Moving On After Cancer–Session 4

Tuesday 5th July 2016

Today was the penultimate session of our five-week course. How terrifyingly fast time flies these days! I shall really miss this when it finishes, and hopefully some of us at least, will continue to meet afterwards because we are definitely bonding with each other, which is great.

The title of today’s session was Thinking, Feeling and Doing, and Body Image and Self-Esteem.

Andrew began with a recap of last week’s session for the person who wasn’t there – he put us all on the spot and asked several questions about the session to see if we’d been paying attention! One person immediately said that he remembered the home-made biscuits I’d brought in!!

On the subject of communication which we dealt with last week, led by Debbie, one of the clinical nurse specialists, we continued to look at the “hand on the door” syndrome (or as I described it, “the Columbo syndrome” – “Just one more thing…” as the famous TV detective always says when he’s just leaving!). Debbie asked us why we thought people did this. It was suggested that perhaps we didn’t want to be seen to be making a fuss, or perhaps it was because we were too scared of the answer! Going back to Session 2, it was “avoidance” in the red circle.

One person was very nervous about an upcoming appointment with her consultant, and Debbie said it would be good for her to speak on the phone to the nurse first and outline her concerns, and the nurse could pass this on to the consultant, so he’d be prepared in advance. Sometimes it’s easier for someone else to voice the concerns than it is for ourselves. It was also suggested that we could write down the questions and if we didn’t feel like speaking them out, to pass over the piece of paper instead.

Debbie said that we needed to be assertive without being confrontational. It was important to remember that the reason the professionals are there at all is because of us; they are paid to offer us a service, and we have a right to have our questions and concerns addressed, and it was their job to make things smooth for us. She described one consultant telling a patient that “it is better this way – this is the way that suits us best,” and she was not pleased about this, because it is not about what is convenient for the hospital staff, but what is best for the patient; this person had to make a special trip in, at great expense and inconvenience, and it could have been dealt with the following week when she had an appointment anyway.

We then moved on to the session proper.

Thinking, Feeling and Doing

Andrew began by asking a question, pen in hand, ready at the flip chart for our answers.

“What is a thought?”

It’s funny how hard a question this is to answer! We all think, all the time, and yet it’s so hard to define exactly what a thought is.

• An idea or concept
• Unspoken words
• A message from your mind
• Inspiration
• Something that pops out of nowhere
• Imagination
• A belief
• A memory

Do we treat our thought as facts? i.e. “If I think that, it must be true.”

We believe our own hype, especially if we are in a difficult place, or stressed. Our thoughts can undermine us and work against us.

They can be:

• Judging
• Evaluating
• Predictions
• Triggers, building fears and anxieties
• Memories

We have thoughts about ourselves; we describe ourselves, labelling ourselves: I am:

• A weak person
• A strong person
• A worrier
• An anxious person
• A failure

What is the problem with this? Our thoughts can be inaccurate. They can imply that we are like this all the time. They can be negative. A person who describes themselves as anxious may just be thoughtful. You can convince yourself that you are anxious all the time, when you are anxious only sometimes.

As well as judging ourselves, we often judge others because we are assessing them, particularly if it is part of our job to do so. Judgements can be wrong, particularly first impressions, and judgements of ourselves.

Our thoughts about ourselves directly affect our feelings, which can directly affect what we do.

We can’t control the thoughts that pop into our heads, but we can control how we feel and how we act – how we respond to these thoughts. Our thoughts can be constant chatter in our heads. We need to ask ourselves, “What am I telling myself? Am I being anxious?” We need to analyse what we are thinking, to think about our thinking, to think rationally about it.

Positive thinking

We hear a lot about this. It is often hard to stay positive. Is it important to strive to be positive? Everybody is different and some people find it easier to be positive than others. People’s glass can be half-full or half-empty.

People say to us that we “must think positive.” Someone said that after getting their cancer all-clear, people often said things like, “”Well, you’re all right now – you can be positive and get on with your life again now,” and this can make things worse, not better.

The problem isn’t the “thinking positive” so much as the “must think positive” – the feeling of pressure to be positive. One person said this made her “close down,” or make a different judgement, and assume that the other person has had enough of what you’ve been saying, and they want to move on. Your being positive makes them feel better, and the unintended consequence is that you feel worse.

What we need is balance. We shouldn’t deny that we are human, and sometimes get anxious and need to talk about it.

Sometimes the reassurance from others that “You will be fine,” is not helpful. It is better to talk about what you are really feeling. You need to choose the right person to talk to, who will listen properly – perhaps a professional person, rather than family and friends, who often tend to glaze over.

Avoidance

Looking at Session 2’s red circle again, when we have anxiety over our health, or over a symptom, etc., we tend to try and avoid thinking about it, and do anything to distract ourselves, but we can’t stop thinking about it.

Andrew did a little “thought experiment” with us. He put up this picture of a pink elephant.

He got us to look at it carefully, and then told us to close our eyes for 30 seconds, and to think about anything we liked, except a pink elephant.

How did we do? Not well! We all said that however we tried, the picture of the pink elephant would intrude on our thoughts.

What does this mean? It is a cognitive paradox. For instance, we might worry about the recurrence of our cancer. We say, “I don’t want to think about that,” and end up thinking about it all the more!

What do you do about this? You can’t get rid of the thought, whatever you do.

Someone suggested, and Andrew agreed wholeheartedly (saying that that person was a psychologist!) – “You allocate it some space.”

You don’t want to accept it, but the reality is there and you can’t get rid of it. It is best not to try to avoid thinking about it, but to think about it properly, turning towards something you naturally want to avoid, and then think it through, and then think beyond it. You can phone a professional, or chat with a friend about it. It is still a worry, but with this approach, it becomes manageable.

If such a thought keeps you awake at night, it is best to write it down, and tell yourself to think about it at a better time (in the middle of the night one’s thoughts are always worse). This stops it bombarding you all the time.

The Mind-Body Link

Andrew began to draw a chart on the flipchart. This is the handout he gave us at the end of the session:

We unpacked this, and Andrew wrote up on the flipchart as we suggested answers to his various questions.

He took the example of a lady he had been helping recently, and described her situation and how her thoughts ended up causing her a great deal of distress. In her case, the trigger was that some friends wanted to come and visit her. What was the first thing that went through her mind? The thoughts in the top circle.

Looking at her emotional reactions in the second (right-hand) circle, nothing had even happened yet! The mind is sabotaging a nice thing (the fact of her friends visiting).

What did she do? She tried to use the TV as a distraction – the “Pink Elephant.”

By the time she reached the fourth (left-hand) circle, she felt worse, with no energy. It was a vicious cycle.

We need to think about our thinking. We need to pause and ask ourselves if it is helpful to think like that.

How could she have brought about a completely different result, simply by thinking differently about it?

This is the same situation.

The trigger (the friends coming) was the same. Her thoughts in the first circle were the same – “the house is in a mess” and “I’m too tired.” However, she’s not giving them a tour of the house! She can think smaller, and simply tidy the lounge, where they will be sitting.

This thinking causes a very different emotional response. She then takes some action in the Behaviour circle, rather than flopping on the sofa in front of the TV, and by being more active, she releases endorphins and oxytocin (which is the bonding hormone), and feels a sense of achievement as she tidies the lounge.

In the Body circle, she is relaxed. Relaxation literally creates energy, both physical and emotional.

None of the negative predictions came about, and she enjoyed it.

We need to watch our thoughts. “What am I saying to myself?” Remember the Thinking Traps chart in Session 2.

Debbie, one of the clinical nurse specialists, said that it’s nothing big; a small trigger can have catastrophic results, or positive results, according to how we think about it.

We were given a compassion-focused chart:

We need to ask ourselves, “What would a compassionate friend say to me now?” or “What would I say to someone else in this situation?” We are so hard on ourselves and need to respond more compassionately towards ourselves.

We broke for tea, and again everybody tucked in with great relish to my home baking efforts – this time I brought some of the almond slices we had last time, and some new chocolate chip cookies, and two new recipes that I hadn’t tried before – lemon drizzle cake, and coconut macaroons filled with chocolate ganache – these last ones in particular certainly elicited a positive response!

After tea, Debbie began to discuss some issues of body image.

Body Image and Self-Esteem

She asked us, “Have you had issues with this?”

One person replied that she definitely had, over her weight. Debbie asked her, “How does it affect how you think about it?” She replied that it affected her over choices of what to wear, if she was going out with a friend, especially if that person was slim. Debbie said that we tended to compare ourselves with others.

She asked us, “Is it right or wrong to have ideas about body image? Are we being vain if we worry about it?”

With cancer, there may be hair loss; mastectomy, or a stoma. Are we vain if we bother about such things?

It’s natural to want to look good, and it makes you feel good.

One person said that since her cancer, her body was not her own any more.

Debbie said that when people have treatment, she hopes that the professionals don’t take away their dignity, etc.

Treatment can restrict what you can wear. “Is my colostomy bag hidden?” etc.

Debbie said that we are born with a natural curiosity about our bodies – a baby will sit for hours looking at his reflection in a mirror, without embarrassment! They are not vain.

Andrew said that it wasn’t just about relationships with others, but with ourselves. Debbie pointed out that we are not attending this course just because we might be worried that our cancer is coming back, but holistically – looking at relationships, etc.

Cancer is a big, and sudden, change; there is no time to adjust – as one person said – it was a bit like coming out of the Navy – they throw you out at age 40 and while they do lay on courses to help you plan for life in civvy street, some people don’t take advantage of this and find it very difficult to make the adjustment.

Debbie said it was important to recognise it, and share it, and not to sit at home thinking about it. She added that we are not our appearance. We should remind ourselves of our strengths, stripping off our layers (being someone’s wife, or a person going out to work, etc.), and we can ask ourselves, “What’s the person that is there?”  and ultimately we will be able to say to ourselves, “I like that person – it’s me!”

Some people expressed how hard it is to receive a compliment – we need to hear it, and listen when someone gives us a compliment, like when someone notices that you’ve lost weight.

At the end of the session, Andrew led us into a short relaxation exercise, mainly concentrating on our breathing.