If you’ve just received upsetting diagnosis news—perhaps cancer, an autoimmune disease or another frightening health condition—it’s perfectly normal to cycle through shock, anxiety, anger and other challenging emotions. When psychotherapist Elizabeth Cohn Stuntz, LCSW-R, was diagnosed with cancer—the same illness that had taken her mother, grandmother, and several close friends—she tried to minimize the impact of the news and tightly control her emotions. She self-critically thought, I’m a therapist who has helped lots of people with cancer. I should know how to cope with this. She later came to understand that when it comes to responding to bad news—medical or otherwise—there are no right or wrong answers.
When you’ve been diagnosed with cancer or another serious illness, it’s understandable to feel scared, sad and/or resentful. Stuntz learned that while we can’t control the cards we’re dealt, we do have a choice about how we play our hand.
The Power of Naming Emotions
One of the most effective ways to regain a sense of control and emotional balance is to learn how to regulate strong emotions. This doesn’t mean ignoring anxiety or giving ourselves a hard time about feeling very upset. Effective emotional regulation involves acknowledging and accepting our feelings without being paralyzed by them. Naming an emotion in real time—That pit in my stomach is anxiety or I’m feeling resentful that my partner didn’t come to my doctor’s appointment—activates the rational part of the brain and puts some healthy space between us and what we are feeling. This helps rein in the unhelpful spiral of intense emotions and narrow thinking—patterns that often get worse when we judge ourselves (I should be braver). These very human reactions can deepen self-blame and make us feel even less able to cope.
Research from UCLA has shown that the “Name it to tame it” technique dampens activity in the brain’s emotional centers, allowing the regions of the brain responsible for logical thinking to power on. Consciously labeling intense feelings also triggers the brain to release soothing neurotransmitters that calm both body and mind. Research also has shown that cancer patients who can recognize and name their emotions are better able to cope and enjoy other health benefits, such as reduced levels of inflammation.
Key to Effective Coping
The mindfulness needed to identify and name our emotions is a core tenet of Dialectical Behavior Therapy (DBT), a form of psychotherapy that teaches people how to fully pay attention to their experience—the good, the painful and everything in between.
“Dialectical” means that two things that seem to be opposite can be true at the same time. Dialectical thinking is a helpful coping skill—it lets you realistically assess a difficult situation without letting overwhelming feelings take over. Examples…
- You can be both horrified by your diagnosis and still keep in mind the wonderful parts of your life.
- You can feel weak and act strong.
- You can feel very out of control about what’s happening to your body and recognize that you have control over how you choose to respond to what’s happening.
By encouraging the use of the word “and” when naming and describing our feelings, DBT helps blunt the black-and-white mindset that often traps us in our fear, sadness or anger. This, in turn, makes it easier to tolerate distress…make wise, strategic decisions…effectively communicate with family, friends, colleagues and medical professionals…and live in a meaningful way, including reassessing priorities and strengthening our connection to what matters most to us.
3 Strategies for Coping with a Distressing Diagnosis
Here are a few resilience-building coping strategies, all of which can help you cope with the runaway, volatile thoughts that accompany emotionally intense situations.
Coping skill #1: Allow, respect and name strong emotions
There are times when we are inclined to try to avoid strong emotions. Stuntz believed she was supposed to be more positive and shouldn’t be so afraid before surgery. A wise Zen teacher taught her that instead of trying to use a clenched first to control or push away her feelings, it’s more effective to imagine allowing that fear to gently rest in an open palm. Allowing our feelings helps us experience an understandable emotion, take in its valuable message, label the feeling and then let the emotion subside.
Coping skill #2: STOP
The STOP strategy is particularly useful for coping with anger, whether it’s related to a diagnosis or something entirely different. Anger can provoke us to act in ways that may damage relationships with others or even with ourselves (shame, self-blame). With STOP, the goal is to pause and remember the important distinction between feeling an emotion…and acting on it.
Stop. Don’t immediately or impulsively react to whatever is upsetting you.
Take a step back and Take a deep breath. Pacing your breathing slows your heart rate and helps quiet the fight-or-flight response that can cause emotions to spiral. This step can help you break out of anger mode and regain control. How to do it: Focus on a longer exhale than inhale, such as four counts in and six or eight counts out.
Observe your thoughts and bodily sensations. Anger usually is a signal that something is amiss, and your mind and body need extra care. Try naming your emotion and notice how it is manifesting in your body.
Proceed mindfully. Ask yourself, Does the strength of my anger match the situation? Will acting on my emotions help me reach my goals? Often the answer is no. That doesn’t mean anger is bad or that you’re a bad person for feeling upset. But using STOP can help you peer beneath the surface of your anger to see what’s hiding there and help you move toward your goals more constructively.
Example: Your oncologist is 45 minutes late for your appointment. Incensed, you angrily ask the receptionist to estimate when he will arrive. It sure would feel good to yell, “Where is my doctor?!” First, stop and breathe. Name your emotion (outrage, indignation), and notice where it is surfacing—a hot, flushed face…tensed muscles…racing heartbeat. Now ask yourself, Am I truly mad at the doctor? What else might be upsetting me? Clearly, I’ve been diagnosed with cancer, and I am unhappy…and my pain medicine isn’t working. Is it going to be effective to yell at the receptionist?
Coping skill #3: Use kind self-talk
Cancer is difficult enough without adding a layer of self-judgment. And yet, it’s common for thoughts like, My children will probably have cancer because of my bad genes… and Nobody will be attracted to my disfigured body to run rampant. We would never say these things to a loved one…so why say them to ourselves? Try to replace harsh thoughts with softer, more compassionate self-talk. Adding an “and” helps acknowledge that both hardship and hope can exist simultaneously.
Instead of, It is my fault I have breast cancer. I shouldn’t have skipped my mammogram…try, I have breast cancer, and my care team and I have mapped out a treatment plan that has a good chance of success.
Instead of, I can’t handle this stress…try, I wish I didn’t have to deal with this stress, and I’ve made it through hard things before.
Instead of I’m going to die without getting to meet my grandchildren…consider also thinking, I want to devote the rest of my time on this planet to doing things I love, including immersing myself in art, relaxing in nature and spending time with loved ones.
The resilience-building skills of DBT are typically taught in a highly structured program including weekly individual therapy and DBT skills group training. Visit The DBT-Linehan Board of Certification website (https://dbt-lbc.org/) to find a DBT-trained therapist near you.
