Cancer is a life-changing and potentially life-threatening diagnosis. Before the news can even sink in, you buckle in for your wellness team’s treatment recommendations, which may include chemotherapy, radiation, and/or surgery. The “warrior mentality” kicks in as an unexpected fight against your own body begins in earnest.

During the active treatment phase, you are surrounded by medical professionals and, if you’re lucky, family and friends supporting you through the various treatments. Then, suddenly, hopefully, you cross that finish line and are told there is no evidence of disease (NED). Cheers and celebrations ensue. NED! It’s all over. You’re a cancer survivor and you get to return to your life.

That’s the way it’s supposed to work, yes?

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Unfortunately, cancer survivorship can bring an emotional tsunami of its own. Many survivors find themselves dealing with the chemotherapy effects of fatigue and concentration problems, which may impact their ability to function at work or at home. Additionally, there is the emotional aftermath of coping with a life-threatening diagnosis and life interruption; possible body image issues resulting from surgery (e.g., mastectomy); perhaps major changes in narrative (e.g., having children, financial strain); changes in self-esteem; survivor’s guilt (“Why did I survive while others didn’t?”); fears of recurrence; and a foreboding sense of a shortened future, to name a few concerns.

It is common to experience emotional turbulence post-cancer. There is nothing wrong with you for not being able to just resume your life after treatment. It may take some time to emotionally heal. Survivors may experience depression, anxiety, even posttraumatic stress. Indeed, PTSD symptoms are not reserved for combat veterans. Survivors of cancer have endured a battle as well—it just looked different.

Cancer survivors can experience myriad symptoms such as being triggered into a state of high anxiety by certain smells, sights, or bodily feelings. They may discover they can’t free their minds from intrusive and unsettling thoughts, memories, or images of their cancer care.

Cancer survivors can experience myriad symptoms such as being triggered into a state of high anxiety by certain smells, sights, or bodily feelings. They may discover they can’t free their minds from intrusive and unsettling thoughts, memories, or images of their cancer care. There may also be a strong desire to avoid certain people or situations because they might be anxiety-provoking.

A survivor may oscillate between feeling too much and feeling numb. It’s also not uncommon to experience body pain or to immediately jump to thinking the cancer is back. Some may find themselves struggling to move forward, afraid to dream of a future again. These types of symptoms are a reminder you have survived a life-altering event. It’s okay to allow yourself some time to heal the post-cancer emotional wounds.

To monitor your emotional health after cancer diagnosis and treatment, it may be helpful to remember the word “tsunami.” TSUNAMI may be used as a mnemonic to help you assess whether you are dealing with posttraumatic stress symptoms. As many cancer survivors would attest, the word fits very well to describe the turmoil that can occur in the aftermath of cancer.

• Trauma: Any time you experience a life threat, you are vulnerable to experiencing an emotional fallout. Most cancer diagnoses meet this standard.
• Significant distress: Are you struggling to get through most days? Has your ability to function at work, at home, and in your relationships decreased?
• Upregulated: Is your sympathetic nervous system working on overdrive? Are you experiencing problems with focus or sleep? Are you easily startled, hypervigilant about your body, or easily angered?
• Negative thoughts and mood: Are you feeling sad, anxious, and fearful a lot? Are you having negative beliefs on a regular basis (e.g., “I am going to have a recurrence,” “I don’t see myself growing old,” “My body is permanently ruined,” “I will never be happy again”)?
• Avoidance: Are you spending a lot of time avoiding places, people, and situations that might trigger your anxiety about your cancer diagnosis and treatment?
• Month: Have your symptoms persisted for at least a month?
• Intrusive memories and symptoms: Are you finding you are upset by memories or images about your treatment? Are you having nightmares about what you experienced? When you are exposed to reminders of your cancer diagnosis and treatment (e.g., news segments about cancer), does it take a long time to calm down?

What You Can Do to Help Yourself

If some of the above questions resonate with you, there is a lot you can do to promote emotional healing. First, seeking counseling from a mental health professional with training in health psychology may help quell your symptoms. Another goal with therapy is to help you feel like you are not just surviving life but thriving again.

There are many other treatment methods that may be used to promote healing. Some methods that are used to help people with posttraumatic stress, such as trauma-focused cognitive behavioral therapy, are utilized to help survivors of cancer. This treatment orientation provides psychoeducation about trauma, fosters development of relaxation tools, and teaches methods for examining dysfunctional thought patterns and desensitizing triggers. Other avenues survivors might explore are cancer support groups, acupuncture to relieve anxiety, iRest meditation, and yoga.

The key to thriving after cancer is to intervene early and thoroughly. So no matter what phase of your cancer journey you are in, it is important to monitor your mood. If you are emotionally struggling, reach out to a mental health professional to provide guidance through your recovery and beyond NED!

Although posttraumatic stress (PTSD) tends to be the issue that most often comes to mind when we consider trauma, there are a number of other responses, including depression, anxiety, substance abuse, and difficulties in relationships. Most of these other issues are embedded within the constellation of PTSD and will make more sense as we understand the condition. Many people think of combat veterans when they think of PTSD. Indeed, much of what we know about trauma its effects is a result of the experiences of Vietnam veterans. While trauma responses of course existed prior to the Vietnam war, there had not been a whole lot of focus on understanding traumatic reactions (Herman, 1992).

Many different types of events can be traumatic. Trauma responses can follow any major change or disruption in a person’s life. Some examples that may come to mind include a serious and potentially life-threatening accident, assault, natural disaster, or combat. Other experiences can be traumatic as well, including surviving or witnessing a crime; physical, verbal, emotional, or sexual abuse; bullying; or even a big relocation.

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In the time immediately following a trauma, many people have experiences of PTSD. In some cases, those experiences decrease over time and the person naturally recovers. It can be helpful to think of PTSD as a process where something got in the way of that natural process of recovery. A therapist works to determine what has interfered with routine recovery. In each trauma experience, the factors that can influence the responses vary. As a result, there are as many individual examples of things that can block a smooth recovery as there are individuals with PTSD (Resick, et al., 2008).

However, there are commonalities among PTSD experiences. Several categories of experiences tend to follow a traumatic event. In particular, the experiences of PTSD fall into four clusters (APA, 2013).

The first cluster is the reexperiencing (intrusion) of the event in some way. This may include nightmares about the event or other scary dreams, flashbacks (acting or feeling as if the incident is recurring), and intrusive memories that suddenly pop into mind. Individuals might have intrusive memories when there is something in the environment to remind them of the traumatic event (including anniversaries of the event) or even when there are no reminders. Common times to have these memories are before falling asleep, when relaxing, or when bored.

Therapeutic work serves to not only provide relief from this cycle, but to eradicate the interruption in the recovery process.

A second set of experiences concern arousal, which refers to a constant alarm signal. As might be expected, when reminded of the event, a person with PTSD is likely to experience strong emotions. Accompanying these feelings are physical reactions similar to the ones we might experience coming face to face with a saber-toothed tiger. Indicators of arousal experiences include problems falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, startle reactions such as jumping at noises, or always feeling on guard or looking over our shoulder even in the absence of an external reason.

The third cluster of trauma experiences is avoidance of reminders of the event. Although it is important to point out this avoidance is often not deliberate, a natural reaction to intrusive memories and strong emotional reactions is the urge to push these thoughts and feelings away. We might avoid places or people who remind us of the event. Some people avoid watching certain television programs or turn off the TV altogether. Some people avoid reading the newspaper or watching the news. We might avoid thinking about the event and letting ourselves fully experience our feelings about it. There might be certain sights, sounds, or smells we find ourselves avoiding or escaping from because they remind us of the event.

Sometimes people with PTSD have trouble remembering all or part of the event. Other times, people with PTSD feel numb and cut off from the world around them. This feeling of detachment or numbness is another form of avoidance. Sometimes it is described as feeling as though the person is watching life from behind glass.

Someone navigating things like reexperiencing, hyperarousal, and avoidance may begin to develop reconstructed beliefs about their life, the world, others, and themselves. It makes sense this set of experiences on a day-to-day basis might begin to reshape our view of not only ourselves and others, but about the world how it works. This refers to the fourth cluster of PTSD, the negative cognitive (or mood-based) shifts that can occur following traumatic experiences.

Conclusion

With this overview of trauma and how the PTSD cycle tends to maintain itself, we can begin to better understand how traumatic events can lead to the types of trauma reactions and PTSD experiences we often see (Resick, et al., 2008). Each of these four components contributes to the others in a cyclical way that interrupts the natural recovery process following a traumatic event. Therapeutic work serves to not only provide relief from this cycle, but to eradicate the interruption in the recovery process.

If you would like help in recovering from trauma (or your responses to it), contact a therapist who specializes in posttraumatic stress-related issues.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5^th, text rev.). Washington, DC: Author.
2. Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.
3. Resick, P.A., Monson, C.M., & Chard, K.M. (2008). Cognitive processing therapy: Veteran/military version. Washington, DC: U.S. Department of Veterans Affairs.

Did you know one of the main predictors for having a substance use disorder is experiencing trauma?

A quick internet search yields many definitions of trauma. I think the simplest definition is this: an emotional response to a terrible event.

Note I did not specify what type of event or what type of response. These are all individualized. What might be traumatic for me could have little or no impact on you. A person experiencing trauma is in the best position to define their experience based on what they are thinking, feeling, and going through.

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In one survey of adolescents receiving treatment for substance use, more than 70% had a history of trauma exposure. Teens who experienced physical or sexual abuse were three times as likely to use substances than those who had not. And 59% of young people with posttraumatic stress (PTSD) develop substance use disorders.

Another study found 60% to 80% of Vietnam veterans seeking PTSD treatment have alcohol use issues. They tend to binge drink in response to memories of trauma. Of further concern, veterans over the age of 65 who have PTSD are at a higher risk of attempting suicide if they also have an alcohol use disorder and/or depression.

People who experience trauma and PTSD often turn to alcohol and other substances to manage the intense flood of emotions and traumatic reminders. They may also use it to try to numb themselves. Drugs and alcohol may initially dull the effects of trauma and help manage associated distress, but a dangerous cycle may begin.

After a traumatic event, a person may drink to deal with anxiety, depression, and irritability. Typically, alcohol initially seems to relieve these symptoms. When we experience a traumatic event, the brain releases endorphins that help numb the physical and emotional pain of the event. This is our body naturally helping us cope.

However, this interrupts the natural protective function the body was already doing. As a result, we create a type of emotional withdrawal that can set us up to deal with increased and prolonged distress that could lead to the development of posttraumatic stress.

Drinking may have been the “solution” you turned to, but it is likely making things worse. We will not take that coping skill away until we teach you new ones.

Drinking often can contribute to PTSD symptoms and increase irritability, depression, and feeling off guard. Some drink to deal with insomnia that results from anxiety, anticipating nightmares, and circular thinking. Drinking actually impairs the quality of your sleep, however, setting up a destructive cycle. Trying to avoid memories of trauma can make them emerge in your sleep. Drinking also can make therapy less effective because you are not allowing yourself to effectively deal with trauma in a safe, healthy setting with a trained professional.

People who use substances may be less able to cope with a traumatic event. They may have increased difficulty with emotional and behavioral regulation. When chemical use starts, development gets significantly impaired. As a result, the person may be more likely to engage in risky behaviors that can lead to additional trauma.

The combination of trauma and drinking can increase challenges related to getting close to people and having conflicts with the people you do have a relationship with. Heavy drinking often leads to a confused and disorderly life. The very thing a person needs is support and connection, yet those are often damaged as a result of drinking consequences and behaviors.

A good therapist knows drinking is generally not THE problem. It is usually a symptom of another problem. Often, the problem is trauma. In such cases, drinking is not generally about having fun. It is about managing the pain of what you are dealing with.

Effective treatment of trauma does not mean you have to talk about what happened. We don’t want you to reexperience it. That probably happens enough. We focus more on how it is affecting you today. Drinking may have been the “solution” you turned to, but it is likely making things worse. We will not take that coping skill away until we teach you new ones. There are many other, more effective ways to deal with the past than drinking.

References:

1. Bombardier, C.H., & Turner, A. (2009). Alcohol and Traumatic Disability. In R. Frank & T. Elliott (Eds.), The Handbook of Rehabilitation Psychology, Second Edition (pp. 241–258). Washington, DC: American Psychological Association Press.
2. Khooury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance Use, Childhood Traumatic Experience, and Post Traumatic Stress Disorder in an Urban Civilian Population. Depression and Anxiety. 27(12): 1077–1086.
3. National Child Traumatic Stress Network. (2008). Understanding Links Between Adolescent Trauma and Substance Abuse: A Toolkit for Providers, Second Edition. United States of America.
4. Trauma and Violence. (2015). Retrieved from https://www.samhsa.gov/trauma-violence
5. Volpicelli, J., Balaraman, G., Hahn, J., Wallace, H., & Bux, D. (1999). The Role of Uncontrollable Trauma in the Development of PTSD and Alcohol Addiction. Alcohol Research and Health, 23(4), 256-262.