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Emotional Wellness

PTSD & Cancer

What is PTS(D)?

Almost everyone who experiences a scary or life threatening situation will show at least a few signs of post-traumatic stress (PTS). Our brains are hard-wired to tell our bodies to tense our muscles, breathe faster, and pump more blood when we’re under intense stress. This fight-or-flight response is a normal reflex during and sometimes even after a traumatic event, which is why PTS is considered a normal reaction and not a mental illness.

 

PTSD (post-traumatic stress disorder) is a clinically-diagnosed condition. Anyone who has experienced or witnessed a situation that involves the possibility of death or serious injury, or who learns that a close family member or friend has experienced a traumatic event, can develop post-traumatic stress disorder.​  PTSD can impact both cancer patients and caregivers.

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Symptoms of PTSD include:

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Intrustion / re-experiencing the traumatic event: memories, dreams, flashbacks, psychological/physiologial distress from triggers or reminders of events.

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Avoidance symptoms: avoidance of memories, throughts, feelings, avoidance of people, places and things that trigger symptoms.

 

Cognition and mood symptoms: persistant negative beliefs about oneself, others or the world, distorted thoughts about the cause or conseques, blaming self or other, persistant negative emotional state (fear, anger guilt shame), reduced interest, feeling detached or estranged from others

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Arousal and reactivity symptoms: irritability or outbursts, reckless or self destructive behavior, hyper vigilance, difficulty concentrating and disturbed sleep.

 

Symptoms that continue for more than one month, are severe, and interfere with your daily functioning are characteristic of PTSD.

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How is PTS(D) connected to cancer?

PTSD is most often associated with traumatic events such as war, natural disasters, serious accidents or sexual and physical attack; however, cancer patients and care givers may experience it too.  People with histories of cancer are considered to be at risk for PTSD. The physical and mental shock of having a life-threatening disease, of receiving treatment for cancer, and living with repeated threats to one's body and life are traumatic experiences for many cancer patients.  Because the cancer experience involves so many upsetting events, it is much more difficult to single out one event as a cause of stress.

 

A 2017 study showed approximately one-fifth of patients with cancer experienced PTSD several months after diagnosis, and many of these patients continued to live with PTSD years later.  Further understanding the impact of PTSD on cancer patients and caregivers may help increase recognition of this disorder, optimize treatment, and enhance the quality of life of these individuals.

 

Patients may suffer symptoms of post-traumatic stress anytime from diagnosis through completion of treatment and possible cancer recurrence, Cancer can lead to PTSD, even when patients manage to drive their disease into remission. Aspects of cancer that may trigger PTSD include: the diagnosis, pain from the cancer, trauma of tests and treatments, test results, long hospital stays, cancer's return or the fear of it's return. 

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Symptoms of post-traumatic stress usually begin within the first 3 months after the trauma, but sometimes they do not appear for months or even years afterwards. In cancer the challenge may lie in the repeated nature of traumas.  There is complexity in the nature and frequency of traumas that may be frequent and prolonged. Cancer and its treatment present unique features that distinguish it from a single traumatic event such as a motor vehicle accident. These include a lack of clarity as to what the critical stressor(s) is i.e. diagnosis, treatment, side effects, changing prognosis, the chronic nature of the disease course, the associated uncertainty of its life-threatening nature with prolonged, repeated or multiple stressful life events, the internal origin of the threat as well as the associated inability to avoid the stressor.  Given the complex nature of cancer trauma, long-term monitoring and support for cancer survivors and their families is important.

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Effects of post-traumatic stress are long-lasting and serious. It may affect the patient's ability to have a normal lifestyle and may affect personal relationships, education, and employment. Because avoiding places and persons linked with cancer is part of post-traumatic stress, the patient may avoid getting professional care. 

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It is important that cancer survivors are aware of the possible mental distress of living with cancer and the need for early treatment of post-traumatic stress. Cancer patients and caregivers may benefit from careful assessment for post-traumatic stress disorder (PTSD) so that early symptoms may be identified and treated .More than one kind of treatment may be used to support PTSD talk to your medical & support team to learn more about the treatments & resources that are available to you.

How does PTSD affect the mind & body?

​Trauma and PTSD are very real diseases that have emotional and physical consequences.  We often think of trauma and PTSD in terms of emotional symptoms, but they take a physical toll on the body as well. General symptoms include chronic pain, headaches, stomach pain, vomiting, lower back pain and muscle cramps.

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When we experience a trauma we trigger a deeply ingrained instinct called fight or flight designed to keep humans and animals alive. The more frequently the fight-or-flight response is activated, the more likely it is to be activated again. It will take less to activate it and the response will likely be more forceful. In additional to our instinctual response of fight or flight we also have a developed frontal cortex, which means we are capable of reason. We are sensitive to the stigmatization of our environment (comments from ourselves and others such as get over it, or suck it up), and are more likely to hold onto our traumatic feelings and thoughts to process at a later date.  This upsets our brains's delicate balance.

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Our brains undergo a physical change when we witness or experience a traumatic event. After any type of trauma the brain and body change. Every cell records memories and every embedded, trauma-related neuropathway has the opportunity to repeatedly reactivate. Sometimes the alterations these imprints create are transitory while in other situations the changes evolve and present in ways that interfere with jobs, friendships and relationships.

 

During a traumatic experience,the sympathetic nervous system increases stress hormones and prepares the body to fight, flee or freeze (reactive mode).  In a normal situation, when immediate threat ceases, the parasympathetic nervous system shifts the body into restorative mode. This process reduces stress hormones and allows the brain to shift back.. For survivors who develop symptoms of PTSD  the shift from reactive to responsive mode never occurs. Instead, the brain remains primed to hold the survivor in a constant reactive state. 

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PTSD symptoms develop by both conditioning and learning. Conditioning explains the 

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One of the most difficult aspects for survivors in the aftermath of trauma(s) is understanding the changes that occur, plus integrating what they mean, how they affect a life and what can be done to ameliorate them. While changes to the brain can seem, on the surface, disastrous and representative of permanent damage, the brain can learn to relax; and the nervous system can recommence its flow between reactive and restorative modes. The key to achieving a state of neutrality and then healing lies in helping to reprogram the body and mind.

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Resilience factors that may reduce the risk of PTS(D) include: seeking out support from others: family, friends, support groups, medical professionals: learning to feel good about your strength and resilience in the face of danger; and having coping strategies in place to reduce symptoms when they arise, receiving correct information about the stage of cancer. 

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Post Traumatic Growth: Some individuals report that the experience of cancer and its treatment elicits personal growth. The concept of posttraumatic growth encompasses such components as increased investment in and satisfaction with relationships, greater compassion, changed philosophy of life, living more in the here and now, willingness to try new things, greater capacity to cope and increased self-reliance,

Self care and support strategies for PTSD

  1. PTSD & Cancer:

    1. Post-Traumatic Stress Disorder and Cancer - Cancer.net

    2. Cancer Survivors Can Develop PTSD, Too - Webmd.com

    3. Cancer Treatment Leaves Survivors with PTSD Scars - Healthlinecom

    4. Heal my PTSD - HealmyPTSD.com

  2. Exercise: The fight-or-flight response is meant to be followed by a burst of activity. Exercise will use some of the energy that has been built up in the body as well as metabolize excess stress hormones. Just 5 minutes of intensive sweat inducing movement will start to break down stress hormones.

    1. 6 ways to Switch Off the Fight-or-Flight Response - Dr. Soph.com​

  3. Seek out support from others:

  4. Benefit Finding: Benefit-finding allows positive reappraisal of a traumatic event. It is a cognitive coping strategy used to reduce distress.

    1. Benefit Finding - Berkeleywellbeing.com​

  5. Trigger the relaxation response: You need to learn how to switch off your fight-or-flight response using breathing exercises and progressive muscle relaxation. To me this is the most important starting block for overcoming your stress response. You need to practice switching off the response when calm, over and over so that it becomes second nature and possible to effectively use when stressed.

  6. Visualization:

    1. 5 MINUTE Calming Meditation (With Guiding Voice) - The Honest Guys

    2. 5 Minute Meditation to Relax and Recharge - OMG

    3. Stop Technique - Yasmine Buraik

  7. Meditation:

    1.  PTSD Visualization: for trauma relief & healing (Spoken Meditation) - Jason Stephenson

  8. Grounding:  

    1. Progressive Muscle Relaxation - Therapist Aid​

  9. Body Scan Meditation:

    1. Compassionate Body Scan - 20 Minute Guided Meditation - ​Mount Sinai Health System

  10. Focus on Your Breathing Exercises:

    1. Quick Calm Deep Breathing - Jordan Friedman

  11. Relaxing Music/Sound Therapy:​​

    1. 432Hz - The DEEPEST Healing | Let Go Of All Negative Energy - Healing Meditation Music 432Hz

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