When you are anxious you may also have physical symptoms like:

• Sweaty palms
• Upset stomach
• Tight feelings in your stomach
• Shaking or tremors
• Difficulty breathing
• Racing pulse
• Hot and flushed in your face

Sometimes these feelings come and go fairly quickly. Other times these feelings last a long time.

Tension can help people to do something well. For example, many actors say that they have "butterflies in their stomach," or anxious moments, before they perform. Sometimes people actually enjoy the feelings of anxiety, like when they are watching a horse race or riding a roller coaster.

However, when these feelings are very strong and contain fearful thoughts, they get in the way of everyday living. When they last a long time, they can prevent people from doing the things that are important to them. This is when people need to learn to manage anxiety better.

Recognizing when a person is anxious

One of the difficult things about anxiety is that people may not know when they're experiencing it. They may think that they are just worried. But then, before they realize what is happening, they are experiencing serious anxiety symptoms.

Sometimes the parents of young persons with cancer don't realize how anxious they are becoming, but family and friends do. Family and friends can help by pointing out what is happening early, and they can help the parents of the young person with cancer control the anxiety before it gets out of hand.

Anxiety related to cancer

When parents are told their child has cancer, it often makes them feel anxious. Some feel afraid, nervous, and even overwhelmed. Others may feel panicky, as if they have lost control of their lives. These are normal reactions.

Many parents experience anxiety during their child's illness. Anxiety can be caused by:

• Worries about medical procedures
• Fear of pain and discomfort in the young person with cancer
• Fear of the illness getting worse

Although some anxiety is normal, it can become so severe that it interferes with your ability to cope with the young person's illness.

What you can do to help yourself

Controlling anxiety is primarily in your hands. You should not feel guilty if, in spite of your best efforts, you are very anxious. If the anxiety is severe, a professional may be needed who can use special techniques such as anti-anxiety medicines or stress management techniques.

Family and friends caring for someone with cancer can become quite anxious. Sometimes it is because they worry about the person's illness and their own ability to cope effectively with all the stress involved. Sometimes it is because the anxiety of the young person with cancer makes them anxious. Poor communication between the person with cancer and family and friends can also be a source of anxiety for everyone.

Therefore, you should read this home care plan to help yourself.

Your goals are to:

• accept that some anxiety is both normal and understandable
• get professional help for anxiety when that is necessary
• learn about your anxiety and manage it as much as possible
• use this home care plan if anxiety is interfering with your ability to help your loved one.

When To Get Professional Help

The first question you should ask is whether professional help is needed. You should call the doctor, nurse, psychologist, or social worker for anxiety if you:

1. Have a history of severe anxiety requiring professional help or therapy and are feeling very anxious now.
   
2. Have a much lower quality of life because of anxiety symptoms.

Professional help is needed if anxiety symptoms are interfering with daily activities or are very upsetting.

Some people are hesitant to ask for help with emotional problems because they don't want to appear "crazy." They should understand that being upset during a major illness is normal, and so is getting help for these problems.

It is best to start with your family physician. Ask for an evaluation of possible causes of the anxiety and recommendations for treatment or referral.

Physicians can evaluate whether to prescribe anti-anxiety medicines. Physicians can also make referrals to mental health professionals such as psychologists, psychiatrists, social workers, and nurse counselors.

If you are not sure whether professional help is needed, ask a nurse or social worker for guidance.

Call the doctor, nurse, or social worker if any of the following symptoms persist for several days

• Severe problems falling or staying asleep several days in a row
• Feelings of dread and serious apprehension for several days
• Trembling, twitching, and feeling "shaky
• Fluttering stomach with nausea and diarrhea
• Increased heart rate or feeling a rapid pulse
• Wide mood swings that you cannot control
• Shortness of breath

What You Can Do To Control Anxiety

If it's not an emergency, here are six things you can do:

• find out what thoughts are causing the anxiety
• talk to someone who has been through the situation causing the anxiety
• increase pleasant, distracting activities
• increase companionship
• encourage use of relaxation techniques
• ask a physician for an evaluation

Always start with the first one-being sure about what thoughts are causing the anxiety.

• Try to find out exactly what thoughts are causing anxiety. Understanding the thoughts that are causing the anxiety is the key to controlling it.
  
  Anxiety has two parts: thoughts and feelings. Worried thoughts lead to nervous feelings. Nervous feelings can lead to more worried thoughts and so on. To stop this cycle, you first need to find out what thoughts are causing the anxiety and why those thoughts are making you nervous.
  
  For example, admitting the young person to the hospital may be upsetting, but, when you ask yourself what it is about the hospital that makes it upsetting, you may decide that you are primarily concerned about paying the bills. On the other hand, you may be anxious about having to work with new staff and explaining your child's needs again. Sometimes you won't be able to find an exact reason; this is when professional help may be useful.
  
  If you are anxious about medical procedures your child must undergo, try to find out exactly what it is about the procedure that is upsetting. Is it needles, pain, leaving the child alone? If you cannot explain it, ask: "How would you change the procedures so that they don't make you and the young person with cancer so upset?"
  
  If you are anxious about receiving medical information, try to find out exactly what kind of news would likely cause you to be upset. Is it being told the young person needs more treatments? Has to go into the hospital? The prospect of being unable to do certain things in the future?
  
  Getting the facts can help you feel less anxious. For example, if you are worried about whether the doctor will say that the disease has progressed, you may learn that the doctor will not know whether the cancer is responding to treatment for another 8 weeks. Or, if you are upset by needles, you may learn that the test the doctor has ordered does not use needles.
  
  When you get the facts, you may also discover that there are ways to "get around" a problem that is making you anxious. For example, if the anxiety is about needle sticks in the veins, blood could be drawn with a small prick on the finger. Or, if you are worried about the young person being alone during a test, you can plan to be with him or her during that time.
  
• Talk to someone who has been through a similar situation. It is often reassuring to hear about what happened to other parents and how they reacted during a stressful experience. It helps parents to know that they are not alone and that someone else got through it. This can make the future seem more manageable, even if the experience was difficult for the other parents.
  
  You should choose the parents you talk to carefully since some people can be more reassuring than others. In general, though, most people find that talking to someone who has been through the same experience reduces worry and anxiety.
  
  Most people who have made it through scary experiences are happy to talk to others about their experiences. The treatment team may be able to refer you to parents or to a support group where you can find others who have had similar experiences.
  
• Increase pleasant, distracting activities Think about and do things that are pleasant and relaxing can help reduce anxiety.
  
  There are three types of enjoyable activities: activities with other people, activities that give a sense of accomplishment, and activities that are especially involving so as to displace thoughts about the situations that are making you anxious.
  
• Increase companionship and time spent with friends and family who care. Being with family and friends whom you know and enjoy is an excellent way to take attention away from what is causing the anxiety. It can also give family and friends the opportunity to express caring and love for you.
  
  Knowing that other people care and are available to help when needed gives people strength and confidence in facing frightening experiences.
  
• Use relaxation techniques. Relaxation is a skill which can be used to counteract anxiety. You can't be anxious and relaxed at the same time. When you do things that make you feel relaxed, anxiety decreases.
  
  There are many ways to feel more relaxed. Choose a way that is comfortable. Prayer or meditation helps many people when they are in tense situations. Many people are relaxed by certain kinds of music. Walking or mild exercise can reduce anxiety, too.
  
  There are also special relaxation exercises and tapes which are available commercially. These programs teach relaxation as a skill. With practice, people can learn to relax their muscles more than they usually would. They can then learn to use this skill when they are in tense situations. Oncology nurses, doctors, psychologists, and social workers are often familiar with relaxation techniques and may be able to recommend a program, book, or audio-cassette tape.
  
  The last section of this home care plan explains how to use and practice relaxation techniques. It is important to practice these skills because the better you are at becoming relaxed, the better you will be able to control anxiety.

Ask a physician for an evaluation and treatment recommendations. If anxiety does not improve in spite of your efforts, you can discuss the problem with a physician. Contact a family physician who knows you and the medical situation of your child.

Physicians can help in two ways:

1. They can assess whether anti-anxiety medicines should be prescribed. You should only take anti-anxiety medicine after consulting with a physician who is familiar with your medical history. These medicines may cause problems when combined with other medicines.
   
2. They can assess whether referral to a mental health professional is needed. If so, they can help with a referral.

Possible Obstacles

Here are some obstacles that other people like you have faced in dealing with anxiety

1. "My problems are real. I have to face them even if they make me anxious."
   
   Response: Your problems are real. A certain amount of anxiety about them is normal and understandable. However, research and experience shows that severe anxiety interferes with the ability to solve problems. Managing anxiety makes problem solving easier. This home care plan will help to prevent anxiety from becoming severe.
   
   
2. "I can't stop the thoughts that make me anxious. They keep coming back and racing around my head."
   
   Response: It's scary to feel like you can't control your thoughts. However, there are some techniques to try which may reduce or even stop them.
   
   
3. "I'm anxious because my child is anxious."
   
   Response: Spending a lot of time with someone who is very anxious can be stressful and can even make you anxious, too. You need to take time for yourself-to take a break from caregiving and rebuild your emotional strength. You should also involve as many people as possible in carrying out this home care plan. Their support will help you take breaks and to know that you don't face these problems alone.

Think of other obstacles that could interfere with carrying out your plan

What additional road blocks could get in the way of doing the things recommended in this home care plan? For example, will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out the plan?

You need to develop plans for getting around these road blocks. Use the four COPE ideas (creativity, optimism, planning, and expert information) in developing your plans. See the chapter on Solving Problems Using the Home Care Guide at the beginning of the book for a discussion of how to use the four COPE ideas in overcoming your obstacles.

Carrying Out and Adjusting Your Plan

Your first step is to talk this plan over with someone you trust. If you think that anxiety is likely at certain times, make plans for what to do at these times to prevent anxiety from building up. It is always easier to manage anxiety before it is serious and before you feel overwhelmed by it.

Stay alert to the possibility that professional help may be needed. Review regularly the questions in the When To Get Professional Help section of this plan. Seek help if the anxiety seriously interferes with your ability to give care and your quality of life.

Checking on results

Talk regularly about emotional feelings. Some people find it helpful to rate their anxiety on a 10-point scale, with zero being "no anxiety" and 10 being "the worst anxiety ever experienced." Keeping a daily log of anxiety levels takes a little extra effort, but by keeping track of it, you can deal with it before it gets serious, and it can save a lot of energy later.

If your plan doesn't work

Ask if you are expecting change too fast. It usually takes time to change someone's anxiety level. Look for small improvements at first. Remember: Your efforts may be successful even if they just stop the anxiety from getting worse.

If these techniques do not seem to be helping and you have been feeling anxious for several weeks, then you should get professional help.

A Relaxation Technique

Many parents of young persons with cancer have found relaxation techniques helpful. These techniques can be used anytime-even for short periods of time. Try this exercise yourself to see how it feels and works for you.

Relaxation should be practiced once a day, but not within an hour after a meal since digestion may interfere with the ability to relax certain muscles.

1. Sit quietly in a comfortable position (such as in an easy chair or sofa) and practice this exercise when you are not feeling rushed.
   
2. Close your eyes.
   
   Deeply relax your muscles, beginning with the face and going throughout the entire body (shoulders, chest, arms, hands, stomach, legs) and ending with the feet. Allow the tension to "flow out through your feet."
   Now concentrate your attention on your head, and relax your head even further by thinking, "I'm going to let all the tension flow out of my head. I'm letting go of the tension, and I'm letting warm feelings of relaxation smooth out the muscles in my head and face. I'm becoming more relaxed."
   
   Repeat these same steps for different parts of your body: your shoulders, arms, hands, chest, abdomen, legs, and feet. Do this slowly-spend enough time to feel more relaxed before going on to the next part of the body.
   
3. When the body feels very relaxed, concentrate on your breathing. Become aware of how rhythmic and deep your breathing has become. Breathe slowly and deeply. Breathe through your nose. As you breathe out, say the word "calm" silently to yourself. Slowly take a breath in. Now slowly let it out and silently say "calm" to yourself. Repeat this with every breath. It helps you to relax more if you concentrate on just this one word "calm." Continue breathing deeply, becoming more and more relaxed.
   
4. Continue this exercise for 10 to 15 minutes more. Remain relaxed and breathing slowly. At the end of the exercise, open your eyes slowly to become adjusted to the light in the room, and sit quietly for a few minutes.
   When it is over, ask yourself how relaxed you became and if there were any problems. One problem can be drifting and distracting thoughts. If this happens at the next session, think to yourself, "Let relaxation happen at its own pace." If a distracting thought occurs, let it pass. Let it fly away like a bird. Don't fight it. Concentrate more on the word "calm." Let the thought drift by and repeat "calm" over and over again as your breathing gets slower and deeper-as you relax more and more.
   
5. Do these exercises regularly-once a day is best. In the beginning, it may help to have someone else give you the instructions. You can record these instructions on an inexpensive tape recorder and play them when you are relaxing. If you prefer, you can record yourself giving the instructions and use that.
   
6. When practicing, choose a time when you will not be disturbed. Tell the other people in your household what you are doing and ask them to be quiet during the exercise.
   
7. After you become skilled at this exercise, you will find that it is easy to apply when you are getting tense. For example, if you are feeling tense while waiting to see the doctor or for a treatment, you can easily close your eyes for a few minutes and use this exercise to relax and feel calm.
   
8. It's a good idea to learn this relaxation technique early-before anxiety becomes severe. It can then help to keep severe anxiety from happening.

Back