Ask CancerCare

A. Experiencing anxiety is very common among cancer patients. For some it occurs when they wake up and become conscious of another day, and for others, as they try to drift off into sleep. You mention three concerns, which trigger anxiety as you're trying to fall asleep. The first is turning off the lights. The second is the fear of dying from your cancer. The third is wanting to have your affairs in order.

The dark can be an especially scary place for people facing a life threatening illness. Absence of light is a metaphor of the darkness of unknowing. Try behavioral modification, by putting down the book, and relaxing into your pillow with the light on. Like a child who sees monsters in the dark, turning on the light, even dimly, can provide comfort and a sense of control, allowing you to relax and fall asleep.

Your second concern, fear of dying, triggers a fight or flight reflex, hardwired into all of us for survival. Using mindful meditation, focus on your breath while non-judgmentally looking at your thoughts when your mind wanders, especially thoughts of worry. When you feel anxious, gently guide your focus back to your breath. Breath, specifically oxygen, is life, which fuels us, and aims to keep us in balance. Anxiety makes us take shallow breaths depriving our body and mind of oxygen and making us more anxious. When anxiety is acute, take a deep breath, hold it for a comfortable amount of time, then release it, and repeat. You can do this for a few minutes or until you fall gently to sleep. You might also try listening to a pre-recorded guided imagery exercise, if you have difficulty meditating on your own.

Finally, thinking about unfinished business, especially if there is a perceived deadline, often makes people anxious. Putting one's affairs in order does not mean giving up on life, it simply means taking care of, and continuing to invest in our lives. With the worry of cancer it can be hard to focus on individual tasks, thereby increasing one's anxiety. Try writing down the things you need to take care of, and then prioritize them. Use creative visualization, by imagining yourself doing and finishing each task, and enjoying a sense of accomplishment as each task is completed. These visualizations can serve as a first step and hopefully increase the likelihood of completion, which in turn can free you of the worry that is keeping you awake at bedtime.

A. There are numerous ongoing studies in the field of mind/body practices indicating that reducing stress can positively affect one's immune system. One theory is that the mind and body communicate through vibration. Simply put, we are all vibrating: from external sources such as the sun, television, satellite and cell phone signals, and from internal sources such as breathing, talking, hearing, digesting, and thinking. Dr. Candace B. Pert, a pharmacologist and neuroscientist and author of Molecules of Emotion: The Science Behind Mind-Body Medicine (Simon & Schuster) examines how the immune, central nervous and endocrine systems are communicating (or vibrating) back and forth all the time. Her book also addresses such questions as: Where do our thoughts come from? How do we store and retain them? How do we transmit these thoughts throughout our bodies to maintain the conscious and unconscious actions necessary to regulate our bodies?

Another excellent guide is The Healing Power of Sound: Recovery from Life-Threatening Illness Using Sound, Voice, and Music (Shambhala Publications) by Dr. Mitchell L. Gaynor, an oncologist who explores the science of vibration and offers practical exercises for harnessing sound as a relaxation technique.

In my work with cancer patients and families, I have found that vibration exercises can sometimes be more effective for some people than meditation or imagery in offering moments of peace and calm during the stress of illness. One of the exercises that I introduce to my clients is drumming. The repetitive beating of a drum with a mallet becomes an active mantra and an expression of emotion. Over the course of 10 or 20 minutes, the vibration emitted by the beating begins to break down the tensions of the body that can cause stress. There are many sounds and instruments that people can use, but percussion instruments tend to have a more vibrational resonance that can be felt physically. Drumming, alone or in a group, can be especially helpful for creating a sense of relaxation.

In pursuing mind/body practices, it's important for each individual to choose a technique that will be helpful to them.

A. We've all heard the saying, "We are what we eat." No one disputes that since it's apparent the food we put into our mouths replenishes cells and becomes our physical bodies. Less commonly heard is, "We are what we think." This is because it is much less apparent what direct impact our thoughts play in our well being. Unlike food, which can be quantified and controlled, our thoughts are affected by external sources often outside our control including people, places and things. Now, the growing field of psychoneuroimmunology (PNI) shows that the mind and body are constantly communicating, back and forth.

If negative thoughts come up for you in managing your cancer, guided imagery exercises can help you counter them with positive thoughts, so the body can be more relaxed. One imagery exercise is called Creative Visualization, which is used in sports psychology, business and other areas where people confront challenges. It's a simple technique that uses your imagination to envision an event as you would like it to happen.

Before receiving a chemotherapy treatment, you might take time to quietly sit and visualize how you would ideally like treatment to go. It helps to think about details such as what clothing you're wearing, how the weather feels, or where you'll be sitting or lying when you get your treatment.

During your treatment, you can continue to visualize the chemotherapy (or radiation or surgery) as it travels through your body and "confronts" the cancer cells. Use your imagination: employ super heroes (yourself or others), ray guns and magic wands, or loved ones providing comfort, hope and strength to defeat the cancer. This technique can ease the mind's tendency to worry and help you focus on "rallying" healthy cells and the immune system to defeat disease.

If you have difficulty coming up with your own Creative Visualization exercise, it might be easier to listen to a pre-recorded Creative Visualization exercise. You can find a large number of CDs and audiobooks on this subject by doing a search (using keywords "guided imagery" or "creative visualization") at Barnes and Noble. Also, a good book on the topic is Creative Visualization: Use the Power of Your Imagination to Create What You Want in Your Life, by Shakti Gawain (New World Library Publishers).

A. Yours is a common concern among cancer patients and families. To survive and live productive lives, human beings are equipped with a full range of emotions. Anger, joy, hope and fear are just a few of those, all of which are appropriate to different life experiences and necessary to the process of taking care of oneself. It is natural that anyone who hears the words, "you have cancer," will experience feelings of fear. Allowing those feelings to come out is part of the healing process; to deny them can cause more internal stress.

A member of a young patient group once said, "I'm a realistic optimist. I'll do everything I can to beat cancer, but I also want to learn to live with the knowledge that I don't have full control." To blame oneself for a terrible disease is not helpful, and to try to be only positive during a crisis is a form of denial, and can repress valid feelings that need to come out.

A simple mind/body technique called "Mindfulness" or "Insight Meditation" is a two-part meditation using the breath as a point of focus for the mind, that can help you acknowledge in a non-judgmental way the full range of feelings, both physical and emotional, that can arise. When we have a negative feeling, physical or emotional, there is the tendency to attach blame to it, thereby doubling the suffering. Mindfulness simply recognizes and observes the feeling, letting it happen without being pulled into it. Through Mindfulness, you can embrace that staying positive in the face of cancer includes recognizing and validating all the feelings that you experience as necessary toward your personal healing.

The benefit of mindfulness meditation is that it can be done sitting quietly at home, at work or during daily activities.

Two books on Mindfulness Meditation you may find helpful are Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life by Jon Kabat-Zinn (Hyperion); and Get Out Of Your Mind And Into Your Life: The New Acceptance and Commitment Therapy by Steven C. Hayes (New Harbinger Publications).

A. Anxiety is a natural emotional experience in everyone's life. When someone confronts a crisis like a cancer diagnosis, anxiety (or worry) can become acute, intruding on an individual's ability to regain a sense of calm, clear his or her thoughts and feel more control over the issue at hand. Chronic anxiety can lead to fatigue and depression over time, so it is important to find techniques that can offer relief from the stress of cancer, even if just for short periods of time.

When confronted with crisis, our bodies trigger a "fight or flight" response. Part of this physical response is rapid, shallow breathing, which increases blood flow through the heart and puts extra oxygen into our bodies. A person under chronic stress will continue to take shorter, more shallow breaths, which will in turn make the stress worse and create a continual state of anxiety.

Here's a simple breathing exercise that can calm your mind and offer respite from the anxiety of a cancer diagnosis:

• Sitting down, place one hand on your chest and the other over your navel.
• Take three breaths and observe your breathing. For most people, the chest area tends to rise more than the abdomen.
• Now, take in a deep breath and extend your abdomen. Picture your lungs as long, narrow balloons, filling up from the end to the front; and from the bottom to the top.
• Hold the breath and silently count to five; then, exhale loudly.
• Do this for three breaths and then sit quietly for a moment. If you feel lightheaded, hold the next breath for a shorter time. Most people find there is a calming feeling that follows.

The beauty of this exercise is you can do it anywhere, anytime. The goal is to reduce stress by returning yourself to a natural state of breathing.

You can find more relaxation techniques in CancerCare's new fact sheet, Relaxation Techniques and Mind/Body Practices: How They Can Help You Cope With Cancer.