• Dr. Nicole Amoyal Pensak

The Top Tips for Managing Stress and Cancer, Part One

Updated: Feb 7, 2019

Click here for some tips on managing stress associated with cancer.

#Worldcancerday



Cancer has interrupted your life and brought with it unwanted stress. As a Clinical Psychologist that specializes in medical psychology, I am here to give you the tips and strategies that I prescribe to my patients for how to cope with cancer stress, because you can. Because you have more control than you think.


Stress is simply your body’s way of responding to a threat, trigger, demand or change. Stressors specific to cancer include adjusting to diagnosis, managing finances, managing relationships, coping with symptoms of disease and side effects of treatment, dealing with uncertainty, and making time for medical appointments. There is an optimal level of stress that prevents boredom, but too much acute and chronic stress can lead to health problems over time (e.g. anxiety, depression, inflammation, disease, obesity, relationship problems, and much more).


Despite various stressors that cancer can cause, there are evidence-based ways to cope with these stressors. Broadly, there are two types of coping strategies- emotion-focused coping and problem-focused coping. Emotion-focused coping attempts to reduce the emotional response associated with the stressor. Problem-focused coping targets the cause of stress in very practical ways and reduces the stress by providing solutions. In sum, emotion-focused coping should be used for everything not in your control, and problem-focused coping should be used for things in your control. For each stressor, ask yourself: Is this in my control? If yes, use an emotion-focused strategy, if no, use problem-focused strategy.


Here are some of The Top Tips for Managing Stress Associated with Cancer:


#10. Get Information.

After a new diagnosis or relapse, you are typically offered various treatment options and a lot of new information regarding disease, prognosis, appointments, specialists, etc. Getting inundated with information can be overwhelming. Here are some problem-focused coping strategies to help you cope.

- Consult the experts, get second (and third) opinions if needed

- Gather as much information as possible about each treatment option

- Make a list of pros/cons list for each treatment option on paper

- Make informed decisions

It’s not easy to keep all the information in your head and to try to work through it. Trust me, do not do this. It is much easier to make a decision when you can see all the options laid out, on a pros and cons list.


#9. Journal

There are a lot of complicated emotions that come up with cancer. When it comes to processing emotions, I like to tell my patients to imagine themselves as a pot of boiling water on the stove. You don’t want the lid on too tight where you are denying negative emotions - because then the pressure builds up and can explode in other ways. You also do not want the lid on too loose where emotions overflow and interfere with daily activities. You want the lid on just right - where you are allowing some steam to escape in a controlled way. Journaling is an emotion-focused coping strategy and a way to put parameters around complicated emotions. There are no right or wrong emotions. Accept the feelings that come up- no judgments allowed. Journaling can also be a great way to self-monitor your emotions and if you find yourself feeling more depressed, anxious, or having suicidal thoughts- it may be time to ask for professional help.


#8. Get Support

You may feel isolated or alone when dealing with cancer. Additionally, involvement in your usual activities may change. They say it takes a village to raise a child. Well, it also takes a village to manage cancer. This is an opportunity to expand your village. Here are emotion-focused strategies to help you increase your support network.

- Join a support group (in-person, online, disease-specific or general)

- Consult with a therapist

- Speak with a friend that makes you feel better

- Speak with a family member that is supportive

- Reach out to religious/ spiritual groups for support

- Don’t be afraid to ask for love, help, and support

You are likely not used to asking for help, love, and support. However, this is an opportunity to focus on you and to take better care of yourself. There are many online support groups that can be general or disease-specific. Ask your oncologist for local resources at your cancer center. In Monmouth County, NJ, I offer regular support groups for patients with cancer and their caregivers through my private practice. Also check out these disease specific resources from the Fudge Cancer foundation created by Yael Cohen Braun and Julie Greenbaum.


#7. Improve Relationships

Yes, you read that correctly. Cancer can be an opportunity to IMPROVE your relationship with your spouse, partner, or significant other. Intimacy may change, but it does not have to go away. If you are physically unable to be intimate, you and your partner can work on redefining intimacy. I often tell my patients, there are other ways to be intimate and connect with your partner. Here is an article I published summarizing of some of the changes in sexual functioning that occurs after cancer. Here are some examples to improve intimacy:

- Holding hands

- Give and receive massages

- Take a long walk together

- Try a new activity together (this can be a large or small activity- e.g. trying a new restaurant or cooking a new recipe together)

Other emotion-focused coping activities I like to recommend for my patients are taken straight from the positive psychology literature as well as Dr. John Gottman’s research on marital satisfaction. In Gottman’s The Mathematics of Marriage, research indicates that marital satisfaction is related to the number of positive experiences a couple has to offset the negative experiences (5:1 accordingly). All couples have stressors, but increasing positive experiences buffers that stress. Here are some brief activities:


1. Conversation Jar: Create a jar of conversation starters/ topics. Then, pick one out of the jar at random and spend time talking to each other about that topic. (e.g., last book you read, favorite T.V. character, ideal vacation, challenging problem at work, etc).


2. Interview Your Partner: Pretend you are writing a biography about your partner. Have them tell you their story. What was your partner’s childhood like? What were their hopes and dreams? Childhood friends and activities? What are your partner’s current passions? What are your partner’s future goals? Be creative with your questions. Now switch roles and have your partner interview you.


4. Gratitude Activity: Write a letter to your partner thanking them for anything. This can include thanking them for having certain attributes, being supportive in a certain situation. It can be anything. Be as specific as possible and explain how their actions/ qualities/ etc. have positively influenced you. Then read it out loud to your partner.

For patients in Monmouth County, NJ wanting more specific, in-depth treatment for improving intimacy, contact me for more information.


#6. Schedule the Difficult Conversation or “Worry Time.”

There may be challenging times ahead. You may find yourself needing to have difficult conversations with your family and friends. You may also find yourself worrying about the future. This is another emotion-focused coping strategy that can be used to help you put parameters around those difficult conversations and emotions.


1. Schedule the difficult conversation: When a conflict arises, schedule a time when both of you can discuss the conflict. Either resolve, or agree to disagree during that time, and then move forward. Do not discuss the conflict outside of the scheduled time. If you would like to discuss the conflict more, schedule another time. The goal is to prevent the conflict from interfering with other activities.

2. Schedule worry time: Pick a 30 minute window each day that you can use to process your negative emotions. Set a timer so that you don’t have to worry about the time. Pick a quiet, private space so that you won’t be interrupted. Allow yourself to feel all the negative emotions during this time. Do not think about the negative aspects at any other times (e.g., “I will think about this later”).


These are some of the tips I recommend for managing stress and cancer. I broke the strategies up into two parts so as to not overwhelm you. Stay tuned for The Top Tips for Coping with Cancer, Part Two for more evidence-based strategies to cope with stress after cancer.

NICOLE AMOYAL PENSAK PHD

LICENSED CLINICAL PSYCHOLOGIST

609-283-2056

210 Broad Street
Red Bank, New Jersey 07701

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