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Anxiety
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By:  Catherine Traer-Martinez RMT, MEd, RCC
 

 What is anxiety?

Anxiety is nervous tension. It’s an emotional and physical state that includes some combination of fear, uneasiness and worry. Thinking about progressive changes in your health and functional ability, your own death, or that of someone close can make you anxious. Like most people, you probably try to avoid such thoughts as you go about your daily life. However, this is difficult if not impossible to do when you are faced with a life-threatening illness. Such a diagnosis thrusts you into uncharted territory where much seems unfamiliar and you feel out of control. No wonder you may experience anxiety or feel scared.  

Anxiety can range from mild to extreme, and can include a variety of symptoms, such as:
  • tension or tightness in various parts of the body, particularly in the neck, chest and abdomen;
  • racing thoughts and difficulty in concentrating;
  • increased heart rate;
  • shortness of breath or rapid, shallow breathing;
  • feeling cold or having cold chills;
  • sweating easily, especially having sweaty palms;
  • constriction of the throat;
  • “butterflies” in the stomach;
  • nausea and vomiting;
  • frequent need to pass urine;
  • restlessness;
  • trouble falling or staying asleep.
Mild anxiety
 
Everyone has been anxious at some time. Anxiety is a normal reaction to anything that threatens your body, lifestyle, values or those close to you. A certain amount of anxiety is normal and can prompt you to take action. For example, you might feel anxious about not knowing where you put your medication because it’s important to take it at a regular time. Mild anxiety like this can trigger you to organize yourself about where you put your medication and how you’re going to manage taking it regularly.
 
Moderate to extreme anxiety
 
Moderate to extreme anxiety can interfere with your ability to function normally. If you get so anxious that you are unable to cope with everyday tasks and responsibilities, talk to your health care team to explore options to ease your anxiety.
 
Panic attacks
 
Anxiety or panic attacks are episodes of intense fear or apprehension that start suddenly. The effects of panic attacks vary. They often reach a peak within 10 minutes and are usually over within 30 minutes. A panic attack can be an intensely frightening, upsetting and uncomfortable experience. Some people, when experiencing a panic attack for the first time, fear they are having a heart attack or a nervous breakdown. Symptoms of a panic attack can include the following:
  • fear or sense of dying;
  • fear or sense of “going crazy;”
  • flashing vision;
  • faintness or nausea;
  • numbness throughout the body;
  • heavy breathing or hyperventilation;
  • overwhelming sense of losing control.
These symptoms, alarming in themselves, can also increase your feelings of anxiety. This article will help you to understand possible sources of anxiety, to evaluate your anxiety and to identify some strategies to help reduce anxiety. 
 
 

 

 Sources of anxiety
 
Anxiety arises when you feel overwhelmed or threatened in some way. Dealing with complex health care and end-of-life issues means that you are faced with a steep learning curve. Often you are trying to absorb and understand unfamiliar information, as well as manage challenging emotional issues. Coping in these circumstances may cause you to feel out of control. However, your anxiety may decrease as you gain a better understanding of your situation.
 
Physical discomfort
 
Anxiety can be closely associated with other symptoms experienced with advancing illness, such as pain or shortness of breath. The combination of anxiety and pain, or anxiety and shortness of breath, can start a vicious cycle in which one can make the other worse. For example, if you feel short of breath, it is natural for you to feel anxious. In turn, if you feel anxious, you may experience more shortness of breath.
 
Uncertainty
 
One of the biggest sources of anxiety for you and your family is uncertainty about how an illness will progress. Although asking questions may put your mind at ease, you may feel uncomfortable or hesitate to do so. You may also lack confidence in knowing what and how to ask, feel rushed for time to do so, or are afraid of what you might hear. Wanting to know and not wanting to know are completely understandable reactions. But you can lessen your anxiety by knowing what to expect.
 
Changing roles
 
Anxiety may arise as a shift in roles and responsibilities occurs. For example, if you are ill, you may need to give up financial responsibilities, grocery shopping and cooking. If you are the caregiver, you may need to assume these responsibilities in addition to your usual tasks. Relinquishing or assuming responsibilities is common if a young parent is affected by illness.
In either case, the ill family member will worry about the burden placed on his or her spouse, other family members or the children.
 
One of your most challenging roles as the “well” parent will be helping your children live in a changing home environment, understand their parent’s illness and cope with their loss. Knowing, too, that you will be a single parent is an understandable cause of anxiety.
 
Isolation
 
Feeling isolated can bring on anxiety. Your social circle may shift and change if you become ill. Not everyone can deal with the stresses and strains that illness brings. You may find that your relationships with those around you change. Some people will continue to be part of your life, but others may stop seeing you if they feel uncomfortable or lack the confidence to cope with your illness.
 
Taking care of you at home may also limit your caregivers’ normal activities and cause them to feel socially isolated.
 
Approaching death
 
Anxiety often stems from worrying not only about how your illness will affect you and what lies ahead, but also about how it will affect those around you, such as your parents, partner, children, friends or colleagues. If death is approaching, you may worry about how those close to you will manage when you are gone.
 
You may also be anxious about death itself and what happens after death. This feeling is normal. Next to birth, death is life’s biggest transition, and knowing that yours is approaching can shake your sense of identity and your security. You may need to re-examine your values and beliefs to help you make sense of your death. 
 

See also: Letting go of anxiety about death

Rate your anxiety
 
Your anxiety levels can fluctuate from moment to moment, hour to hour, and day to day for many reasons. Using the anxiety scale below, rate how anxious you’re feeling right now on a scale from 0 to10. 
 
 

 

 
Taking time to notice your level of anxiety is the first step to relieving it. If you are feeling anxious, you may find it helpful to identify the sources of your anxiety. The following provide general guidelines about when and what to do.
 
Anxiety self-rating of 3 – 5:  Pay attention to how you feel.
 
Anxiety self-rating of 6 – 7: Make contact with supportive family, friends and your health care team.
 
Practice self-care (see the next section).
 
Anxiety self-rating of 8 – 10:  Seek professional help from your health care team if your high level of anxiety persists (see the next section).


Coping with anxiety
 
Everyone copes with anxiety in their own way, and there isn’t a right or a wrong approach. You may find that some of the following strategies will work for you. 
 
Understand your anxiety
 
Anxiety can be a normal response to dealing with serious illness. Understanding the source of your anxiety can be a helpful first step in beginning to decrease it.
 
Identify its source
 
Review the sources of anxiety in the section above and consider what might be causing you to feel anxious. If you are able to identify a source, you are more likely to address your anxiety directly.
 
Seek balance
 
There are some simple things you can do to help yourself cope better and lower your anxiety. Balance your activity with sleep and rest, enjoy good food as you are able, and get fresh air and exercise (within the limitations of your illness).
 
Seek emotional support
 
Seeking emotional support from family and friends is important. You may not be comfortable sharing your feelings, thoughts and fears with others, especially if you feel want to “protect them.” However, people often tell us that it makes a difference to them, and to those close to them, when they are able to talk more openly about what is going on for them. Finding a listening ear can help you or your loved ones deal with your situation and may help ease your anxiety. 
 
Seek practical assistance
 
Find out whom in your circle of family and friends can help with specific tasks. Often people want to help but are unsure how, and will appreciate concrete suggestions and guidance. Explore what programs and services are available in your community to help you with practical tasks. For example, could a hospice volunteer drive you to appointments, or a home care worker help with laundry or housework if you can’t do these tasks?
 
Bring calm to yourself
 
Taking some quiet time to direct your focus inward can help you calm your mind and body. The following relaxation strategies can help you shift your attention to the present and focus your awareness on your body’s natural ability to calm itself. Knowing what happens in your nervous system can help you to understand how you can reduce anxiety. Simply speaking, the primitive part of your brain is hard-wired for keeping you safe. When it detects you are safe, all is well. When it detects you are in danger or threatened, your subconscious responses are fight, flight or freeze. Becoming aware of what you are sensing in your body can help you calm your nervous system and minimize these “automatic” reactions. Bringing your awareness to the present can help you achieve calmness in your body and mind. The following are some relaxation strategies you may find helpful.
  • Breathing. When you are stressed or worried, a quick and effective way to calm yourself is to notice the rhythm of your breath. Notice how you are breathing and how your body wants to breathe. Pay attention to the sensation of your in-breath and your out-breath. Notice the movement that happens in your nose, chest, lungs and abdomen each time you breathe. If you are breathing shallowly and rapidly, take a deeper breath and notice you how can immediately alter the depth and rhythm of your breath. (If you are having difficulty breathing because of your illness, don’t focus on the rhythm of your breath unless it’s soothing to you.)
    Paying attention to your breathing helps you tune in to your body in the present moment. You’re not in the past or in the future, you’re just here, right now.
  • Grounding. Sitting in a chair, put your feet flat on the floor and press them into the ground. If you can’t put your feet on the floor, press them against a footstool or a bed mattress. You can also visualize pressing your feet into the ground. Wiggle your toes so that you can feel the floor or the mattress underneath you. What sensations do you feel in your feet and lower legs

Try moving your feet, alternating between your heels and toes, then stop. What sensations do you feel in the rest of your body? Now feel your feet supported by the floor. Do you have a sense of the ground pushing up against your feet? The simple act of shifting your attention to your feet making contact with the floor is a way of “grounding” yourself. Grounding can calm and help settle your mind. It’s a useful strategy if you start to worry. Notice how you can regain your focus by bringing your attention back to your feet.

  • Feeling physically supported. Sitting in a chair, allow yourself to feel the chair supporting your body. Notice how the seat of the chair supports the backs of your legs and your pelvis. Or, if you are lying in bed, notice how the mattress supports your back, arms and legs. If you are in bed, you can modify this exercise by propping yourself up on pillows or by raising the head of your bed to feel the support under your back.
  • Orienting yourself to your room.Let your gaze shift around your room. Notice what you see in the room and what you sense in your body. When you are distressed, your gaze can become quite fixed. Noticing what is around you can give your eyes a more open focus.
     
  • Seeing images in detail. Look at something beautiful in your environment or remember a beautiful place in nature. See or remember the scene in as much detail as possible. Notice the colours, feel the textures, hear the sounds, and think about how they make you feel. What do you begin to sense in your body as you look at this scene or hold its image in your mind? Nature can play a very important role in creating a sense of balance in your body. Walking by the ocean, a lake, a river or in a forest can be deeply soothing and calming.
  • Soothing touch. Place your hand on your forehead, or have someone else hold your forehead gently. This naturally calms your mind. It's very difficult to continue worrying or thinking hard with a hand holding your forehead. Receiving a soothing touch is a very important way to relax. Even holding someone’s hand can help your whole body relax as you sense the warmth of the person and feel how much he or she cares for you. Bodywork, such as massage therapy, therapeutic touch, Reiki or acupuncture, may be worth exploring.
  • Sensing the supportive presence of another. One of the best ways to relax is by connecting with others who care for you. Sensing the presence of a calm, caring person is an important way to help you feel less anxious. Think about a person who is supportive to you. Be aware of the sensations in your body when you are with this person or when you hold his or her image in your mind.
  • Listening to music. Listen to music that helps you relax. Notice how your body settles itself. If you play an instrument and find it restful, take time to enjoy playing. When you are stressed and anxious, simply listening to music can be soothing and pleasurable. 

See also: Mindfulness: Making Moments Matter.

What your health care team can do
 
Talk to your health care team about the anxiety you are experiencing and ask for their help, especially if your anxiety worsens or persists.
 
Help in connecting with additional sources of support
 
Your health care team can refer you to social workers, counsellors, spiritual care providers, volunteers and group programs that offer counselling, emotional support, education (e.g., relaxation techniques), practical suggestions, and information. Your health care team can also help with referrals for in-home services, such as nursing visits and assistance with personal care or household tasks.
 
Medications
 
Sometimes, in addition to the approaches mentioned above, your health care team may determine that medication may be helpful in easing the anxiety you are experiencing.
 
Symptom management 

It’s important for your health care team to be aware of and address other symptoms that may increase your anxiety such as pain or shortness of breath. Relief from distressing symptoms can help reduce your anxiety.
 
 
 
Content reviewed July 15, 2015