Stress is sometimes described as a sense of pressure. Long-term stress can lead to feeling exhausted or drained.
A stress response occurs when you feel you are pushed to the limits of your capabilities (practically or emotionally, or both) and unable to cope with the pressures on you. Stressors (things that cause stress) can take many forms, including a significant life event like having a diagnosis of lymphoma.
When you face a stressor, your body goes into a ‘fight or flight’ mode. This is an evolutionary survival mechanism that gives you a surge of energy to either fight with or run from danger. In preparation for ‘fight or flight’, adrenaline (a hormone) is pumped into your bloodstream. Once it is in your bloodstream, it causes physiological changes that you recognise as signs of stress.
Signs of stress
Stress affects how we think, feel and behave.
Common psychological signs of stress include:
- difficulty concentrating
- difficulty relaxing
- increased worry and anxiety
- making hasty decisions or having difficulty making decisions
- increased impatience and irritability.
Common physical signs of stress include:
- quicker heart rate
- sleep problems
- muscle tension.
Some less healthy reactions to stress include:
- loss of appetite
- lowered libido (sex drive)
- nausea (feeling sick).
Speak to your medical team if you experience any of these symptoms. Your doctor can check whether they’re related to your treatment and give you advice on managing stress.
How common is stress?
Diagnosis and treatment, as well as the follow-up period, can be extremely stressful. Similarly, if you are a family member or a friend of someone who is living with lymphoma, this can bring a great deal of stress. For some people, high levels of stress and anxiety can lead to panic attacks. Symptoms of panic attacks include heart palpitations (feeling as though your heart is racing or pounding), sweating, trembling and breathlessness.
You can find more information about panic attacks on NHS Choices.
Breathing techniques may help you to feel calmer. They can prevent hyperventilation (‘over-breathing’) by restoring the balance of oxygen and carbon dioxide in your body. Practising these techniques while you are calm can help you to use them more easily when you are feeling anxious. There are various breathing techniques. One exercise that many people find helpful is called ‘7/11 breathing’.
- Find a comfortable position – you can be sitting, standing up or lying down.
- Breathe in through your nose while counting silently to 7.
- Breathe out through your mouth while counting silently to 11.
- Repeat until you feel calmer – research suggests that a few minutes is often enough.
Don’t worry if you’re unable to breathe in for the count of 7 and out for the count of 11 at first. The main thing is to breathe out for longer than you breathe in. You could start by breathing in for 3 counts and out for 5. This slows the rate you take oxygen in and, in turn, helps your body stop preparing for ‘fight or flight’.
No Panic is a website that outlines relaxation techniques, including muscle relaxation, to help manage stress, panic and anxiety.
Having cancer is stressful, even if it is in remission (no evidence of disease). Adjusting to a life with lymphoma is a process; there are many things you need to adapt to during the course of your diagnosis, treatment, and life after treatment. You will need to process new information and make important decisions. You might need to change your daily routine. As well as attending hospital appointments, having tests, scans, and treatment, you might worry about childcare, your relationships or career. You might also experience fears about cancer. Stress is a natural response in such circumstances.
There is no evidence that stress can make lymphoma (or any type of cancer) worse. Prolonged stress might, however, negatively affect your health in other ways. For example, it could weaken your immune system or increase the risk of cardiovascular (heart) disease.
The British Heart Foundation have more information about stress and cardiovascular health..
Some findings suggest that you are more likely to feel a sense of hopelessness if your stress levels are very high. As a result, you are less likely to take good care of yourself by exercising, eating healthily, getting support from friends and family and seeking medical advice when you need to. This can impact your overall health and wellbeing. It is therefore important to find ways to manage your stress.
Different people have different ways of managing stress. Coping strategies can be categorised as problem-focused, emotion-focused and meaning-focused. The type of strategy that works best depends on what the problem is and on you as a person. Some forms of therapy, eg cognitive behavioural therapy (CBT), can combine problem-focused and emotion-focused strategies depending on the techniques used.
- change the stressor in order to make it more manageable and/or
- increase your ability to cope with the stressor.
This approach can help with a range of stressors, including making a treatment decision or addressing financial concerns. It’s important to understand the problem before you can plan a strategy. You may find it helpful to talk the problem through with a friend or partner, your Clinical Nurse Specialist (CNS) or a member of our helpline team. A conversation may help you to consider the resources available to you to put your plan into practice.
As an example of a problem-focused approach, consider balancing childcare while experiencing side effects of treatment:
- Problem: Difficulty coping with childcare and the side effects of treatment (eg nausea and vomiting after chemotherapy).
- Strategy: Find ways of managing the side effects of treatment, eg with antiemetics (anti-sickness) drugs. Arrange help with childcare for when you are particularly likely to feel nauseous, eg the day after having chemotherapy.
- Helpful resources: Your Clinical Nurse Specialist (CNS) can advise on coping with side effects of your treatment. Your friends, family and neighbours might be able to help you with childcare. Local voluntary organisations (your CNS may be able to put you in touch with them) might offer practical help, eg with household chores.
Emotion-focused strategies help to manage the level of stress you feel in response to a stressor. These can be useful when a stressor (eg a scan at the hospital) is unavoidable. We outline some examples of emotion-focused strategies.
Meditation helps to calm the mind and body. There are many types of meditation; some of them involve movement and breathing techniques. All of them encourage relaxation.
Further research is needed, but available studies suggest that meditation can help to enhance the wellbeing of people living with cancer. It may help to improve your mood and concentration, and to reduce the symptoms of depression and anxiety. For some people, meditation could also reduce the length and severity of nausea after chemotherapy.
You might have heard of ‘mindfulness’. This is a popular type of meditation that encourages you to slow down and take note of your body and thoughts, as well as the world around you. Focusing on the present moment can lower the stress you feel in worrying about the future or going over the past. It encourages you to give your energy to the present day, which can improve your quality of life.
As with other types of meditation, further research is needed. Some findings, however, already suggest that mindfulness can reduce stress and improve quality of life for people living with cancer.
Cancer Research UK have more information about research on how meditation can help people with cancer.
Note: As with any intervention, there are possible side effects of mindfulness. If you are in a state of distress, you should not practice mindfulness without the guidance of a trained and experienced professional. Ask a member of your medical team for more information and advice.
Complementary therapies are used in addition to, not instead of, your hospital treatment. They aim to improve mental and physical wellbeing. Many people find the experience of having a complementary therapy session pleasant in itself.
Examples of complementary therapies include:
- art therapy
- music therapy
Complementary therapies cannot cure your lymphoma – be suspicious of promises that they can or might. Many people do find they help them to relax and cope better with their feelings and emotions, though.
Note: Always speak to a member of your medical team before you try a complementary therapy.
Stress is a natural response to challenges in your life. There is no specific medication for stress but there might be medication to help you to cope with some of the symptoms of stress. Examples include: sleeping tablets, anti-anxiety medication, beta-blockers and anti-depressants. Speak to your GP for advice about whether medication is suitable for you. They might recommend medication in combination with other strategies, such as relaxation techniques, cognitive behavioural therapy or counselling.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy trains you to think differently about stressors, which can help change your responses to them. CBT might benefit a variety of people, for example, someone who often feels anxious and worried about the possibility of lymphoma relapsing (coming back).
CBT uses various techniques. An important part of the work is identifying which of your thoughts are unhelpful and disempowering. These thoughts may raise your levels of stress and anxiety. You and your therapist work together to:
- Challenge unhelpful thoughts: for example, you might focus much of the time on the possibility of the worst happening. CBT helps you to take note of when you do this. With this awareness, you can more easily recognise unhelpful thoughts when they come to your mind. You are encouraged to make an effort to consider alternatives alongside the ‘worst case’ you usually think about. Practising this can help to adjust your perspective, bring balance to your thoughts, and lower your anxiety.
- Manage realistic worries: CBT can help you to identify appropriate problem-focused and emotion-focused strategies to manage the level of stress you feel in response to realistic worries.
- Find alternatives to unhelpful behaviours: for example, faced with a lymphoma diagnosis, you may put pressure on yourself to act as if nothing has changed. CBT helps you to identify when this adds to your stress levels and encourages you to find effective, alternative ways of responding.
Your CBT therapist might also help you to plan activities. Fatigue, pain, or cancer-related cognitive impairment (‘chemo brain’) can heighten stress, particularly if they impact on your day-to-day life. You and your therapist may consider your daily responsibilities and enjoyable activities. Your therapist helps you to find ways that can save you energy where possible, yet maximise your ability to do the things you want to.
Physical activity can improve both physical and mental health. Even light activity, such as a gentle walk, can have a positive effect on how you feel. There may be some restrictions on the type, frequency and intensity of exercise you can safely do, eg if have low levels of platelets (thrombocytopenia) or white blood cells (neutropenia). Speak to your doctor for advice about what exercise type is suitable for you.
Meaning-focused strategies concentrate on helping you to make sense of your experience. They include working on accepting that you have lymphoma and recognising the impact it has had, and continues to have, on your life.
Meaning-focused strategies are also concerned with learning to continue to find joy and meaning in your life. Many people have big questions after a cancer diagnosis, such as, ‘What is the purpose of life?’ Such questions go to the heart of human existence. While everyone considers them from time to time, a lymphoma diagnosis can bring such questions to the forefront of your mind.
Talking openly and honestly about your feelings with someone close to you can help you to process and make some sense of what is happening. Sometimes, however, it can be difficult to have these conversations with the people closest to you. Should this be the case, you might wish to speak to a counsellor, who is trained to help people explore their thoughts and feelings.
There are many different types of counselling. What they all have in common is the counsellor’s aim to provide a safe and non-judgemental space for you to feel heard and to explore your feelings.
Counselling can help you to consider:
- your thoughts and feelings
- what’s important in your life
- how you tend to respond to people and things, relating this to your current situation
- what the people and things in your life mean to you
- your resilience and inner coping resources
- resolutions and strategies to address problems.
Not everyone finds counselling helpful, although many people do. For some people, counselling provides an opportunity to talk about the things they feel unable to talk about to others. If you are interested in counselling, speak to your doctor, who may be able to refer you to a counsellor on the NHS. You can also search for a private therapist in your area using the British Association of Counsellors and Psychotherapists online tool.
More and more people are living with cancer; there are around 2 million people in the UK today being treated for, or in remission from, cancer.
Evidence shows that those living with and beyond cancer have significant concerns and needs. These include anxiety about relapse (the disease returning), difficulties associated with long-term side effects, and adjusting to a ‘new normal’ – which might include a different routine, an altered outlook on life, and changes to relationships.
The National Cancer Survivorship Initiative (NCSI) recommends a set of interventions, which can make a positive difference to people living with and beyond cancer:
- Holistic Needs Assessment (HNA) – an assessment to identify and address physical, practical, social, emotional and spiritual needs. Various health professionals (eg your consultant, CNS, physiotherapists) might be involved in the assessment and in making suggestions to address your needs.
- Treatment summary – a record, provided by your hospital, of your diagnosis and ongoing care, any treatment you’ve had (including any side effects and possible late effects of treatment) and signs of recurrence. You and your GP should receive a copy of the summary.
- Education, wellbeing and support events – which aim to empower you to live well. Such events might include sessions on diet and nutrition, spotting signs of recurrence, financial welfare support and returning to work.
- Cancer care review (CCR) – a review that takes place at your GP surgery within 6 months of your diagnosis. It aims to check how well you understand lymphoma and whether you know where to get further information and support, should you need it.
Further information and resources
Living with lymphoma can be stressful. Support is available to help you to manage your stress and live well.
Lymphoma Action offers a range of support. You might wish to speak to a member of our helpline team or contact other people affected by lymphoma via our online forums and support groups. Our helpline team also run a buddy scheme and may be able to put you in touch with someone who has had a similar experience to yours.
Carers UK offer support to carers, including information, a helpline, and online forums.
Macmillan Cancer Support offer support and information and have further material about breathing exercises.
MIND is a mental health charity that offers information and support to improve mental wellbeing.
NHS Choices Moodzone is an online resource to help you manage mild to moderate stress and anxiety. It offers practical information, interactive tools, and videos to support you.
Self management UK is a company that offers online and face-to-face courses. It aims to equip people living with a long-term health condition with skills to improve their wellbeing.