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Living Well With MBC > Managing Your Emotions

Managing Your Emotions

Living with metastatic breast cancer can be emotionally challenging. You may feel anxious one day, sad the next, and angry another day. Sometimes you might not be able to figure out what you’re feeling. This is especially true when you’re already under stress. There is no right or wrong way to feel. Every person is unique, and every person will feel different things at different times. But identifying your emotions can help you manage them better.1,2,3

Managing anxiety, worry, and fear

It’s common to feel anxious, worried, or fearful when you’re unsure about the future. Uncertainty is a normal part of life—particularly when you’re living with advanced or MBC. You may be feeling nervous about your next doctor’s visit or medical test. Or you may be concerned about your treatment and wonder how well it’s working.1

Sometimes we can feel these emotions in our bodies. They can cause physical symptoms, like:4

  • A racing heart (feeling like your heart is beating faster than normal)
  • Sweaty palms
  • Fast, shallow breathing

These tips may help you manage the anxious thoughts and the physical symptoms they may cause.

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    Review medications with your doctor

    If a medication or related challenge is causing you to feel anxious, your doctor may be able to provide suggestions to help you manage anxiety or switch you to another medication.

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      Focus on what you can control

      There are some things in life that we just can’t control. You can’t prevent a storm from coming, but you can prepare for it. And you can’t control what someone else does, but you can control how you react to it.5

      When you’re worried, it can help to be aware of which things are out of your control. Control the things you can and try to focus less on things you can’t.

      For example, when you go for a medical test, think about the following:

      What you can’t control What you can control
      What the test result will be The questions you ask
        Who you bring with you
        What you do afterward

      Sometimes all you can control is what you try to do and how you try to do it. That can be hard to accept. But when you focus on the things you can control, you may be able to deal with any anxious feelings better.5

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        Prioritize yourself and your health

        • Do something each day that makes you smile and laugh, even if it’s something small1
        • Eat foods that you enjoy, in moderation
        • Get more sleep
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          Start or get back to an activity that you enjoy1,6,7

          • Watch a funny movie
          • Music, art, and writing may help you creatively express your emotions
          • Some mind-body practices, such as yoga, meditation, and deep breathing, can help lower anxiety1
          • If you are physically well enough, activities like gardening, walking, or cycling may take your mind off your cancer for a bit and release chemicals in your brain that can lift your mood
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            Focus on your breathing7,8

            When you feel anxious, worried, or fearful, your breathing may become fast and shallow. This exercise may help control your breathing and make you feel more relaxed.

            Practice this breathing exercise regularly. Then, once you’re comfortable with it, you can use it anywhere and at any time. 

            • Find a comfortable position, such as lying in bed on your back or on the floor with a pillow under your head. You may choose to sit in a chair with your shoulders, head, and neck supported.
            • Take a deep breath through your nose. Let your belly fill with air.
            • Slowly release the air through your nose.
            • Place one hand on your stomach; the other on your chest.
            • As you inhale, feel your stomach rise. As you exhale, feel it sink. The hand on your stomach should move more than the hand on your chest.
            • Repeat this 3 more times, inhaling deeply each time. Feel your belly rise and fall with each breath.

            Processing feelings of sadness

            It’s natural to feel sad when you’re living with MBC. You may grieve the life you had before your diagnosis or feel sadness about how the disease has impacted your appearance, your life, and your plans.9 You don't have to pretend that you're not feeling these things.

            It’s also OK if you want to be alone. You may need time to be by yourself. Use that time to acknowledge your feelings. Let yourself cry or express sadness in whatever way feels right.9

            If you need some time for yourself, it may help to tell your family and friends:2

            • "I appreciate your support, but I need some time to myself."
            • "I still care about you, but I need some time to myself."
            • "I don't feel like talking about the cancer now. I will tell you more when I feel ready."

            During that time, it may also help to ask yourself these questions and write down your reaction:

            • "What am I most worried about?"
            • "What am I hoping for?"
            • "What is important to me right now?"

            Make an appointment with yourself once a week to explore the emotions you are feeling.

            Sometimes feelings of sadness can be overwhelming and get in the way of your daily life. Be open with your healthcare team about your emotions. They may be able to help.9

            Planning activities

            It may help to maintain your normal routine as much as you can. This can be meeting a friend for coffee, having breakfast with your family, or anything else you enjoy as part of your normal schedule.

            However, you may not enjoy doing some things as much as you used to. Planning activities can help you work them back into your day-to-day life. It can give you something to look forward to and provide a sense of purpose. It can also distract you from thinking about cancer. Try starting with these steps:

            Write a list of small, everyday activities you like doing. Below are a few ideas. The activities are in groups to help you think through each of them. Maybe you prefer some of the categories over others. Or maybe you want to pick one activity from each group. To help choose activities that are meaningful to you, you can rate them by how rewarding they are and by how easy they are for you.

            • Nature-related: Bird watching/feeding, gardening
            • Social: Meeting a friend for dinner, having a video call with someone you haven’t seen in a while
            • Physical: Joining a yoga class, taking a short walk around the block
            • Spiritual: Meditating, praying
            • Reflective: Stargazing, writing in a journal
            • Creative: Drawing, cooking

            Once you choose your activities, use a calendar to schedule the day and time for each one. Try to plan at least one a day. Keep your schedule somewhere visible to remind you and your loved ones of the planned activities.

            Letting go of your thoughts and feelings

            It can be too easy to let sad thoughts and feelings build up inside. It’s important to have an outlet—a way to express those negative emotions. Talking and writing about them can help.

            Talking

            Talking with other people about your thoughts and feelings may help you make sense of things and help you to feel less alone.

            • Think about the people in your social network. Which of your friends, family members, colleagues, or neighbors might you want to talk with? Is there someone you’ve talked with in the past? Maybe someone who has also had a health issue could relate to what you’re going through. Or maybe you know someone who’s just a good listener.
            • Once you’ve chosen someone you trust, agree on a time and place to talk. You might want to meet face-to- face. Or a phone call or video call might work better for both of you. Allow enough time to say what you want to say, in a place where you won’t be distracted. You may even want to have notes ready.

            Many people find it helpful to talk with a professional, like a counselor or psychologist. If that’s something you’d like to try, ask your doctor for a referral.

            Writing

            If you aren’t ready to talk to someone about your feelings yet, try writing them down. It may help you clear your head.10

            Two common ways to write about your feelings are:

            • Journaling—express your thoughts in a book or a blog. Plan a specific time each day to write in your journal or just write whenever you feel like it10
            • Letter writing—write a letter to yourself or to someone you know. You don’t need to send the letter. In fact, you don’t even have to keep it. Simply writing your thoughts down can be helpful11

            Whatever way you choose to do it, writing can help you let go of negative thoughts and feelings.

            When sadness won’t go away

            When sadness won’t go away12

            Most people have feelings of sadness at some point. But sometimes, these feelings can be lasting. Worse, they can stop you from enjoying your daily life. When that happens, the feeling may be more than just sadness. It might be a treatable condition called depression.

            Think about these sentences below. Are any of them true for you most of the time?

            • I feel very sad most of the day
            • I don’t enjoy doing things I used to do
            • I feel worthless or guilty
            • I have a hard time focusing or making decisions

            Be sure to talk with your healthcare team about your feelings. if your doctor thinks you have depression, they may prescribe things to treat it, such as medication and talking with a psychologist or counselor.

            Managing frustration and anger

            You may be asking yourself, “Why me? What did I do to deserve this?” You may be mad at your healthcare team, family members, friends, and even yourself. If you are religious, you may even question your faith. These are common feelings among people with advanced or metastatic breast cancer.13

            Frustration and anger can be powerful emotions. They may show themselves in physical ways, like tightness in your chest, a racing heart, or tension in your muscles.14,15

            The key is to manage these emotions before they take control of you and affect the people around you. Here are a few tips that can help you manage these feelings. They may even help stop your frustration and anger from building up in the first place.

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            Clear communication

            It is common to feel angry and frustrated about having cancer or with things that have happened during your diagnosis or treatment. You may find yourself lashing out at healthcare providers or friends and family members.13 That’s understandable. Using clear communication can help make sure your feelings are understood. Clear communication works two ways: it means expressing yourself clearly and listening to others carefully.16

            The next time you feel anger or frustration building, try these tips:

            Express yourself clearly

            • Think about what you are really feeling. It may actually be pain, rejection, or sorrow, rather than anger. Once you figure out what your emotion is, express that instead.17
            • Direct your anger at the cause of the feeling, not at other people.17
            • Discuss the reasons for your anger with a trusted family member, friend, or counselor.17
            • Tell your loved ones exactly what you need. Saying something like, “Can you come to my next appointment with me?” gives friends and family a clear way to help.
            • Use “I” to express your feelings so it doesn’t sound like you’re blaming the other person. Start each sentence with phrases like “I feel...,” “I think…,” or “I need…” instead of “You…”

            Listen carefully to others

            • When someone is talking, focus on what they’re trying to say16
            • Try to avoid making assumptions. This can lead to misunderstandings. To be sure you understood correctly, use your own words to repeat what the person said to you
            • Don’t jump to conclusions or try to read someone’s mind. If you’re not sure what they are thinking, ask
            • Try to understand the meaning and emotions that the other person is expressing. It can be helpful to know their reasons for saying what they’re saying16

            Bottom line: Do not wait for anger and frustration to build up. Express your feelings as soon as you recognize them. If you hold them in, you are more likely to express anger in an unhealthy way.17

            Distraction

            Distraction can be a good way to let go of frustration and anger. Distraction is not about trying to escape or avoid a feeling.18 Distraction can take your mind off things by redirecting your thoughts to something more positive. 18 It also may help you think more calmly and clearly about the situation.

            Consider these ways to help distract you for a little while:

            • Try to appreciate small details in your surroundings
            • Read a good book or watch a funny movie
            • Play a game that needs focus or attention, such as a crossword puzzle
            • Focus on your breathing. For example, pay attention to how it feels to breathe in and out
            • Visualize being in a pleasant, safe, and comfortable setting, like under a palm tree on a beach
            • Listen to your favorite music. Try to pick out all the different instruments and sounds that you can hear

            Releasing muscle tension

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            Anger and frustration can make our muscles feel tight. Muscle relaxation exercises can help you deal with that feeling.19

            To do a muscle relaxation exercise, you tense and then relax different muscles in your body. You start with your toes and then move up through your body to your head. With practice, it should become easier for you to recognize and respond to tension in your body.

            Take a moment to try this simple muscle relaxation exercise

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            At the end of the exercise, it can be helpful to spend a few minutes just relaxing quietly. See if you notice any tension in your body and try to relax it. Otherwise, just let the tension be. If your mind wanders, try to bring your focus back to your breathing.

            Find more tips and tools to help you manage your emotions.

            Download 5 steps to take care of your emotional and spiritual needs.

            REFERENCES

            1. National Cancer Institute. Facing forward: life after cancer treatment. https://www.cancer.gov/publications/patient-education/life-after-treatment.pdf. Accessed November 4, 2019.
            2. Handler JC. Identifying your feelings: sometimes I don’t even know how I feel. Psychology Today [blog]. https://www.psychologytoday.com/us/blog/art-and-science/201801 /identifying-your- feelings. Accessed November 29, 2018.
            3. Becholdt MN, Rohrmann S, De Pater IE, Beersma B. The primacy of perceiving: emotion recognition buffers negative effects of emotional labor. J Appl Psycol. 2011;96(5):1087-1094.
            4. HelpGuide.org. Anxiety disorders and anxiety attacks. https://www.helpguide.org/article/anxiety/anxiety-disorders-and-anxiety-attacks.htm. Accessed September 23, 2019.
            5. Morin A. How to stop worrying about things you can’t change. Psychology Today [blog]. https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont- do/201705/how-stop-worrying-about-things-you-cant-change. Accessed September 24, 2019.
            6. Springboard Beyond Cancer. Anxiety. https://survivorship.cancer.gov/springboard/stress- mood/anxiety. Accessed November 4, 2019.
            7. Lengacher CA, Johnson Mallard V, Post-White V, et al. Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psychooncology. 2009;18(12):1261-1272.
            8. WebMD. Breathing techniques for stress relief. https://www.webmd.com/balance /stress- management/stress-relief-breathing-techniques?print=true. Accessed September 15, 2019.
            9. Cancer Research UK. Coping with sadness. https://www.cancerresearchuk.org/about- cancer/coping/emotionally/cancer-and-your-emotions/coping-with-sadness. Accessed November 6, 2019.
            10. University of Rochester Medical Center. Journaling for mental health. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentID=4552&ContentTypeID Accessed September 23, 2019.
            11. Piedmont Healthcare. Therapeutic effects of writing letters. https://www.piedmont.org /living- better/therapeutic-benefits-of-writing-letters.
            12. National Cancer Institute. Depression (PDQ®) – Patient Version. https://www.cancer.gov /about- cancer/coping/feelings/depression-pdq. Accessed November 4, 2019.
            13. National Cancer Institute. Coping with advanced cancer. https://www.cancer.gov/publications/patient-education/advancedcancer.pdf. Accessed November 4, 2019.
            14. Ankrom S. Differences Between panic and anger attacks. Verywellmind website. https://www.verywellmind.com/panic-attacks-and-anger-attacks-the-difference-2584386. Accessed September 10, 2019.
            15. Mills H. Anger management relaxation techniques. https://www.gracepointwellness.org/116- anger-management/article/5815-anger-management-relaxation-techniques. Accessed September 10, 2019.
            16. HelpGuide. Effective communication. https://www.helpguide.org/articles/relationships- communication/effective-communication.htm. September 23, 2019.
            17. American Society of Clinical Oncology. Coping with anger. https://www.cancer.net /coping-with- cancer/managing-emotions/coping-with-anger. September 10, 2019.
            18. Tull M. Using distraction as a way of coping with emotions. Verywellmind website. https://www.verywellmind.com/coping-with-emotions-with-distraction-2797606. Accessed September 10, 2019.
            19. National Health Service (NHS) Scotland. Anger Moodjuice Self-help Guide. https://www.moodjuice.scot.nhs.uk/Anger.asp. Accessed November 6, 2019.