Chemo Month Two – Worry

It’s been hard to write the blog in week’s four, five and six of Chemo; I didn’t know where to start, there didn’t seem to be time, and I was worrying.  Even Music didn’t show up much; I didn’t hear it or go looking for it – strange.

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I started to worry about having little time; not time on this earth but time during the day to do all the things I needed to do. Sound familiar?  I have learned over the years that when I worry about not having enough time, it usually means I am probably trying to do too much and am not getting enough rest or chill space. I noticed too that when reminders popped up in my calendar to get some ‘headspace’ or do a visualisation, I was swiping them away and thinking I’ll do that later yet later never came. This worried me.   

I wondered whether my blood test results for week four would not be as good as the previous weeks and imply that going away to Canada had been a bad call after all.  It turned out this worry, while natural, was unfounded; my results showed more test results falling within the normal range than in the previous weeks and suggested my immune system was hanging in there – a good result. 

I worried about an interaction with a Nurse and found myself feeling ‘told off’, then wondering if I was being over sensitive, or not sensitive enough to others.  I felt guilty for coping well with and doing well on Chemo.  The nurse had asked how I was doing and I had said something along the lines of “really well thanks” and “chemo had been quick today”. I heard a response of “well that’s not the case for everyone”.  

Then a stream of thoughts flooded my mind;

  • Sh*t, had I spoken too loudly?  
  • A lot of people look very ill and drained on the Chemo ward today, have I not thought of them? Should I think of them?
  • I have answered honestly and positively; that’s what I committed to do throughout this process wherever possible.  

Feeling a bit indignant, more thoughts rushed in;

  • No, it’s fine for me to be positive after all it’s not my fault I’m doing well,
  • Being positive is meant to help with healing so I’m not going to stop answering ‘I’m Doing Well’, when I am doing well.   

Overnight and with reflection I decided I probably was being a bit sensitive and it was also fine to be positive.  The following day I checked in with the nurse, who quickly reassured me that he had not thought I’d been insensitive to others on the ward at all. We cleared any misunderstanding and he reiterated how great it was that I was doing well.  This frank discussion helped bring clarity and perspective to my thoughts. It stopped this worry completely. I’m glad I raised it with the nurse even though I was uncertain (and nervous) about what I might hear.  

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Despite this resolution, a residual sense of stress, worry and an over active adrenal system remained; the opposite of the many calm moments that I had been experiencing last month.  The overall worrying continued. 

My weight had dropped again to 66kg and I was struggling to eat enough calories. I often didn’t feel hungry but still tried to eat. I hoped my weight would stabilise and even climb back up to 68kg.  That weight had felt comfortable while now I noticed I didn’t seem to have much padding, wondered if I really did have much of a reserve if I got an infection and I noticed I had lost muscle mass. The backs of my hands look like some very elderly person’s hands; dry and wrinkly despite the constant fluid intake.  I worried that my weight would keep falling and my skin would get worse. 

I worried about whether I should stick to the plan of not working for six months to focus on getting to remission as successfully as possible or to work while I still could.  I worried about if I worked, would it be too stressful, leave me enough time to rest or feel like it’s getting in the way.  I worried about not being able to work out how much work was too much, and for private practice whether enough work matched with breaking even financially.  I worried about how to contain my clients’ concerns if my appearance changed with more chemo and how I provide a consistency of safe space for them if my medical appointments needed to change in the future.  I worried and yet I missed making a difference and being the psychologist I know I can be.

To cap off the week, I finally had a long-awaited Ear, Nose and Throat appointment (yet another hospital visit) to check my possible hearing loss.  This is something else I have been worried about for a long time and that has no doubt been bugging Si for years as I constantly ask him to repeat himself or need the TV volume well above the level he would choose.  I had noticed my hearing was worse when; I’d find it difficult in crowded places (and with background noise) to hear the person I was standing next to and speaking with, or to hear what someone was saying if I couldn’t see their face and mouth.  I noticed I had started guessing (not always accurately) what someone was saying.

For a psychologist; listening skills are imperative and before listening skills can be invoked one has to be able to hear! While I had rarely experienced these problems in one to one therapy sessions, I was concerned symptoms would get worse or impact my functioning.  Sure enough I wasn’t dreaming this either; tests showed my hearing has deteriorated though is still in the mild loss range; inner ear cochlear deterioration so unrecoverable.  This is essentially the kind of loss most people start experiencing from around 60 years old on…except I’m not 50 yet! I suspect I’m paying the price for good times; a burst ear drum while scuba diving as a teenager and damage from standing far too close to speakers at Fabric nightclub a few years back (ok, so quite a few years ago now).

So I’ve been worrying and it’s completely natural to worry.  It is not helpful to dwell in worry or worry about things I can’t control so how do I let go of it?  Worry is something I have helped many clients with over the last ten years so it is definitely time for some self-help.  Below are the psychology tips and strategies I reminded myself to use. 

Psychology – Overcoming and managing worry

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What is Worry? How worry works.

Worry is a form of mental problem solving about potentially negative future events.  It can be triggered by a variety of external events or from thoughts that just pop into your head.  Worry is characterised by a lot of ‘what if’ questions. For example, ‘What if my Chemo doesn’t work?’  ‘What if my new boss doesn’t like me or think I’m good enough?’ 

Normal worry is usually short lived and leads to positive problem solving activities.  Worry becomes unhelpful when it is about several things, is frequent and difficult to control or dismiss.  We can think prolonged or frequent worry helps with problem solving, planning and preparation however worry breeds more worry (and anxiety) which prevents positive thinking and action.

Worrying can rob people of time. It’s exhausting and often leaves people feeling tense, with disturbed sleep, difficulties concentrating, and feeling irritable.  While sometimes it can feel appropriate or necessary, worrying is exactly the opposite; it’s restrictive, and takes up time, attention and energy that could be spent on useful, enjoyable and meaningful activities.  

Why do some people seem to worry more than others?

Worrying is human!  The causes of are not clearly understood though it may be that a number of vulnerabilities increase the chance of developing a tendency to worry excessively; prolonged stress, past experiences of uncontrollable or traumatic events, an inherited biological disposition to experience negative emotions, learned messages from others that the world is unsafe or that worry is useful, and a coping style that involves avoiding challenges or situations where there is a chance of experiencing negative emotions (which prevents positive experience of coping and positive emotions).

Managing worry. 

UNDERSTAND YOUR WORRY CYCLES – Understand your vicious cycles of anxiety and how avoidance contributes to anxiety.  See the handout below (CCI – Vicious Cycle of Anxiety).

NOTICE YOUR PAYOFFS AND COSTS.  Part of understanding your worry can be to notice if you are getting a pay-off from worrying, ‘buying into it’ and most importantly what the cost of the pay-off might be. Are you avoiding going out? You might get a pay-off of avoiding any negative emotions such as uncertainty of what will happen or be said when you see someone but you also miss out on the potential positive experiences; fun, laughter, connectedness or ease which going out may also provide.  Also notice, where do you worry and what are you doing when you worry. For example, are you sitting down and telling yourself ‘you are worrying but getting rest at the same time’.  Consider that your type of ‘sitting down’ in this instance is not truly restful and what it actually costs you is feeling rested.  If you shifted your attention away from worry to giving yourself permission for genuine rest, and allowed yourself to do something enjoyable without the worrying in that same time, you are much more likely to feel rested and relaxed (and be better able to cope with normal levels of worry that we all experience).

Other practical strategies:

USE A WORRY TREE to identify where to put your attention so that you shift your attention to worries you can do something about and form a plan for rather than worries you have no control over.  There is a link to a handout below

CHANGE “WHAT IF’ STATEMENTS TO ‘HOW’ STATEMENTS’. For example, instead of “what if Chemo doesn’t work?’ I might ask myself ‘How will I act if Chemo doesn’t work?  How will I find out what action can be taken next?’

POSTPONE WORRY.  This is where you give yourself permission to worry about a specific topic, at a particularly time later in the day, for a maximum duration of say 20 minutes).  This way you are acknowledging your concern and allowing yourself to think about it for a contained amount of time without it taking over and impacting the rest of your day.  Sometimes you may find the thing you were worrying about has resolved itself by the time the allotted worrying time has come around, or it looks completely different and isn’t as big of an issue as it seemed earlier or doesn’t have to be dealt with today after all. 

Summary

These are just some tips for managing worry and there are others if these don’t work for you. Remember, while worry is normal, excessive worry can be gripping and creep up on anyone.  Even when worry can feel like a good thing to do, it creates more anxiety.  When it stops you from enjoying life or doing the things you want to do, worry is not your friend.  Excessive worry can be overcome.  Please try the strategies outlined above and the links to helpful handouts below. If you find them hard to do alone, do talk with your GP or ask a psychologist to help with gaining treatment or to work through the strategies with you. 

 

Acknowledgements, Permissions and Helpful Handouts:

Centre for Clinical Interventions (CCI), Department of Health, Australia http://www.cci.health.wa.gov.au/

CCI Generalised Anxiety and Worry

http://www.cci.health.wa.gov.au/resources/infopax_doc.cfm?Mini_ID=46

CCI Vicious Cycle of Anxiety

http://www.cci.health.wa.gov.au/resources/docs/Info-Vicious%20Cycle%20of%20Anxiety.pdf

CCI Postponing Worry

http://www.cci.health.wa.gov.au/docs/ACF3D66.pdf

Get Self Help Get.gg – Worry Tree 

https://www.getselfhelp.co.uk/docs/worrytree.pdf

Images: Simon Hayward

© 2017 Janine Hayward www.psychingoutcancer.com.  All rights reserved.

May 2nd, 2017 by