Our health is crucial to our survival and quality of life. Any possible sign that our health may be in jeopardy is alarming. One of the biggest threats to our way of life is cancer. And it’s impacted us all somehow. We all know someone who either was diagnosed with cancer or has died from it. We should be concerned about it. And if you are, it means your brain is working correctly, warning you of possible dangers. At the same time, when worry becomes circular and persistent, it can consume a lot of our energy and attention and interfere with our lives.
Worry and anxiety about cancer are challenging. One part of us knows we may be overthinking things and worried too much, while the other part is tortured by the possibility of getting the diagnosis one day and doesn’t want to let its guard down. This tug-of-war can leave us feeling trapped and exhausted.
In this article, I’ll explore worry and anxiety about health. How it serves us, how it tricks us, and what we can do to get unstuck when we do find ourselves trapped.
The Brain and Uncertainty of Cancer
Our brain’s priority is to keep us alive. It scans for possible threats and aims to resolve them immediately. Our brain’s threat detection system is also extremely quick to react and is terrible with accuracy. It’s always overreacting. It values safety far over accuracy and works on the premise: “I’d rather keep us safe than be right. Let’s panic now and figure out the details later.”
Imagine what happens when an overreactive and inaccurate system encounters uncertainty. It gets triggered. Then combine this with the degree a cancer diagnosis could negatively impact your life. The threat detection system goes into overdrive.
The tricky and terrifying truth is this, there is no way to be sure we don’t have cancer. No matter how many experts we get examined by, there’s always a chance they missed something. Even when our brain fully trusts the doctor, our bodies constantly change. We could be diagnosed a month from now. And no matter how small the probability is, to the threat detection system, a 1% chance feels like a 90% chance. As long as there’s a .001% chance of cancer, it remains on guard: Scanning, predicting, and even expecting a cancer diagnosis.
The Anxiety Cycle
Anxiety is a reinforcing cycle:
- Triggering Event: This can be a new sensation in your body, a concerning symptom, or a doctor saying, “We need to do some further testing.”
- Anxiety Sensations: Anxiety hits in various ways: increased heart rate, sweating, stomaches, heart palpitations, or chest pains.
- Automatic Worry and Negative Thoughts: Our mind starts racing with “What if” scenarios and imagining the worst.
- Avoidant or Escaping Behaviors/Urges: This may look like researching on the web for symptoms, excessively visiting your doctor, avoiding the doctor or trying to think about symptoms, or asking a friend or family member for reassurance.
- Short-term Decrease in Anxiety: Our protective actions often work in the short term, giving us a small break from anxiety.
- Long-term Maintenance of Anxiety: Anxiety quickly returns after the protective action and short-term decrease.
Why does decreasing anxiety in the short-term reinforce it long-term?
The threat detection system learns by watching how we react when it sends us danger signals. Suppose it sees us acting in a way consistent with danger (e.g., excessively searching the web or asking others for reassurance). In that case, the threat detection system learns, “This must be dangerous. I’ll continue sending danger signals in this situation in the future.” As a result, our threat detection system will activate the next time we approach the same situation or topic (or a similar situation).
This is the anxiety cycle—a reinforcing, circular trap.
Part four deserves most of our attention within the cycle because it’s the only part we can control.
There are many ways our threat detection urges us to seek safety. In the world of anxiety, we call these “safety” behaviors. These behaviors seem helpful but reinforce the anxiety cycle if there isn’t an actual or imminent danger.
Here are some examples:
- Reassurance seeking: Anxiety might urge us to excessively ask a person their opinion about our symptoms. We ask friends with no medical background, and we’ll excessively seek professional advice.
- Excessively Searching the Internet: Researching articles, forums, or blogs are common ways to seek certainty. Searching for any information like cancer symptoms, misdiagnosis rates, testing options, survival rates, and treatment options.
- Avoidance of Medical Professionals: Out of sight, out of mind is another strategy we may adopt when facing health anxiety. We may avoid going to the doctor or telling the doctor about specific symptoms.
- Self-monitoring and Scanning Body: Constantly examining, monitoring, or analyzing perceived abnormalities or body sensations that may be signs of cancer.
- Adopting Strict Health Behaviors: Adopting extreme dietary changes or alternative therapies to prevent cancer.
- Emotional Avoidance: Attempting to suppress our anxiety by avoiding reading or watching anything about cancer and avoiding people who have cancer.
Now that we have an idea of how the cycle of anxiety is created and maintained let’s cover how to break the cycle.
How do we prevent or get out of the cycle once we’re in it?
Acknowledging the Intolerance for Uncertainty
At its core, anxiety is an intolerance for uncertainty, demanding from us the impossible: Make sure you don’t have cancer. Even though we know it’s impossible to achieve, it’s hard to give up the pursuit.
It’s challenging to give up the pursuit of certainty for two reasons. Certainty is tempting and alluring. It promises us complete safety and freedom from anxiety. The second reason is that imagining giving it up the pursuit feels extremely dangerous. Even though you may know your threat detection system is sending you false alarms, there’s no difference in the feeling between a false alarm and a true danger alarm. It’s just as intense and just as real. To give up the pursuit of certainty means going against very primal instincts.
One of the first and most important steps is acknowledging that you’re in the anxiety cycle and pursuing certainty. By doing so, you switch off the autopilot and move into the more objective part of your brain. However, this doesn’t turn off the threat detection system or stop anxiety. We’re simply trying to bring awareness to our current state. By doing so, we uncover what’s hidden: Having a choice. We realize we can do what the anxiety urges or choose to do something different.
Teaching Your Brain New Lessons
Before we get into specific ways to do something different than what anxiety urges, it’s crucial to understand how the threat detection system learns.
Ultimately, you can’t control if or how your threat detection system reacts to a situation. However, there are things you can do to teach it new lessons and increase the chances that it will respond differently in the future.
Imagine going to a haunted house at a Halloween carnival. Before entering, a carnival worker pulls you aside and gives you an hour PowerPoint presentation on how safe the haunted house is: “We’ve been in business for 30 years, and not one person has ever been injured. Not even a stubbed toe!” The carnival worker intends to comfort you, hoping your “fight or flight” response won’t be triggered. However, no matter how convincing the presentation is, your “fight or flight” response will get triggered at some point inside the haunted house. Why? The threat detection system doesn’t understand language. Instead, it speaks the language of experience.
If you say to yourself, “I’m not going back in there. That was too scary,” and avoid the haunted house, you reinforce the anxiety long-term. Why? Remember, your brain is watching how you react.
By not going back in, you’re telling your brain, “The signals you sent me were accurate. I was in danger. Keep sending me the same signals in these types of situations.”
If you want to teach your brain not to react, you do the opposite: you go back inside the haunted house.
When you go back in again, your threat detection system will likely send you the same signals (and maybe even more intense signals), but it’s watching how you react. As you walk back inside the haunted house, while your brain screams, “Don’t!” you’re teaching it a new lesson. You’re saying, through your actions: “You’re wrong about this. This is a perfectly safe situation, so I’m returning, regardless of what you tell me.”
The way to step out of the anxiety cycle is to do the opposite of what it urges you to do. It’s a paradox. The more you seek “safety,” the more you reinforce anxiety long-term. The more you seek “danger,” anxiety will decrease long-term.
This concept is simple: as long as we’re not in real danger (99% of the time, we’re not), do the exact opposite of what the anxiety urges. It’s easier said than done, though.
Doing the opposite urge is scary. There’s no difference in the feeling between a false alarm and a true danger alarm. It’s just as intense and just as real.
So, it takes quite a bit of courage. Examining your automatic worry thoughts can help with this.
Make Your Worry Get Specific
When anxiety hits, automatic worry thoughts are there to follow:
- “What if this a sign of cancer?”
- “How will I keep working and pay my bills?”
- “I won’t be able to cope with treatment.”
Most of the time, we’re fused with our automatic thoughts. We believe them and don’t question them. They’re impossible to question when we’re fused because we’re unaware we have them. We become one with our thoughts, and they take us for a wild ride.
Automatic thoughts also love to stay vague. As long as they remain vague, they will remain unexamined, and we will remain fused with them. Here is an example of worry thoughts staying vague:
- Worry: “What if this is a sign of cancer?”
- Response: “Oh no. I don’t even want to think of it. That would be awful.”
- Worry: “Right? Aren’t these the same symptoms Mike had when he was diagnosed?”
- Response: “I forgot about that. Was it the same symptoms? I can’t remember.”
- Worry: “Let’s check online.”
- Response: “Good idea. This says the symptoms are rarely a sign of cancer.”
- Worry: “Ok, maybe it’s rare, but Mike had the same symptoms. Remember, he even said he checked online, thought nothing of it, then didn’t go to the doctor for months. “
A helpful exercise is to force the thoughts to get specific. Here’s an example of how to do that:
- Worry: “What if this is a sign of cancer?”
- Response: “Ok, what if it is a sign? Then what?”
- Worry: “What do you mean, then what? Are you crazy?”
- Response: “No, I want to know. What would happen if it’s a sign of cancer?”
- Worry: “Well, it would completely disrupt our life. It’d be awful.”
- Response: “That’s possible. How would it disrupt our life?”
- Worry: “Well, he would tell other people and talk behind our back.”
- Response: “Ok, then what would happen?”
- Worry: “I wouldn’t be able to explain myself, and everyone would turn against me.”
- Response: “Ok. Then?”
- Worry: “Well, we would lose out on potential friends and all our good existing friends.”
- Response: “And?”
- Worry: “Then we’ll live a lonely life forever.”
The more we drill down and force worry to get specific, the more we expose its flawed assumptions. It becomes less scary, and often, when we reach the bottom, we realize that we don’t want that thing to happen but that it’s improbable, and if the worst does happen, we’ll be able to handle it.
Remember, engaging in this exercise doesn’t stop the threat detection system from sending us anxiety. Instead, it gives us access to logic, giving us more control over our behavior and urges. It gives us a greater ability to do the opposite of what anxiety urges, setting us up to teach the brain a new lesson.
Focusing on what you have control over
When anxiety sends us false alarms, it urges us to keep our focus on things we don’t have control over:
- Knowing for certain if we have cancer or not
- Knowing for certain if a doctor overlooked something or not
- Our age or genetics
One of the best things you can do is to remind yourself what you have control over and focus your energy there:
- When I go to the doctor or not
- How I respond to my worry
- How I respond to my urges
- How I respond to anxiety
Don’t Engage with Automatic Worry Thoughts
Worry is a cognitive process. It’s a process of mentally engaging with thoughts about future undesirable events. You can think of worry as a two-step process:
- An automatic worry thought appears
- You engage with the thought
For example, imagine watching TV and a commercial for a cancer research organization appears. An automatic thought occurs: “I forgot about that mole I saw in the mirror the other day. I wonder if that’s cancer.”
This isn’t necessarily a worry just yet. Worry occurs when we engage and put energy into these automatic thoughts:
- Trying to answer the question of the mole being cancer or not.
- Trying to stop the automatic thoughts.
- Judging the thoughts, “I shouldn’t be having these thoughts. I’m trying to relax.”
Instead of these things, treat automatic thoughts like background noise in a busy city. As we walk through the streets, there are sounds of construction, people talking, and horns honking. We don’t try to block out the noise or convince the construction workers to take a break. Instead, we acknowledge the sounds without getting entangled or trying to control them. We focus on our goal, letting the noise fade into the background.
All this is easier said than done, but with practice and repetition, you may notice more and more that thoughts do not determine our destiny. Thoughts are just thoughts; they are random, with no meaning or value, and completely distorted.
Health anxiety can be tricky. We should be concerned with our health, checking symptoms, and going to our doctors for regular checkups or when new symptoms appear. This makes it challenging to eliminate safety behaviors entirely. The aim is to practice identifying when your behavior’s main intention is to lower anxiety. If your primary intention is reducing anxiety, it’s likely a safety behavior. Instead of emotions driving our decisions, we want to work towards facts and objective information being the drivers. This takes practice and repetition.
I hope you found this article helpful. If you did, you might find my Self-Help section useful. You might also want to subscribe to my Weekly Thoughts on Anxiety.