Mental wellbeing

It’s not unusual for people with cancer to struggle mentally and emotionally at times. On this page:

How cancer may affect you mentally

It’s normal to feel sad when you’ve been diagnosed with a serious illness. It can make you anxious too, which can affect your ability to concentrate. You may feel as if you’re all over the place and unable to think straight. It takes time to process everything and emotionally you’re bound to have good days and bad days.

You may also feel quite angry at times. Anger may hide other feelings – if you’re frightened or feeling vulnerable, for example. This can be hard for you (and those around you) to cope with. When things have calmed down, it may help you to feel better if you explain that it’s really the cancer you’re angry with, not your family or friends.

Generally, these feelings become easier to cope with in time. But some people need a bit of help to get past them. On this page there is information about what you can do if you’re feeling overwhelmed.

Feeling isolated

Some of us have a tendency to withdraw a little when things gets tough. It may feel too difficult to carry on as normal when you feel as if life is anything but. You may also have been too unwell or tired to do much because you are having treatment and then recovering.

You can also feel alone when you’re surrounded by others. You may feel as if the cancer has set you apart and that no one else knows what you’re going through. You’re right – they don’t. But that doesn’t mean they can’t listen and try to understand. If you’re pushing people away, they may think you prefer being your own or keeping things to yourself.

Sometimes people can be uncomfortable talking about cancer. If they change the subject when you bring it up, it can be even more isolating.

Keeping apart from everyone isn’t going to help in the long run. If you’re isolated and lonely, you won’t have an outlet for your feelings and that can make you feel even lonelier.

Recognising depression

Depression is very common in people with cancer. As many as 1 in 3 people with a cancer of the digestive system have depression at some point. But it’s not inevitable and it can be successfully treated.

Being depressed can creep up on you. If you’ve been feeling low all the time for a couple of weeks, you may be depressed. Some of the symptoms can be similar to the effects of the cancer, making it even harder to spot. Depression can make you feel tired, lose your appetite and have trouble sleeping. You may also:

• lose interest in things you normally enjoy
• feel worried and restless and find it hard to relax
• lack confidence and feel useless, or that you’re a burden to others
• be snappy and irritable with those close to you
• have difficulty concentrating
• dwell on past events and get things out of proportion

If you think you might be depressed, talk to your doctor. They can refer you for the therapies we cover below. They may suggest a short course of antidepressant medicine. But don’t be surprised if they want to try other options first.

Seeing people and doing things

Doing something you enjoy can help you to feel better if you’re feeling low. You may not feel like going to a party or joining a group event, but you might enjoy it if you do.

You need to be kind to yourself of course. But sometimes it’s better in the long run to make an effort. Only you can decide what’s best for you at any given time.

We know that physical activity can lift your mood and help with depression. Exercise can improve your sleep, your appetite and your recovery. If you’re not well enough for sports or exercise you normally do, you could try just going for a walk with a friend. It’ll get you out of the house for some fresh air. Just meeting friends for coffee may give you a break from worrying about the cancer or treatment. Think about what you enjoy doing and make time for it.

You may find a cancer support group helpful. Even if there isn’t anyone with the same type of cancer as you, they’ll know how it feels to be diagnosed and go through treatment. There is information about finding support from others in this section.

Relaxation

People often find it difficult to relax when they’re going through a difficult time. Relaxation is a skill that you can learn. It can bring real benefits in managing stress and anxiety.

For some, a warm bath or listening to music may be enough to unwind. But if you’re finding it more difficult, there are relaxation exercises you can learn such as:

• guided imagery – picturing a calming scene or a happy memory of an event or place
• progressive muscle relaxation – tensing and relaxing muscles in turn, from feet to head
• breathing exercises to manage stress – focusing on slowing and deepening your breathing

The NHS has information on breathing exercises for stress. There are also books and tapes you can buy. Or you may want to join a group or class. Below there is information on mindfulness, which many people find very helpful for managing anxiety.

Mindfulness

There’s been a lot of interest in mindfulness recently. But it’s not a fad. It can have real benefits. Basically, it means learning to stay in the present, rather than worrying about the past or future.

Brooding on past troubles is common when people are anxious or depressed. Your mind goes round and round in circles, thinking how you might have done things differently. But that time’s gone and you can’t change it. Focussing on the present will give you a break from this type of negative thinking.

The first step is to spend time noticing your thoughts and feelings and the world around you. So on a mindful walk, you may notice how the breeze feels on your skin, or the sound and feeling of walking on autumn leaves. When negative or stressful thoughts come into your mind, don’t try and suppress them. Acknowledge them and then let them go. This might all sound simple, but it’s harder than it sounds! It will take practice, but you may find it really helps you.

The mental health charity, MIND has information on learning mindfulness. Your specialist nurse or cancer support group may also know of local courses or organisations that teach mindfulness.

Counselling

This is a kind of ‘talking therapy’ that can be helpful in all sorts of situations. When you have cancer, you’ll need an outlet for your feelings at times. Sometimes it helps to talk to someone who isn’t so close to you. You can say things to them that you may not want to say to family or friends for fear of upsetting them. Or they may find talking about cancer difficult and tend to change the subject when you try to bring it up.

Counselling can help you to come to terms with your feelings. It can help to understand yourself better and recognise ways of thinking that are unhelpful. This can help you manage stress and cope with anxiety.

Your GP can refer you for counselling. Some cancer units have a counsellor on the team, so it’s worth asking your doctor or nurse. Cancer support groups may have contacts. Or you can look at a directory run by MIND that has information on how to find a counsellor that you may find useful.

You have to feel comfortable to get the best out of counselling. You don’t have to stay with the first therapist you see if it doesn’t feel right. It’s also important to find someone who is properly qualified. A good therapist will tell you about their background and qualifications, but if they don’t, ask.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy is another type of ‘talking therapy’. It examines both your thinking and how you react to situations or in relationships. Then it can support you in re-learning behaviours and thought patterns that have become a habit.

For example, you may have got into a cycle of negative thinking that really isn’t helping. Or if you have a tendency to be very self-critical, it can help you learn to quieten that voice inside you that points out all your ‘mistakes’.

The therapist guides you in developing more helpful coping strategies for problems you’re dealing with. There are similarities with mindfulness, in that CBT concentrates on the present rather than the past.

Your GP, hospital clinic or support group may be able to recommend CBT services locally.  As with counselling, it’s important to ‘click’ with your therapist. And to find one who is properly qualified. There is an official register of qualified CBT therapists you could use.

More information and helplines

We have more information, and links to helplines, on the British liver trust website .