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Coping with Distress
Many people aren’t well-prepared for the mental distress that can come with cancer and cancer treatment. If you or a loved one experiences mental distress, it’s important to get support.
There are treatments available and steps you can take to help cope with distress.
Learning to cope with distress
It’s important to find healthy ways of coping with distress. But coping is a skill. Like all skills, it has to be learned. It doesn’t come naturally to most people. There are many reasons you might have an easier (or harder) time coping.
- Social support (from friends, coworkers, or others)
- Family relationships
- Worries about money
- Beliefs and values
- Health behaviors
- Access to support and resources
If you don’t have the support and coping skills you need, you might end up coping in less healthy ways, like denial.
Denial is one way people often cope with distress. By denying or avoiding a problem, a person might convince theirself and others that they are fine. But even though they seem fine, they are often struggling on the inside.
Learning to manage and cope with your distress during cancer care is especially important. Denial about cancer can lead to delaying care, missing appointments, not getting treatment, or misunderstanding your disease or prognosis.
Denial is a normal response to extreme distress. Our brains actually do this to protect us from potential harm (including emotional and mental harm). It isn’t anything to be ashamed of. But it’s important to be aware of it so you can learn healthy ways to cope.
Treatments
Mental distress often has more than one single cause. This is why it’s so important to use more than one tool to manage it. Treatment for distress works best when more than one strategy is used.
Psychotherapy (talk therapy)
There are many different types of psychotherapy (talk therapy). Some of the most common types are:
- Cognitive behavioral therapy (CBT): CBT teaches you how to process your feelings instead of avoiding them. You’ll learn how to identify automatic negative thoughts. You’ll also learn relaxation techniques and healthy coping strategies.
- Acceptance and commitment therapy (ACT): ACT is a sub-type of CBT. You’ll learn to use mindfulness as a way to notice and acknowledge your negative thoughts, feelings, and actions without trying to change or get rid of them.
- Interpersonal therapy (IPT): IPT focuses on the connection between your mental distress and your relationships with others.
- Eye movement desensitization and reprocessing (EMDR): EMDR therapy uses directed eye movements along with talk therapy to help your brain heal from past life experiences.
- Exposure therapy: Exposure therapy helps you face your triggers. (A trigger is something that reminds you of a past trauma and causes an emotional reaction.) By facing your triggers, you can learn to cope with them if they come up in the future.
- Family and couples therapy: This type of talk therapy focuses on constructive (positive and productive) communication. It has been shown to improve distress and relationship satisfaction in spouses or family caregivers coping with cancer.
- Supportive therapy: This can include group or peer therapy with other people who have, or had, cancer.
Medicines for distress
If you’re struggling with mental distress to the point that it affects your everyday life, your doctor might suggest adding medication.
Many types of medicines used for mental distress are also used for other health conditions. For example, certain antidepressants also help improve anxiety.
The most common medicines used for mental distress are described below.
Antidepressants
Antidepressants can help with more than depression. They also help with anxiety, pain, and sleep problems. Antidepressants work by affecting the levels of certain chemicals in your brain, like serotonin and norepinephrine.
Most antidepressants take a few weeks to start working, so it’s important to give them time. There are also several different types of antidepressants. Don’t get discouraged if the first doesn’t work for you.
Learn more about the different types of antidepressants and other treatments for depression.
Benzodiazepines
Benzodiazepines are used for anxiety. They work much faster than antidepressants. This can be helpful if you are feeling overwhelmed or nervous about a procedure. Benzodiazepines are controlled substances and can be habit-forming.
Talk to your health care team about the risks and benefits of any new medicine.
Support or peer groups
Support or peer groups give you the chance to talk with people who have been through similar experiences. These groups can be helpful even if you have an amazing personal support system. It is often healing to see that you aren’t alone in the way you feel.
Complementary therapies
Studies show that some complementary therapies improve quality of life and symptoms of mental distress. These therapies are used along with standard medical treatments to help you manage your symptoms.
For example, mindfulness meditation has been shown to improve mental distress.
Mindfulness-based activities
Mindfulness is about noticing and being present with your thoughts, emotions, body, and the world around you. Our minds distract us from the present moment all the time, so it’s easy to get caught up in thoughts about the past or future.
Mindfulness takes lots of practice, but it can help you stay connected to the present moment. Noticing more around you (such as in nature, moments of joy, or even moments of grief) can help you feel more connected to the world.
Some common mindfulness-based activities are:
- Meditation
- Body scan
- Yoga
- Tai chi/qui gong
- Breathwork
- Progressive muscle relaxation (PMR)
- Imagery
- Massage
- Music and art therapy
- Hypnosis
- Music and art therapy
- Reflexology
- Acupuncture
Learn more about practicing mindfulness and relaxation.
The following video is brought to you by Healing Works Foundation.
Guided Meditations to Relieve Stress
Explore different ways to be calm when you are feeling anxious. It is best to listen to these meditations in a quiet place without distractions.
Education and resources
Your health care team might give you education and resources about lifestyle habits that can improve mental distress, including mindfulness, meditation, good sleep, and physical activity.
Additional referrals
Your health care team might refer you to additional resources such as patient navigation, social work, counseling, or chaplaincy care.
Palliative care and distress
Your cancer care team might also refer you to palliative care to help manage your distress.
Palliative care is provided by specialists who work with you and your cancer care team. They can help you find ways to manage many of the things that might be causing your distress or making it worse.
Many people confuse palliative care with hospice care. But they are not the same thing. Palliative care is for anyone with a serious illness, not just people at the end of life. Your care team could refer you to palliative care at any stage of your cancer, cancer treatment, and beyond.
A palliative care team might work with you to manage:
- Physical side effects of cancer and cancer treatment
- Family dynamics and communication
- Caregiver support and respite
- Access to community resources
- Social isolation and loneliness
- Money, insurance, or legal concerns
Studies show that people who get access to palliative care have a better quality of life and may even live longer than people with cancer who don’t get this type of care. Learn more about finding palliative care resources.
Tips for coping with distress
Mental health is one of the most difficult topics for many people to talk about. But it affects almost every part of our lives. Just like other health problems, it’s important to manage your distress so it doesn’t get worse.
Simply naming your distress out loud to another person is often one of the best things you can do to cope. But mental distress is tricky. It distorts (changes) how we think about ourselves. It can also make us think that other people are judging us, or that the feel negatively about us.
This makes it harder to reach out for support. But it’s important to keep trying. If you aren’t ready to talk about your distress, there are other steps you can take to help yourself cope.
Steps you can take on your own:
Reflect. Think about what helped you in the past during distressing situations.
Take one moment at a time. Also, it’s okay if you don’t always feel positive. An important part of healing is letting yourself feel all your feelings, good and bad.
Stay informed and ask questions. One of the most distressing things for many people is the unknown.
Take deep, slow breaths. This tells your nervous system you’re safe and can relax. Doing this over time can help change your physical reactions to mental distress.
Use a journal. Writing down or recording your thoughts and feelings can help you process what you’re going through.
Try complementary therapies. Yoga, massage, imagery, writing, music, and pet therapy have all shown to be helpful. Even getting outside for a walk can make a difference.
Steps you can take with the help of others:
Build a reliable support system. This might be a friend, family member, group, or a pet. Connection, community, and meaningful relationships are what give our lives meaning and connect us to one another.
Find someone you can talk to. A therapist can help you identify and reframe negative thoughts and behaviors and learn new coping skills.
Connect with people who’ve gone through similar experiences. If you aren’t ready to talk in a group, listening to a podcast where other people talk about these experiences is another great option.
Ask a doctor about medication. Antidepressants can also help with depression, anxiety, and sleep problems. Most take a few weeks to start working, so give them time. There are also different types of antidepressants, so don’t get discouraged if the first one doesn’t work for you.
Get help with the stressors in your life. If you have distress about money, work, school, transportation, or insurance, ask for a referral to a social worker or navigator. They can often find community resources or other support for you.
Figuring out what works for you
Distress is a very real side effect of cancer. You can’t just turn it on and off by thinking your way around it. Some days will be better than others. This doesn’t mean you’ve failed, or lost all progress, or gone backward.
Sometimes, there isn’t one single fix. A coping method might work one day but not the next. The more tools you have in your toolbox, the better prepared you’ll be when you need them.
If you have a history of mental health problems
If you’re going through cancer and already coping with mental health problems, you might need extra support.
For someone who is already struggling with mental health problems, the added mental distress of cancer can feel overwhelming or like too much to handle. These are completely valid and normal feelings to have.
You might already be using some of the tips or treatments mentioned here. It’s important to continue doing the things that have helped you in the past. It’s also important to ask your care team about other things that might be added to help you cope during this time.
This might look like:
- Letting people know you’re struggling more than usual and might need extra support or check-ins
- Talking to your therapist or psychologist more frequently
- Reviewing your medicines to make sure they are still working well
- Changing or adding medicines as needed
- Joining a support group
- Getting screened for new or worsening mental illness (such as PTSD or panic disorder)
Even if you are used to coping with mental health issues on your own, you don’t need to suffer alone. There are people who have gone through similar experiences. They can share what they learned or what worked best for them.
Managing distress is a normal part of cancer care. It should always be addressed, no matter your history with mental health.
988 Suicide & Crisis Lifeline
988 Suicide & Crisis Lifeline provides 24/7, free and confidential support via phone or chat for people in distress, resources for you or your loved ones, and best practices for professionals. Includes information on finding your local crisis center.
Phone: 988
- Interpretation for more than 240 languages
- ASL Videophone for people who are deaf or hard of hearing
Text: 988 (English and Spanish only)
Website:
To get immediate help, you can also go to the emergency department or call 911.
Getting help from your care team
Many doctors and cancer care teams screen for distress, anxiety, and depression. No matter what they screen for, it’s important to talk to them about how you’re feeling. They can often help treat mild or occasional distress.
You might need more help if your distress is severe, or if it isn’t getting better. Your health care team can often connect you with the right resources, referrals, and specialists.
Who can help?
There are many people on your care team who might be able to help you manage your distress:
Nurses and doctors can give you information and education. They can help you understand why distress often affects people with cancer differently. They can also listen and affirm your feelings and experiences.
Psychologists, psychiatrists, therapists, and counselors provide different types of mental health care. This might include talk therapy, medication, and help with building coping skills.
Chaplains provide support no matter what your religious or spiritual beliefs are. They are excellent listeners.
Navigators, social workers, and case managers can help find resources like transportation to appointments, lodging near treatment centers, financial assistance, and more.
Questions to ask
It can be hard to talk about mental health. Sometimes it helps to write down your symptoms or the questions you want to ask. Here are a few ideas:
- Can my symptoms be managed?
- What types of treatments do you recommend?
- Would medication help?
- Can I talk with a therapist or specialist about my symptoms?
- Can you recommend a support group for me?
- Is palliative care a good option for me?
What caregivers, friends, and family can do
Find more support
- Written by
- References
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.
Adams RN, Mosher CE, Rand KL, et al. The Cancer Loneliness Scale and Cancer-related Negative Social Expectations Scale: development and validation. Qual Life Res. 2017;26(7):1901-1913. doi:10.1007/s11136-017-1518-4
American Cancer Society Cancer Action Network. Survivor views: Social connection during cancer diagnosis & treatment. Survey. August 2023. Accessed March 1, 2024. https://www.fightcancer.org/sites/default/files/national_documents/survivor_views_on_social_isolation.pdf
Borenstein J. Stigma, prejudice, and discrimination against people with mental illness. American Psychiatric Association. August 2020. Accessed December 15, 2023. https://www.psychiatry.org/patients-families/stigma-and-discrimination
National Comprehensive Cancer Network. Distress during cancer care. NCCN Guidelines for Patients. 2023. Accessed December 15, 2023.
National Comprehensive Cancer Network. Distress management. Version 1.2024. NCCN Guidelines. Updated October 2023. Accessed December 15, 2023. https://www.nccn.org/professionals/physician_gls/pdf/distress.pdf
Office of Disease Prevention and Health Promotion (OASH). Social cohesion. Healthy People 2030. 2021. Accessed December 15, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/social-cohesion
Our epidemic of loneliness and isolation: The U.S. Surgeon General’s advisory on the healing effects of social connection and community. US Department of Health and Human Services. May 2023. Accessed December 15, 2023. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
Roy-Byrne PP. Management of psychiatric disorders in patients with cancer. UpToDate. UpToDate Inc; 2023. Updated September 2023. Accessed December 15, 2023. https://www.uptodate.com/contents/management-of-psychiatric-disorders-in-patients-with-cancer
Syrjala KL & Chiyon Yi J. Overview of psychosocial issues in the adult cancer survivor. UpToDate. UpToDate Inc; 2023. Updated October 2023. Accessed December 15, 2023. https://www.uptodate.com/contents/overview-of-psychosocial-issues-in-the-adult-cancer-survivor
Last Revised: July 25, 2024
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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