The Power of the Mind: An Emotional Self-Help Guide for Cancer Patients | He Yi, Peking University Cancer Hospital | Panda Patient Education Live Replay

Today, cancer is increasingly considered a chronic disease, with longer survival times and improved quality of life. We have advanced medications and continuously evolving treatment methods to address cancer. Science reveals the truths of the objective world, as vast as the universe and as minute as genes.

Yet, each person's joys and sorrows, desires and ideals remain impossible to precisely predict or grasp. Various worries and thoughts drift like feathers in the wind, unsure of where to land.

In the field of psycho-oncology, a new diagnosis not found in general psychiatry has been introduced: demoralization. It refers to a state of discouragement and passivity that occurs when fighting cancer feels like a battle. Just as one gathers all their strength to achieve some progress, a recurrence or a new problem delivers a heavy blow, leaving the patient disheartened.

Similarly, after a cancer diagnosis, a series of psychological issues arise. How can patients self-regulate and self-manage? How can family and friends comfort patients to improve their mood, giving them more energy and strength to undergo treatment and achieve better outcomes? These are all challenges we must face.

Article Summary | Wuxian
Proofreading | Memocha
Editor-in-Charge | Xianning

[ Conference Date: November 11, 2024 ]

On November 11, 2024, Han Kai, founder of the Panda & Friends public welfare organization, and Director He Yi from the Rehabilitation Department of Peking University Cancer Hospital, discussed psychological concerns frequently raised by cancer patients and their families.

Why does a physical illness like cancer affect a person's inner world so profoundly, making it impossible to escape the more one tries to avoid it?
Like an elephant in the room, can humans remain calm, act normally, and pretend it isn't there?
For patients, with a tumor in their body, can they find inner peace by simply not listening, not looking, not talking, and just following doctors' and family members' instructions blindly?
No. When you turn around, you will find that despite the care around you, there is immense loneliness within. Like a black hole in the universe, it swallows all confidence amidst a deliberately cultivated atmosphere of positivity and optimism, leaving a heavy, dark pressure.

——Yes, I am anxious, I am depressed, but do you, who love me, truly understand?

Two Common Self-Regulation Methods

One is like during the pandemic: at the slightest hint of a bacterial infection, we desperately try to eliminate it.
Some patients, upon experiencing any negative feelings, sensations, or thoughts, will do various things to cheer themselves up and stop dwelling on them, aiming to relieve tension, anxiety, and fear.

The other is to ignore everything related to the illness, only listening to doctors and family, and doing whatever is told.
Without overthinking or struggling internally, they act like an ostrich burying its head in the sand.

When facing negative emotions, people naturally generate inner strength to combat them. Both methods above are acceptable as long as they resolve emotional or psychological issues, whether we actively cope or passively avoid.
However, some patients find that the more they try to adjust, the less they can; the more they try to avoid, the more afraid they become. Why? This situation resembles a psychological test called the "White Bear Effect."
When thoughts about illness arise, desperately trying to adjust and suppress them, telling ourselves not to think about it but feeling out of control, often leads to insomnia at night. Insomnia then makes patients worry about how it will affect their treatment.
We often find that these thoughts are like a spring: the harder we try to suppress them, the more they bounce back into our minds. This is actually a psychological phenomenon known as the White Bear Effect.

Several Effective Ways to Combat Anxiety

1. Set Aside a Fixed Time to Think
When we suddenly feel anxious and start thinking about our illness, we can tell ourselves: "I have specifically set aside a time to think about these things. It's not that I won't think about them, but I've scheduled it, for example, at 3 PM."
When that time arrives, you can deliberately think about all your worries and fears. You will find that when the time actually comes, even if you try hard to think about them, it doesn't last long. Because when you actively choose to do something, you actually feel less worried and tense. This is a method worth trying.

2. Allow Yourself to Do Nothing
When you have tried many methods to adjust your mindset but still cannot, it is best to simply do nothing.
This emotion or psychological state is like being stuck in a swamp: the harder you struggle to climb out, the deeper you sink.
When is the best time to adjust your mindset? Just as after a bone fracture, you must let the bone heal before exercising, the same applies to psychological states. When you can no longer adjust, the most important thing is to do nothing, rather than intensifying your efforts. Doing so not only backfires but also easily leads to self-blame.

3. Stop Constantly Analyzing "Why," and Accept Yourself
Once negative emotions arise, people tend to overanalyze: "Why is this happening?" Many believe that once the cause is identified, things will change and they can adjust. In reality, it doesn't work that way.
What can we do? We must learn to become observers. For negative thoughts or feelings, simply observe them without judging, responding, or trying to get rid of them.
Our brains generate countless thoughts daily, like clouds drifting in the sky. When we look up, no matter how hard we try, we cannot make them whiter, move faster, or shape them as we wish. All we can do is watch and observe them. The same applies to our bodies.
Therefore, for physical reactions caused by anxiety and fear, such as stomach discomfort, sweating, slight hand tremors, or palpitations, the only thing we can do is experience the current thoughts and bodily sensations without judging, reacting, or resisting.
Acceptance and Commitment Therapy (ACT) means accepting these feelings and coexisting peacefully with negative thoughts and sensations, rather than trying to make them disappear.

4. Mindfulness Therapy

In the cartoon above, a person is walking his dog in a park. The human mind is often cluttered with chaotic thoughts about work, children, etc., so much so that he forgets he is currently in a park with blue skies, white clouds, green trees, and sunshine.
But the dog's thoughts are pure. Whatever it sees is exactly what appears in its mind. This is essentially the state of living in the present moment.
One of the most important exercises in mindfulness meditation is called the Raisin Exercise.

For example, when taking a bite of food, we notice the sensation as it enters our mouth, the feeling with each chew, the slight sweetness, and the entire process until we swallow. By carefully experiencing and feeling these sensations in our mouth and body, we are essentially living in the present moment and maintaining awareness of the now.

5. Body Scan
When experiencing physical discomfort, such as stomach or intestinal unease, we guide the patient to experience what that sensation feels like, notice how other parts of the body feel, and then explore the sensation in greater detail. Instead of thinking it's bad and trying to make it disappear quickly—which often makes it worse—we observe it.
Through the body scan process, you may find that negative thoughts and experiences are gradually accepted. They are merely sensations, just physical conditions, and not as worthy of worry or fear as they seem.

6. Relaxation Training
To relax, you must first experience what tension feels like.
First, learn how to tense up. Gradually, you will discover that without doing anything extra, you naturally relax.
Simply telling yourself to relax is theoretically correct, but you often end up more tense because you don't actually know how to relax.

Q&A Session

Q1: Under what circumstances should patients visit the outpatient clinic?
A: When insomnia cannot be self-managed, patients can visit the clinic for evaluation. Poor sleep triggers a series of emotional reactions, which worsen sleep, and lead to daytime physical issues like poor appetite and fatigue.
Emotional issues often manifest physically. For example, anxiety can make people feel restless, suffocated at home, experience palpitations, hand tremors, and various physical discomforts. These physical conditions then feed back into emotions. They influence each other. For instance, after an argument, you might lose your appetite. This is a direct impact of negative emotions on the body.
These symptoms are particularly pronounced in gastrointestinal cancer patients. They can easily worsen gastrointestinal reactions, and GI discomfort in turn exacerbates emotional symptoms, creating a vicious cycle.
Generally, patients do not actually reach the clinical threshold for anxiety or depression disorders. They are often experiencing a normal range of psychological reactions to fear and worry about the illness, varying in intensity from person to person.
Not everyone needs medical treatment. Some patients can adjust on their own simply by talking with a doctor about how to cope with these issues.

Q2: If family members are experiencing negative emotions, can they also visit the rehabilitation clinic?
A: Family members sometimes bear even greater pressure. While patients can express themselves to family, family members may lack an outlet to express their own feelings and face challenges in how to communicate with the patient.
When facing a major trauma, the warmth of the entire household seems to drop. Even if no one mentions the illness, everyone speaks cautiously. Everyone carries internal pressure and tension without an opportunity to express it, which is also a cause of psychological issues.
You can try this: When communicating with the patient, avoid treating it like a negotiation where every word is calculated for the other's reaction. Try to interact as you normally would in a mother-daughter or spousal relationship. Aim to restore at least 80% of the family dynamic to a relatively normal state, reserving 20% for specifically discussing illness-related details.

Q3: How can family members comfort patients?
A: We often forget what someone said or did, but we never forget the feeling they gave us.
Therefore, the feeling family gives patients of "I am facing this difficulty with you" is the true source of strength, making patients feel, "I am standing with you."
Repeatedly preaching logic only makes patients feel that family members are on the opposite side, "demanding" them to do this or that from a bystander's perspective, without feeling psychological resonance.
When a patient falls ill, it feels like drowning, as if they are sinking. What we can do to help is create a rich and meaningful life, give the patient dignity, and accompany them in accepting the ensuing uncertainty, exploring and navigating the unknown.

Q4: How to maintain mental stability in stages despite the uncertainty of the outcome?
A: Some might say, "Usually I feel fine, but suddenly, without knowing why, I start thinking about my illness again, and my whole mood drops instantly."
A more common situation is feeling good most of the time, but a sudden negative thought triggers feelings of uncertainty about the future.
When such feelings and thoughts arise, the first step is not to reject them or rush to make them disappear. Instead, focus on what the current thoughts and feelings are, and concentrate on experiencing these bodily sensations. Gradually, the worry about uncertainty will fade during the process of experiencing physical symptoms.
Although the outcome is uncertain, it is at least stable for a certain period, such as the next one to three months. During this time, if you can focus your attention on the present, it is actually quite manageable.

Q5: What treatment methods are available at the rehabilitation clinic?
A: The rehabilitation clinic can prescribe medication, and therapists can also provide certain treatments.
For example, for sleep issues, some patients can accept medication, while others, worried about side effects or dependency and carrying a heavy psychological burden, may need non-pharmacological treatments.
Non-pharmacological treatments include emotional regulation, sleep therapy, and some physical therapies using medical devices.
The clinic has professional psychotherapists. Mindfulness therapists provide one-on-one treatment.
For instance, professionals provide a space where patients can talk entirely about their illness—worries, anxieties, fears, the treatment process, the final outcome, etc. This offers an opportunity to express inner fears.
In daily life, such opportunities may not exist. Just as one starts to talk, they might be persuaded to stop. Once suppressed, those negative experiences and inner emotions do not actually disappear. Therefore, professional treatment helps patients express themselves better. They can show any emotion and receive positive feedback from professionals to aid their healing.

Q6: Self-Attribution and Stigma in Cancer Patients
A: After a cancer diagnosis, patients often search for reasons within themselves: "Did I stay up too late? Did I smoke or drink for too long? Was my mental burden too heavy?"
But some patients with healthy lifestyles also get sick, making them even more eager to know why.
If patients can find some reasons, psychologically it might be somewhat easier to bear. Conversely, finding no clear cause often leads to greater psychological burden or stress.
We need to give patients an opportunity to explore this issue, to understand how they view it behind the scenes, what their worries are during this process, what emotional experiences and feelings they go through, and what confusions they face, to help guide them through it.

Postscript:
If you were mentally healthy before your cancer diagnosis, trust yourself: you are still a mentally healthy person now. Insomnia, anxiety, and fear are all a series of psychological and emotional reactions brought on by the illness.
If the pain of illness, the hardships of treatment, and the uncertainty of the future trap you inside like a mirror, making it hard to break free, then please give yourself a broader space. Let us feel the blue sky, the ocean, the white clouds, and the sunshine; let us experience the gentle breeze, the drizzle, and the fresh scent of the earth; let us accept and embrace every subtle sensation in our bodies; let us continue to be a normal mother, son, or partner.
——Perhaps I don't know how long the future will be, but the present moment is enough.

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