Tell us about your background and the catalyst for writing this book.
I am a Zen student and psychoanalyst with a family therapy background, heavily influenced by DBT. As a cancer survivor who lost my mother and grandmother and too many friends to cancer, I have had a long term interest in awareness of and services for the social and emotional aspects of the disease. After being encouraged by my Zen teacher, Marsha Linehan, to be open to all experiences and perspectives, I recognized the value of the DBT framework for people living with cancer.
Now, Linehan and I have developed a program of coping skills based on DBT. Our work is informed by the wisdom of Zen, now validated by neuroscience and psychoanalytic thinking. We wanted to try to fill a gap highlighted by Institute of Medicine that constructive ways to deal with the social and emotional sides of cancer were not keeping pace with the amazing progress in medical treatments.
We felt it was important for patients and their loved ones to know that their reactions are understandable. And, that there are also ways to mange fear, anxiety, sadness or anger that may be more intense than is in their interest. We share strategies to make wise decisions and be hopeful without being in denial. We include tools for patients to let loved ones, colleagues and medical providers know what they want and need without compromising a relationship or their self regard. Lastly we present ways to live meaningfully even in the darkest days.
What do therapists and medical professionals need to know about the emotional toll of a cancer diagnosis and treatment?
Patients can doubt themselves. They may question whether they are coping the way they "should." Are they too overwhelmed? Are they facing facts? Should they be more positive? Less stressed? More in control? Less angry?
They may have a roller coaster of emotions. They may be frightened, anxious, sad or angry about an unknown future. It is not uncommon to have ideas about their health, relationships or themselves that are not based on facts. Some worry whether the need to rely on others will change the relationship. Are they viewed differently now? Seen as needy, helpless or a burden? Everyone responds uniquely. Some feel alone. Others may be the one to distance - perhaps defensively or in reaction to feeling smothered, pitied or discounted.
It is important for loved ones, therapists and medical professionals to validate the understandable anxiety, fear, sadness or anger that can come with cancer. It is helpful when those in the patient's life also know ways to help balance those reactions when they are more intense than is useful.
Using Strategies from DBT to Cope with Cancer
How can dialectical thinking help people who have been diagnosed with cancer endure the unknowns and balance uncertainty with hope.
The D of DBT stands for dialectics. Two things that seem to be opposite can both be true. Dialectics makes it clear that it is possible to think feel or act in more than just one way. What is the relevance for cancer? When we are upset, it is easy to reduce life and our view about ourselves to one way or the other, black OR white, good OR bad. Things are either a total disaster OR no big deal. We are in control of what is happening OR powerless.
Life with cancer is actually more complex. In many cases, a cancer patient is neither simply completely healthy NOR dying immediately. A larger balanced perspective includes ideas that can seem to be at odds. For example, it is possible to feel weak AND act strong. We can be unhappy about cancer AND still be happy about parts of our life. The key to coping is taking a balanced view that includes BOTH views. Indeed, we can feel frustrated by the limits of our control over cancer AND recognize that it's possible to learn effective ways to deal with what is happening.
I like to compare coping to going back and forth on a seesaw. Paying attention to the continual movement between seemingly opposite sides helps to maintain a more balanced perspective. Acknowledging the ebb and flow between sides helps make this balance act work. While we start on one end of the seesaw, we need to notice the other extreme so we can push off and not remain stuck. Yet, like a on a seesaw, no one really stays in that balanced place all the time. In dark times, it is easier to deal with hopeless feelings when we remind ourselves that light still exists, even at moments we can't see it.
What is your favorite skill?
Wise mind is particularly useful for people living with cancer. People have more faith in them selves when they recognize and trust their own intuitive wisdom. They realize the balance of their emotions and logic, bringing together left-brain rational thinking and right brain emotions, helps them trust their own sense of what is and is not in their interest. They feel more capable of making the difficult decisions they can face.
Do you believe that DBT can help anyone facing a medical challenge?
DBT can be very helpful to anyone facing a medical challenge or dealing with unknowns in general, including this COVID pandemic. Any situation where we feel uncertain or out of control may leave us unsure how to manage feeling more anxious, sad or angrier than is in our interest. Yet, coping is less about the particular stress and more about how we respond to it.
Like dealing with the unknowns of cancer, other medical conditions or this pandemic may leave us feeling frightened, helpless about our health or more isolated. The strategies to balance uncertainty with hope can be particularly useful.
Effective coping in challenging times like cancer, other medical conditions or COVID involves five steps, facing the circumstances and then balancing the four parts of our response.
1. Accepting the reality of the danger is an essential first step. We can't manage problems we haven't recognized. For example, right now the reality for us all is that COVID is dangerous and spiking
2. Pausing to recognize and identify our emotional response. The neuroscience expression is "name it to tame it.”
3. Broaden our perspective by balancing distressing thoughts with ideas that may seem at odds.
4. Use our body to promote calm. Longer exhales can slow down the rapid heart rate that comes with anxiety. Scanning the body and relaxing tight muscles can ease tension.
5. Take actions to balance the painful parts of life with actions that evoke opposite feelings. Laughter is some of the best medicine for sad times or COVID blues. Connections on Zoom, reorganizing at home or learning new skills can offset feeling isolated or less in control. Finding safe ways to support others may minimize a sense of helplessness and loss.
I am not simply saying just look on the bright side, as being distressed about cancer or a pandemic is understandable. Yet, a balanced view that considers both sides of the situation and our reactions may ease our anxiety and strengthen our resilience, as we trust that we can cope.
A broader view of a medical crisis like cancer or a pandemic presents both an immense challenge and a unique opportunity to remember what and who are most important to us.
Congratulations, Liz! You can purchase Coping with Cancer: DBT Skills to Help You Manage Your Emotions and Balance Uncertainty with Hope here.