‘Let it Go’: Overthinking and How to Overcome It

 

Our experiences of overthinking the past (also known as rumination) and our fears about the future (also known as worry) is much of a topic for discussion in BRiC. 

 

    We have 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 have 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 have 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. 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 is closely tied with anxiety. Interestingly, rumination discriminates, it is more prevalent in women than men.

 

    A lot of 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.

 

Managing Overthinking

 

We’ve 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 goal is to help us survive in the most effective manner. 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. We want 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.

Mental Health Awareness Week - Naz (Founder of BRiC)

Mental Health Awareness Week 2020.

"Slowly, quietly, never giving up"

BRiC celebrates mental health awareness week 2020. It showcases its members' resilience and coping tips on what has helped in COVD-19 lockdown stressful times.

Every day, we will be posting a few of our members' messages, in the hope to show how we've embraced our anxieties as well as taken small steps to alleviate the distress and uncertainty we've faced. How we've exercised courage to face our fears, and how we've risen to nourish the wounds we've endured as a result of COVID-19 collateral damage to our treatments. The meltdowns, the emotional rollercoasters. We share how self-compassion has helped us when we've been low.

Mental health is important. Just as we nourish our wounds to heal we need to nourish our mental health to heal from the distress it faces in scary and uncertain times.

It is not an easy task, but in the middle of every difficulty lies opportunity, and that is what resilience is about. Finding that opportunity, and to keep going, slowly, quietly, never giving up.

Sending love and virtual hugs to all of our followers and the bigger world.

Naz xx (founder of BRiC)

#mentalhealthawarenessweek

#resilience

#COVID19

#lockdown

#breastcancer

#secondarybreastcancer

#BusyLivingWithMets

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

Weekly Discussion Summary ~ The loneliness of cancer

'We didn't know it was possible to feel so alone and yet be surrounded by love and people.'

The collective voice of BRiC: the loneliness of cancer. In free verse, in our own words, from one of our recent discussions.

A silent holding of hands

A listening ear

Is that too much to ask for?

They don’t want us to talk about our cancer

Our friends fall away

They block us out

Put distance between us

So much time alone at home,  recovering from our treatment, not just alone, but lonely

We see our scars every day

But we can’t talk about it.

Others don’t get it, they don’t get us

They change the subject

‘But you’re ok now, aren’t you?’ they say

We’ve given up trying to explain

Our emotions belittled because they feel uncomfortable

We hide our feelings to protect our loved ones

We didn’t know it was possible to feel so alone and yet be surrounded by love and people

We feel like ghosts

Not able to be our real selves

We hold back, hold it in, hold on

Deny who we are 

Our cancer is part of us now

We don’t really know who we are anymore

It’s the whole effort of figuring it out, not burdening people with it,

Yet lacking that connection because we can’t explain it

Sometimes we self-impose isolation because we don’t feel 

Important enough to take up other people’s time

And we find it hard to accept support

A lonely place to be, especially at night when the pain is bad

And our minds are working overtime

Are we responsible for our own loneliness?

We’re not OK

We want to be allowed to not be OK

We want to be acknowledged

But they are bored of our journey, living with the legacy

And no-one understands this inbuilt fear

The loneliness of our thoughts

So busy fearing the future that we aren’t living in the present

We’ve learned it’s ours to carry alone,

We withdraw into our little lonely bubble 

Our loneliness a constant companion

Alongside isolation, fatigue, boredom, silence, regret

Where is our joy?

Where is our excitement?

We carry this huge secret,

We want to shout out, ‘if only they know what’s going on inside me!’

We are scared, we are alone, we are lonely in this new world

We walk alone.

Yet there are a few of us, who have limited time left

Who have never felt less alone.  We are blessed to have devoted family 

And our happiness may seem inappropriate

Are we in denial? Or just acknowledging our real feelings, 

Rather than the emotions the situation would seem to demand?

Does it even matter?

For others this is a terrible time,

Thinking about death, we try to be part of the crowd, the living,

But we are sad and lonely there. 

We cling to each other, our cancer friends,

The ones who’ve been there, the ones who understand

Sharing our loneliness through our honesty

And when we reach out to those who understand, we build a bridge

And for a time we can feel less alone

As Joseph Conrad said, ‘We live as we dream, alone.’ 

Alone at night, afraid of the future,

But with hope 

We’re finding our way now

And other special people become our friends

In our parallel world

Our virtual safe space

To be whoever we want to be, and know we are not quite so alone

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 the public Facebook page.

Weekly Discussion Summary ~ Lack of psychological support after diagnosis

"There is no guidance, no help, and crucially no psychological support. It feels as though we are thrown out of a plane with a parachute that we don't know how to open, with no instructions."

In our weekly discussion, timed to coincide with World Mental Health Day on 10th October 2018, we shared our experiences about the lack of psychological support after a diagnosis of primary or secondary breast cancer.

The psychological and emotional toll of a breast cancer diagnosis is a heavy one. It is a traumatic event that affects our mental health as well as our bodies. Few of us emerge psychologically unscathed, even when the diagnosis and treatment appears to have been successful. Our fear of recurrence (for women with primary breast cancer) or spread (for women with secondary breast cancer) is real.

At the end of our active treatment, we are told to get on and live our lives. Many of us don't know how to, we have forgotten. There is no guidance, no help, and crucially no psychological support. It feels as though we are thrown out of a plane with a parachute that we don't know how to open, with no instructions.

Some of us have been lucky enough to find counselling which helps us to process our experiences, others have attended a course that helps us with knowledge. We may find an on-line support group such as ours, where we can ask questions and most importantly, find others who are going through the same experiences. We learn from those who are emerging into their lives again, tentatively and often harbouring great sadness.

Those of us with secondary diagnoses described how psychological support seems even more sparse. Private counselling is an option that few of us can afford. Hospices, in some areas, can offer support but their resources are also stretched. The value of groups such as BRiC and others, some of which are specifically aimed at women with secondary breast cancer should not be underestimated.

We reported feeling cast adrift at the end of treatment. Some hospitals offer regular physical checks, others discharge patients at the end of treatment and provide annual mammograms only for a number of years, usually five. We are then back on the regular screening programme. Many of us were exhausted at the end of treatment, which can last many months, even years, and is gruelling. 

Yet we are expected to get back to normal, to pick up our jobs, our lives, as if nothing has happened. This just isn't possible in most cases. We talked of our isolation, our anxiety, our depression, having no-one to talk to as friends and family view us as cured; they can't understand the severe fatigue, the side effects of ongoing medication, the loss of self-confidence, the fear and vulnerability.

There is valuable support offered by Cancer Centres like Maggie's and the Haven but this is dependent on where we live and can feel like a postcode lottery. Some provide HOPE or Moving Forward courses, and some providing free counselling. These do have their place but are limited in scope. The courses tend to provide information about living a healthy lifestyle post cancer, and the counselling may be so focused on the cancer that the rest of our lives is ignored, whereas a holistic approach may be the most beneficial. The timing of the offerings is also crucial - some of us are ready to process the trauma sooner than others.

Why is the body treated so comprehensively while the mind is ignored? Why does the medical profession seem to believe that we are OK once active treatment has finished? Why is it that any help beyond the physical is provided by the voluntary sector or by charities? As Naz described, we show NORMAL reactions to a set of ABNORMAL effects following the trauma that is breast cancer, and these continue well beyond the treatment suite, perhaps for the rest of our lives.

The lack of effective psychological support following her breast cancer diagnosis led Naz to set up BRiC. Our group is a safe space where can express our fears, and support one another in a psychotherapeutic way. It is so important for us to know that we are not alone.

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 the public page 
https://www.facebook.com/resilienceinbreastcancer/

Research at BRiC ~ Training Cognitive Control to Reduce Emotional Vulnerability in Breast Cancer

Research at BRiC

Please give a huge cheer for the brilliant and beautiful Jessica Swainston, seen here on the right with BRiC's head, Prof Naz Derakshan! 

CONGRATULATIONS on the recent publication of their paper, "Training Cognitive Control to Reduce Emotional Vulnerability in Breast Cancer" in Psycho-oncology.

Huge and heart-felt thanks to all those participants who took part in the intervention and for helping us build our research programme on resilience.

Here’s a preview: https://www.ncbi.nlm.nih.gov/pubmed/29631328

The full text will be available on line soon so watch this space!

#BRiCResearch

Balancing Positive and Negative Emotions

“Well, I've got thick skin and an elastic heart, But your blade—it might be too sharp, I'm like a rubber band until you pull too hard, Yeah, I may snap and I move fast, But you won't see me fall apart, cause I've got an elastic heart” (Sia, Elastic Heart)

"Think positive” is a phrase we often hear when we are diagnosed with breast cancer. Sometimes we say it to ourselves, sometimes others say it to us as a way of encouraging us. But what does it really mean to 'think positive'? How does it benefit us and are there drawbacks of a 'positive' mental attitude?'

In our network, we shared that adopting a positive outlook had helped us to manage the intense emotions that are in the driving seat when we find out we have primary or secondary breast cancer. Our initial reactions include shock and disbelief; we are often forced to make treatment decisions​ and manage schedules, adopting our natural tendency to adopt an avoidant style of coping. Many of us described being naturally drawn to avoiding our negative feelings, wishing to appear positive in our interactions with the world at large, and in some circumstances we thought this was helpful​. However, draw backs to this attitude include becoming cut-off from our emotions, numb, or unable to share our authentic feelings, leading us to feel isolated.

Some of us shared that we could express positive and negative emotions, and felt this was liberating. Others described consciously or unconsciously finding themselves being drawn to the 'silver linings' - the positives that had come about as a result of our changed circumstances, such as spending time with our children while being on sick leave.

Naz told us about research on cognitive flexibility, its promising influence on mental well-being and encouraging effect on building resilience. The elasticity and plasticity by which we embrace our diverse range of emotional experiences helps us regulate our emotions appropriately and appreciate our experiences, however complex they may seem.

In terms of our feelings, this means feeling sad, grieving when we need to and being fearful when it’s necessary. A flexible style of thinking, like the rubber band, is elastic. Naz explained that brain plasticity is not a simple thing to achieve, especially when we have gone through highly traumatic experiences, ones that continue to haunt us. Breast cancer brings with it uncertainty and the danger of recurrence, the progression of disease, loom high. In these circumstances, our brains are geared towards anxiety related thinking styles, appropriately even, hypervigilant for signs of danger, feeding into anxiety and worry. However, this increases our vulnerability.

Naz explained that research shows that our ability to embrace negative thoughts and painful experiences paves our way to allow the positives we experience to nurture us. This is especially relevant to those of us living with breast cancer and its effects because we take our cancer forward with us. Our moments of ‘being down’ can help us to understand ourselves and embracing our inner fears helps us to practice gratitude, and grit. The balance is hard to achieve, but it can be done with practice.

Post Traumatic Stress Disorder and Breast Cancer (PTSD)

Some evidence* suggests that nearly 80% of women with a breast cancer diagnosis experienced PTSD for at least one year after their diagnosis.

As a network, our experiences are diverse, including women with primary breast cancer, recurrence, and secondary breast cancer. Some of us had finished our active treatment, while some of us were still undergoing treatment for primary and secondary breast cancer. Many of us shared that we experienced insomnia, nightmares, flashbacks and panic attacks. Some of us described our minds going into over-drive and our efforts to manage, as well as feeling disconnected, or, conversely, highly sensitive. Some of us have been diagnosed with depression and/or anxiety.

Naz explained why anxiety, depressive vulnerability and PTSD can be seen as ‘normal’ responses to an ‘abnormal’ set of adverse events and experiences. For instance, depression is a natural response to loss and trauma involving helplessness and despair; anxiety and worry are natural responses to profound, single, or prolonged sets of fearful experiences, particularly when they are beyond our control and involve uncertainty, fuelling our stress responses.

What happens when we are confronted with life threatening events involving significant degrees of uncertainty?

Naz has mentioned us that our amazing brains have evolved to respond in ways that protect us and aid our survival. So, if our goal is to be vigilant to a potential threat awaiting us, the emotional neural networks in our brain will be on high alert, responding continuously, sometimes on over-drive, impacting on stress hormones such as cortisol. Our cognitive systems in principle help us to regulate our emotions, but the emotion - cognition network is highly connected so that in trauma, our cognitive systems take a backseat while the emotional networks keep firing.

Naz has shared that evidence which shows that in anxiety especially, a system called the default mode network, a network supposed to recharge our brains at resting state, and the amygdala, an organ key to experiencing fear, become highly active. This is linked with a prolonged experience of anxiety symptoms well after the event, even for years to come. The brain adapts to this vigilant response and clinical disorders can develop because it is simply too much for the body to take on.

The article* summarises several PTSD symptoms, many of which were experienced by the group including: Emotional numbing, or distancing, because the brain goes in protective mode. Poor concentration. Lapses in attention and poor memory.

Why does this happen?

Naz has explained that our emotional networks prepare us for danger which means our cognitive systems, which have a limited capacity, need to work harder to help us regulate powerful emotions, such as intense fear.

Almost all of us had vivid memories of our diagnosis and experienced a range of powerful emotions such as fear and anxiety which continued during our treatment, for instance, surgery, or emergency admissions during chemotherapy. Some of us described witnessing deeply distressing scenes while in hospital, for instance someone witnessed a heart-attack, as well as other breast cancer patients in various stages of illness or treatment. Our heightened, and sometimes overwhelming feelings continue, not only during active treatment, but following it, for instance, when we have scans, or when new symptoms arise which require investigation. For those of us living with secondary breast cancer, these intense emotions are ongoing and relentless.

Some of us had experienced trauma prior to our diagnosis of cancer, for instance neglect in childhood, or abuse. As horrific and distressing as these experiences are, and especially challenging when they were followed by cancer, it became clear to us that the experience of trauma in cancer presents unique challenges: when we think of trauma as a result of war, abuse, a serious accident or crime, the task facing the individual is to move on in their life after these terrible events and experiences. However, in cancer, the threat to our lives comes from within us. We cannot flee from our selves and our body represents the source of our fear. For many of us, especially, but not solely those of us living with secondary breast cancer, the threat of recurrence and progression of disease is ongoing and very real. It is not something we can put behind us and our survival may depend upon our ability to be vigilant to symptoms which we need to report to our doctors.

Like it or not, we continue to take our cancer forward with us.

Very few of us had been able to share our feelings with our loved ones, partly because we did not want to worry them; because in our gratitude to be alive, we felt we could not share our contradictory feelings, or we felt under pressure to 'move on' and 'put cancer behind us.'

According to Naz it is possible to manage and regulate PTSD, but our brains will not be working with us to eradicate it because of the way they have evolved to ensure our survival. We can, however, build our cognitive strength towards resilience. This can then help us to regulate our responses over time, strengthening connectivity networks in our brains. Naz explained that there is much scope for understanding and managing PTSD through understanding the cognitive functions behind our emotions.

In terms of psychological support, some of us reported positive experiences in terms of accessing psychological support in a timely manner which was flexible enough to meet our needs. However, most of us felt cast adrift and either had limited support or we had found sources of support ourselves. Most of us had not even been told about our potential psychological vulnerabilities.

What can help?

We shared that counselling, CBT, mindfulness, yoga and in some instances, medication, haveall helped. Opportunities to talk and share as a group were invaluable because they both validate and normalize our responses - we could say 'What you too?' and breathe a sigh of relief we are not alone.

---

*Brief summary: http://www.breastcancer.org/research-news/many-women-have-ptsd-symptoms-after-dx

Weekly Discussion Summary ~ Loss of a Friend or Loved One to Cancer

In this week's discussion we shared our feelings about the loss of a friend or loved one from cancer.

We all described feelings of intense sadness and how deeply we are affected by the loss of someone with cancer. For some of us there is numbness, which can shield us from our most painful emotions. Others described feelings of guilt, or worry for their own family and friends and some of us shared that they had needed to withdraw from groups and forums. We also acknowledged that our immediate reaction is often a combination of sadness, mixed with deep fear for ourselves. We realised that underlying our grief is the obvious - yet unspoken - fact that we are reminded of our own vulnerability, something that we carry with us, yet often suppress to keep going. This uncertainty, adds to our fear, which can then make us extremely apprehensive about the future.

More than loss though, was the importance of our friendships with one another, the way we enrich one another's lives through our shared experiences and our understanding of one another's feelings and fears. We all felt this was a positive we had taken from our experience of cancer. Our discussion concluded that while there is loss, we gain so much more from our friendships with one another and there is love, which outweighs the sadness, and which we carry forward with us.

In relation to our psychological resilience, the question we asked was what is the best course of action?

Naz told us about George Bonanno, a profound Research Professor of Psychology, who has written a book called 'The Other Side of Sadness'. In it, he outlines evidence from longitudinal studies showing that people who allow themselves to grieve and express emotions associated with the trauma have better psychological and physical health in the longer run.

As our discussion highlighted, there is no right or wrong way to experience fear, sadness, and grieving for our loved ones, but if we allow ourselves to get closer to our emotions, our 'hurt', then this evidently has beneficial effects on a number of levels. This is the opposite of denial, and of course needs much flexibility and strength to know how to down regulate our emotions when we feel ready to move forward. Grieving, and acknowledging our fears can only give us the strength to move forward.

For interest, here are two blogs on the bonds of friendship between those living with cancer and its effects. One by our very own Tamsin, the other by Kira Goldenberg:

http://www.huffingtonpost.co.uk/tamsin-sargeant/the-living-infinite-frien_b_11996066.html

https://www.theguardian.com/commentisfree/2016/jun/23/cancer-survivors-bond-grief

#ResilienceDiscussion

Weekly Discussion Summary ~ Cancer and Anti-Depressant Use

This week's discussion was triggered by this article posted by one of our members highlighting that the use of anti-depressants amongst those diagnosed with cancer is double that of the general population (1 in 5 compared to 1 in 10).

Some of us shared that we'd found anti-depressants a great help, others were adamant that we don't wish to use them, although even those who have abstained so far were clear they would consider them. Experiences of taking anti-depressants varied, from providing clarity at one end of the spectrum, to masking reality and numbness at the other. The difficulty of coming off medication due to withdrawal side effects was also highlighted.

What is clear from our members' contributions is the immense psychological challenges that accompany a cancer diagnosis. Many of us have sought help for low mood and anxiety, others have experienced fatigue and long term pain, many had been given anti-depressants - sometimes because they felt that there was little alternative. The end of treatments like chemotherapy/radiotherapy/surgery was identified as a vulnerable time, accompanied by and a sense of feeling lost and being cast adrift. We also wondered about the psychological needs of those living with secondary breast cancer.

Though we would never want to take away any strategies for coping, we think it is important to highlight the contradictions, and controversies in relation to anti-depressants, including the lack of understanding about the mechanisms by which they 'work'.

While we need to cope as effectively as we can, and we need to survive, Naz told us that the longitudinal 'effects' (or lack of) in these drugs are problematic - we expect the brain to take over after a course of antidepressants, but what happens? Many people need to go back on them again. We also don't know how they affect cognitive function.

We all feel that more holistic and longer term support is required to help us with the breadth and depth of the psychological adjustments required and identified the importance of our group as a safe place to share our feelings.

http://www.everydayhealth.com/cancer/living-with/high-rate-antidepressant-use-after-cancer/

#ResilienceDiscussion