Written By Dr Jodie Fleming
Clinical & Health Psychologist at The Psychology of It – Author – BRCA1 Positive Breast Cancer Survivor
There are several cognitive and behavioural strategies we can learn to effectively manage our scanxiety.
Here are just a few.
Breathing is one of the first things to change automatically once our Fight or Flight response is activated through our sympathetic nervous system. You'll usually notice when you are anxious your breathing becomes faster and shallower as you attempt to obtain more oxygen into your body (it’s definitely counter-intuitive).
To nip the Fight or Flight Response in the bud, we can take conscious control back over our breathing by holding our breath.
Try this simple controlled breathing exercise.
- Hold your breath and count to six.
- Exhale slowly to the count of three, forcing all of the air out of your lungs.
- Then, inhale slowly and deeply to the count of three.
- Repeat the exhale/inhale process nine times.
Once you've completed that full cycle, one minute will have passed and you should notice your anxiety symptoms have or are subsiding. You can easily repeat the controlled breathing cycle one more time and that should be enough to have returned your body to a more relaxed state.
Feel free to get creative with the counting. You might inhale for 2, hold for 3 and exhale for 4, for example. It doesn't matter, as long as you count.
The counting is important because it occupies your cognitive space that you might otherwise use to worry!
In cognitive therapies, we rely on a theory called the ABC Model. The A (an activating event) is followed by our B (belief) which then tends to influence our feelings, the C (consequence).
Let’s use having an MRI as an example for how this works. In this case, the activating event is having the MRI which in the past has made me feel very claustrophobic due to my belief that I wouldn’t be able to breathe and also anxious about what it would reveal.
Some of my less-than-helpful thoughts and beliefs about having an MRI have included these:
‘I won't be able to get out if I need to.’
‘I'll be trapped inside the tunnel.’
‘I won't be able to breathe.’
‘They’re going to find the cancer has spread all over my body.’
In my last MRI, I chose a thinking strategy from a cluster of tools called defusion strategies. Defusions come from Acceptance and Commitment Therapy (ACT) and are aimed at changing, not the thought content, but instead, our relationship with the thought.
I took the thought, ‘I won't be able to breathe’ which when it stands alone, is a serious life-threatening proposition... if it were true.
I knew I had to quickly let go of that worry because I was in the middle of the tunnel with no easy way out and I needed to reduce the impact it was having on anxiety levels, so I chose to turn it into a funny thought - something I could laugh at instead.
I brought up an image of Sheldon Cooper from the television show The Big Bang Theory - you can use your favourite TV character but make sure it’s someone who makes you laugh. I pictured him sitting in his position on his red leather couch, wearing a short-sleeved t-shirt over a long-sleeved shirt and then I saw him look right through the camera at me, as he repeated my thought to me, word for word.
Before he'd even finished the sentence with his slow American Southern drawl, I'd already begun to smile at how funny it sounded and I was able to re-focus my attention onto other things.
I'd bought myself some emotional distance from the thought as it was now Sheldon's thought and not mine. The fact that I find him so funny also allowed me to easily detach from it and let it go. I was not thinking about Sheldon and not my breathing.
Immediately my anxiety levels dropped.
When the spotlight of our attention is in the present moment, we tend to feel better. Our mind is free from the ‘what ifs’ of the future and the ‘what dids’ of the past and it makes an incredible impact on our stress and anxiety levels.
The simplest method for anchoring your attention in the here and now is to take the position of the curious, open-minded scientist, making non-judgemental observations about your immediate environment by asking yourself the following five questions:
What are five things I can see?
What are five things I can hear?
What are five things I can feel?
What are five things I can smell?
What are five things I can taste?
In the MRI machine, I chose to use my sense of sight and realised quickly that if I looked up and backwards from the mirror, there was a perfect gold sticker right above my head.
I began describing that to myself in great detail.
Mentally, I traced the outline of the sticker, noticing its rectangular shape and slightly rounded corners. I noticed how it sat flush with the machine, no parts of it had lifted and it contained no air bubbles. The bloom from the lighting in the back of the machine - it is very bright in there - caused the metallic gold to reflect and refract the light in lots of different ways.
While I marvelled at all of that, my anxiety once again calmed down. My mind was full of thoughts about the object that I chose to focus on and every time an unhelpful thought tried to trick me into feeling scared again, I noticed it and refocussed my attention back onto that sticker.
Once I finished with the sticker, I noticed a solid grey band that ran behind it and circled the entire tunnel, providing me with a new focus for my attention.
Once again, I'd managed to reduce my anxiety, quickly and effectively.
Described above are three quick and effective anxiety management tools: Controlled Breathing; Thought Defusions; and, Mindful Grounding. I have been teaching and using these strategies regularly for years and so for me, they have become automatic processes.
In order to make them automatic for you too, rehearse them often and begin when you are feeling calm. Try them on neutral or positive thoughts to get the hang of imagining your character or focussing your attention on an object.
Once they become easier and more automatic you can try using them during slightly more uncomfortable situations, gradually building your confidence in both applying the strategies, but also in their effectiveness so that the next time you need a scan, it’ll be a breeze.
And one little note on the fear of recurrence...
In 2012, two years after my cancer diagnoses (there were two) I travelled to New York to celebrate my 40th and was lucky enough to meet the head social worker at Memorial Sloan Kettering cancer hospital. We spoke about the unique trials of cancer survivorship including fear of recurrence. I asked if it ever stopped and was met with a resounding YES!
“One day you’ll notice that you’ve gone an hour without thinking about cancer. Then it will be two hours; half a day; a day; a week; a month; a year. Time will be your friend, just wait and see.”
And that’s exactly what came to pass.
Dr Jodie Fleming is the author of breast cancer memoir A Hole in My Genes, a book filled with her professional and later personal candid, raw experiences of being diagnosed with two primary breast cancers at the age of 37 and later discovering she is BRCA1 positive. A Hole in My Genes is filled with all of the psychological tools Jodie used to navigate her way through her own cancer treatment with a healthy amount of family dysfunction to boot. You can find A Hole in My Genes in all your usual online bookstores in hard copy and eBook. You can also join Jodie on one of her international Wellness Retreats. For more, visit her websites thepsychologyofit.com.au or drjodiefleming.com.au.
Sign up for our latest webinar, 'Dealing with a High-risk of Cancer' featuring Dr Jodie Fleming here.