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The Stress of Cancer: Seeking Support


Learning that you have a diagnosis of cancer is usually a traumatic experience. And following the shock of diagnosis, people have to face treatment decisions and side effects, changing personal relationships and uncertainty about their future.

"Stress can appear at every stage of the disease, at diagnosis, during treatment and after treatment," says Josée Savard, PhD, a professor of psychiatry at Université Laval in Quebec, Canada. While some stress is expected to accompany a diagnosis of cancer, Dr. Savard and other experts say that people with cancer should monitor their stress levels to make sure they are not crossing the line into depression and anxiety, which are conditions that can interfere with someone's quality of life and even their health status.



Stress vs. Anxiety and Depression
Most of the research on the psychological impact of cancer has been conducted in women with breast cancer. It's estimated that between 22 and 50 percent of women with breast cancer are depressed, while 33 percent have acute stress disorder and 3 to 19 percent have post-traumatic stress disorder (PTSD), a condition seen in people who have experienced traumatic events such as natural disasters or military combat.

A Canadian study published June 14th in the British Journal of Cancer found that almost 38 percent of its 3,095 participants—who included people with breast, prostate, colorectal and lung cancer—met the criteria for distress levels that should be treated. But almost half of these patients had not sought psychosocial support, primarily because they weren't aware of support services or because they didn't think they needed them.

According to study author Linda Carlson, PhD, a clinical psychiatrist with the University of Calgary/Tom Baker Cancer Centre in Alberta, Canada, not getting help can have major repercussions. "If people don't feel like they can talk to anyone, their distress just snowballs over time," she says, adding that people with untreated depression and anxiety often end up visiting doctors more often.

That snowball effect may be one of several reasons patients find the post-treatment period stressful. "Some patients find it most difficult when treatments end because they feel they're not fighting anymore and they don't have the support of their medical team," Dr. Savard says.






Getting Support
Sometimes people with cancer find that the friends and family they thought they could rely on aren't offering them the support they need. In fact, cancer can sometimes expose existing cracks in relationships, particularly in couples. "For couples who were functioning well before cancer, the cancer will usually have a minimal impact on their relationship, or even improve it. In couples who had difficulties before cancer, it will generally create more problems," Dr. Savard explains.

Other times, Dr. Carlson says, people don't want to overburden their friends and family with their worries and may feel pressure to stay upbeat. And those friends and family members don't always know what to say or how to be helpful, especially if they haven't faced a life-threatening illness themselves.

Many people with cancer find the support they need in psychotherapy. Depending upon someone's personality and preferences, they may choose one-on-one psychotherapy or a support group of their peers that is led by a mental health professional, such as an oncology social worker. A study published in May 2001 in The Archives of General Psychiatry found that support groups helped reduce distress in people with metastatic cancer, primarily by helping them face their advanced disease on an emotional level. (Because the concerns of people with early stage and advanced cancer are so different, separate support groups are often found to be helpful for participants.)

"Supportive treatment, whether it's individual or group therapy, allows people to express their concerns and fears," Dr. Carlson says. "There's this myth that you have to be positive all the time when what's really important is that people are able to express their feelings, whatever they are."

Support groups and psychotherapy are also available to the family and friends of people with cancer. People with cancer and their families can find psychosocial support though their hospital or cancer center, or though support and advocacy organizations such as the American Cancer Society and The Wellness Community and CancerCare, which offer online support groups led by health professionals.

Other options available to people with cancer include hypnosis and guided imagery, where you relax by focusing on a positive mental image. Biofeedback, a technique that helps people learn how to relax, works with bodily functions such as breathing and muscle tension. If it's feasible, mild aerobic exercise can also provide energy and a mood lift. Some people, especially those who have had anxiety disorder or depression in the past, may need antidepressants or anti-anxiety medications to help them cope.

Cancer is an isolating experience, Dr. Carlson says, but reaching out for support can help people living with the discomfort and uncertainties of cancer gain reassurance and a better quality of life.

National Cancer Institute's Symptoms of Depression Having a depressed mood for most of the day and on most days:

Loss of pleasure and interest in most activities
Changes in eating and sleeping habits
Nervousness or sluggishness
Tiredness
Feeling of worthlessness or inappropriate guilt
Poor concentration
Thoughts of death or suicide

More Than Mood Swings: Bipolar Disorder in Teens


Parents are often exasperated by their moody teenage children. After all, teenagers are known to be irritable, to sleep a lot and to resist authority figures. So how can a concerned parent determine when a teenager is just being a typical teenager and when their child has a mental illness such as bipolar disorder?

In teenagers, symptoms of bipolar disorder can include dramatic mood changes within a single day and may have different symptoms than adults. Below, Barbara Geller, MD, a professor of psychiatry at Washington University in St. Louis, discusses how to recognize and treat bipolar disorder in adolescents.



What is bipolar disorder?
It's defined like other psychiatric disorders across the age span in a manual called the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The specific definition for what we now call bipolar disorder, but used to be called "manic-depressive" illness includes certain symptoms that patients must have to make a diagnosis.

People have to experience both depressed and manic episodes. For example, to fit the depressed part, they would need to be sad, to lose enjoyment in usual activities, to have trouble sleeping and eating, to be guilt-ridden, suicidal. To fit the manic part, they'd have to have elation: a mood of being happy as if the most wonderful thing in your life is happening except it's on a day that's like any other day. Families often describe it as Jim Carrey—like behaviors: silly, giddy, joking without an apparent reason.

People with bipolar disorder also get very grandiose. In adults, it may be developing business schemes that are unlikely to work so they wind up maxing-out credit cards. They have very active personal lives and may have multiple marriages. They seem to be able to go without sleep and are very social.



When does bipolar disorder usually first appear?
It's really only been in the last decade that people have started to pay attention to diagnosing bipolar disorder in young children and early adolescents. So many adults looking back can describe that they had the illness, but it may not have been recognized at that time. It's estimated from current studies that maybe as many as half of adults who have bipolar disorder had their onset before age 17.



How is the bipolar disorder different in younger children?
In adults, what people are used to thinking is that there will be a discrete episode with a clear onset and a clear offset. You generally have mostly a high or a low, and people function somewhat better between episodes.

What we see in the younger population is they have continuous illness for years, but on a daily basis, they can be both high and low. So they may spend four hours of the day high and giddy and silly, and it's very infectious and amusing, and maybe another four hours of the day morose, gloomy, not wanting to be with friends and thinking of hurting themselves. You see these very rapid cycles shifting from extreme high to extreme low on a daily basis, day in and day out, year after year.

And in children, the high manifests a little differently because children are not likely to max-out credit cards or have had four marriages by the time they're seven or eight. So what we look for in children is being super happy, as if it were Christmas morning or the day you're going to Disneyland, except it's the average day in school.



What are some of the risk factors for bipolar disorder?
The biggest factor is that it seems to run in some families. Bipolar symptoms also can occur with use of certain prescription medications such as steroids, with some illicit drugs such as cocaine and with various brain diseases such as stroke, tumors and trauma.



What are some of the warning signs in teenagers?
What families may notice is an exaggeration of all the stereotypes of what we say teenagers do. So we think of teenagers as being irresponsible and being irritable, but the child with bipolar disorder may suddenly decide, "I'm not going to school. They're not teaching me anything. I'm going to be President of the United States anyway, why do I have to go to school?" They have very grandiose behaviors that are out of keeping with reality.

They can also get very hypersexual. We think of adolescents getting very interested in the opposite sex, but bipolar adolescents will feel an urgent need to have multiple partners. They'll begin using very sexy language in inappropriate places. At school, they may write it on the blackboard.

How can parents distinguish between a moody teenager and someone who might have a mood disorder?

It's extremely important for parents to get a professional evaluation if they have any suspicion. The worst that will happen, if it's unfounded, is they will have spent a little time and money. But if it is not evaluated, and you let it go on, it can devastate a child's life. There will be multiple suspensions from school. They can get sexually transmitted diseases because they have unsafe sex. They can very rapidly go into a depression and get very suicidal and act on it. So it's very important, especially in families where a family member has bipolar disorder or has depression, for parents to get consultations at the first sign of any suspicion.



Are teenagers with bipolar disorder more likely to have drug and alcohol problems?
There is a very high rate among people with bipolar disorder of using alcohol and drugs across the age span. Parents have to be very suspicious because a child who's using drugs may seem like they're just having "the normal moodiness of adolescence."

There are some common things to look for. For example, drugs cost money and the family may find that items are disappearing from the house. A child may ask to borrow Mom's jewelry, and it somehow gets lost. Or they borrow electronic equipment, and what they're doing is selling it so they can afford their drugs.



What treatment is recommended to teenagers with bipolar disorder?
There are three classes of medication that are used for bipolar illness across the age span. The antimania drug lithium is the mainstay, and lithium is especially good if somebody else in the family with bipolar disorder has responded to it. The second class of drugs is called anticonvulsants because they were originally developed to treat epilepsy. And the third class of drugs is called neuroleptics.

It's very important to educate the family about the illness and to let them grieve. The last thing they want is for one of their children to have the illness. Then you can help them adapt and take part in the child's treatment. You also have to educate personnel at the school so that the expectation about the amount of work that the child can do is geared toward what the child can manage.



How well does medication control the disease?
Some kids do very well and become indistinguishable from other children as long as they take their medication regularly. The medication essentially has to be taken indefinitely, as it is in adults. Most who take it regularly will have fewer hospitalizations and suicide attempts, and they will be able to hold jobs better and have more stable personal relationships. For others, bipolar disorder is very difficult to treat, and it can be months of trying to find the right combination of treatments.



Are there strategies for helping teenagers stay on their medication?
Strategies have really not been formally researched and developed. This is a very important area for future research. For example, will there be Web-based programs the patients can go to? One thing that we find very helpful to do with adolescents is to grieve with them. The way parents have to mourn the loss of a child who's well, the children themselves have to mourn the loss of their former well self.

But grief hurts a millimeter less every day, so we usually can tell them that six months from now, it'll be more automatic just to take the medication and go about your other business.

More Than Mood Swings: Bipolar Disorder in Teens


Parents are often exasperated by their moody teenage children. After all, teenagers are known to be irritable, to sleep a lot and to resist authority figures. So how can a concerned parent determine when a teenager is just being a typical teenager and when their child has a mental illness such as bipolar disorder?

In teenagers, symptoms of bipolar disorder can include dramatic mood changes within a single day and may have different symptoms than adults. Below, Barbara Geller, MD, a professor of psychiatry at Washington University in St. Louis, discusses how to recognize and treat bipolar disorder in adolescents.



What is bipolar disorder?
It's defined like other psychiatric disorders across the age span in a manual called the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The specific definition for what we now call bipolar disorder, but used to be called "manic-depressive" illness includes certain symptoms that patients must have to make a diagnosis.

People have to experience both depressed and manic episodes. For example, to fit the depressed part, they would need to be sad, to lose enjoyment in usual activities, to have trouble sleeping and eating, to be guilt-ridden, suicidal. To fit the manic part, they'd have to have elation: a mood of being happy as if the most wonderful thing in your life is happening except it's on a day that's like any other day. Families often describe it as Jim Carrey—like behaviors: silly, giddy, joking without an apparent reason.

People with bipolar disorder also get very grandiose. In adults, it may be developing business schemes that are unlikely to work so they wind up maxing-out credit cards. They have very active personal lives and may have multiple marriages. They seem to be able to go without sleep and are very social.



When does bipolar disorder usually first appear?
It's really only been in the last decade that people have started to pay attention to diagnosing bipolar disorder in young children and early adolescents. So many adults looking back can describe that they had the illness, but it may not have been recognized at that time. It's estimated from current studies that maybe as many as half of adults who have bipolar disorder had their onset before age 17.



How is the bipolar disorder different in younger children?
In adults, what people are used to thinking is that there will be a discrete episode with a clear onset and a clear offset. You generally have mostly a high or a low, and people function somewhat better between episodes.

What we see in the younger population is they have continuous illness for years, but on a daily basis, they can be both high and low. So they may spend four hours of the day high and giddy and silly, and it's very infectious and amusing, and maybe another four hours of the day morose, gloomy, not wanting to be with friends and thinking of hurting themselves. You see these very rapid cycles shifting from extreme high to extreme low on a daily basis, day in and day out, year after year.

And in children, the high manifests a little differently because children are not likely to max-out credit cards or have had four marriages by the time they're seven or eight. So what we look for in children is being super happy, as if it were Christmas morning or the day you're going to Disneyland, except it's the average day in school.





What are some of the risk factors for bipolar disorder?
The biggest factor is that it seems to run in some families. Bipolar symptoms also can occur with use of certain prescription medications such as steroids, with some illicit drugs such as cocaine and with various brain diseases such as stroke, tumors and trauma.



What are some of the warning signs in teenagers?
What families may notice is an exaggeration of all the stereotypes of what we say teenagers do. So we think of teenagers as being irresponsible and being irritable, but the child with bipolar disorder may suddenly decide, "I'm not going to school. They're not teaching me anything. I'm going to be President of the United States anyway, why do I have to go to school?" They have very grandiose behaviors that are out of keeping with reality.

They can also get very hypersexual. We think of adolescents getting very interested in the opposite sex, but bipolar adolescents will feel an urgent need to have multiple partners. They'll begin using very sexy language in inappropriate places. At school, they may write it on the blackboard.

How can parents distinguish between a moody teenager and someone who might have a mood disorder?

It's extremely important for parents to get a professional evaluation if they have any suspicion. The worst that will happen, if it's unfounded, is they will have spent a little time and money. But if it is not evaluated, and you let it go on, it can devastate a child's life. There will be multiple suspensions from school. They can get sexually transmitted diseases because they have unsafe sex. They can very rapidly go into a depression and get very suicidal and act on it. So it's very important, especially in families where a family member has bipolar disorder or has depression, for parents to get consultations at the first sign of any suspicion.



Are teenagers with bipolar disorder more likely to have drug and alcohol problems?
There is a very high rate among people with bipolar disorder of using alcohol and drugs across the age span. Parents have to be very suspicious because a child who's using drugs may seem like they're just having "the normal moodiness of adolescence."

There are some common things to look for. For example, drugs cost money and the family may find that items are disappearing from the house. A child may ask to borrow Mom's jewelry, and it somehow gets lost. Or they borrow electronic equipment, and what they're doing is selling it so they can afford their drugs.



What treatment is recommended to teenagers with bipolar disorder?
There are three classes of medication that are used for bipolar illness across the age span. The antimania drug lithium is the mainstay, and lithium is especially good if somebody else in the family with bipolar disorder has responded to it. The second class of drugs is called anticonvulsants because they were originally developed to treat epilepsy. And the third class of drugs is called neuroleptics.

It's very important to educate the family about the illness and to let them grieve. The last thing they want is for one of their children to have the illness. Then you can help them adapt and take part in the child's treatment. You also have to educate personnel at the school so that the expectation about the amount of work that the child can do is geared toward what the child can manage.



How well does medication control the disease?
Some kids do very well and become indistinguishable from other children as long as they take their medication regularly. The medication essentially has to be taken indefinitely, as it is in adults. Most who take it regularly will have fewer hospitalizations and suicide attempts, and they will be able to hold jobs better and have more stable personal relationships. For others, bipolar disorder is very difficult to treat, and it can be months of trying to find the right combination of treatments.



Are there strategies for helping teenagers stay on their medication?
Strategies have really not been formally researched and developed. This is a very important area for future research. For example, will there be Web-based programs the patients can go to? One thing that we find very helpful to do with adolescents is to grieve with them. The way parents have to mourn the loss of a child who's well, the children themselves have to mourn the loss of their former well self.

But grief hurts a millimeter less every day, so we usually can tell them that six months from now, it'll be more automatic just to take the medication and go about your other business.

What The Most Dangerous Job In The World Taught Me About Coping With Stress
By: Kevin Thompson



I just got through reading some troubling news in the New York Times this morning.

62% of employees now say that work-related stress leaves them overwhelmed and overtired.

And for many of us, who bring work home from the office, the problem is even worse.

So what’s going on?

Why are most of us so stressed?

I’ll tell you what a major part of the problem is… lack of job security.

I remember as I was growing up, my father only had two jobs. He was a high school teacher for the earlier part of his life, and later on he went into the real estate profession.

Two jobs, and they spanned his entire lifetime!

And the one career change he made was something he wanted to do. He didn’t make the change because he was losing his job as a teacher. In fact, the school district wanted him to stay.

But that’s a far cry from the way things are today. In fact, the days of job stability, and working for a single employer for your entire working career are long gone.

You’ll probably change jobs at least 11 times before you retire.

Downsizing, rapid business expansion and outsourcing are terms that we’re all too familiar with.

Before I got involved in the health industry and started my own indoor air quality business back in 1996, I’d already held 5 jobs in 5 completely different industries.

I worked as a telecommunications technician (in the Army), as a framer, on the green chain at 2 separate lumber mills, as a farm hand and finally as an Alaska fisherman for seven years (which was the hardest and most stressful job I ever had).

Now, you may be thinking to yourself, “You must’ve been a problem employee”.

But the fact is, nothing could be further from the truth.

I was in fact a model employee for every company I worked for, and never left a single employer on bad terms.





For example…

I began working as an Alaska fisherman in 1988. My main motivation for doing this was the money. Quite honestly, that’s the only reason I took the job.

And if you’ve ever seen that movie “The Perfect Storm” or watched those shows on the discovery channel, you have an idea of what it’s like to fish in Alaska.

My own story isn’t much different and it taught me why being an Alaska Fisherman is know as “The Most Dangerous Job In The World”.

The winter of 1995 had been an especially bad winter in Alaska. Fishing boats and fishermen's lives were being claimed by the Bering Sea almost weekly.

I was working on the outside deck after dark and we were in an unbelievable storm. It was the worst I'd seen in my 7 years of fishing. The kind of thing you only see in the movies.

I was scared to death!

But I had my own way of dealing with my fears. I'd never look out at the horizon when we were in a storm like this because I didn't want to see the big picture. I didn't want to know how high the waves really were. So I'd just concentrate on my job, which was to get all the fish onto the boat. As long as I did my job, and didn't look up, I could almost convince myself that the storm wasn't that bad.

While this certainly wasn’t the best way to deal with stress, at the time, it was the only way I knew how.

As always, the captain was in the wheelhouse driving the boat. His job was to keep an eye on me and watch for the dangerous rogue waves that would come out of nowhere and slam into us broadside. He'd tell me if I was in any real danger.

And then it happened!

I heard the captain's thundering voice over the intercom system.

Kevin! Hit the deck!

Before I could react, I was buried under a wall of water that hurled me all the way across the deck of the boat, face first into the railing on the other side.

When the water settled, and I realized what had happened, my immediate thought was, "Thank God I'm still on the boat" The impact had knocked out my front teeth and caused serious facial damage, but at least I was still alive, and on the boat.

If that wave would have lifted me just a few inches higher, I would have been thrown right over the top of the railing into the freezing waters of the Bering Sea. And there's one thing I knew for sure. In a storm like that, there's no way in hell the captain would have got that boat turned around in time to save me. I would have died right then and there.

It was at that moment I decided my life as an Alaska Fisherman was over.

While it was a great experience, I’ve never regretted my decision to leave the fishing industry. I just didn’t want to deal with that much stress in my life.

Decades of research has linked stress to everything from heart attacks and stroke to diabetes and a weakened immune systems, and none of us want to deal with that.

I’ve since found much better ways to deal with stress, and you can too by using the resources on this site.

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Kevin Thompson is a national authority on indoor air quality and health issues. His free Health Articles & News Update service gives you instant access to the world's most respected and sought after health experts in 70 categories, including Men’s Health, Women’s Health and Children’s Health just to name a few. Find out how this free service is changing people's lives and how you too can live a longer, healthier and more prosperous lifestyle... beginning today!