Anxiety - The See-Saw of Fear

‘None of us will ever forget the earth-shattering day when we were told ‘it’s cancer’. From that day, things change’.

 

In women who have all been diagnosed with breast cancer you might expect our experience of anxiety to be high. Discussion on anxiety in BRiC loom high. We have all experienced anxiety in some form or another, either throughout our lives or since our diagnosis. Anxiety around recurrence (for those with a primary diagnosis) and progression (for those with a secondary diagnosis) is never far away. Every pain we experience, every test, scan, routine mammogram, produces anxiety. A cancer diagnosis may trigger anxiety caused by earlier trauma, which we may previously have suppressed or coped with well.

 

What does anxiety feel like? A racing heart, sweating, butterflies, a fuddled head, an uncomfortable adrenalin rush. Gut churns, tummy knots, heart palpitations. A feeling of hot and cold that washes over us from head to belly and back again. Some of us have an urgent need for the loo, others are physically sick. Panic attacks can be the result of anxiety and often occur with no warning, in the most ordinary of situations. They can be frightening and debilitating, and the anxiety grows and fuels the fear, so that we don’t want to go out in case it happens again. Anxiety can make a huge dent in our self-confidence, and can affect our work, our relationships, our social life.

 

Anxiety can also be exhausting, sapping our energy. It can manifest as rashes, rosacea, fire on the skin, tinnitus, headaches and other aches and pains, fatigue, procrastination and insomnia. We may feel faint or pass out. We may feel emotional, on edge, tearful. We may feel we are doing fine and then our symptoms creep up on us or suddenly appear. Feeling very unwell due to anxiety may be connected to our bodies letting us down at various times in our lives, not least our cancer diagnosis. Many of us are aware of a low-level undercurrent of anxiety which we ignore, we are good at coping, just getting on with it, but at what cost to our mental health? Some of us grew up in a family where expressing our emotions was frowned on, and this can affect how we cope in our adult lives. Severe anxiety can make us feel we are alive but not living. Ongoing severe anxiety can cause physical illness including weight loss.

 

Some of us mentioned that our anxiety hits us at inappropriate times, perhaps while we are at work, and we have learnt to shut it away. However it will appear later, and sometimes will be stronger after a period of denial. We may find we have flashbacks to our treatment, and our fear is always at the back of our minds. Anxiety makes many of us feel weak and helpless, and it’s hard to remember that our anxiety is not our fault. Some of us feel most anxious when we wake in the morning, and this might be very early, or late at night preventing sleep. We find it hard to summon up defences at this time of day. It takes a strong resolve and huge self-compassion to face the day with courage when we start it this way.

 

Many of us take on the worries of others as well as our own, particularly within our families. We find ourselves experiencing anxiety about their problems. We may also find that our loved ones have no patience with our anxiety and don’t understand. ‘What became apparent was that people understood the impact of cancer more than they did anxiety’. Many of us worry about how our loved ones will cope without us, particularly pertinent for our women with secondary breast cancer. Focusing on the present can help us to get past this. Practising control over the things we can control and accepting and letting go of what we cannot is a useful mantra.

 

Lots of us have come to terms with the fact that we are natural worriers, and a light-bulb moment may be when we accept that it’s ok to worry. This recognition can help us to take steps to alleviate our anxiety. If we acknowledge how we are feeling, we can then ask for help. Groups like ours can really help us to realise we are not alone.

 

Naz explains the way the brain adapts to persistent fear, preparing the body to expect danger and meet it, triggering the primitive flight or fight response - to run, to fight, or perhaps freeze. We are, by default, vigilant. She used the image of a see-saw to explain the way the cognitive and emotional brain systems interact. At one end of the see-saw, in an anxious state, the emotional system dominates and weighs us down. At the other end of the see-saw, the cognitive system lets go to prevent becoming overwhelmed. Resilience can strengthen the cognitive system to gain weight as it moves towards calm and rational thought, allowing the see-saw to swing back into balance. This is not about numbing, controlling, or avoiding, but a robustness which promotes neural plasticity and supports good communication between the cognitive and the emotional brain systems. Resilience helps us to bring flexibility to the see-saw. It is a key adaptive factor in coping, indeed to survival, and Naz’s research is highlighting the possibility of building a ‘cognitive vaccine’ to protect against the damaging effects of anxiety.

 

Here is ‘the science bit’, copied verbatim from Naz’s introduction. It adds illuminating background to the discussion and deserves to be read in full by a wider audience as it was so helpful to our members.

 

Understanding anxiety and how to manage it. (Naz)

 

According to the World Health Organisation, anxiety and depression are the biggest disabilities worldwide. In an era where we are washed with therapeutic techniques, and all kinds of ‘tips’ this is highly worrying. Personally, I think it is largely because we haven’t taken time to understand the nature of our anxieties, why they are there and how they affect us.

 

The first book I ever read on ‘Anxiety’ was: “Understanding Stress and Anxiety” by the late Charles Spielberger (the father of Anxiety Research) whom I was fortunate to meet and receive the Young Scientist and Early Career Award from, back in the early 2000s from the International Society for Research on Stress and Anxiety. I was 13 when I read his book, the first of dozens I ended up reading, and it was then I knew that I wanted to do a PhD on Anxiety. I have since spent over 25 years studying Anxiety, its origins and nature, its neural underpinnings, and its behavioural and physiological manifestations.

 

Anxiety is a prolonged response to acute as well as chronic stress, some say its “prolonged fear”. It is fuelled with uncertainty and a main feature of it is worry. Many physiological responses come with anxiety and these can persist even when the source of stress isn’t there, this is mainly because the brain processes threat really quickly outside of our conscious awareness. So the experience of anxiety can be triggered unconsciously. Anxiety is not something we can easily control or put a lid on. It is the result of an interaction between the stressors we experience, our coping strategies (e.g. avoidance of anxiety can backfire and intensify it), as well as the level of control we have over the situation and the stressors we experience. It is also a result of a long learning process of how we have responded to stressors in the past. In large amounts, anxiety can be crippling, and prolonged anxiety is known to lead to depression.

Counter-intuitively, anxiety is a protective response, its origins are there to protect. So, some anxiety is good, it's beneficial, it can protect us from danger, fear can motivate us. It is saying that we must do something about the situation. The brain responds to fear really quickly because of its survival value, it has a preparedness to process danger.

 

When we have little control over what we CAN DO about the situation we are in, anxiety exacerbates, the intolerance of uncertainty fuels anxiety, and we can experience unnecessary escalating levels of anxiety. When we are diagnosed with a life threatening disease it is normal to feel anxiety, and we live in the anticipation of the ‘what ifs’, when we have little control over the outcome. Research shows that breast cancer increases risk of anxiety significantly. A balance needs to be in place to regulate our anxieties so that we can experience them in moderation. Scananxiety is a big one, then there is the wait for the results, there can be relief or increased apprehension depending on the results and I’m sure you can come up with more examples.

 

If, like me, we have a predisposition to experience anxiety (either through traumatic experiences of the past or the like) then we are likely to experience anxiety provoking situations with greater intensity. Generalised anxiety (or free floating) can at times be debilitating. People who have a tendency to worry, feel anxious without being able to pin down the exact source of anxiety – this is much harder to manage.

 

Balancing anxiety is a tricky act. There are lots of therapies and tools we can use to our advantage to relax, in essence what we are doing is targeting the symptoms, not the cause as the cause is hard to tackle and often a mixture of things. There is no right or wrong way but a good behavioural approach can help. Consistency in how we tackle anxiety, acknowledge it, take time to understand it and how it is affecting us is important. Dampening it or avoiding it is not helpful, because it has emerged for a reason! Mindfulness meditation if done systematically can lower anxiety, so can cognitive training as we are building our cognitive systems to regulate our emotional brain systems. In fact research shows that both cognitive training and mindfulness-based meditation interventions independently can lower anxiety related symptoms longer term.

 

If we f    eel anxious, we do not need to beat ourselves up for not being able to cope, far from it, it is when we need to love ourselves more than ever, be kind to ourselves and each other and not judge. We can be broken, we can be hurt, we may not be able to access our resources and we may be lacking in resources. It is not our fault. It is ABSOLUTELY NOT OUR FAULT.

How to Cope with Anxiety

Our strategies and coping mechanisms were wide ranging and include the mindfulness and meditation. We talk to counsellors, therapists, friends. We learn CBT techniques and undertake inner child healing. We receive and practice Reiki. We practice yoga, focus on our breathing, visualise and take ourselves to a safe space, finding fond memories of when we were happy and safe calming. Aromatherapy helps to relax us. We go outside and find nature and fresh air revives us. Tapping is a useful tool for some. Reminding ourselves that anxiety is an ongoing process is also useful, it comes and goes. In mindfulness terms, this too shall pass. Although of course it may also return another day. Medication also has a place in helping us to feel better.

 

Many have had ongoing therapy to address trauma, which can be very helpful. We may learn that avoidance fuels our anxiety rather than calms it, and we can try to face our fears by asking ourselves: what’s the worst that can happen? Life can prove to us that what we worry about often does not come to pass. However, anxiety can still dominate even after we have learned about our triggers and after we have practised alleviating strategies. Our subconscious brain brings us more anxiety, and we may have no idea where it’s coming from.

 

Some of us have tackled anxiety by challenging ourselves, by facing our fears. However when we do this we may find that although we get through the activity that makes us anxious, it doesn’t make it easier the next time we do it. This means that some of us see avoidance as a perfectly valid strategy in some situations. We seek to understand our anxiety and when it arrives one day without warning, for no apparent reason, we are frustrated not knowing what’s going on. On another day we feel ok and function without undue anxiety. Anxiety does not seem to present itself consistently or logically and this can make us feel stupid and out of control.

 

Practising self-compassion and self-kindness can be very useful with anxiety. It helps us to realise we are not weak or useless, our anxiety is not who we are. Perhaps we must try to live alongside our anxiety, even befriend our anxiety, rather than searching for a fix. We can learn tools and techniques, we can work out our own life lessons through counselling or experience. Fighting against our anxiety is common, we start to think there is something wrong with us, we may have been told this in our past. We want to make ourselves ‘right’ and we don’t know how to do this, despite our learning, and so we end up more anxious. In these situations, recognising when we are being hard on ourselves is key.

 

In BRiC we have shared our coping strategies: mindfulness and meditation, deep breathing, practising realigning thinking by keeping an emotional diary, simplifying our life by reducing responsibilities where possible, taking time for ourselves and practising self-compassion and self-soothing. Hobbies, exercising and being outdoors and in nature can also help. One suggestion was to focus the attention on something else – drinking a cool glass of water through a straw with closed eyes. Another was to embrace our anxiety as one would comfort a fretful child.

 

A question was whether breast cancer had caused or heightened our anxiety because we face our mortality or whether, because it leads to a change in our values, an increased sense of what’s important to us in our lives. Letting go of things that are no longer important and discovering who are in the aftermath brings another set of challenges.

 

We are changed by cancer. We can never ‘get over’ it. We can learn to live alongside it in some sort of harmony, with the see-saw constantly moving, but gently tilting back towards equilibrium as we practice self-care.