There is an inherent friction at the very core of life. A spark, an urgency, an insistence. In many ways, it is this friction that helps generate the forward momentum of our day-to-day lives, creating an energy and drive to get things done.
But the way we react to this friction – in the moment and over time - can, if not regulated, generate stress and ultimately do us harm. Events in themselves are not inherently 'stressful'. Stress comes rather from the way in which our minds and bodies respond to life's demands and unavoidable hiccups, our ingrained reaction to challenge.
We all know how it goes. The ancient, animal part of our brain that delivered the impetus for our ancient ancestors to run away from sabre toothed tigers and which hasn't kept pace with human development. Our limbic brain which flicks the switch on our sympathetic nervous system’s flight-or-fight survival mechanism - a rapid response system which served us well in the life and death reality of our brutal past, but which is less well adapted to our complex, nuanced, 24/7 lives.
And so, too often, many of us find ourselves living in a state of chronic stress. A state triggered perhaps not by the existential threat of a marauding mammal, but instead by the near constant stimulus of our high-speed, switched-on lives – an impending deadline, a spiral of negative thoughts courtesy of late-night doom-scrolling on social media or a misunderstanding with a loved one. A reality in which our body’s rudimentary survival mechanism is consistently in over-drive, over-responding to perceived threats and flooding our bodies with stress hormones. A reality which can be damaging not just psychologically and emotionally, but also physiologically – leaving our bodies depleted and vulnerable.
Evidence shows that stress impacts all areas of our health – deregulating our immune system, increasing systemic inflammation and even modifying our genetic pathways. Although there is no scientific data yet to indicate that stress can directly cause the initial onset of cancer (though I suspect this will come), there is a growing body of research linking chronic stress with the regrowth of tumours and cancer proliferation, potentially leading to worse outcomes for those already with a diagnosis.
Studies have shown that stress hormones may wake up dormant cancer cells which have remained in the body after treatment, stimulating them to form new tumours. In addition, the biological changes caused by chronic stress make our internal micro-environments more hospitable to cancer cell growth - a double whammy. It is thought that chronic stress and the release of stress hormones can influence every one of the hallmarks and biological processes linked to cancer growth.
The main cause of all cancer deaths are metastases – when the cancer spreads from its primary site, reappearing in other areas of the body. Once cancer has progressed to this stage - stage 4 - it becomes increasingly complex to treat and is generally considered ‘incurable’ by mainstream oncology.
For this reason, managing stress levels and undertaking activities which soothe my nervous system come absolutely top of my list when looking at ways to structure my anti-cancer life.
When our nervous system is well regulated, our body's systems feel anchored in a place of safety, psychological well-being and physical homeostasis. Our healing autonomic rest-and-digest responses are toned, our immune system functions more healthily and inflammation levels reduce, allowing our natural defence mechanisms to operate more effectively.
Getting a cancer diagnosis is, in itself, an intensely stressful life event. In an instant life goes into free fall and inevitably feels deeply insecure, not only practically and materially (‘Can I keep working?’, ‘How will I pay my mortgage?’, ‘Who will look after my children or walk my dog?’….) but also existentially. Suddenly you are eyeballing death – often for the first time in your life. It is no surprise that the emotions most commonly related to a cancer diagnosis include anxiety, fear, anger, confusion, sadness, isolation, shame, depression, denial, overwhelm, regret, a loss of purpose, impotence. All totally natural responses to toe-ing the line of our mortality. All deeply tough emotions to ride. All potentially deeply triggering for our ragged nervous systems.
It is normal that we should move in and out of different states of nervous system response throughout our day. What is damaging though is when we get stuck in an adaptive survival response over time. If we are to optimise our chances of out-pacing cancer, we therefore need to find ways to regulate our nervous systems and manage our stress responses. Of course, while we would do well to minimise the number of stressful events and situations in our lives, we cannot remove them all (especially when living with a cancer diagnosis). Rather we need to learn how to understand, nurture and soothe our nervous systems, learning to manage our moment to moment reactions to daily stressors.
For me, this has been perhaps the biggest focus this past year, and feels the most important thing for me to concentrate on as I move forwards. A voyage of self enquiry and self discovery. In no particular order, here are some of the things I have found particularly helpful in my quest to gain mastery of my own stress responses. I hope others might find them useful, whether living with cancer or not:
- Listening to my thoughts. Taking time to try to identify, acknowledge and express emotions – rather than bottling them up. All feelings are valid. Pushing them down creates more stress and can lead to a sense of isolation. Knowing I have people on my support team that I can share even my darkest emotions with honestly has been invaluable.
- Identifying the areas of my life which cause me most stress. Asking myself honestly if there are changes that I need to make in my life to reduce my stress load. Challenging relationships I could potentially improve? Things that I have swept under the carpet but that have been burning through me and need addressing? Small modifications to my life that could reduce my daily tension levels?
- Considering whether there are areas in my life where I am having trouble saying no. Recognising that when I say yes to something, I am necessarily saying no to something else (if I choose to spend time or energy doing something, there will always be an opportunity cost , other things I won't be able to do as I will have run out of time or energy), and trying to get really explicit with myself about this interplay. Ensuring that I prioritise what really matters to me, rather than doing what I feel I should do, and practising saying no.
- Getting really curious about my own response to stress. Getting to know what triggers me, and how my body responds. Are there ways to change these patterns – for example, if when I am stressed my breathing becomes high and shallow, how would it be to slow my breathing down and bring it down my body? Are there ways I could reframe my perception of certain events, shifting the narrative, and indeed my language, from one of ‘stress’ to one of ‘challenge’?
- Developing ways to moderate my response to stressors – staying in the moment rather than ruminating about the past, or worrying about the future. As I've mentioned before I find using Sophie Sabbage's trick of asking myself "True? False? Or don’t know?" about anything I am worrying about really useful. If I am worrying about something in the future (for example, whether my cancer will return) the answer is inevitably "don't know". This creates some breathing space to step back and recognise that there is no point expending precious energy on something that may not even happen. I have found this really helpful, used alongside mindfulness practices to ground me in the here and now.
- Flip the script. Trying to notice the stories that I tell myself to discover where I create unnecessary stress. For example, when we hear a siren, where does our mind go? Are we automatically in a downward spiral of thoughts about car crashes or knife crimes - triggering a physical stress response? If so, how might we flip the script, responding instead to the noise of a siren with a positive story, telling ourselves that the ambulance is attending someone in need, and saving a life?
- Engaging in practices that help me to de-stress - Yoga, qi gong, meditation and yoga nidra are all excellent ways to move out of fight-flight-freeze mode and move instead towards our restorative rest-and-digest mode. Meditation has been shown to modify brain function, changing gene expression and lowering stress hormone levels in the body. Building such restorative practices into my daily routine feels like an absolute priority.
- Trying to cultivate a positive frame of mind. This does not mean employing false (or ‘toxic’) positivity – covering up negative feelings with a forced jolliness or flippancy. That is not helpful. But we do know that excessively dwelling on the negative eventually has a physiological impact – triggering an inflammatory response in our bodies. Research shows us that attitude does make a difference in the outcomes of those living with cancer, and that, everything else being equal, those with a positive approach to their situation, a sense of purpose and an active response to their own treatment tend to live longer.
- Doing something every day that brings joy, makes me smile or laugh, or feeds my soul. Playing a favourite piece of music, watching a funny clip on you tube or laughing with a friend. Simple.
- Cultivating gratitude – trying to focus on what I am grateful for - either in the moment, or through journalling, asking myself 'what went well' at the end of each day, or encouraging myself to find the elements I am grateful for in any given situation. Research clearly shows that practicing gratitude reduces levels of the stress hormone cortisol and reduces inflammation - two biomarkers linked to a variety of diseases. It can also help to improve sleep quality and reduce depression or low mood.
- Exploring breathe work. When we're stressed or rushing about, our breathing tends to speed up and sits high in our chest. By actively trying to use diaphragmatic breathing, slowing down our breathing rate and bringing our breath lower, down into our belly, we can help to calm ourselves. Two or three ten minute sessions a day, breathing in through the nose for four counts and out through the nose for six, can help to stimulate the parasympathetic rest-and-digest nervous system – decreasing stimulation levels and regulating the nervous system.
- Working with a therapist to help manage the stress of diagnosis and treatment, but also to work through unresolved issues from my past. Research clearly shows a direct link between people who have had adverse childhood experiences (for example, the death of a parent, neglect or abuse) and multiple diseases, including cancer. Such experiences catch up with us if not addressed, and the long-term psychological impact of trauma has a physiological impact on our body’s systems, potentially predisposing us to illness (for more on this I'd suggest reading Gabor Mate’s When the Body Says No - although some may find this a confronting read).
- Connect to others – when we are stuck in flight or fight mode, we can find it difficult to connect to others. When we are without human connection, our nervous systems respond, inflammation levels increase and pathways for illness become triggered. Research shows that loneliness and social isolation are risk factors for early mortality. Connection with a loved one, partner, or child is invaluable, but so too is connecting with strangers. Taking time to chat to local shopkeepers, a hairdresser or the person sitting next to us on the bus can all help to fill our covid depleted connection buckets.
Books I'd recommend reading for a deeper exploration of some of the issues mentioned above:
Cured - the power of our immune system and the mind-body connection: Dr Jeff Rediger
Anchored - how to befriend your nervous system using poly vagal theory: Deb Dana
Anti Cancer Living - the six step solution to transform your health: Dr Lorenzo Cohen and Alison Jefferies
When the Body Says No - the cost of hidden stress: Gabor Maté
The Cancer Whisperer - Sophie Sabbage
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