Managing medical phobias during cancer treatment

Overcoming extreme anxiety when facing cancer and its treatment.

  1. What is a medical phobia?
  2. Anxiety triggers during cancer treatment
  3. How your body reacts to phobias during cancer
  4. How can I overcome my fear of cancer treatment?

What is a medical phobia?

Although the experience of fear, anxiety, and stress in response to your cancer diagnosis and treatment plan may be normal, it is another demanding challenge set by cancer.

Despite recent medical advancements, cancer is still the most feared disease by the general population of the United Kingdom and United States.1

The reasons behind the anxiety and stress that can lead to medical phobias during cancer may be due to the anticipation of the medical procedures and over what these tests or scans may show.

Many people living with cancer fear being sick, suffering pain, or becoming a burden to others. In survivorship, there is also the dread of coping with difficult side effects from treatment and, ultimately, the possibility of reoccurrence, more treatment, or even of life being cut short.

Equally, extreme anxiety is felt in the build-up to receiving the scans’ results, which is when the threat of facing an uncertain future feels ever-present. Such fear is medically recognized as (PSS) Pre-Scan Syndrome2 and is commonly known as ‘scanxiety’3. Notably, this is a popular thread of conversation in support groups online and in face-face group support.

Often the definition of fear compared to a phobia is hard to separate4. However, if your worries and fears start to impact your daily life to the extent that your aversions are beyond your own control5, then you may have what can be called a ‘medical phobia’ or ‘illness phobia.’

A phobia is classed as an uncontrollable, excessive, and irrational, fearful reaction to an object, situation, or activity6 disproportionate to most other people’s reactions.

Although such phobias towards cancer and its treatment are quite common, not everyone will experience the same depth of anxiety and fear, with the experience ranging from mild to severe on the ‘phobic scale.’ Every one of us is individuals with an individual response to fear, and stress has been found to make the fearful situation worse7.

When faced with an uncomfortable situation or feared object, the natural reaction of the person experiencing the phobia is to flee or avoid8. If it is impossible to escape the situation, the person will often suffer from extreme distress9.

So, if your anxieties are affecting your everyday quality of life and risking putting your treatment in jeopardy, then you need strategies to help you overcome and manage your medical phobias during cancer treatment.

Understanding your anxiety triggers is the first step in keeping your fears under control and, most importantly, keep your cancer treatment on track.

Anxiety triggers during cancer treatment

Your anxiety response to phobias during cancer will probably be triggered in two interlinked ways.

Firstly, your fears can be treatment-related anxieties amplified by the medicalized environment; seeing the doctors and nurses in their scrubs, witnessing a cancer ward, and seeing other cancer patients around you may be the source of profound distress.

Other common anxiety-inducing triggers are; blood samples, biopsies, injections, IV lines, ports, swallowing pills, surgery, MRI machines… the list of potential triggers for medical phobias in cancer treatment is seeming, never-ending.

However, such feelings of extreme anxiety may be temporary and be felt just before a test or hospital appointment. They may pass quite quickly once you can get control over the panic and stress of the moment.

Cancer surgery

Secondly, your phobic response can be in reaction to the very fact that you have cancer. You may still be struggling with anxious thoughts, debating internal worries, and making presumptions about the future10, as you attempt to process this fast-moving situation.

Such fears can become deep-seated and stay with you over the long-term, especially if your cancer becomes a chronic condition. Cancer survivors are more likely than the rest of the general population to be diagnosed with an anxiety disorder such as a phobia11 in the year following their diagnosis.

How your body reacts to phobias during cancer

The way your body reacts when faced with your ‘medical’ or ‘illness’ phobias during cancer is the same as when you are afraid or threatened for any other reason.

Your body suffers from a strong reaction to the perceived threat as your mind obsessively is consumed by panic. Of course, you feel threatened and out of control!  Consequently, you will naturally feel unease in your body and potentially a deep sense of genuine fear.

Your body is hard-wired to react as it would to any potential hazard or distress. Your nervous system activates, and your ‘fight or flight’ response kicks in as your body screams internally to either flee the situation or fight the danger.

Adrenaline in your bloodstream surges as your body becomes primed for action, your breathing slows, your palms become sweaty. You can feel tension strain in your muscles, and your heart rate begins to race. As your mouth dries, you can have a strange sense of being slightly detached from your hearing. You may become dizzy, weak, feel sick to your stomach, or you may even feel like your head is spinning so hard you could faint.

Panic and cancer

In reaction to any state of emergency, your mind prepares your body, even if there is no physical danger. The stresses are coming from your internal dialogue.12 Your brain cannot distinguish the type of threat, whether it is perceived through thought or physically in front of you.

This means that even thinking about what scares you, such as a biopsy, surgery, or test result, can evoke your phobic response. You can still suffer from extreme anxiety, even in anticipation of the event actually happening.

Thankfully, you can learn effective ways to control your ‘medical’ or ‘illness’ phobias during cancer and significantly calm the situation.

How can I overcome my fear of cancer treatment?

Although you may never be free from the clutches of fear, the goal is to overcome these medical phobias.

At the very least, you need to be able to bring your anxieties down to an acceptable and manageable level. These aversions cannot stand in your way of receiving all the treatment you need; they cannot hinder your progress in beating this disease.

By having a toolkit of coping strategies already in place to help you manage every situation and eventuality, you can learn how to build your resilience. When facing those moments that you find extremely tough, you will be able to over-ride the surge of negative emotions and successfully get through such challenging times.

So, how can I overcome my fear of cancer treatment?

  • Let your medical team know

If you are suffering from any medical phobias that can impact your fight, you must speak up and raise any concerns you have. More importantly, you need to make sure your medical team hears your fears for you to gain access to the help you need at the moment.

Your medical team is the expert in dealing with such extreme anxieties and will have dealt with such phobias in cancer patients before, so be open and honest with the stresses you are facing.

Some psychologists and counselors use talking therapies such as CBT (Cognitive Behavioural Therapy) to help you manage your thoughts and behaviours13.

You can also speak to your doctor or primary physician about anti-anxiety medications, which may help you become calmer and more in control of how your body reacts.

  • Seek reassurance regarding the procedures

Often the specialist nurse will have an explanatory session with you before starting the treatment. This will allow you and your caregiver to discuss the procedures in detail.

You can ask all the questions you may have, note down important information, or even record the briefing. Armed with this knowledge, you can set your mind at ease14.

Find out how long it takes to process the tests and when the results will be available to you. By knowing these details, anxiety, and stress can definitely be better managed15.

Also, don’t be afraid to inform the nurse of your extreme anxieties, as they can help you by talking through what they are about to do and the reason behind any of the treatments or tests.

Overcoming medical phobias
  • Rationalize the reasons why

Let’s be clear; the goal is to rid your body of cancer and live as well as possible for as long as you can.

When you know the reason behind all these tests and procedures is for your long-term benefit, you can usually put your fears into perspective and stick to your plan to help you overcome your medical phobias.

It may not be easy; in fact, it will probably be massively difficult, but this does not mean that it is impossible to overcome your phobias during cancer and its treatment16.

  • Make a plan of action

By planning the detail of your experience, you will give yourself a framework to cling to if and when your phobic reaction takes hold.

Make practical arrangements so the journey goes smoothly, and know where you are going in the hospital to cut down any other stress sources.

Be prepared for worry and tension by bringing distraction and relief sources such as; music, a book, an aromatherapy stick, or an item that brings you comfort like a necklace or photo.

Plan to do something nice after the treatment is over17 and focus on the day, with a little detour to the hospital first. Reward yourself after accomplishing what previously may not have been possible.

  • Practice inner rehearsal

Your inner dialogue will be a crucial force for good or harm in a distressing situation. If you can find and harness your positive, supportive, and relaxing voice, then you will be able to focus on getting through your phobias during cancer.

Using creative visualization and imagining yourself in a calm atmosphere will help induce a more relaxed feeling within. These techniques can be practiced in advance and help you combat a panicked episode when you feel it start to build.

  • Utilize ‘gradual exposure’

The idea that you don’t face your fear and avoid or evade the situation will not help you overcome your anxieties. To ease your phobia, the best way is to introduce small, regular exposure that can build over time.

So, visit the treatment center where you will be receiving your treatment, talk to the nurses, and find out as much information as possible to know what lies ahead18.

By doing this, the acute fear will pass, and your body will eventually start to calm, and you begin to have a more rational view of the perceived danger. Gradually you will become ‘de-conditioned’ to the threat and de-sensitized to the situation.

As you become more comfortable with your surroundings, get to know the staff, and understand more about your diagnosis and treatment procedures.

  • Go with someone

If there is a particular flashpoint for your phobia, for example, a test, examination, scan result, or treatment you know that you will difficult to cope with, make sure you have someone.

Having a strong, supportive, reassuring and calm presence with you will help you counteract any fear that you may have around the hospital experience.

Bring someone along to appointments with you, someone close to you, and whom you can rely upon for support and encouragement, an understanding friend or family member. Be sure to choose someone who is reliable and will not belittle your worries.

If you don’t have a big network surrounding you, there is practical support out there and people who want to help.

The local charities may offer a driving service or a companion to sit with you through your treatment. More often than not, these volunteers are cancer survivors who are giving back after having completed their own treatment. Their experience can help you come to terms with the situation, and their experienced support can prove invaluable.

  • Try conscious breathing

Learning how to slow your breathing is a way to find a sense of control over the situation.

With the intake of a deep breath followed by a long, slow exhalation, your body will immediately feel a sense of relaxation. Your muscle tension will release, your brain will feel the benefit of the added oxygen, and the situation’s stress will feel less acute.

Conscious breathing
  • Plan distractions

Use distraction as a technique to overcome your phobias during cancer.

Talk to your supporter, or try to tune out by bringing a book, magazine, device, music to distract you in the waiting room.

If you find your mind wandering or your anxieties escalating, have your set of go-to positive and calming thoughts already lined up to re-direct your thought towards something you find relaxing or interesting.

During the test or procedure, use distraction methods to cope, such as; talking to the nurses, looking away when getting injections, visualizing yourself in a different situation during a nicer activity.

  • Get comfortable

Packing a bag for your hospital appointment means that you can bring along home comforts to long treatment protocols, for example, when receiving chemotherapy.

Ensure that you have items to help you get comfortable with making the experience as pleasant as possible. Bring a blanket, pillow, slippers, hot water bottle, and lose yourself in distractions such as a book or movie to help pass the time and keep your mind off reality.

Lie down when receiving blood or getting a test; get comfortable. Practicing meditation or listening to relaxing music are proven methods that can soothe and calm.

  • Intentionally relax

Relaxation doesn’t always come naturally to everybody, especially in uncertain times and moments of high intensity.

It is important to consciously and mindfully set yourself the challenge of internally calming by trying out some common relaxation strategies.

For some people, progressive muscle relaxation proved useful for coping with anxiety. Either directed by a guided script or simply thinking through the exercise, you systematically tense and relax the muscles in your body, such as your legs, arms, hands, feet, chest, and abdomen.

It can also help to have a massage, aromatherapy, or reflexology session before your procedure or even during the treatment20. Complementary therapies can even happen at the bedside, whether they are carried by a trained professional or a loved one, simply giving your shoulders a massage.

  • Accept your medical phobia

Your natural reaction may be to avoid your fears, but that won’t be possible if you have a medical phobia and face a cancer diagnosis.

An avoidance strategy is clearly not an option as interfering with your treatment schedule of testing, appointments, and medications would jeopardize your recovery.

Start by changing your perception of the situation, accept that this medical intervention could be life-saving. Be prepared to flip negative inner talk and over-ride associations of threat, fear, and danger.

If you have previously associated cancer and its treatment with negativity, re-frame your outlook by seeing your treatment as beneficial and a necessary step towards your recovery.

It is only by accepting that you have these worries and fears and seeking the help and support you need that you will be able to reduce your levels of distress and maintain your quality of life.

In finding acceptance, you are choosing to take positive steps towards managing your phobias during cancer and get through your treatment.

If you think the information on this new website would be helpful to others, please like and share the word.

Recommend to others facing cancer, on support forums, social media, in person or by email. Thank you.

References

  1. Vrinten, C. et al., (2017) ‘What do people fear about cancer? A systematic review and meta‐synthesis of cancer fears in the general population’, Psychooncology, 26(8), pp. 1070–1079 [Online]. Available at: doi: 10.1002/pon.4287 (Accessed: 6th October 2020).
  2. Cure Today (2015) 10 Tips for Coping with Scanxiety, Available at: https://www.curetoday.com/community/tori-tomalia/2015/02/10-tips-for-coping-with-scanxiety (Accessed: 6th October 2020).
  3. Bauml, J. M. MD et al. (2016) ‘Scan-associated distress in lung cancer: Quantifying the impact of “scanxiety”’, Lung Cancer, Volume 100, pp. Pages 110-113 [Online]. Available at: https://www.sciencedirect.com/science/article/pii/S0169500216304433 (Accessed: 4th October 2020).
  4. Alman, Dr. B. M. & Lambrou, Dr. P. (1997) Self-Hypnosis, 2nd edn., Great Britain: Souvnenir Press.
  5. Schmid, M. et al. (2009) ‘Tomophobia, the phobic fear caused by an invasive medical procedure – an emerging anxiety disorder: a case report’, Journal of Medical Case Reports, 3(131), pp. [Online]. Available at: doi: 10.1186/1752-1947-3-131 (Accessed: 6th October 2020).
  6. Harvard Medical School, Health Publishing (December 2018) Phobia. What is it? Available at: https://www.health.harvard.edu/a_to_z/phobia-a-to-z (Accessed: 6th October 2020).
  7. Antony, M. M. & Watling, M. A. (2006) Overcoming Medical Phobias. HOW TO CONQUER FEAR OF BLOOD, NEEDLES, DOCTORS & DENTISTS [Online]. Available at: http://martinantony.com/wp-content/uploads/Overcoming-Medical-Phobias1.pdf (Accessed: 7th October 2020).
  8. Hogan, B. (2007) An Introduction to Coping with Phobias, 1st edn., United Kingdom: Constable & Robinson Ltd.
  9. Mackereth, PhD., P. & Tomlinson, L. (2014) Procedure-related anxiety and needle phobia: rapid techniques to calm. Available at: https://www.nursinginpractice.com/article/procedure-related-anxiety-and-needle-phobia-rapid-techniques-calm (Accessed: 6th October 2020).
  10. Antony, M. M. & Watling, M. A. (2006) Overcoming Medical Phobias. HOW TO CONQUER FEAR OF BLOOD, NEEDLES, DOCTORS & DENTISTS [Online]. Available at: http://martinantony.com/wp-content/uploads/Overcoming-Medical-Phobias1.pdf (Accessed: 6th October 2020).
  11. Greer, J.A. Ph.D. (2011) ‘Anxiety Disorders in Long-Term Survivors of Adult Cancers’, Psychosomatics, Volume 52 (Issue 5), Pages 417-423 [Online]. Available at: https://doi.org/10.1016/j.psym.2011.01.014 (Accessed: 6th October 2020).
  12. Hogan, B. (2007) An Introduction to Coping with Phobias, 1st edn., United Kingdom: Constable & Robinson Ltd.
  13. NHS (2016) Cognitive behavioural therapy (CBT)- Overview, Available at: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/#:~:text=Cognitive%20behavioural%20therapy%20(CBT)%20is,mental%20and%20physical%20health%20problems. (Accessed: 6th October 2010).
  14. Sweet, C., 2010. Change Your Life with CBT. 1st ed. Great Britain: Prentice Hall Life.
  15. Chua, G. P. et al. (2018) ‘What information do cancer patients want and how well are their needs being met?’, Ecancermedicalscience, 12(873), pp. [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214674/ (Accessed: 6th October 2020).
  16. Antony, M. M. & Watling, M. A. (2006) Overcoming Medical Phobias. HOW TO CONQUER FEAR OF BLOOD, NEEDLES, DOCTORS & DENTISTS [Online]. Available at: http://martinantony.com/wp-content/uploads/Overcoming-Medical-Phobias1.pdf (Accessed: 6th October 2020).
  17. Goodhart, Dr. F. & Atkins, L., 2013. How to Feel Better. 1st ed. Great Britain: Piatkus.
  18. Sweet, C., 2010. Change Your Life with CBT. 1st ed. Great Britain: Prentice Hall Life.
  19. Dana-Farber Cancer Institute (2016) How Can Patients Cope with Medical Phobias? Available at: https://blog.dana-farber.org/insight/2016/04/how-can-patients-cope-with-medical-phobias/ (Accessed: 6th October 2020).
  20. Spiegel, M.D., D. and Classen, C., Ph.D. 2000. Group Therapy for Cancer Patients. 1st ed. United States of America: Basic Books.

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Vrinten, C. et al., (2017) ‘What do people fear about cancer? A systematic review and meta‐synthesis of cancer fears in the general population’, Psychooncology, 26(8), pp. 1070–1079 [Online]. Available at: doi: 10.1002/pon.4287 (Accessed: 6th October 2020).

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