Building a Healing Tool Box
Anne Coscarelli, Ph.D.
When cancer is diagnosed or a recurrence is found, the most common feelings are shock and anxiety. These feelings are often followed by anger, upset, concern, and a sense of being overwhelmed by the experience. Some people report going into a state of shock or numbness, while others feel revved up and ready to fight for their lives. There are a myriad of different responses, but most people have some kind of emotional response. While the details of figuring out the best and right treatment are often at the forefront of the experience, many people realize that managing cancer goes beyond their body’s cellular level to their inner core of mind, spirit and emotion. Everyone hopes that their cancer will be cured or arrested and we need to fully understand the importance of healing from the overall impact of the illness. Healing is a process that allows you to live as well as possible under the circumstances of the disease; it affects your experience of the illness and engages the mind, the body, the soul and emotions. When a patient engages in the healing process they have the ability to foster a sense of wellness and can discover ways to find meaning in their experiences. Overall, the healing process fosters your ability to live well despite having cancer. That being said, it does not mean that we do not face emotional upheavals or bad days or days without significant impact on daily function. Everyone, no matter how committed to wellness or gifted in their ability to find meaning, will experience alterations, changes and, sometimes, downright horrible times. However, when you engage in activities that promote healing you can focus on reducing symptoms, psychological suffering, and turning difficult experiences into meaningful ones. Living with cancer and its treatments can be challenging. But having tools to meet these challenges can make a significant difference in your experience.
After 25 years of working with cancer patients individuals in all phases of disease, I am convinced that everyone needs a “Healing Tool Box.” I like to ask patients to imagine a tool box--paint it whatever color you like, decorate it with any symbols you choose, imagine its many compartments—in which various tools are stored and new ones can be added to facilitate improving wellness, wellbeing, meaning and quality of life. Here are the tools I recommend for your “Healing Tool Box.”
Mind-Body Approaches
There is no question that cancer affects the psyche. It creates stress, anxiety, depression, and a sense of being overwhelmed. There are a variety of techniques that can be used to assist in managing these effects.
The Relaxation Response. Being able to create a relaxation response to counteract the stress associated with cancer and its treatment is a powerful and effective mind/body approach. The relaxation response turns down the sympathetic nervous system that makes your heart race and blood vessels constrict and can be brought about by a variety of techniques. Some of the most common ones include: self-hypnosis, guided imagery, progressive muscle relaxation, and all forms of meditation including Transcendental Meditation and Mindful Meditation. The Center offers a variety of ways to learn these approaches.
Cognitive Coping Strategies. Our thoughts influence how we feel. Our thinking processes can determine how we cope with an event like cancer and its treatment. Cognitive copies strategies provide a way to reframe your thoughts in a way that makes them less stressful and more hopeful. These strategies teach you to pay attention to your inner voice, to question your conclusions and even to alter the way you think. Recognize thoughts that increase stress, challenge them and then change them by substituting new ones. Reframing how we see things can make a world of difference. For example, when something difficult happens, try to see it as “challenge” and use that word, rather than calling it a crisis. A challenge implies that you can apply knowledge and skills and overcome or modify it while a crisis implies hopelessness, frustration and being unable to manage. By framing your experiences in these more hopeful and empowered ways you can change your emotional response and experience. It can be especially helpful to seek the services of a professional, such as a psychologist with cognitive-behavioral training, to help develop this skill to carry in your toolbox.
Process emotional experiences. We can all agree that cancer is a major life event for patients and family members. When you are able to process the experience, look at it from a different angle, share your feelings and develop your own narrative about the meaning of the experience you can often cope and feel better. There are many techniques to help you process your emotional experiences. For example, just talking about your experience, in and of itself, can be helpful. This can be done in support groups, with family and friends and with professionals, such as psychologists and social workers trained in the field of oncology. Writing about your experiences can also help to alleviate distress. Consider starting a journal where you write about the things that really bother you as well as the parts of your life that you value, appreciate and enjoy. For some people, writing poetry about the experiences can bring about the same healing effects. Sometimes writing a letter to an imaginary person, an old friend or someone that was once in your life can be a way to process the experience. You don’t have to mail it or send it. Do not be afraid to just write. Remember, you do not have to share your writings; they can be private. Finally, think about art as another way to process and express your emotional experiences. Here at the Center we have an art therapy group designed just for that and no art skills are required. I am amazed by the work that comes from this group and how healing it is for individuals who use this outlet. Using your creativity related to a traumatic event can be restorative.
Professional Support. Professional support from psychologists, social workers and psychiatrists─especially those who are well versed in the cancer experience─is an invaluable tool. We offer these services at our Center. Professionals can help you in a variety of ways. Sometimes all you need is a one-time consultation at a particular phase of your experience; or you may want ongoing support during the many different phases from diagnosis through treatment and beyond. Many people think that seeing a “shrink” is for people who are seriously distressed or disturbed. This way of thinking is outdated and only limits your opportunities. Having cancer creates an opportunity for rapid psychological growth in all aspects of your life and professionals with mental health training and cancer knowledge can serve as guides and direct you to resources. They can help you figure out solutions to problems that others like you have faced. In addition, they can help facilitate your cognitive coping, teach relaxation exercises and facilitate your journey of finding meaning. They can help you develop an overall coping strategy and help you resolve a myriad of issues. These types of professionals are often oriented toward helping patients and family members find their strengths, build resilience and increase mastery over the cancer experience. Our Center is staffed by compassionate and experienced professionals who can guide you through your cancer experience.
Social Support
Research supports the importance of having social support during the cancer experience. Peer support comes from those who have had or are currently going through the disease experience. It can be very helpful to have the opportunity to talk to other survivors or veterans of this disease and treatment. This allows you to normalize the experience, provide opportunities for learning and help manage that feeling that “no one else really understands except someone who has gone through it before.” Research also reinforces that social support can come from having just one person in whom you feel comfortable confiding. In addition, family and friends can provide all sorts of social and concrete support. This is a topic unto itself, but an important resource to assess, develop and strengthen during this time.
Complementary Approaches
In reality, all of the approaches discussed for a healing tool box are complementary to cancer treatments. However, there are some that have often been label as CAM (Complementary and Alternative Medicine) approaches. I have difficulty with “alternative” because I do not believe that cancer can be adequately treated without traditional western medicine. I also believe that practitioners who tell patients to avoid or limit their use of traditional western medicine tools─such as chemotherapy, radiation and surgery─are depriving people of the best treatments possible. That being said, I believe that there are many treatments that complement traditional western medicine and it is appropriate for patients to include these modalities in their healing tool box. These approaches can help with symptom management, help patients better tolerate treatments and procedures and to assist you in maintaining a sense of well-being through the process. These techniques can have psychological and physical benefits and include massage, acupuncture, dietary supplements, Qi Gong or Tai Chi and Yoga.
I strongly encourage anyone using complementary medicine to communicate with their physician─it is important that all the health professionals on your team know exacting what you are doing and taking. Our Center has a wonderful new Integrative Oncology Program that includes physicians with specific training in integrative medicine who help patients develop an individualized wellness plan to fit their situation and to educate and direct patients into appropriate complementary interventions. I encourage you to arrange an individualized educational meeting or participate in a small class before spending your resources on treatments that may not be helpful. I have known patients who take many supplements (sometimes more than 20 per day) only to find out that four or five high quality supplements would be more impactful and bio-available. As always, be careful in your selections. Remember to look at the source of your information. Ask yourself the following questions: What is the source of the information? Is the source credible and affiliated with a credible institution? Is the source objective and impartial or is it selling its own products or services? How much does it cost and what are you getting? Do they really understand your medical situation in addition to their own area of practice? Are they certified with an appropriate board? Are they required to get continuing education? Are they licensed? Asking these questions can help you assess whether you are getting good and objective information. Finally, let me caution you about practitioners who facilitate the myth that traditional Western medicine is part of a conspiracy to keep CAM approaches off the market. There is no credible evidence to support this. Every scientist that I know working in the trenches of cancer research is avidly pursuing better treatments and cures from all sources.
Nutrition
Nutrition is a very important part of healing. Through foods your body is nourished to be as strong as it can be. This is a confusing topic, because the messages changes with new research. While this is a huge topic with many resources to consult I would like to touch on a few key issues. Patients undergoing and recovering from treatment need a healthy diet with good sources of protein, 7-9 fruits and vegetables and whole grains daily. Seek consultation from experts in this area and be careful to carefully research your choices. At our Center we have two physicians with special training in diet and nutrition who are excellent resources. Be wary of fad diets that promote a particular approach to eating. Ask yourself if the data supporting these approaches is credible as well as verified by different sources. If the data is primarily anecdotal, question the approach. If anyone suggests that you can cure your cancer with just your diet (and some people do) find a new source. It sounds nice, but it is not realistic. However, if food is used as a supplement to treatment and important sources of protein, vitamins and minerals are part of that diet then you are more likely to be on the right track. I strongly recommend that nutrition be part of your “tool box.” Being appropriately nourished throughout treatment and recovery is important and your nutritional needs may be different during different phases of treatment.
Exercise
There is a long standing belief that being physically fit has multiple advantages to everyone. Sometimes exercise patterns need to change to accommodate the fatigue that often accompanies cancer treatment, but there is data that suggests that exercise can help with relieve this side effect. It is important to have both aerobic exercise (cardio-vascular exercise to get your heart beating) and strength-building exercise (to build and maintain lean muscle mass). Exercise can also reduce anxiety and depression. Don’t give up exercise; look for ways to tailor it to your current circumstances.
Symptom Management
A healing tool box should have resources to manage symptoms such as fatigue, pain and nausea. Sometimes some of the same tools that alleviate anxiety and stress can also manage these symptoms. For example, fatigue is often managed by complementary approaches such as yoga and exercise. Pain can be managed by a variety of medications, but some of the mind-body approaches also have benefits. Combining modalities can be beneficial and it is important to talk to your physician about your symptoms. Some of your complementary practitioners may be able to provide additional advice about these symptoms as well.
Inspiration/Hope Builders
Hope, an ongoing process that evolves time with different goals, is an essential part of living. I believe that hope is an essential ingredient in all healing. While the story of Pandora in Greek mythology is one which is debated and told with different meanings, it provides one inspiring thought about hope. When Pandora opened the container releasing all of the blessings and curses, the one blessing that remained was hope. The premise is that we mortals cannot endure without hope. Inspiration and hope can come from many sources and it is important to tap into these sources to find ways to nourish one’s hope through the process of cancer. Sometimes special quotes can be motivating during this process and I have known patients who have collected various sayings and quotes. Some have done it on post-it notes that they place around their environment while others have chosen a journal to log in inspirational and hope building words, phrases and stories. Hope is not just focused on the process of cure, but may be redefined throughout the illness. Hope must be nourished.
Spiritual Resources
Each person will seek spiritual resources in different ways. For some it is their specific religion and faith community that can assist with the questions that arise and healing. If belonging to an organized religion is not part of your world view, there are still many spiritual questions and answers that can be found. One of the most important aspects of spiritual healing is finding a way of making sense of and finding meaning in the experience. Remember that others do no have to share your spiritual journey; it can be a personal one. The medical center has chaplains as part of our team and they can help you in your search for meaning and healing. Others may find spiritual healing in their contacts with nature or meditation practices. Spirituality is highly individual and personal for each of us; it might be an important part of your individualized tool box. I encourage each of you to be open to new possibilities that can lead you on different, yet meaningful pathways.
Information Resources
Information is critical! Know where to get access to good information. Seek reliable and credible resources that provide science-based evidence. If you do not know where to go on the web, look at our website, www.CancerResources.mednet.ucla.edu and access some of our information resources and community sites. Remember that just because something is written -- on the web, in a book, or in an article -- does not make it true. As I mentioned before question the information you are getting and who is providing it to you.
Escape Hatch
Every toolbox needs an escape hatch! There are times when everyone needs a vacation from cancer. It is sometimes a mini-vacation, but it is still a chance to get away, to be distracted. Hopefully your escape will involve activities that are fun, rewarding and will lift your spirit and mood. Many of the options discussed for this tool box have a dual value. For example, a massage may be an escape, but it may create relaxation, reduce pain, and lift your mood. Going to the movies, playing cards, and visiting with friends are also forms of distraction, often fun and involve social support. I encourage patients and caregivers to have a list of escapes, great and small to turn to in the toolbox.
Anti Anxiety/Depression Medication
Medication for anxiety and depression is another tool that is sometimes overlooked. Many patients have negative perceptions of these medications and refuse to use them because they believe that they should be able to manage without them. Some of the frequently cited reasons include being on “too” many medications, being worried about becoming dependent, or feeling that using them is a sign of weakness. If your doctor suggests a trial on these medications and you find yourself resisting for these or other reasons, reconsider. These medications can be an important tool for many people can be protective of your neurochemistry and mood. They can also help even out some emotions, facilitate sleep, or reduce reactivity to stress. Consider making an appointment with a psychiatrist to discuss which medication would be the best one for your symptoms. Further, psychiatrists often start patients at low doses, working up to therapeutic levels slowly and monitoring any side effects to ensure the medication is helpful for you. A UCLA psychiatric researcher has reported evidence that supports giving an anti-depressant medication for at least three months to determine its value. You don’t have to take these medications forever, and many people go off of them as they adapt or get through their treatments. If you have a pre-existing history of depression, then these are necessary tools for your healing toolbox.
Lock for the Computer
There are many times when patients and family members go to their computers seeking information, reassurance or help with their cancer and treatment decisions. In turn they come away feeling overwhelmed, stressed and over-stimulated. When you are in the middle of this process it’s hard to recognize that the computer may be adding to your stress. It can often feel like you are getting “more knowledgeable.” Every now and then, put an imaginary lock on your computer, step away from it and give yourself some time to be away from it. Give yourself permission to walk away, put your quest for information in the hands of the professionals who know your individual situation and use your time to turn to other healing tools.
Trash Can
Everyone’s healing toolbox needs a trash can. Yes, a trash can. The trash can is a place to dispose of tools, information, thoughts and advice that are irrelevant, unwanted, or not useful. We always have unwanted thoughts and feelings that come along with this experience; it is essential that we can imagine ourselves dragging our unnecessary emotional and intellectual “stuff” to the trash can and disposing of them. A trash can is also good for the tons of advice that you will receive along the way that does not apply to you, is not solicited and wanted or just is not accurate or relevant. Throw it away. Do not forget to empty the trash can now and then and do not allow yourself to rummage back through it. Keep your trash can handy.
Summary
Let me close with a wish that everyone who reads this will start to build their own healing tool box. We are here to help you with this project. Feel free to access our resources. Let me leave you with an inspiring quote from Mary Anne Radmacher,
“Live with intention Walk to the edge. Listen hard. Practice wellness. Play with abandon. Laugh. Choose with no regret. Appreciate your friends. Continue to learn. Do what you love. Live as if this is all there is.”
Anne Coscarelli, Ph.D.
Wallis Annenberg Director’s Initiative in Psychosocial Oncology
© Anne Coscarelli, Ph.D. All rights reserved.
For reprint authorization, contact SimmsMannCenter@mednet.ucla.edu.