Calming Strategies for Anxiety

 

‘I took a deep breath and listened to the old brag of my heart. I am, I am, I am.’ Sylvia Plath

Our discussions have focused on strategies that our members have found useful to calm themselves, both in times of stress and generally in the day-to-day. We have confirmed that anxiety may be a major problem following a breast cancer diagnosis.

    Naz explained what happens to our brains when we take a moment, sit down and breathe. Our neural networks are highly active when we are busy doing things, occupied with thinking, remembering, attention, decision making and so on. When we stop and ‘do nothing’ our brain is just as active, but it’s our default mode network (DMN) that takes over in this state. 

    Its job is to make sense of our experiences, to process what has happened and what it has learned. This is essential for our survival. If our DMN didn’t do this for us, reaching homeostasis, we would be continually overwhelmed. It makes sense that if we encourage our DMN to engage by being still, then we will cope better when we are busy. Meditative breathing induces calm into the body and mind via a two way exchange of relaxation signals. Practicing being calm means we’re better able to calm ourselves at will.

    For many, seeking a calm state is part of a general desire to look after ourselves. Calming activities that we’ve shared include movement, activities such as walking, running, yoga, Pilates, cleaning and gardening. 

    For those too unwell to move much, then simply getting outside into the fresh air helps. Activities such as reading, watching a film, listening to music – all can be both distracting and calming. 

    Occupying the brain whilst resting the body is an essential part of healing. Knitting, crochet, doing jigsaws and colouring are absorbing soothing activities that many women find helpful. Visualisation is seen as a useful tool, particularly as a distraction during treatments such as scans. Many enjoy being in nature and imagining a beautiful place can be very relaxing.

    Specific calming exercises recommended by our members include breathing exercises of various kinds (e.g. alternate nostril breathing, box breathing, the three minute breathing space) and some have tried sipping ice old water very slowly which works as a mindful activity. Grounding exercises include things like rubbing our thumbs together to feel the lines, and stopping what we are doing to observe and be mindful of our bodies and our surroundings. Some women find their faith helpful in keeping them calm.

    Not everyone finds focusing on the breath helpful. One of the problems with classic meditation is that focusing on breathing leaves the sub-conscious brain free to roam. Following trauma such as breast cancer, this may interrupt our attempts at becoming calm by presenting intrusive troubling thoughts. 

    For some women this makes them feel overwhelmingly sad and leads to overthinking and dark 'worst case scenario' thoughts. For this reason some women may choose distracting relaxation over sitting in silence. Playing an instrument, singing and listening to music provide pleasure, and require concentration which focuses the mind and relaxes it too. Some women like calming neutral music (it may not be a good idea to play songs that are associated with memories) but others prefer something heavy and loud which they find dispels their worries much better.

    Taking part in activities where we are out and about meeting others can help us to feel more confident, which can assist in alleviating anxiety. Several of us sing in a choir and many belong to groups to practise their hobbies and suggested classes or workshops in improv comedy and laughter yoga.

    An exercise in gratitude was mentioned which many women find helpful: listing three things each day we are grateful for, or perhaps keeping a gratitude diary. A good cry is a great stress reliever too.

 

Our anxieties coming out of lockdown: BRiC's Collective Voice

 

The topic for a recent Sunday night’s discussion suggested by our lovely Anita Traynor, focused on how we feel about, ‘coming out of lockdown’. Naz led the discussion by sharing her personal reflections as we explored our thoughts and opinions on the topic.

Lockdown has played an important part in protecting our well-being and in doing so it’s also ‘over-protected’ our social life and social connections as well as our relationship with the outside world. Anxiety about whether it will ever be the same again, anxiety about whether we will hit another wave and go back into lockdown, the fear of whether we will be exposed too much and become vulnerable, and anxiety about social interactions and how they will 'look'. A lot of us have changed the way we work and study, so there is the uncertainty hanging over what it will look and feel like should we go back to the way 'things were'.

Some of our members had mixed feelings about all this, whilst many of us felt a nervousness, some members actually were not anxious, as all they seemed to hear was how scared people are. There was a common understanding around this as it has been one ‘heck’ of a year and the situation is set to continue for some while yet, as described by a majority of us.

Many of our ladies have made plans and need the ‘taste’ of normality in order to look forward to the future with optimism.

A number of our members have become much more solitary and the loneliness has had a significant impact on our mental health and well-being, we acknowledged similar feelings when we went through our breast cancer journey, however we found that trying new things like meditation, arts and crafts, experiencing the beauty of nature has helped us cope better.

We are worried about resuming ‘normal’ life as some of us don’t wish to go back to how busy life was before the pandemic, and have made firm decisions to learn to say ‘no’ to too many social engagements, as many of us are most comfortable and safe in our own homes and familiar surroundings.

Some of us who are keyworkers have travelled to work throughout the lockdown despite restrictions in place. Seeing patients has been tough for nurses; the anxiety around having to start organising clinics for patients and the fear of how safe we may feel is going to be a challenge.

Many of us are excited and looking forward to seeing our families, friends and colleagues. We yearn to hug our nearest and dearest, the laughter, the touch, the sharing of emotions and face-to-face meetings. However it may not come naturally and may take some time to adjust to a ‘new normal’.

The sadness around not being able to be with others during their hour of need, not being able to be together at funerals to support each other and missing many milestone events like, weddings, birthdays, new babies, graduations and the list goes on. But we have been fortunate enough to have had the internet technology we have nowadays, which has let us connect with our loved ones and mark these occasions differently.

We sometimes bounce between two opposite views. Sometimes we are desperate to get back out into the wider world, eating in the restaurants, travel, theatre, going to the cinema, seeing friends and on the other hand we feel anxious about whether we will ever feel safe in these types of surroundings.

Whilst some of have had the option of working from home, we now fear the pressures of employers wanting us to return back into the office. We are experiencing negative thoughts, like, will I be safe? Would they accept me? Can I still do the job? We need to be open, honest and share how we are feeling, which can be a challenge, so therefore circumstances make us feel trapped.

The rollout of the vaccination programme which is in place gives us hope and a sense of protection, that our fears will subside in time, as we learn to live with the virus and also have some kind of freedom to do what we enjoy.

BRiC's Collective Voice: Overthinking and how to Overcome it, April 2020

“Let It Go” – BRiC describes Overthinking and how to Overcome it.

In our recent Sunday discussion, we shared our experiences of overthinking the past (also known as rumination) and our fears about the future (also known as worry). We talked about how breast cancer has affected our thinking and how we react in the current climate when uncertainty over COVID19 impact can breed our overthinking.

We shared how overthinking can sometimes get the better of us, that we wake up at weird times in the night and get stuck in these repetitive negative cycles of thinking, how it can interfere with our sleep. Some of us described its effect as paralysing, holding us captive, how it can lead us to self-blame and grieve over our actions; make us feel low in self-esteem and confidence.

Some of us thought we had a predisposition to ruminate about the past, and/or worry about the future, because of our childhood experiences, and learning to feel guilty and self-blame. Having breast cancer also increases our tendency to overthink. Of course these tendencies are even more alive in situations where we feel alone and are in self-isolation. Yes, we have a lot of time to think and overthink, fear the future, and detail what we could have, or should have, done better.

Research shows that overthinking the past is one of the biggest predictors of later depression, and worry closely tied with anxiety. Interestingly, rumination discriminates, it is more prevalent in women than men.

A lot of our research shows that when we get stuck in cycles of negative thinking we are using up quite a bit of our cognitive resources that would have otherwise been used more efficiently getting stuff done. So, overthinking can slow the brain down, making us inefficient and sluggish. While rumination and worry can be natural responses of the brain, when they get excessive they become interfering, and circumstances which breed uncertainty and lack of control over our immediate situations can enhance our tendency to worry and ruminate. The brain is trying to make sense of what is happening.

What tips can help manage overthinking and help us gain some control?

We discussed that if we acknowledge it, give it some space, then it is less likely to dominate us. While this may sound counter-intuitive, as we would immediately want to fight it and push it aside, it can actually make our thoughts less threatening. Some of us have developed a laid back approach, others have found meditation and fresh air helpful. Structured breathing has also helped. Finding resources to be grateful and count blessings were also mentioned as useful strategies.

Our brain has an amazing capacity to learn and to adapt because its ultimate goal is to help us survive in the most effective manner. However when our brains respond, with fear, with overthinking, with sadness and so forth, they are signalling emotions that are critical to our experiences to our being as humans. The strength we want is to be able to embrace them and listen to them, perhaps let go of their controlling forces because then they may not be so loud once they are heard, they may not be so threatening when they are embraced, and we may not need to overthink, when we have accepted.

If you are a woman in the UK affected by breast cancer and would like to join our private support group please leave your name in the comments or message us.

With love #BRiCteam

#breastcancer
#secondarybreastcancer
#metastaticbreastcancer
#mentalhealth
#resilience

BRiC's Collective Voice: Uncertainty, and how we cope with it, Jan 17, 2020

‘Confronting, accepting, even embracing fear, according to research, can lower uncertainty. ‘

This week we talked about uncertainty since breast cancer: how it can affect us and what strategies we’ve found useful in managing it.

A key flash point for uncertainty is once active treatment for primary cancer is finished and we are no longer attending regular appointments which give us momentum in attacking our cancer. We have time to reflect and to worry. The enormity of what we’ve experienced sinks in and we wonder what we can do to prevent recurrence or spread. Cancer does not discriminate, it pounces on those who run marathons and eat their five a day just as regularly as it seeks out those who are not as healthy in their diet or as active. We realise that our future is outside our control, and this brings feelings of guilt, why me? And what if? If we are living with secondary cancer, as many of our members are, then stability versus progression becomes our uncertainty.

One of the most uncertain times in a breast cancer diagnosis is when waiting for test results. We have all experienced the agony of this, and a few days or weeks can seem a very long time. Once we know, the uncertainty of what’s next reduces and we can get on with whatever treatment our medical teams recommend to us. Some of us like to take control by questioning and researching our treatment plans, seeking the very best way forward for our particular situation.

How can we minimise the effect of uncertainty on our mental wellbeing? For some, distraction is the key, keeping busy, with work or other activities. The downside of this is that relaxation may become difficult as intrusive thoughts ruin any attempt at taking a break. For others, peaceful reflection, mindfulness and living in the moment helps. Walking in nature and creative hobbies are absorbing popular pastimes. To realise that everything is ok in this moment, right now, works for some, but for others the uncertainty simply overwhelms the present moment. Talking about our fears and sharing experiences helps many of us. Confronting, accepting, even embracing fear, according to research, can lower uncertainty. The brain is so powerful, and the more we allow our vulnerability in and think of it as an opportunity rather than a threat, the more we can shield ourselves from the anxiety inducing effects of uncertainty. For those of us prone to anxiety, the added uncertainty of a breast cancer diagnosis has the potential to be be crippling, but many of us take a pragmatic approach and ‘just get on with it’, not allowing fears related to cancer to add any extra weight. Some of us feel angry and bewildered, and increased anxiety can lead to depression. If we can turn these strong emotions to our advantage we can find a strength and determination to change our lives for the better.

Self-care is an aspect that we embrace in our group, and members report that this attention to our own needs and wants is key to our wellbeing. Some of us make a lifestyle change following cancer, as this can help us to feel that we are doing the best we can to look after ourselves. We might eat healthier, exercise more. Some of us throw ourselves into life with renewed zest, with a feeling that we want to make the most of every moment. Some of us have the urge to give back to life, and take on charity projects or volunteer. Some of us seek out help from professionals to improve wellbeing, this could be a counsellor or a cancer support group or course. Others talk to friends (although many of us find we don’t get adequate support from those who have not had cancer, and we often stay quiet with family as we want to protect them from the worry) and spend lots of time with loved ones, and still others prefer lots of alone time and make time to relish their solitude.

If you are a woman living in the UK with a breast cancer diagnosis and you would like to join our private group, please leave your name in the comments or send us a private message.

Weekly Discussion Summary ~ Calming Strategies for Anxiety

‘I took a deep breath and listened to the old brag of my heart. I am, I am, I am.’ Sylvia Plath

This week our discussion focused on strategies that our members have found useful to calm themselves, both in times of stress and generally in the day-to-day. Our members are women with both primary and secondary breast cancer, and previous discussions and our members’ posts highlight that anxiety may be a major problem following a breast cancer diagnosis.

Naz explained what happens to our brains when we take a moment, sit down and breathe. Our neural networks are highly active when we are busy doing things, occupied with thinking, remembering, attention, decision making and so on. When we stop and ‘do nothing’ our brain is just as active, but it’s our default mode network (DMN) that takes over in this state. Its job is to make sense of our experiences, to process what has happened and what it has learned. This is essential for our survival. If our DMN didn’t do this for us, reaching homeostasis, we would be continually overwhelmed. It makes sense that if we encourage our DMN to engage by being still, then we will cope better when we are busy. Meditative breathing induces calm into the body and mind via a two way exchange of relaxation signals. Practicing being calm means we’re better able to calm ourselves at will.

For many, seeking a calm state is part of a general desire to look after ourselves. Calming activities that many women shared include movement, activities such as walking, running, yoga, Pilates, cleaning and gardening. For those too unwell to move much, then simply getting outside into the fresh air helps. Activities such as reading, watching a film, listening to music – all can be both distracting and calming. Occupying the brain whilst resting the body is an essential part of healing. Knitting, crochet, doing jigsaws and colouring are absorbing soothing activities that many women find helpful. Visualisation is seen as a useful tool, particularly as a distraction during treatments such as scans. Many enjoy being in nature and imagining a beautiful place can be very relaxing.

Specific calming exercises recommended by our members include breathing exercises of various kinds (e.g. alternate nostril breathing, box breathing, the three minute breathing space) and some had tried sipping ice old water very slowly which works as a mindful activity. Grounding exercises include things like rubbing our thumbs together to feel the lines, and stopping what we are doing to observe and be mindful of our bodies and our surroundings. Some women find their faith helpful in keeping them calm.

Not everyone finds focusing on the breath helpful. One of the problems with classic meditation is that focusing on breathing leaves the sub-conscious brain free to roam. Following trauma such as breast cancer, this may interrupt our attempts at becoming calm by presenting intrusive troubling thoughts. For some women this makes them feel overwhelmingly sad and leads to overthinking and dark 'worst case scenario' thoughts. For this reason many women chose distracting relaxation over sitting in silence. Playing an instrument, singing and listening to music provide pleasure, and require concentration which focuses the mind and relaxes it too. Some women like calming neutral music (it may not be a good idea to play songs that are associated with memories) but others prefer something heavy and loud which they find dispels their worries much better.

Taking part in activities where we are out and about meeting others can help us to feel more confident, which can assist in alleviating anxiety. Several of us sing in a choir and many belong to groups to practise their hobbies and suggested classes or workshops in improv comedy and laughter yoga.

An exercise in gratitude was mentioned which many women find helpful: listing three things each day we are grateful for, or perhaps keeping a gratitude diary. A good cry is a great stress reliever too.

If you are a woman living in the UK with a breast cancer diagnosis and you would like to join our private group please send us a private message via 
https://www.facebook.com/resilienceinbreastcancer/

Weekly Discussion Summary - Anxiety

The See-Saw of Fear

In this week’s discussion we talked about anxiety - a feeling of worry, nervousness or unease about something with an uncertain outcome.

A diagnosis of breast cancer brings with it huge fears and uncertainty: women with primary breast cancer are faced with the fear of recurrence; women with secondary breast cancer are faced with the fear of progression. Regular checks and scans remind us of our vulnerability, every ache and pain causes worry that ‘it’s back’ or has spread further.

The threat to life that cancer represents is ever present and anxiety becomes the background music of our lives. Anyone who has struggled with anxiety knows how debilitating it can be, and if we are someone who has always struggled with anxiety, our mental state becomes one of heightened anxiety. It is exhausting.

Sometimes we recognise and face our feelings, sometimes we cut off from them and yet we experience a subconscious reaction to a perceived threat, whether real or imagined. Anxiety is as real as a post-traumatic stress and as we know, a breast cancer diagnosis is a traumatic event in our lives.

Many of us had experienced anxiety all our lives. For some, the discussion itself highlighted how anxious we feel. Some of us could accurately describe the physical sensations of anxiety within our bodies. Some described pushing away anxiety with distractions, such as keeping busy. Some tried to embrace the worry and accept it, whilst striving to let it be.

A few of us described panic attacks, others a continuous underlying feeling that something awful about to happen. Physical symptoms included heart palpitations, shortness of breath, sweating and nausea. Some of us worry about every little thing. Others no longer ‘sweat the small stuff.’ Most of us experience extreme anxiety around the times of scans and anniversaries. For some, anxiety is so high that it interferes not only with our hopes and dreams but day to day activities. Our advice to anyone in this position is to seek professional help.

Naz explained 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 in order 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.

We 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.

If you are a woman living in the UK with a breast cancer diagnosis who would like to join our private group, please message the centre 
https://www.facebook.com/resilienceinbreastcancer/

Can Training Cognition Enhance Psychological Wellbeing? ~ Jessica Swainston ~ *GUEST BLOG*

I was recently shocked to discover that the world health organisation has estimated that 50 million years of work, an annual global loss of £651bn, will be lost to anxious and depressive disorders between now and 2030. Although I was aware that emotional disorders such as anxiety and depression are on the increase, I found this figure particularly alarming not only for the state of the economy, but more importantly for the future psychological well-being of individuals, their families, and the society we live in. 

As it stands, current pharmacological and psychotherapeutic treatments have been shown to be only modestly effective in both the treatment and prevention of emotional disorder. To me, it seems critical then that more research is carried out in order to better understand the underlying mechanisms involved in these conditions. 

By achieving this, there is hope that we can develop effective interventions to not only treat emotional vulnerability, but further to build resilience against its onset and recurrence.   

So, how do we become more resilient? How do we continue to cope with the ever demanding stresses that society and life place upon us? 

It is these questions that motivated me to embark upon a PhD exploring how we can develop appropriate interventions to build resilience in vulnerable populations. Luckily, Professor Nazanin Derakshan at Birkbeck University of London, Director of the Laboratory for the study of Risk and Resilience in Mental Well-Being, and Director of the Centre for Building Psychological Resilience in Breast Cancer, is of a similar mind-set, and agreed to supervise me throughout this journey. 

For many years Derakshan has investigated the cognitive mechanisms that are involved in emotional disorder.  Derakshan is of the mind that our ability to flexibly direct where we place our attention, is the key mechanism in regulating our emotions and boosting our psychological resilience. In other words, the better we are at paying attention to our current goal (e.g. Writing this blog post), the less distracted we are at the expense of irrelevant intrusions and worrisome and ruminative thoughts that can quickly lead to cognitive and emotional fatigue (e.g. 'What if I fail my PhD?!'). We can refer to this ability as 'attentional control'. 

Backing up this claim, research has shown that people with high anxiety and depression are poor at exercising attentional control, they find it difficult to focus, concentrate, and get easily distracted. Research shows that when there are possible faulty brain connections between 'emotional' and 'cognitive' systems they can lead to problems in regulating attentional control and using it more effectively when we need it.  

If then attentional control is the key mechanism by which emotional vulnerability can be moderated, how then can this process be targeted? 

It was many years ago that I first became aware of online 'cognitive training' games in psychological science, at the time being investigated for its reversal effects on cognitive degeneration through ageing. However, it is only recently that I have discovered a line of research investigating the effects of these games on emotional disorder, led by Derakshan. Can training our attentional control through cognitive training games better our ability to stop intruding and ruminative thoughts from occupying brain space? Further, is the training applicable to other circumstances, such as improving anxious states that can interrupt sports performance? Preliminary findings show great promise.  As yet, compared to control groups, a course of adaptive attentional control training has shown to reduce anxiety, increase cognitive efficiency leading to better performance and improve sports performance under high pressure. 

I am a firm believer in always considering the potential directions and clinical relevance of new interventions for emotional disorder. So, what is the future for cognitive training in psychological health?  I think it is fair to say that a number of current psychological therapies such as mindfulness and cognitive behavioural therapy are of varied success. Yes, for many patients they have wonderful effects, however many others fail to engage at all. This may in part be due to the lack of attentional resources that severely depressed and anxious individuals possess. If one's attention is poor, how can one easily engage in a 10 week course of psychological therapy which requires focus and concentration? It can often be problematic. 

Therefore, cognitive training may be beneficial as a complimentary treatment to current therapies. If attentional control processes are improved through training, individuals will be better enabled to pay attention and gain the most value from their treatment. 

So improving our cognitive flexibility and ability to adaptively pay attention to our current goals may, in effect, help to our build resilience and protect against emotional vulnerability. This research is in its infancy and there is a long journey ahead, but I am excited by our initial findings and am keen to build developing cognitive interventions that may help alleviate and prevent emotional distress.

Jessica Swainston

PhD candidate in the Department of Psychological Sciences, Birkbeck University of London

Laboratory for Risk and Resilience in Psychopathology and Mental Well-Being

Centre for Building Psychological Resilience in Breast Cancer