Working Out to Avoid Freaking Out

It’s hard to imagine a cancer diagnosis that doesn’t provoke some level of anxiety.

When I was told that I had breast cancer, it didn’t take long before I got a prescription for Xanax because my anxiety was going through the roof — I clearly couldn’t handle everything I was feeling. It wasn’t until my radiation oncologist suggested that I try meditation that my view of the best way to handle my anxious feelings changed, and eventually I dropped the Xanax altogether.

But one thing that I kept on doing was exercising, at least as much as I could manage on a given day. So after reading a recent study about exercise, I had to wonder how much worse my experience might have been if I hadn’t kept to my workouts.

Henriksson et al. (2022, Journal of Affective Disorders; see link below) found that engaging in moderate or strenuous exercise was very effective in relieving the symptoms of anxiety. What I found so interesting was that half of the study participants had actually lived with anxiety for at least a decade, and they still got relief!

The subjects in the exercise groups did a combination of both strength and cardio training.

The subjects in the experimental groups were assigned to one of two groups: low-to-moderate intensity group exercise or high intensity group exercise. The exercise was timed circuit training that combined both cardiovascular and strength moves and subjects maintained heartrates at levels appropriate for their assigned intensity levels. At the end of the 12-week program, everyone’s anxiety had significantly decreased, as compared to a control group that was not participating in group exercise.

What is striking is that there was a tendency for the improvement to follow the level of intensity; the harder the subjects exercised, the more anxiety relief they experienced. Talk about motivation!

My own experience echoes this, but in a subtractive sense. At times of intense stress, my anxiety skyrockets when I’m prevented from engaging in my regular workouts. This may happen, for example, when I’m dealing with an unreasonable workload that ties me to my desk and preempts my exercise sessions.

I used to wonder why I felt so much worse when I was getting more work done. This study answers that question for me.

Couple these results with what we’ve learned about the beneficial effects of exercise in decreasing the risk of recurrence of breast cancer and it is incredible why physicians don’t write exercise prescriptions for their patients, and why personal trainer sessions are not covered by health insurance.

~~~~~~~~~~~~~~~~~~~~~~~~

There are several things that I feel are important to underscore here if you’re interested in trying this out yourself.

The social aspect of the exercise sessions may have also played a role in alleviating the anxiety that the study participants had initially complained of, and there was the added benefit of a pre-planned, supervised program.

First, this was a group session. That means that there was also social support involved as no one was exercising alone. The subjects were supervised by a physiotherapist; they didn’t have to come up with their own program, as it had been created for them.

Also, the exercise included both cardio and strength exercises and included warm-up, cool-down and stretching, so it covered all the bases, so to speak. And the subjects got fitter as the study progressed, so there was also a sense of self-efficacy at work here.

Does this mean that the exercise didn’t matter? Not at all! The emotional benefits of exercise have been documented in previous studies. If you consider the mind-body as a single system, as your physical fitness improves, your mental health will generally follow.

If you’d like to see the original article, it is available free online:
Malin Henriksson, Alexander Wall, Jenny Nyberg, Martin Adiels, Karin Lundin, Ylva Bergh, Robert Eggertsen, Louise Danielsson, H. Georg Kuhn, Maria Westerlund, N. David Åberg, Margda Waern, Maria Åberg. Effects of exercise on symptoms of anxiety in primary care patients: A randomized controlled trialJournal of Affective Disorders, 2022; 297: 26 DOI: 10.1016/j.jad.2021.10.006

For a reader-friendly version, see the write-up in Science Daily:
University of Gothenburg. “Anxiety effectively treated with exercise.” ScienceDaily. ScienceDaily, 9 November 2021. www.sciencedaily.com/releases/2021/11/211109095348.htm

The Voice of Reason: Why I Love Guided Meditations

If you’ve read my posts, you’re aware that I really like guided meditations. There are a number of mindfulness apps that I use everyday, and if it’s not a meditation, it may just be ambient noise that I have in the background that helps keep me grounded.

The fact is that guided meditations have been a game-changer for me. During those times when I am trying to fall back to sleep and shake off anxiousness, having someone else’s voice in my head makes a huge difference.

When I’m groggy, I’m vulnerable. My thoughts can run away with me and take me to places that will keep me awake.

What do I mean by that? I’ve found that I’m a very visual person and for better or worse, I have a vivid imagination (this seems to be the case for many anxious people). During the day, it’s much easier for me to ground myself with the techniques that I often write about here — and it’s even better if I can find a quiet corner to do so. But nighttime is different. Sometimes I wake up stressed and clearing my head of all the noise feels like a Sisyphean task.

When I am groggy, I am vulnerable. But I certainly don’t want to do anything to make me more alert since my goal is to fall back to sleep, not to practice improving my concentration. That is the perfect time allow someone else to guide me in meditation.

The guidance does this: it allows me to focus on someone else’s voice. That’s enough. I do not want to have to exert effort beyond that required to listen.

The exact topic of the meditation is far less important than the delivery. A gentle voice at a low volume draws my attention just enough that it keeps my anxious “Monkey Mind” occupied and quiet.

The Monkey Mind running loose is a good way to visualize what your thoughts might be doing inside your head, swinging from branch to branch, chattering, jumping and constantly changing directions. It can be a jumbled mess in there. The meditation helps sort it out.

I have tried this on a number of occasions and have been very impressed with how effective a guided meditation is in dulling the clarity of what my mind has cooked up and clings to. It provides space between my worries and my self. And then I drift off to sleep.

As I mentioned, the meditation doesn’t have to be anything specific. While body scans work particularly well, any calming meditation will do as long as its purpose is to relax the listener. Breathing cues can also be highly effective, as can novel ambient noise that pulls you away from your worries.

No need to overthink it. Just indulge in a lulling guided practice and get some rest.

Don’t Call It a Boob Job…

I remember telling people that I had breast cancer. Most tried to be as supportive as they could, some weren’t quite sure what to say. But regardless of how they reacted, there was a general expectation that breast cancer surgery meant that I had lost both breasts to the disease.

A few people went as far as trying to get me to “look on the bright side” that I had gotten a “nice rack” out of the deal. For the record, I had opted for a lumpectomy, otherwise known as breast-conserving surgery, which removes only the tumor and some surrounding healthy tissue to ensure that the entire diseased part is removed. There was no “nice pair” to be had.

So maybe this is a good place to clarify a few things.

A mastectomy is performed to remove all breast tissue, usually (but not always) along with nipples, areolae and lymph nodes, of one or both breasts. It’s done to treat breast cancer or, in the case of prophylactic mastectomy, prevent development of cancer in the breasts.

There are alternatives to reconstructive surgery that may be very meaningful to the breast cancer survivor, including creating something beautiful out of what she might otherwise consider an ugly experience.

Whether or not a woman chooses to have a mastectomy vs. a lumpectomy is a very personal decision and based on a number of physiological and even emotional considerations. No one should ever be judged for their decision regarding this.

Similarly, well-intentioned folks should not assume that breast cancer means a bouncing new set of perky breasts. Not everyone who gets a mastectomy will opt for reconstructive surgery. In fact, there are tattoo artists who specialize in using mastectomy scars and the newly-flat chest as a canvas to create meaningful and beautiful artwork.

It’s also important to note, total removal of the breast does not come without its downsides. Surgical complications are more likely with mastectomies, and because so much breast tissue and skin is removed, there may be loss of sensation in the chest area that in some cases is permanent.

A newly published study in JAMA Surgery (Dominici et al., 2021; note, the free PMC version of this article does not appear until Sept 2022) with a reader-friendly version appearing in the NCI blog Cancer Currents) compares quality-of-life scores between a variety of breast cancer surgery types, including lumpectomy, unilateral mastectomy (one breast) or bilateral mastectomy (both breasts). All subjects were young (under age 40 at time of diagnosis) cancer patients with early stage breast cancer who gave scores to their perceptions of items such as breast statisfaction following surgery and both psychosocial and sexual well-being. Having a bilateral mastectomy with radiation treatments resulted in the poorest quality-of-life scores out of all surgery options.

Important: while the sample size of this study was ample, with 560 subjects filling out the questionnaire, the women were predominantly white, married and financially stable. A more diverse subject pool might affect the scores and the study must be replicated with inclusivity in mind in order to extrapolate the findings to the general female population. It should also be noted that no surgical groups’ quality-of-life scores were particularly stellar – such is the way with cancer surgery – but those of bilateral mastectomy patients were worse.

All women, regardless of age, have the right to have their questions answered before making a decision about breast cancer surgery.

Given the notable difference between these scores, and the fact that all the different surgical options were open to these young women due to their early-stage tumor status, it stands to reason that women should be informed by their oncologists and surgeons of the possible outcomes of their decisions and second opinions should be encouraged.

That doesn’t mean that a bilateral mastectomy isn’t the right choice for a younger woman with early-stage breast cancer, only that she should be aware of the possibilities of complications and persistent quality of life issues. She should not be pressured in either direction because there is a lot to consider and it’s not an easy choice, nor does it come at an easy time in her life.

So please, don’t call it a free boob job.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If you are contemplating a prophylactic mastectomy in the absence of a genetic predisposition (BRCA+) and have early-stage breast cancer, please read this article from breastcancer.org and discuss your options with your medical team.

Breathing into Limbs: A Grounding Visualization

I’m perpetually on the lookout for different ways to ground myself.

When things get tough and I feel my anxiety rising, I’ve gotten better at pausing and pulling a grounding technique out of my “mental tool bag” before the feelings become too intense.

One that I came up with recently works quiet well, especially if you can take a quick break and find a quiet corner.

As I breathe, I visualize my breath inflating my limbs, filling them with relaxation.

The idea behind this one is that you take a few deep breaths to help slow your breathing down, and then start imagining that your breath is going down into one arm, inflating it.

I’ve visualized it in two ways. The first being breathing into the arm as if it were a balloon that inflates in all directions, all the way down to the fingertips, until it’s completely full. I imagine it glowing from within.

The second entails imagining the breath filling the arm in the way that a fern leaf unfolds. The expansion starts at the shoulder, then upper arm, elbow, lower arm, wrist, hand and finally fingers. As the arm fills with the inhalation, it brightens. This visualization is best when your breathing has already slowed considerably, as it may take a longer breath for your entire limb to sense the serial expansion down to your fingertips.

If my breathing has slowed enough, I imagine the breath entering my limb gradually, just like a fern leaf gently unfurls, part by part.

Either way, I wiggle my fingers at the end of the in-breath, and then as I exhale, the fingers fall still again and the breath exits my arm as it arrived.

Then I do the same with my other arm, followed by one leg and then the other.

On days that I’m really rushed, I might only have time for one limb, particularly if I’m sitting at my desk at work. But that’s okay. Even that short bit is better than letting stress run away with me. That little pause may be exactly what I need.

If this “extremity inflation” sounds too complicated in the heat of the moment, I urge you to try it when you’re lying in bed with your eyes closed. Then you can focus on the sensation of expansion and get familiar with it, so that when you need to call upon it in a stressful situation, you’ll have an easier time bringing up that imagery.

My limbs glow as the breath brings brightness into them.

What I particularly like about this visualization is that it’s a touch more complex, and therefore requires more attention from you. The inhalation all the way to the wiggling fingers makes it more difficult to be thinking about other things. So while it may demand more, I feel that it also delivers more, since everything else decreases to a dull roar in the background as you visualize the air rush in and inflate your body.

And of course, there are different variations of this that you can play with, such as expanding your entire body.

If you are able to practice with this, or even duck out to the bathroom for a few moments of eyes-closed peace, I think you’ll find it a lovely way to give your nervous system a needed break.