Reducing Stress in the Stressed-Out World of Cancer

David Spiegel, M.D. Susan Diamond, L.C.S.W. Ernest Rosenbaum, M.D.

Coping with cancer entails navigating effectively between being so overwhelmed by threat that you feel helpless and denial that the threat exists.

The pattern of response you establish during an acute crisis is likely to become cemented in place, regardless of its relative effectiveness.

Getting that balance is a constantly shifting and demanding process. It involves accepting temporary crisis situations and utilizing the disruption to formulate new plans of action.


The pattern of response you establish during an acute crisis is likely to become cemented in place, regardless of its relative effectiveness. Effective coping involves taking in and processing the emotional reaction to the danger and seeking the opportunity for a response that at least mitigates the danger.

Acknowledge the problem: It's better to face head-on whatever is threatening you than to try to deny or avoid it.

Be specific: See the problem as being on a continuum, more or less difficult, rather than as an all-or-nothing catastrophe.

Seek information: The more you know about a problem, the more likely you are to figure out a better way of dealing with it.

Feel what you feel: Difficult situations bring strong emotions with them. Let them come and learn from them. Emotions can point out to us what is important and, when shared appropriately, can build intimacy and support.

Seek social support: Don’t do it alone. Family and friends often feel more helpless than you do. They welcome any opportunity to help. Give them many.

Find an Active Response

You will feel better about any problem when you can find a way to be active about it. Even if you can’t solve the problem or make it go away, you will feel better if you can do something about some aspect of it.

False Positives

Don’t force yourself to be more upbeat than you feel. Indeed, defining what constitutes a truly positive attitude is a complex problem. Being too positive all the time can verge on denial. This can inhibit obtaining necessary medical information and treatment. It also can lead family and friends to actively discourage the expression of appropriate sadness and fear.

One of our patients related to her support group that when she started to cry in front of her husband about the progression of her inflammatory breast cancer, he said: “Don’t cry, you’ll make the cancer spread.” Another member of the support group referred to this as the prison of positive thinking. We see many people with cancer whose family members are afraid that giving vent to these negative feelings will somehow unleash the  cancer itself,  as though  the feeling uncontrolled is the same as the disease uncontrolled. Many people are desperate to do anything they can to control the illness, and are willing to exist in an emotional straightjacket if it will somehow improve their odds of survival. Yet another downside of the positive attitude often recommended to someone with cancer is that progress of the cancer provides fertile ground for inappropriate guilt: “If I can control the spread of disease through my attitude, and the disease has progressed, then there must be something wrong with my attitude.” There is simply no medical evidence that a positive attitude per se has any effect on the course of cancer.

Group Support

Harboring fears and anxiety about cancer can be absolutely paralytic. The opportunity to share thoughts and concerns and express even the most frightening feelings, such as “I’m terrified I’m going to die,” offers enormous comfort, allows you to realize you are reacting normally to an abnormal situation, and helps you regain your emotional balance while significantly reducing your stress (Spiegel, 1993).

Sharing experiences with other people who have cancer is a potent experience. Many people find that being a member of a cancer support group offers multiple benefits. The very thing that has made you feel separated from the rest of the world is your admission ticket into the group. Thoughts and feelings that previously seemed bizarre are normalized. It is the rule rather than the exception to feel terrified, enraged, grief-stricken, immobilized, and wondering if you’re going to die. You can experience tremendous relief in finding out that you are not alone and that others sharing your dilemma accept you and understand.

Just as the group helps you integrate a new sense of self, it simultaneously helps you define and revise what is important to you. The issue of how to make the best use of time becomes paramount in the face of an uncertain future. This usually involves seizing the moment and taking full advantage of the present instead of becoming exclusively focused on the future. You may begin rearranging your priorities as you develop new interests, or expand on or drop old ones. Cultivating experiences that are enriching and pleasurable should become a key goal; eliminating those that no longer interest you is another.

For example, a woman with progressive, metastatic breast cancer decided to undergo a bone-marrow transplant as a “last ditch” treatment. Not knowing what the outcome of this procedure would be, she determined that there were certain things she wanted to accomplish in the event she died. She and her partner took a long-delayed vacation to Hawaii where they agreed to make a more formal commitment to their relationship prior to her hospitalization.

Another woman, a prolific poet with incurable brain cancer, was encouraged by her partner to take up painting. She did and, to her delight, found herself immersed with an almost child-like fascination in a new world of shapes and colors (some of her paintings were exhibited at the hospital where she was treated). Rather than giving in to her cancer, she viewed it as an opportunity for creative growth and unanticipated pleasure.

Some  people  with  cancer  continually reorder their priorities. A lovely woman of forty-one  with  advanced  ovarian  cancer chose to forgo a level of pain medication that, essentially, would have left her pain-free but unconscious. She wanted to stay alert, aware, and connected to the people she loved. For her, the importance of this far outweighed being physically comfortable.

Clearly, openness and expressiveness— emotionally and in other areas—is critical to your overall recovery and goes a long way toward helping you manage the inevitable stresses of the disease. Using family and friends as a resource is a crucial part of this process. Early involvement of your family in both decision making and treatment helps you integrate your experiences with cancer into the rest of your life. Family and friends can encourage you to talk about how you feel and about what is happening to you. A simple statement from someone close, such as “I’m scared too, but we’ll fight  this  together”  is  both  encouraging and comforting. The relief in knowing that you can give voice to what is frightening and painful can remind you that you’re not
fighting this battle alone.

As barriers to communication are overcome, you can benefit from and help your natural support system while feeling sustained through the cancer experience. In sharing all emotions, both the positive and the negative, you don’t hide or deny any aspect of your experience. It also offers those who care about you a way of better understanding your experience, as well as the means to feel closer to one another and to you.

Some people diagnosed with cancer find that they need the privacy of individual counseling or therapy to work through some of their feelings about their cancer. A therapy session with a specially trained and caring professional at the time of diagnosis or recurrence, with the potential for continued visits, provides a safe place for you to discuss your feelings about and experience with the cancer. This can help lessen fear and offers a setting for the diagnosis and treatment of more serious forms of anxiety and depression.

Serious sleep and appetite disturbance or persistent suicidal thoughts call for professional evaluation. Although the thought of living with cancer will never be free of anxiety, you may need help in recognizing that while cancer is now an undeniable part of your life, it is not the only part.

Your renewed ability to see yourself as an active participant in your life will help you maintain your emotional perspective, which will help keep the stresses of living with cancer from constantly intruding into your life.

Reprinted by permission from Coping magazine.

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David Spiegel, M.D.

Dr. David Spiegel is Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine, where he has been a member of the academic faculty since 1975.  More He is Past President of the American College of Psychiatrists, and Past President of the Society for Clinical and Experimental Hypnosis, and a member of the Institute of Medicine of the National Academies. He has published ten books, 368 scientific journal articles, and 156 book chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. His research has been supported by the National Institute of Mental Health, the National Cancer Institute, the National Institute on Aging, the National Center for Complementary and Alternative Medicine, the John D. and Catherine T. MacArthur Foundation, the Fetzer Institute, the Dana Foundation for Brain Sciences, and the Nathan S. Cummings Foundation.


Susan Diamond, L.C.S.W.

Senior Group Psychotherapist, Psychosocial Therapy Laboratory, Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA

Ernest H. Rosenbaum, M.D.

Clinical Professor of Medicine, University of California, San Francisco, Comprehensive Cancer Center; Adjunct Clinical Professor, Department of Medicine, Stanford University Medical Center; Director, Stanford Cancer Supportive Care Programs National/International, Stanford Complementary Medicine Clinic, Stanford University Medical Center, Stanford, California. More 

Ernest H. Rosenbaum’s career has included a fellowship at the Blood Research Laboratory of Tufts University School of Medicine (New England Center Hospital) and MIT. He teaches at the University of California, San Francisco, Comprehensive Cancer Center, was the cofounder of the Northern California Academy of Clinical Oncology, and founded the Better Health Foundation and the Cancer Supportive Care Program at the Stanford Complementary Medicine Clinic, Stanford University Medical Center.

His passionate interest in clinical research and developing ways to improve patient care and communication with patients and colleagues has resulted in over fifty articles on cancer and hematology in various medical journals. He has also participated in many radio and television programs and frequently lectures to medical and public groups.

He has written numerous books, including Living with Cancer: A Home Care Training Program for Cancer Patients; Decisions for Life: You Can Live Ten Years Longer with Better Health; Cancer Supportive Care: A Comprehensive Guide for Cancer Patients and Their Families; Nutrition for the Cancer Patient; Everyone’s Guide to Cancer Therapy; and Everyone’s Guide to Cancer Survivorship. For Everyone’s Guide to Cancer Therapy, Ernest Rosenbaum, M.D., Malin Dollinger, M.D., and Greg Cable received and Honorable Mention in 1991 from the American Medical Writers Association for Excellence in Medical Publications. Ernest and Isadora Rosenbaum received the same award in 1982 for their book, A Comprehensive Guide for Cancer Patients and Their Families.