Stress is a natural response to feeling stretched to the limits of your physical, practical, psychological (mental and emotional) capabilities. You might feel overwhelmed and unable to cope with the pressures on you. In the long-term, stress can affect your energy levels, blood pressure and general emotional wellbeing.
Stressors (things that cause stress) can take many forms, including a diagnosis of, and treatment for, lymphoma.
When you face a stressor, your body goes into a ‘fight or flight’ mode. This is a survival mechanism that gives you a rush of energy to either fight or run from danger. In preparation for ‘fight or flight’, the hormone (chemical messenger) adrenaline is pumped into your bloodstream. Once it is in your bloodstream, it causes physiological changes that are recognisable as signs of stress.
Stress affects how we think, feel and behave.
Common psychological (mental and emotional) signs of stress include:
- difficulty concentrating
- difficulty relaxing
- increased worry and anxiety
- making hasty decisions or having difficulty making decisions
- being more impatient and irritable than usual.
Common physical signs of stress include:
- quicker heart rate
- sleep problems
- muscle tension.
Some other reactions to stress include:
- loss of appetite
- lowered libido (sex drive)
- nausea (feeling sick).
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 being short of breath. You can find more information about panic attacks and how to cope with them on the NHS website.
Adjusting to any life change and facing the unknown can be stressful – it’s human nature to feel some level of anxiety in response to uncertain circumstances. A cancer diagnosis is particularly stressful, even if your cancer goes into remission (no evidence of disease) after treatment.
Living with lymphoma is a process. There are many things you need to get used to during the course of your diagnosis, treatment, and life after treatment. You may have worries and fears about the cancer and about your future.
Differences in how you look and feel can also take some mental adjustment, and there may be changes to your relationships with family and friends.
There will be a lot of information to process and you’ll need to make important decisions. Your daily routine might change, temporarily or in the long-term. As well as attending hospital appointments, having tests, scans and treatment, you may need to consider practicalities such as childcare arrangements and your working life. All of this can bring stress.
Caring for a loved one with lymphoma can also bring a great deal of stress and anxiety. In addition to the initial shock of the diagnosis, you might take on new responsibilities. For example, as well as supporting the person with lymphoma practically and emotionally, you may have additional household tasks that your loved one did before they were diagnosed.
There is no evidence that stress can make lymphoma (or any type of cancer) worse. Remember: scientists have found no evidence to suggest that there’s anything you have, or have not done, to cause you to develop lymphoma.
It is important, however, to find ways to manage stress. If your stress levels remain high over time, this could 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 gives 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 taking exercise, eating a healthy diet, getting support from friends and family, and seeking medical advice when you need it. 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. Taking care of your general health by eating well, taking exercise and getting enough rest can help to improve your general wellbeing. To reduce stress, many people find simple breathing techniques helpful. There are other coping strategies you might also find helpful. If your level of stress stays high over time, speak to your GP for advice – you may wish to ask about CBT (cognitive behavioural therapy) or medication.
Breathing techniques may help you to feel calmer. They can prevent hyperventilation (breathing too quickly) 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 ‘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’. The Human Givens website gives more information about this technique.
No Panic is a website that outlines relaxation techniques to help manage stress, panic and anxiety.
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, for example cognitive behavioural therapy (CBT), combine problem-focused and emotion-focused strategies depending on the techniques used.
This approach can help with a range of stressors, for example making a treatment decision or addressing financial concerns. It aims to:
- deal with the stressor to make it more manageable
- increase your ability to cope with the stressor.
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 strategy 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 (such as nausea and vomiting after chemotherapy).
- Strategy: find ways of managing the side effects of treatment, for example with anti-sickness drugs (antiemetics). Arrange help with childcare for when you are most likely to feel nauseous, for example 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 with childcare. Local voluntary organisations might offer practical help, such as with household chores – ask your CNS if they can put you in touch with any such services.
Emotion-focused strategies help to manage the level of stress you feel in response to a stressor. These can be useful when a stressor is unavoidable, for example, going for a scan at the hospital. Some examples of emotion-focused strategies are outlined below.
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 depression and anxiety. For some people, meditation could also shorten the length and severity of nausea after chemotherapy.
Cancer Research UK have more information about research on how meditation can help people with cancer.
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 wellbeing and quality of life. Some findings suggest that mindfulness can reduce stress and improve quality of life for people living with cancer, though further research is needed.
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.
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 complementary therapy 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. Speak to a member of your medical team before you try a complementary therapy to check that it is safe for you.
There is no specific medication for stress but there might be a suitable medication to help you with some of the symptoms of stress. Examples include: sleeping tablets, anti-anxiety medication, beta-blockers and anti-depressants.
Speak to your medical team 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) 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 coming back (relapsing).
CBT uses various techniques. An important part of the work is identifying which of your thoughts are unhelpful and disempowering. Often, these thoughts raise levels of stress and anxiety. You and your therapist work together to:
- Challenge unhelpful thoughts: for example, you might spend a lot of time focussed on the possibility of the worst happening. CBT helps you to notice when you do this. With this awareness, you can more easily recognise unhelpful thoughts when they come to your mind. You are encouraged 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 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 might put pressure on yourself to continue with your daily life as if nothing has changed. CBT helps you to identify when this adds to your stress levels and encourages you to find effective, alternative responses to the situation.
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. Together, you consider ways of saving your energy where possible. This, in turn, can help to maximise your ability to do the things you need and would like to do.
Physical activity can improve both physical and mental health. Even light activity, such as a gentle walk, can have a positive effect on your mood. However, there may be some restrictions on the type, frequency and intensity of exercise you can safely do, for example, if you have low levels of platelets (thrombocytopenia) or white blood cells (neutropenia).
Speak to your doctor for advice about which types of exercise are suitable for you.
Meaning-focused strategies help 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 also focus on continuing 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 front 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, speak to your clinical nurse specialist, who can help signpost you to a trained professional such as a counsellor, to support you emotionally.
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
- plans and strategies to address problems.
Many people find counselling helpful. For some, it 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 2.5 million people in the UK today being treated for, or in remission from, cancer. Evidence shows that people living with and beyond cancer have significant concerns and needs. These include anxiety about the disease returning (relapse), difficulties associated with long-term side effects and late 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) and Macmillan Cancer Support have worked together to develop the recovery package. It uses a combination of strategies to identify your individual needs, help you prepare for the future and support you to live well after treatment. Ask your medical team about the recovery package. It should be available to everyone with cancer by 2020.
You might also be interested in attending one of our Live your life workshops, which offer practical advice and support to help you live with and beyond lymphoma.
We have more information about living well after a diagnosis of lymphoma. This includes topics such as diet and nutrition, coping with emotions and managing day-to-day practicalities such as work and finances.
Living with lymphoma can be stressful. Support is available to help you manage your stress and to live well.
You might wish to speak to a member of our helpline services team or contact other people affected by lymphoma via our online community forums and support groups. Our helpline services 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.
You might also find the following organisations and resources helpful:
- AbbVie is a pharmaceutical research and development company. On their website, you can find information and podcasts about mindfulness for people with blood cancer.
- 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 relaxation techniques.
- MIND is a mental health charity that offers information and support to improve mental wellbeing.
- Moodzone is an online resource on the NHS website to help you manage mild to moderate stress and anxiety. It offers practical information and interactive tools to support you.
- Living life to the full offers free online courses to help with low mood, stress and building resilience.
- Local IAPT (Improving Access to Psychological Therapies) are talking therapies provided free of charge by the NHS. Search online for a therapist near you. Ask your GP for a referral or refer yourself.
- 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.