Constantly Worried About Cancer. A Psychotherapist’s Perspective

Brian O'Sullivan, M.S., LMFTAnxiety

This article is for informational use only, should not be considered clinical advice, and does not establish a patient-therapist relationship.

No matter the physical symptoms you’re experiencing, if you engage in online research in attempt to self-diagnosis, more times than not, cancer will show as a possibility.

The worry of cancer has crossed all of our minds. 

For some people this worry leaves the mind just as quickly as it enters. For some, they determine it’s worth a trip to the doctor, the doctor does some tests, determines it’s not cancer, and the person quickly moves on from the worries. 

For others, the worry of cancer is constant. Always there. And it can consume a lot of time, money and energy. It can even impact their relationships.

What does it mean if I constantly worry about cancer?

If you find yourself constantly worrying about cancer despite doctors telling you that you’re healthy, it’s very likely you’re dealing with health anxiety, not cancer.

Health anxiety is when healthy people worry they are sick, with no evidence or facts to back it up. They may have symptoms or minor symptoms.

More times than not, people dealing with health anxiety tend to fear life-threatening, terminal illnesses, like cancer.

How do people develop chronic worry about cancer?

Knowing exactly why a person develops chronic anxiety or worry about cancer is impossible to know.

What is known, is that anxiety, no matter the type, is caused by “biopsychosocial variables.” This is a term often used in the field of psychology and means that biological, psychological, and social variables are at play. 

There’s no question that biopsychosocial variables influence if someone develops anxiety and what type of anxiety they develop. Here are examples of all biopsychosocial variables:

Biological

  • Genetics
  • Disease/illness
  • Substance use
    • Alcohol
    • Drugs
    • Caffeine

Psychological

  • Post-Traumatic Stress Disorder
  • Social anxiety
  • Obsessives Compulsive Disorder

Social

  • Divorce
  • Death of a family member
  • Job change
  • Retirement
  • Moving
  • Family conflict

We also know that people experiencing constant worry and anxiety have a biological vulnerability. For people dealing with anxiety, it’s as if their volumes are turned up. They may experience the same level of anxiety as another person, but they are more sensative to the anxiety. They can feel it more intensely and it impacts them deeply. 

Am I weaker because of this vulnerability?

If you have health anxiety, it’s important to remind yourself that you’re not weird, sick, or weak because of your vulnerability to worry and anxiety. It’s also not your fault. You did not cause it.

Simply, it just a biological trait. That’s it.

If you tend to compare yourself to others, there’s likely an extra layer to your anxiety: self-judgement, shame, and embarrassment about the anxiety. 

It’s important to keep this in check. 

I hear quite often, “Well, other people are able to easily deal with their fear and worry about having cancer. My friends tell me they also have the worry, but get over it pretty easily. I must be weaker or less capable than them. I’m not as brave.”

Logically, this makes sense. However, what this train of thought fails to recognize is that the friend’s worry volume isn’t turned up as much as yours. If their volume was higher, they’d likely have the same challenges as you. 

I think it would also be a fair argument to say that a person who has to overcome more, is stronger, not weaker; and is more brave, not more afraid. 

It’s not very strong or courageous to overcome something that’s easy. That’s boring. Unremarkable. 

What’s remarkable and extraordinary, is overcoming challenges. And what makes something challenging isn’t universal. It’s very much relative and unique to each person. 

If someone gives you advice that starts with something like, “Well just…” it’s usually a good sign that they don’t share the same challenges as you. 

Try not to compare yourself to others. There will always be someone who has it better than your and someone who has it worse than you. 

What can trigger anxiety about cancer?

Triggers are things that happen within a person (internal triggers) or within someone’s environment (external) that start the cycle of cancer anxiety.

Examples of internals triggers:

  • Random “What if I I have cancer” thought 
  • Noticing new or odd physical sensations
  • Noticing visible physical changes (e.g. spot or lump on skin)

Examples of external triggers:

  • Hearing a friend was recently diagnosed with cancer
  • A commercial about cancer treatment
  • News about cancer
  • Overhearing someone talk about cancer
  • Going to the doctor
  • Disruption to your routine (e.g. travel or relocation)
  • Seeing a person who recently had chemotherapy
  • Test results
  • Waiting for test results

Understanding worry and anxiety?

We often use the words worry and anxiety interchangeably. I think it’s helpful to define them and distinguish them from one another.

Worry is thinking about a possible negative future outcomes. It’s a process that goes on in our heads.

Anxiety is a feeling or emotion and is often what follows worry. It can be a racing hear, muscle tension, headaches, restlessness, etc. 

Worry and anxiety are there to protect us. Clients come see me because they want to get rid of anxiety and worry. It’s logical to want that.

However, though it might be nice to think of a life without worry and anxiety, in reality it would be much different. Our lives would be a mess. We’d never plan, we’d get ourselves into risky, life-threatening situations over and over again. We’d likely have a very short life. 

Worry and anxiety can cause us problem though. 

When is worry and anxiety unhelpful?

Worry is helpful when it causes us to act in a way that benefits us. That’s why worry exists. We have a problem, we experience worry, and it causes us to find a solution. 

Worry becomes problematic when our thoughts become circular. The worry exists, it goes around our head over and over again, and there is no solution. 

When worry becomes circular, anxiety is almost guaranteed to follow. 

Worry that becomes circular is rumination. Rumination is when we engage with unrealistic thoughts in attempt to resolve or problem them. However, it’s impossible to resolve the thoughts.

Take for example the thought of, “Do I have cancer.” Even though this person has been to the doctor, the doctor cleared them of any illness, the thought still pops up. Rumination would be engaging with this thought. “Well, maybe the doctor wasn’t qualified. Maybe the doctor was having a bad day…” 

By engaging more with this thought process does not bring us any closer to resolving it. Because, we will never be 100% certain we don’t have cancer. More importantly, we will never be 100% convinced we don’t have cancer. 

Seeking Reassurance and Certainty

When we worry and ruminate, we have anxiety. We then try to find relief. One of the most common ways we seek relief is by trying to find certainty. 

This makes a lot of sense. We worry and have anxiety because of uncertainty. So, if we find certainty, we will won’t feel anxiety anymore. 

We strive for certainty in a number of different ways

  • Asking a loved one for their opinion
  • Researching online symptoms and possible diagnoses
  • Checking and scanning body
  • Seeking medical opinions repeatedly

The logical is, “If I just find enough information, I will figure out that it’s actually not cancer. I will know for certain. And then I won’t feel anxiety.”

The problem, however, is that we live in a very uncertain world. So, if our only way of dealing with anxiety is to relieve it by attempting to find certainty, we’ve set ourselves up for failure. It’s unachievable. 

And even in situations where certainty is obtainable, for example finding out if there is a tumor or if the tumor is cancerous, what we’ll usually find is that the anxiety still isn’t convinced:

  • “The machine that tested us is broken”
  • “They mixed up the test results with another patient”

In short, seeking reassurance and certainty, at best, only maintains our anxiety. And often times it makes it stronger and more frequent. 

The health anxiety cycle

The maintenance and growth of our anxiety can be thought of as a cycle. 

We feel anxiety, which causes us to take action to relieve it. This brings short-term relief, but long-term maintenance and growth of the situation we’re looking to escape.

This is exactly why anxiety is tricky. It traps us very quickly. And it can spread to so many areas of our lives. 

Luckily, we can get out of the cycle. 

Stepping out of the health anxiety cycle

The most important step is to be aware that you are in the cycle to begin with. 

Awareness is choosing to be an observer of your experience rather than just a participant. We we are a participant of our thoughts, worry, and anxiety, we have a thought and we believe the thought. 

Just because we have a thought doesn’t make it true or worth acting on. In fact, most of our thoughts are pretty worthless. 

One of the best way to become aware of our thoughts are by labeling them. The act of labeling our thoughts is adding a layer of thinking on top of the thinking. And by adding that layer, we become an observer and more objective.

Here are ways we can label our thoughts:

  • Worry
  • “What if” thinking
  • Catastrophizing
  • Anxiety thought

The word we use to label our unrealistic, trash thoughts isn’t really important. As long as it makes sense to you, and you have a word, it’s effective.

After we label our thought, we want to make a choice not to engage with it. 

We don’t want to try to get rid of the thought (thought suppression doesn’t work). We don’t want to reason with the thought (that’s ruminating). We just want to observe the thought. We want to accept the thought. 

Next, we want to be aware of our urges. Maybe you have a worry thought about a bump on your skin being cancer, and you notice an urge to open your laptop and beginning searching online for what that bump could possibly be. 

Next, we want to label that urge as a compulsion. Again, just like labeling our thoughts, the act of labeling our urges puts us in an observer role and stepping out of the participant role. 

Next, we want to resist the compulsion. This is where things can get tricky.

As someone resists their compulsion, they’ll likely notice their anxiety ticking up. And the urge is to decrease the anxiety in some other way. 

Instead, we need to even resist the urge and goal of reducing our anxiety. This is very counterintuitive and is trading short-term discomfort, for long-term gains. 

Here are some examples of trying to reduce the anxiety when resisting compulsions:

  • Negotiating with the worry thoughts, “Well, it’s unlikely it’s cancer, because …” This is rumination. 
  • I’m going to try and distract myself and get rid of the thought. Thought suppression doesn’t work. 
  • Hoping the thought, worry, or anxiety disappears. This is engaging with the thought and rumination.

All of these things will maintain the anxiety long-term. The commonality between all these examples is that they share the goal of getting rid of the anxiety. 

Again, intuitively it makes sense to have the goal of getting rid of the anxiety. Why else would you be reading this article? Why else would people go to counseling?

However, anxiety does not work this way. 

Instead, the goal is to accept it and increase our tolerance for it. 

Shifting the goal

By making a shift in attitude toward accepting the anxiety, thoughts, and compulsion urges and by making it a goal to build your tolerance for experiencing all of these extremely uncomfortable experiences, you begin to disarm anxiety’s power.

By shifting the goal, you use anxiety’s trick against itself.  

Fight anxiety with anxiety

Fight anxiety is like fighting a fire using fire.

One of the best ways to prevent or fight a forest fire, is to burn out all of its fuel in a controlled way. Anxiety is very similar. 

Anxiety’s fuel is resistance, avoidance, and fear of it. By having an attitude of encouraging, wanting, and needing anxiety, and taking steps to expose ourselves to anxiety, we slowly burn off its fuel.

As we learn to deal with anxiety, our self-confidence grows, and anxiety no longer has any fuel. 

Taking action against worry of cancer

So, what can you do?

Naming what it is. If you’ve been to a doctor, and they have not found cancer, but your worry and anxiety for cancer continues, it’s important that you call it what it is. And it’s likely that it’s health anxiety. 

By admitting to yourself that you have anxiety, you can start addressing the actual cause. Until then, people usually find that they are spinning their wheels, constantly seeking reassurance and certainty, with no long-term relief. 

Once you’ve figured out what the issue is, and you’ve determined that it’s anxiety, a great next step is learning more about it. Arming yourself with knowledge can assist is learning which strategies work and which strategies don’t work. It will also help you realize that you’re not alone in your battle against health anxiety. What I try to help clients realize is that we all struggle with health anxiety, just to different degrees. Being constantly worried you have cancer doesn’t make you crazy, it makes you human.

Resist the urge to engage in reassurance seeking, body checking/scanning, and self-diagnosis or research about cancer signs and symptoms. 

Know that seeking support from others is different than seeking reassurance. It can be very helpful to talk about anxiety with trusted family members or professionals. But, there’s a difference in asking someone for their opinion on whether or not you have anxiety and asking for support surrounding health anxiety. Talk about the anxiety, not about the possible threat of cancer. 

Sometimes knowledge is enough and people will start to find relief by slightly adjusting how they respond to their anxiety. Other times, it’s not enough. If you’ve read books and articles, and aren’t finding the relief you’re looking for, seeking out extra support in the form of group therapy, online forums, and one-to-one counseling is a great way to gain more insight into your anxiety and learn new ways to approach it. 

 

 

 

This article is for informational use only, should not be considered clinical advice, and does not establish a patient-therapist relationship.