ineffective. As a 90+ year old said in our support group, "The only thing I am afraid of is driving on the parkway at night." You have a potential that you need to recognize and accept and live the message. As Ernest Holmes said, "What if Jesus was the only normal person who ever lived?"

Great question. Yes, I have a specific guided meditation for uncovering and finding the higher purpose or role that cancer plays in people's lives. Often the ego does not want to hear this kind of information. So during the meditation we tap into the wisdom of the soul in order to explore and find the deeper meaning of the healing journey. Great question. Yes, I have a specific guided meditation for uncovering and finding the higher purpose or role that cancer plays in people's lives. Often the ego does not want to hear this kind of information. So during the meditation we tap into the wisdom of the soul in order to explore and find the deeper meaning of the healing journey.

One of the most common psychological responses to the experience of cancer is anxiety!

A clear distinction does not always exist between the normal fears that cancer initiates and other anxiety reactions that are intense. What is known is that cancer is a stressful journey and normal anxiety reactions present at different points along the cancer continuum: at diagnosis, during treatment, at recurrence, and other times when the patient does not know what to expect and feels powerless to what is happening to them.

The most effective anxiety and stress relief technique I have found is in the form of education! I believe that if the patient has insight and knowledge about what exactly is happening to them and what they are facing, it gives them a sense of control and empowerment. Thus, decreasing the amount of stress and anxiety! For example, if I were to do a bone marrow biopsy on a patient I would first explain the purpose of the test. I would then take the person through the procedure one step at a time so that they would know what to expect at each moment in time.

Apprehension and fear drive stress and anxiety. Feelings of helplessness also contribute to stress and anxiety. To me, knowledge translates into control. It is important for us as healthcare practitioners to make the patient an informed "partner" in the his or her health care plan.

After education I believe in relaxation techniques such as progressive relaxation, deep breathing, guided imagery, yoga, biofeedback, and meditation. Progressive relaxation and deep breathing techniques can be learned easily by the patient and can give them a sense of control over what may be a frightening treatment or procedure. Listening to relaxation or guided imagery tapes during chemotherapy treatments is very effective in reducing anxiety.

There is also a role for the short term use of anxiolytics (drugs that reduce anxiety) such as the benzodiazepenes (ativan, xanax, etc) but these should be reserved for special circumstances, e.g., the fear and physical discomfort associated with a bone marrow biopsy.

Educating the patient is weaved through all the interventions mentioned and is my number one choice! One of the most common psychological responses to the experience of cancer is anxiety!

A clear distinction does not always exist between the normal fears that cancer initiates and other anxiety reactions that are intense. What is known is that cancer is a stressful journey and normal anxiety reactions present at different points along the cancer continuum: at diagnosis, during treatment, at recurrence, and other times when the patient does not know what to expect and feels powerless to what is happening to them.

The most effective anxiety and stress relief technique I have found is in the form of education! I believe that if the patient has insight and knowledge about what exactly is happening to them and what they are facing, it gives them a sense of control and empowerment. Thus, decreasing the amount of stress and anxiety! For example, if I were to do a bone marrow biopsy on a patient I would first explain the purpose of the test. I would then take the person through the procedure one step at a time so that they would know what to expect at each moment in time.

Apprehension and fear drive stress and anxiety. Feelings of helplessness also contribute to stress and anxiety. To me, knowledge translates into control. It is important for us as healthcare practitioners to make the patient an informed "partner" in the his or her health care plan.

After education I believe in relaxation techniques such as progressive relaxation, deep breathing, guided imagery, yoga, biofeedback, and meditation. Progressive relaxation and deep breathing techniques can be learned easily by the patient and can give them a sense of control over what may be a frightening treatment or procedure. Listening to relaxation or guided imagery tapes during chemotherapy treatments is very effective in reducing anxiety.

There is also a role for the short term use of anxiolytics (drugs that reduce anxiety) such as the benzodiazepenes (ativan, xanax, etc) but these should be reserved for special circumstances, e.g., the fear and physical discomfort associated with a bone marrow biopsy.

Educating the patient is weaved through all the interventions mentioned and is my number one choice!

A woman confronting mastectomy can do several things to prepare for the emotional loss of her breast. Losing one's breast will have an impact on body-image, self-esteem, and sexuality.

To help with body-image the woman can educate herself regarding options post-mastectomy such as reconstructive surgery or the prostheses and bras that are available. If the woman is prepared for one of these options prior to mastectomy she will feel more empowered and less vulnerable than the woman who waits until she has already lost her breast. Investigating reconstructive options can take place prior to surgery and reconstruction can even take place at the time of surgery, dependent upon the type of surgery and the reconstruction chosen. For a woman who does not choose reconstruction it would also be helpful to learn about available prostheses and bras prior to surgery. Although it isn't advised to wear a prosthesis until the chest wound has healed, educating oneself about the options available can help prepare the woman for body image changes.

Reaching out to other women who have had mastectomy can be very valuable emotionally. Many hospitals or private practice settings have arranged for cancer survivors to be available to talk to others who are in a similar position; much like the American Cancer Society's Reach to Recovery program. Talking to someone else who has survived mastectomy can provide hope for emotional healing.

Losing one's breast can be an assault on a woman's sense of femininity and wholeness both of which play an important part in self-esteem. Expressing one's feelings about the impending loss of one's breast is very important. This should begin at the time the decision of mastectomy is made. Sharing with a partner, a friend or confidant can begin the process of grief. Grieving the loss of the breast is normal and should be encouraged so that healthy psychological recovery can take place. Losing a body part is devastating and the emotions associated with the loss require a healthy outlet. If a woman cannot confide in a partner or friend then therapeutic intervention in the form of counseling is advised.

Mastectomy affects the total being, including the sexual aspect's of one's self. The breast plays an important role in our sexuality. Sexuality not only refers to intercourse but also to intimate body language, hugging, kissing, and touching. Mastectomy can alter a person's sexuality but it cannot take away a woman's sense of her sexual self. If a woman can express the role that her breasts play in her sexual being, this is a first step in identifying how the loss will be translated emotionally.

Empowerment occurs when the necessary insight takes place for the individual to successfully meet the challenges faced with mastectomy. Preparing emotionally for losing a breast depends upon grieving the loss and gaining insight into the meaning of that loss for the woman. A woman confronting mastectomy can do several things to prepare for the emotional loss of her breast. Losing one's breast will have an impact on body-image, self-esteem, and sexuality.

To help with body-image the woman can educate herself regarding options post-mastectomy such as reconstructive surgery or the prostheses and bras that are available. If the woman is prepared for one of these options prior to mastectomy she will feel more empowered and less vulnerable than the woman who waits until she has already lost her breast. Investigating reconstructive options can take place prior to surgery and reconstruction can even take place at the time of surgery, dependent upon the type of surgery and the reconstruction chosen. For a woman who does not choose reconstruction it would also be helpful to learn about available prostheses and bras prior to surgery. Although it isn't advised to wear a prosthesis until the chest wound has healed, educating oneself about the options available can help prepare the woman for body image changes.

Reaching out to other women who have had mastectomy can be very valuable emotionally. Many hospitals or private practice settings have arranged for cancer survivors to be available to talk to others who are in a similar position; much like the American Cancer Society's Reach to Recovery program. Talking to someone else who has survived mastectomy can provide hope for emotional healing.

Losing one's breast can be an assault on a woman's sense of femininity and wholeness both of which play an important part in self-esteem. Expressing one's feelings about the impending loss of one's breast is very important. This should begin at the time the decision of mastectomy is made. Sharing with a partner, a friend or confidant can begin the process of grief. Grieving the loss of the breast is normal and should be encouraged so that healthy psychological recovery can take place. Losing a body part is devastating and the emotions associated with the loss require a healthy outlet. If a woman cannot confide in a partner or friend then therapeutic intervention in the form of counseling is advised.

Mastectomy affects the total being, including the sexual aspect's of one's self. The breast plays an important role in our sexuality. Sexuality not only refers to intercourse but also to intimate body language, hugging, kissing, and touching. Mastectomy can alter a person's sexuality but it cannot take away a woman's sense of her sexual self. If a woman can express the role that her breasts play in her sexual being, this is a first step in identifying how the loss will be translated emotionally.

Empowerment occurs when the necessary insight takes place for the individual to successfully meet the challenges faced with mastectomy. Preparing emotionally for losing a breast depends upon grieving the loss and gaining insight into the meaning of that loss for the woman.

Thanks for another great post.

It's sad that the following is not always so "simple:"...

"Simply having someone be with you and accept you for what you are feeling and thinking without judgment can be extremely healing in and of itself."

...but when you do have someone like that, it's true, it's so healing... and it probably helps you to heal "faster" than if you have a person who wishes you'd "get over it."

Often, things that are deceptively simple are also those that we treasure the most. It's hard to put down in a list the things that a therapist does that are therapeutic. For me, therapy and counseling has always been about cultivating a relationship with the client that involves compassion, empathy, trust and respect.

In situations like you describe, I start by trying to convey acceptance of the client where they are, "warts and all." Developing a working relationship can take time, but then I explain the different stages of the grieving process and normalizing what the person is feeling. The loss of a body part IS like a death, or maybe even many deaths. The loss of a physical part of us changes how we see ourselves physically, it can perhaps change what we saw ourselves capable of, what we can accomplish, where we will be int he future. The images we have had of ourselves and of our lifes is changed forever. Therefore it feels like we have experienced a death.

The stages of grief are defined by Elizabeth Kubler-Ross as Denial, Bargaining, Anger, Depression and Acceptance, but unlike other processes with stages, the grief process is not navigated in a linear fashion. Simply having someone be with you and accept you for what you are feeling and thinking without judgment can be extremely healing in and of itself.

I also help people see what stage they may be in at a particular time and suggest healthy ways to cope within that particular stage, perhaps anticipating shifts and therefore changes that need to occur in thought and behavior. For example, helping someone in the Anger Stage to recognize their anger for what it is and redirect it from well meaning friends and family to a safer, more healthy channel.

Every client of mine is encouraged to re-engage with stress management and self-care. The depression that comes along with this can sap energy and cause people to retreat to their beds to nest until they "feel like" getting back into living. Some clients will need a push or two to get back out there. They need to see themselves as capable, beautiful and enduring. I engage people to see themselves as more than a collection of parts. "I am not my body. My body is a vessel where I dwell. I am not my mind. My mind is the conversation I have with myself. I transcend my body and my mind. I am."

It's also important to note that since every person is unique, every grief process is unique. Just because you haven't moved on in the same time as someone else you know doesn't mean you are wrong or crazy. It means this is where you are... for now.

This is a wonderful, detailed and thoughtful post. Thank you! In body-mind-spirit medicine, it's important to use interventions that address the whole person. I don't always advise a grieving person to "stay calm" as that can produce additional pressure on them to have to be responsible for making everyone else feel o.k. Grief is one time where a person has earned a right to be a little selfish and let it all hang out. Now, that shouldn't give the person who's grieving carte blanche to strike out at anyone in their path, but they do need to be given a little lee-way to express themselves without fear of retribution.

BODY: People often lose control because they feel overwhelmed and tired. Start with stress management and self care. To reduce stress, encourage them to eat well, get rest, and be as active as they can be without feeling over taxed. Pain management is a biggie here. Encourage them to stay ahead of the pain with medication rather than wait for the pain to get bad enough and then take the medication. That lag time until the medication takes effect will be taxing and distressing.

The increased stress level from pain, fatigue, insomnea, etc. pushes their sympathetic nervous system to the edge creating a physiological reaction we call the "Fight/Flight Response". If the feeling is associated with fear, the person has an anxiety attack and wants to get away. If the experience is associated with anger, then the response can be rage and a behavior of striking out verbally or even physically.

The best way to undo the Fight/Flight Response is to engage in relaxation breathing techniques, often simple yoga breathing techniques, which calm the body and decrease the excitatory hormones raging through the body. Grab Dr. Andrew Weil's "Breathing: The Master Key to Self-Healing" and use cut #7, "The Relaxing Breath." Engaging in muscle stretching, physical exertion and massage can be helpful only if it doesn't provoke pain.

MIND: Help the person understand what this event means to them. Don't try to correct them or rebut their comments. Just listen, express understanding and empathy. Someone who has just had a mastectomy may feel quite certain that they will never be attractive again. It won't work to tell them, "But look at how beautiful your face is." or "Phsyical beauty isn't everything." Listen to what they are saying and express how you understand that they would feel the way they do. Trying to convince them they are wrong in their thinking will only lead to conflict. There will be time later in the grief process for them to come to terms with a different view point on life. But it will take time, their time.

If the person is wanting to deal with their anger differently, have them try to conceptualize something that is the real source of their anger and, using various techniques, communicate their anger. Too often people will try to hold it all in causing themselves much more distress in the long run. They need not actually communicate it to the person (if there is an identifiable person). They can simply write their thoughts down or tell them to an empty chair symbolizing a person or scream the thoughts into the ether. Emotive activities can be quite a release as long as they have an end point. Carrying on too long can simply re-indoctrinate the person in their grief and anger.

Encourage them to seek counseling and/or a psychiatric appointment if they decompensate or things don't seem to be getting better within a few months. That's right, I said "months." Grief is a long process that can take a year, or more. But it isn't the same level of distress every day. It gets better a bit at a time. Some may never fully recover from a significant loss. Your indicator for whether they need to go to therapy is functionality: how functional are they on their own when you take into account any mental or physical limitations they may have.

SPIRIT: Not just talking about a person's religion here, but the more basic level of spirituality. Help the person connect to nature, to themselves, and to other people. Encourage them to be engaged socially. Perhaps they could benefit from a support group where people can truly express themselves and feel understood by someone in their shoes. Encourage them to get back to doing things that they loved to do, een if they don't feel like it yet.

Lastly, speak to the people around the grieving person, ask them to have patience and to understand that the lashing out isn't about the situations and people at the time, but probably about deeper issues. Suggest patience and understanding if the person turns their back on their faith for a while. There may be things to work out between them and God before they can do that. If there is a God and s/he is eternal, s/he can wait.

Grief is part of the process of adapting to a new reality. It comes at a time when a major life transition has occurred. It's understandable that that transition would take time and affect our moods and functioning. Have patience with the person who's grieving and practice forgiveness, especially if that person is you.

PTSD stands for Post Traumatic Stress DISORDER.... is it possible to experience post-traumatic stress without it being "full-blown" PTSD? Thanks. Nightmares are a diagnostic criteria, but the flash backs involved in PTSD occur when a person is awake. The person has the experience of mentally and emotionally reliving the traumatic event in the present. There are a number of other criteria which must be met to have a PTSD diagnosis. A quick search of the web will provide you with the complete diagnostic criteria from the Diagnostic and Statistical Manual of Mental Diseases and Disorders (affectionately known as the DSM).

On that criteria alone, I wouldn't venture to say you have PTSD. More likely you are describing someone with a more common, short-lived condition called Adjustment Disorder with Mixed Disturbance of Emotion and Conduct. This can include a chronic form but typically resolves in 6 months to a year of the event, depending on treatment and the client's support system and resources.

Anxiety is the result of putting ourselves into the future and anticipating bad things. Mindfulness is a philosophe re-discovered by Jon Kabat-Zinn that suggests that if we can live in this moment, this one... where we are living and breathing, we can moderate our anxiety and depression considerably. Mindfulness is a simple concept but a challenge to perfect. Here is a program by Dr. Kabat-Zinn where he describes the approach. http://www.youtube.com/watch?v=qvXFxi2ZXT0 Look for his book "Full Catastrophe Living" or "Mindfulness for Beginners."

Using yoga breathing at the time of sleep as well as stretching can reduce muscle tension and the levels of excitatory hormones in your body that could be involved.

Since I'm not a doctor or herbologist, I can't comment on medications or herbal remedies. Check with your doctor before beginning any herbal or natural remedies as they can interact with medications you take and cause serious consequences. I also suffer an anxiety disorder and have had to address this myself. When I started to meditate I felt a world of difference with the stress and actually felt a power within myself. On my first breast cancer surgery I was meditating before I went under and woke up so calm. Whenever I have to have my mammogram waiting for the radiologist to tell me the results I also meditate and take deep breaths to calm myself down. It really does work. Even taking deep breaths calms the mind.

I have a blog that is geared toward metastatic cancer called www.MiracleSurvivors.com. I am a stage IV breast cancer survivor, author and blogger who is doing very well after almost four years after my recurrence. There is hope, and I share stories of other people who beat the odds, as well as things to do to improve your outcome. It's a nice community, and I'd love you to join us! Thank you for reaching out during a very scary time. It sounds like you're already being proactive about getting some support. Because I don't know the particulars of your situation, I am going to give you some general responses. If you want to clarify, please reply to this answer and I'll try to get more specific. First of all, it is helpful to feel as though you have received all the information that you need about your diagnosis and treatment. It may be useful to make a list of what you know now and what you feel like you want or need to know. Once you have the facts, then you can do your planning and decision making with better information. Once you have the facts, then it's time to assess your emotional support. Do you have friends and family who can listen to your real feelings, especially fear or frustration? Or do you feel like you need to shelter/protect friends and family from your struggle. If you feel like you need to shelter your loved ones, it is even more important to get external support. It sounds as though the communities you're finding through the web and through the cancer center aren't quite meeting your needs. If that's the case, it might be time to look for someone who is focusing exclusively on your support, who can help you assess exactly what you need and make concrete plans to get those needs met. This could be a pastor or a therapist. If you have never worked with a therapist before, here is a brief set of tips on how to select one: http://bit.ly/pD4kgt. Please remember that being diagnosed with a stage 4 tumor is a tremendously stressful event. It's normal to feel confused, scared, angry, and overwhelmed. It's also normal to need quite a bit of help and support as you try to cope. I hope that you are able to get all the support you need. Please feel free to ask for more detail if I didn't quite answer your question.