Managing stress

What is stress?

Stress is a natural response to feeling pushed to your limits. This might be physically, practically or psychologically (mentally and emotionally). When your stress levels are high, you might feel overwhelmed and unable to cope.

In the long-term, stress can affect your general physical and emotional wellbeing.

Common psychological (mental and emotional) signs of stress include:

• irritability and impatience
• difficulty concentrating 
• ‘racing mind’ – with lots of thoughts going around your head
• feeling worried and anxious
• feeling unable to enjoy yourself or relax
• finding it hard to make decisions.

Common physical signs of stress include:

• higher heart rate
• feeling dizzy or nauseous (sick)
• higher blood pressure (hypertension)
• sleep problems
• headaches
• muscle tension
• grinding your teeth.

Some other possible reactions to stress include loss of appetite and lower sex drive (libido).

When something causes stress, the chemical messenger (hormone) adrenaline pumps into your bloodstream. The adrenaline in your bloodstream causes changes in your body, which can be seen as signs of stress. It prepares your body to go into one of the following:

• Fight, where you try to get rid of the threat.
• Flight, where you try to get away from the threat.
• Freeze, where you become unable to move or take any action.

For some people, high levels of stress and anxiety lead to panic attacks. Symptoms of panic attacks include a ‘racing’ or ‘pounding’ heart (palpitations), sweating, trembling and shortness of breath. You can find more information about panic attacks and how to cope with them on the NHS website and through Mind. Your clinical nurse specialist or GP can also offer advice.

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How can lymphoma heighten stress?

Living with and beyond lymphoma can be stressful for lots of reasons. For many people, the uncertainty it brings can be very difficult to cope with.

My medical team referred me to a psychiatrist, as they were fairly sure that what I was experiencing was psychological. They explained that it was a form of disassociation as a result of a dramatic change in my life. I was suddenly facing a life-threating illness, which involved being an in-patient for at least five days every month. I had to stop work and could not see people because of the risk of infection. All these things were causing me an enormous amount of stress.

Colin, affected by heightened stress after a diagnosis of lymphoma

As well as medical appointments for any tests, scans and treatment you might need, there are lots of things that you, and possibly your family, need to adjust to. You might need to make changes in your day-to-day life, for example, to your work or childcare arrangements.

Even after treatment, and if your lymphoma goes into remission (no evidence of any lymphoma), you might worry about lymphoma coming back (relapsing). Some people become more worried about their health in general, or that of a loved one.

If a family member or friend has lymphoma, the initial diagnosis can be highly unsettling and stressful. You might also take on new or different practical responsibilities to help support them. You might find our book for family and friends helpful: When someone close to you has lymphoma.

All of this can impact on your emotional wellbeing, and can have an effect on your relationships with family and friends.

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Why is it important to manage stress?

Stress can have a negative impact on how you feel emotionally, and on your general physical health. For example, for some people, heightened stress can increase the likelihood of:

• using unhealthy ways of trying to cope, such as drinking alcohol, smoking or using drugs
• feeling helpless and hopeless, which can lead to less self-care, such as not seeking medical attention when you otherwise would
• higher blood pressure, which can lead to serious health conditions, such as kidney disease
• activating other health conditions that can be linked to stress, such as asthma attacks, psoriasis and shingles.

If your stress levels stay high over time, it could weaken your immune system or increase the risk of heart (cardiovascular) disease. The British Heart Foundation gives more information about stress and cardiovascular (heart) health. 

There might also be a link between self-criticism and unhealthy emotional coping strategies. Some research shows that being kind and compassionate towards yourself is associated with lower levels of stress. 

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Ways of managing stress

Taking good general care of yourself is important in managing stress. This includes eating well and taking exercise.

Physical activity plays a key role in mental wellbeing and can be a good way to relieve stress. Although you could participate in structured exercise, you can also include movement in your day-to-day life. A gentle walk, talking the stairs instead of a lift, light household duties or gardening, all count as physical activity. You might also be interested in activities that use movement, like dance or some types of yoga. Try not to let building physical activity into your life be an added pressure – do as much as you feel comfortable doing.

The NHS website outlines 5 steps to mental wellbeing: connecting with other people, being physically active, learning new skills, giving to others, and paying attention to the present moment (mindfulness). They also have some tips to help lower stress.

As part of your personalised care plan, your medical team should offer you a holistic needs assessment (HNA). The HNA is a questionnaire to help you and your medical team work together to identify and address any practical, financial, physical, emotional and social needs you might have. This should include helping you to find ways to manage stress.

Different people have different ways of coping that stay quite steady over time and across different situations. 

One of the things that I found really helped throughout the whole process was keeping a journal. I was never really someone who kept a diary, but I thought it would be something to do during my chemo sessions, so I started a journal on day one of my treatment. Initially, it served as a record of what I did and how I felt, on a scale of one to ten. I found writing things down very cathartic, and would really recommend it. It was a good way of recording my thoughts, feelings – physical and mental, and, in the absence of having anyone at home, a way of being able to vent on the bad days. 

Ian, affected by heightened stress  after a diagnosis of lymphoma

Coping strategies might include strategies that help you to find a solution, avoid a problem, or to make sense of your experience. Strategies might aim to:

• lower the physical tension in your body, such as through muscle relaxation, breathing techniques and complementary therapies, like massage and yoga
• change your feelings towards the things that heighten your stress, through mindfulness techniques
• change how you think about the things that heighten your stress, through cognitive behavioural therapy (CBT).

I had regular sessions with my psychologist and we tried several types of complementary therapy, like acupuncture and aromatherapy. I don’t know how well these worked for me, but I gradually managed to cope and changed my mindset. I had to put my trust in my medical team, and believed what the doctors told me.

Colin, affected by heightened stress  after a diagnosis of lymphoma

There are many different strategies you could try to help manage stress. We outline some of these below: 

• Meditation
• Mindfulness
• Breathing exercises
• Yoga
• Connecting with other people
• Solution-focused strategies
• Cognitive behavioural therapy (CBT)
• Meaning-focused strategies. 

You might also be interested in our video on fatigue and physical exercise. This includes a muscle relaxation technique (starting at 39 minutes).

Some people also use complementary therapies to help relieve stress, for example massage or creative therapies. 

Speak to a member of your medical team for advice about what might help you, and what is safe for you to do, based on your individual situation.

Meditation

Meditation aims to calm the mind and body, and could help to lower blood pressure. There are lots of types of meditation, such as yoga, mindfulness and breathing techniques. Meditation techniques can be useful in managing stress where the source of stress is something you can’t realistically avoid, for example, a medical appointment.

Some research suggests that meditation can help to enhance the wellbeing of people living with cancer. It might help to improve your mood and concentration, and to reduce depression and anxiety. For some people, meditation could shorten the length and severity of nausea after chemotherapy. In turn, this might help to lower stress.

Cancer Research UK have more information about meditation and how it might help people with cancer.

Mindfulness

Mindfulness is a type of meditation that encourages you to slow down and notice your body and thoughts, as well as the world around you. Focusing on the present moment can help to lower the stress you feel in worrying about the future or going over the past.

One of the aims of mindfulness is to give your energy to the present moment, which can improve your overall wellbeing. It can help you to better tolerate uncertainty and physical discomfort. Some findings suggest that mindfulness can lower stress and improve quality of life for people living with cancer, though further research is needed. There is also some evidence to suggest that mindfulness can help people who are caring for someone who has cancer to manage their own stress.

Some people set aside time to practice mindfulness techniques. However, you can bring mindfulness into your day-to-day activities. For example:

• Pay attention to the feeling of the water on your body when you shower, as well as to its temperature, what you can smell and hear
• Focus on the flavour and texture of what you are eating, and any sounds you hear as you chew it.

There are some courses in mindfulness-based stress reduction (MBSR). These encourage openness and acceptance, which increases capacity to cope and lowers stress levels. Usually, MBSR involves around 4 to 8 weeks of training in meditation techniques. Ask a member of your medical team if you are interested in MBSR.

You can find out more about mindfulness on the NHS website. Podcasts about mindfulness, including some short mindfulness exercises, are also available, free of charge, from the Mental Health Foundation. Ask a member of your medical team for more information.

Mindsight

Another idea that some people find helps in becoming more mindful is mindsight. This aims to help you give attention to your thoughts and emotions without being overwhelmed by them. As a simple example, you can notice an emotion like sadness and say: “I feel sad” (instead of “I am sad”). This recognises that the sadness is temporary, helps to acknowledge and accept the feeling with the aim to ‘let go’ of it over time. 

One of the ideas behind mindsight is that, in addition to the five senses (sight, smell, hearing, touch and taste), we have three further senses: bodily awareness, awareness of mental activity, and connectedness with others. These help us to check-in with our ‘internal’ self. Some research suggests that mindsight allows us to be more compassionate towards ourselves and to others, which can help to improve overall wellbeing and reduce stress.

Breathing exercises

Breathing exercises can help you to feel calmer. They can prevent hyperventilation (breathing too quickly) by balancing the oxygen and carbon dioxide in your body. Simply taking some deep breaths can help to lower your heart rate and blood pressure.

It’s often helpful to practise breathing exercises when you feel calm, so that you can use them more easily when you are starting to feel anxious or stressed. 

There are various breathing techniques. One exercise that many people find helpful is ‘7/11 breathing’. During this, you sit or lie comfortably, breathe in for 7 counts and out for 11. If you prefer, you can breathe in for 3 counts and out for 5; the important part is that the outward breath is longer than the inward one. Find more detail about 7/11 breathing on the Human Givens website.

The NHS website has more information about breathing exercises to help with stress. You can also find out more about relaxation techniques on the No Panic website.

NHS Inform has resources to help explain where stress comes from and to help you to manage it, including an audio breathing and relaxation playlist and breathing and relaxation videos.

Yoga

Yoga uses movements, stretching and breathing techniques alongside meditation and relaxation. Many people find yoga helpful in improving their overall wellbeing. There is also some evidence to suggest that it can have a positive effect on overall wellbeing in people who have cancer.

Find out more about yoga on the NHS website.

Connecting with other people

Many people find that connecting with other people who can listen and relate to their situation helps to lower stress. It can be helpful to share thoughts, feelings and tips for coping. 

You could connect with others through the support on offer through Lymphoma Action:

• support groups
• closed Facebook support community
• buddy service, which offers peer support from a buddy who has a similar experience
• Live your Life self-management course, which offers practical support and gives you an opportunity to meet others affected by lymphoma
• health and wellbeing resources.

You might also be interested in joining online communities offered by other organisations, such as the Macmillan online community.

You can also ask your medical team also if they can signpost you to local sources of support.

Solution-focussed strategies

A focus on finding solutions can be particularly appropriate in helping with practical concerns, such as making a treatment decision or looking at your finances. Breaking down problems into manageable chunks can help to lower stress.

It’s important to understand the problem before you can make a plan to address it. Although this might sound obvious, it can be difficult to think clearly if you are feeling very stressed. You might find it helpful to write down what the problem is, or to talk it through with someone – a friend or partner, your clinical nurse specialist or a member of our helpline team. You can then start to think about what you might be able to do to help address the problem, including the resources available to help you.

An example of a solution-focussed approach is given below:

Problem: I am likely to find some of the day-to-day tasks in looking after my children difficult while I’m coping with the side effects of chemotherapy, especially as I’ve been told I might experience sickness.

Strategies: 

• talk to my children to let them know in advance that there might be times I’m feeling unwell and unable to do all the things we would usually do
• find out if someone could help with taking the children to and from school
• consider what could help me if I’m experiencing side effects of treatment.

Resources: 

• Lymphoma Action’s information and support
• my medical team, for advice on managing side effects and for signposting to any local sources of practical support
• friends and neighbours, for help with childcare.

You might be interested in our information about day-to-day living, which covers some of the practical aspects of living with and beyond lymphoma.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) trains you to respond differently to the things that cause you stress, by helping you to think and feel differently towards them. 

CBT might be helpful if, for example, you’re worried about the possibility of lymphoma coming back (relapsing), or about going for treatment. It uses different techniques to help you notice any unhelpful thoughts that raise your stress and anxiety. You can then work to:

• Challenge unhelpful thoughts – for example, if you are very critical of yourself for not being able to do what you used to do, this might give rise to an unfair and unhelpful sense of ‘failure’. It might instead help you to be kind to yourself and how you might respond to a friend who was in the same situation. 
• Manage realistic worries – CBT can help you to identify appropriate strategies to manage your stress. An important difference you can make is between ‘what if’ and ‘what shall I do about…?’ You can start to give more energy to those worries that are more realistic, and less to those that are smaller possibilities.
• Find alternatives to unhelpful thoughts and behaviours – for example, you might put pressure on yourself to continue with your usual day-to-day life even when you are experiencing side effects of treatment. This can lead to stress. You can question this approach and find effective, alternative responses to the situation.
• Plan your activities – consider your day-to-day responsibilities and activities, choosing which to prioritise giving your energy to. This can help to maximise your ability to do the things you need to do, and the things you would most like to do.

The more you speculate about future events, the more stress you are likely to experience. CBT helps you reduce this stress by training you to recognise these and other unhelpful thoughts, and then to devise ways to give them less importance and attention.

Nigel Sage, Clinical Psychologist in Cancer and Palliative Care

You can find out more about CBT on the NHS website.

Meaning-focused strategies

A significant challenge for people affected by cancer is difficulty accepting their situation. Many people have big questions after diagnosis, wondering why it’s happened to them and what the purpose of life is. Such questions go to the core of human existence. While it’s human nature to consider them from time to time, a lymphoma diagnosis can bring such questions to the front of your mind.

Meaning-focused strategies aim to help you to make sense of what is happening in your life. They include working on accepting that you have lymphoma and recognising the impact it has had, and continues to have, on your life. The hope is that they will also help you to continue to find joy and purpose in your life.

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. Some people find support within a faith-based community. It can sometimes feel difficult to have these conversations with the people you know. If this is the case, speak to your clinical nurse specialist, who can help signpost you to a trained professional such as a counsellor, to support you emotionally. 

Counselling

There are many different types of counselling, all of which aim to help you to improve your sense of wellbeing. By talking to a trained professional, counselling might help you to consider your thoughts and feelings, and to develop your sense of inner strength and resilience. Some counsellors offer sessions over the phone or by video call, as well as face-to-face. Speak to a member of your medical team or your GP if you’re interested in counselling. You can also search for a private therapist in your area using the British Association of Counsellors and Psychotherapists online tool.

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Frequently asked questions about stress and lymphoma

We answer some common questions people have about stress and lymphoma. Speak to your medical team for advice specific to your situation, and to help you manage stress.

Can stress make my lymphoma worse?

From the available research, there isn’t strong evidence that stress can worsen lymphoma or any type of cancer, or that it can make it come back (relapse). However, it’s important to find ways to manage stress. If your stress levels stay high over time, it could have negative effects on your overall health and wellbeing.

Cancer Research UK has more information on whether stress can cause cancer.

Will stress affect my treatment?

Stress can heighten your senses, which includes experiences of pain, discomfort, fatigue and restlessness, which can affect your quality of sleep.  Your concentration, memory high levels of stress could worsen, which some people might refer to as ‘chemo brain’ (cancer-related cognitive impairment).

Managing stress can also help in your recovery after treatment, both physically and mentally.

What can I do if I feel stressed?

Living with and beyond lymphoma is challenging; however, there are ways you can help yourself to manage stress. 

Speak to your medical team if your level of stress stays high over time. Talking through concerns with them might help to reassure you and help you to feel calmer. As well as talking through ways of managing stress, they might also check whether any signs of stress are actually linked to your treatment, for example, a side effect.

You might also be interested in our list of useful organisations, which includes a list of organisations that offer support to help with emotional wellbeing.

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