Taking Care of Yourself

Anxiety is a normal reaction to a perceived threat or stressful situation. It can range from mild nervousness to a full-blown panic attack. In some cases, it may be helpful; in others, it may not.

The nervousness you feel before a work presentation, for instance, might spur you to prepare for it a little better, giving you more confidence when the time comes to actually deliver it. But the fear you feel before cancer treatment or a medical scan doesn’t really help anyone.

Problems arise when we feel more anxious than a given situation warrants, or it interferes with our ability to work, sleep, and interact normally with others. 

Here are some tips to help you better understand why you’re feeling anxiety, and what you can do to relieve it.

What does anxiety feel like?

Anxiety can cause a wide range of feelings. You could experience a general sense of worry about the future, a sensation of tension in your head and shoulders, or an urge to avoid certain people or situations.

Other physical symptoms of anxiety may include:

• Rapid heartbeat
• Quick, shallow breathing
• Nausea
• Chest pain
• Light-headedness
• Fear of dying
• Tingling sensation or numbness
• Upset stomach/urge to empty your bladder or bowels

All of these physical effects are nature’s way of preparing you for “fight or flight” — in other words, a fight for your life or a quick sprint away from danger to save it. So, there’s nothing wrong with you for feeling this way, and you’re not crazy or broken. 

Why do I react like this to stressful situations?

Think back to prehistoric times, when people lived in caves instead of cities. What would’ve been the most significant threat to personal safety? 

Back then, it was likely fierce predators like lions, tigers, bears, and so forth, which were all around humans in the natural world. And if you encountered one of those face-to-face, it would make perfect sense to feel anxiety, right? 

So, anxiety evolved as a way of helping to keep us out of danger. It gave us an evolutionary advantage by alerting us to when situations were not safe. 

Common ways to cope with anxiety

Escaping dangerous predators is a far cry from the types of stressors most people face today. But the feelings we experience now can be just as intense, especially when you’re dealing with a cancer diagnosis or cancer treatment. 

The brain and body are always trying to keep us safe by learning what sort of things around us are related to threats. For example, the sound of a predator’s growl or footsteps nearby is a signal that we are unsafe. But when you go through something scary like cancer, your brain starts associating certain sensory memories with being unsafe, whether it’s true or not. That’s why some patients tell me that just the smell of hand sanitizer or the act of putting on a mask can trigger a panic attack.

Fortunately, there are lots of tools available to help. Here are three of the most common:

• Psychotherapy: Talk therapy with a licensed therapist can help identify the sources of your anxiety and find ways to reduce them.
• Medications: Whether they’re taken daily or on an as-needed basis, anti-anxiety drugs work best when used in tandem with psychotherapy. They can only be prescribed by a licensed physician, such as a psychiatrist or your primary care doctor.
• Lifestyle choices: These could be coping mechanisms you use to reduce anxiety in the moment, or conscious choices you make to reduce the overall number of stressors in your life.

Physical activity can help reduce anxiety

Sometimes, just a little aerobic activity can help dispel anxiety, by burning off some of that nervous energy. Jumping jacks, wall jumps and brisk walking are all things you can do almost anywhere to increase your heart rate.

Box breathing can be done anywhere

If you’re not in a place where physical activity is possible, consider a simple breathing exercise instead.

In “box breathing,” also known as “square breathing,” you take four seconds each to perform four different steps, then repeat the sequence at least three times:

1. Breathe in through your nose.
2. Hold it.
3. Breathe out through your mouth.
4. Hold it. 

It sounds deceptively simple. But it really works, and it’s something you can do almost anywhere — even when you’re having your blood drawn or getting an MRI done. 

Use 5-sense grounding to help you refocus

In this exercise, you take several minutes to check in with yourself physically and identify:

• 5 things you can see
• 4 things you can feel
• 3 things you can hear
• 2 things you can smell
• 1 thing you can taste

Refocusing your attention on the physical world really brings you back into the moment. This method is especially helpful when you’re in the throes of an anxiety attack or feeling disconnected from your body.

6-sense self-soothing

This exercise is a little different from the previous one because it involves actions rather than perceptions, even if they’re only in your imagination.

• Sight: Picture a loved one or a beautiful bouquet of flowers in your head.
• Touch: Feel the softness of a fuzzy blanket or the warmth of a bubble bath.
• Sound: Listen to rain falling, a cozy fire crackling, or calming music.
• Smell: Rub a favorite scented lotion on your skin, or burn some candles.
• Taste: Savor a few pieces of sour candy or dark chocolate.
• Movement: Take a leisurely walk or do some gentle stretches.

While these may sound really simple, there’s a lot of research behind them that shows they’re proven ways to make you feel better.

Keep in mind, though, that the “taste” exercise is not a license to eat mindlessly. It’s about being intentional in savoring small quantities of something with a really strong flavor. So, think about the people in those TV commercials who act like they’ve never tasted chocolate before, and try to get that level of enjoyment.

Make a plan to manage anxiety

As our emotional intensity increases, our ability to think clearly decreases. So, take time to experiment with these methods when you’re feeling calm. Then, practice! Make the ones that work best for you as convenient as possible. That may mean storing a hard copy of the steps in your purse or bookmarking a video on YouTube.

The key is to make a plan before you need it. That way, you won’t have to worry about figuring out what to do when you’re stressed in the moment. Because you’ll already know. And you can just look at the plan you made earlier and carry it out. 

When to seek help

Anxiety can be uncomfortable, but it’s actually a sign that our bodies and brains are working the way they’re supposed to. Ultimately, anxiety is designed to keep us safe.

But if you find yourself avoiding normal activities, turning to substances like drugs or alcohol for relief, or becoming unusually irritable with your loved ones due to anxiety, it’s probably time to seek help.

MD Anderson patients and their caregivers can get support by contacting Social Work or the Psychiatric Oncology Center, or by sending a message to their care team through myChart.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Burnout is the combination of exhaustion, detachment and cynicism that can sometimes develop when we’re faced with unrelieved stress over a long period of time.

People usually talk about burnout in the workplace, but everyday factors can contribute to it, too. That includes ongoing financial struggles and chronic tension in personal relationships – and now living through the COVID-19 pandemic. Throw in a cancer diagnosis and some level of burnout is almost inevitable – whether you’re a patient or a caregiver.

So, how do you prevent burnout if you haven’t reached that point yet? And how can you find some relief if you’re already burned out? Here’s a three-step guide to get you started.

1. Recognize signs of burnout

There are many degrees of burnout, and they look different for everybody. Some people don’t even realize they’re burned out until they’re right in the thick of it. So, the first step is to recognize that it’s occurring, and put a word to it so you can start taking steps to reverse it.

Burnout may appear in physical, mental or emotional ways. But one of its hallmarks is a feeling of just being “over it.” You might not care as much about things as you used to, or you may just want a particular thing or situation to be done and over with. It’s actually similar to the concept of “senioritis,” which affects some people during their final semester of schooling.

Other signs of burnout can include:

• EMOTIONAL: Feeling angry, anxious, depressed, resentful or stressed; avoiding or dreading certain tasks, people or situations
• MENTAL: Having difficulty concentrating or finishing projects
• PHYSICAL: Headaches, or an overall feeling of tension in your body

2. Normalize burnout

There’s no doubt that this past year has set the stage for widespread burnout. The combination of financial hardship, social isolation and resource depletion has hit many people very hard.

So, try to be gentle with yourself if you’re feeling overwhelmed or exhausted, too. Experiencing burnout doesn’t make you a bad person — it just makes you human.

3. Reverse feelings of burnout

Everybody’s situation is different, so there’s not going to be any one-size-fits-all fix. But think about the resources you have available, and come up with an action plan that works for you. Consider using SMART goals. Here are some things to try:

• Improve your sleep habits: Sleep deprivation can contribute significantly to burnout. Getting enough sleep can play a huge role in counteracting that. Use these tips to help you sleep better, and aim for 7-9 hours a night.
• Find emotional outlets: Schedule regular opportunities to talk to someone else about your problems. It could be a friend, a loved one, a therapist, a spiritual advisor, or a support group. Just knowing you’re not the only one who’s struggling can sometimes provide much-needed encouragement.
• Limit negativity in your life: Some people say that “misery loves company.” But I say, “Misery loves miserable company.” It’s good and healthy to get your feelings out. But surrounding yourself with people who vent constantly is probably not going to be very helpful.
• Clean off your plate: It’s easy to feel overwhelmed when your to-do list is growing faster than you can scratch things off of it. But take a few minutes to examine it critically every now and then. Which deadlines are artificial or arbitrary? And how much of the pressure to get them done is self-imposed? Is there anything that can wait a few more days, be delegated to someone else, or even be removed entirely? Clean off your plate as much as possible to give yourself some breathing room.
• Feed your soul with mental escapes: Give yourself a mental vacation by thinking about the things you were passionate about in the Before Times. Read a book, watch a funny movie or comedy routine, or visit an art gallery online. Do as many of those things as you can to help yourself reset.
• Try a change of scenery: Identify activities that can physically remove you from the source of your burnout, even if it’s only for five minutes a day. Then, do them. Grab a cup of coffee from a kiosk, take a walk in the park, or go birdwatching in your neighborhood to decompress. Whether you’re a patient or a caregiver, getting out of the cancer world even for a single day can make a huge difference in your morale.
• Try small indulgences: Self-care doesn’t have to be elaborate or expensive to be effective. So, trade pedicures with your teenager, ask your spouse to trade massages, or take a bubble bath alone by candlelight.
• Get some exercise: Recruit a friend to go walking or biking with you, or open the windows and take virtual workout classes. Exercise releases endorphins, which reduces stress and helps you feel better naturally.
• Schedule guided relaxation: Set aside some time each week to practice yoga, meditation or whatever mindfulness method helps you unplug and shed stress.
• Watch your cravings: When people are stressed, they tend to crave things that aren’t very helpful, like excess carbs, sweets or fatty foods. They also tend to drink alcohol and smoke more. In the moment, these behaviors may seem like they’re helpful, but in the long run, they’re really not. Recognize these cravings and, when you notice them, reach for a piece of fruit, go for a walk, or phone a friend instead.
• Engage in positive self-talk: Many people have a critical voice in their head that makes them feel bad about certain things. So, when you notice your inner-monologue taking this route, interrupt it and contradict it with more positive messages like, “Good enough is good enough. It doesn’t all have to be perfect. Even Bs still get degrees. You don’t have to be the best friend to everybody.”

The most important thing to remember about burnout is that you don’t have to face it alone. Talk to your doctor if you have any concerns. MD Anderson patients and caregivers can also ask for a referral to one of our social work counselors or psychiatrists. The one thing we don’t want people to do is stop their cancer treatments due to burnout, so notify your care team if you’re struggling.

And, if you or someone you know is in danger of hurting themselves, please call the National Suicide Prevention Hotline at (800) 273-8255 immediately. Counselors are available seven days a week, 24 hours a day, and offer free and confidential support.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.