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This is the therapy I wish I knew about when I had cancer

Elizabeth Cohn Stuntz, co-author of “Coping with Cancer,” reflects on her breast cancer journey, how she discovered dialectical behavior therapy and ways cancer patients can benefit from it.
Therapist Elizabeth Cohn Stuntz shares her experience recovering from breast cancer and advocates for the ways DBT can help other cancer patients navigate their health journeys.
Therapist Elizabeth Cohn Stuntz shares her experience recovering from breast cancer and advocates for the ways DBT can help other cancer patients navigate their health journeys.Elizabeth Cohn Stuntz

I laughed as I told a friend about my cancer diagnosis, “No worries, I am not freaking out." I naively tried to deny any stress at the time. It was 2002 and I was desperately trying not to overreact to the “big C” that had cut my mother and grandmother’s lives short. They died long before anyone knew about the BRCA gene. Now I knew that I carried this gene that makes breast cancer up to 70 percent more likely and increases vulnerability to recurrence and other types of cancer.

Nonetheless, I decided that worry wasn’t going to rule me. On some level, I assumed that if I let myself acknowledge any anxiety or fear, I’d be overwhelmed like a terrified, depressed patient I treated as she coped with cancer.

As a psychoanalyst for over 30 years, I wanted to prove to myself and everyone else that I could handle what was happening. I did not want to face being thrown off balance, gripped by the strong emotions that left so many of my patients feeling out of control.

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While I initially tried to deny how I felt, there was no avoiding my anxious middle-of-the-night worries about the future. Could I continue to work? Would I be weak and needy? Or see my children grow to adulthood? My guilt seemed unescapable. As a parent my job was to keep my children safe. It was hard to shake the feelings of sadness and responsibility that I may have passed the BRCA gene to them. I was unsure of myself.

My professional competence working with children and their families felt beside the point as I faced talking to my own children about chemotherapy, a lumpectomy, a 12-hour bilateral mastectomy and oophorectomy (removal of ovaries). How could I keep their trust and be honest about my long-term risks and their potential vulnerability? My normal self-assurance was nowhere to be found. Was I doing this right?

At the time I didn’t know constructive ways to deal with the stresses of cancer. I wish I had!

I’ve now spent the last 20 years expanding my views and writing a book about how to effectively cope with the social and emotional sides of the disease, called "Coping with Cancer - DBT Skills to Manage Your Emotions and Balance Uncertainty with Hope."

Breast cancer survivor Elizabeth Cohn Stuntz applies the tactics of dialectical behavior therapy (DBT), developed by Dr. Marsha Linehan, to the unique challenges of cancer for the first time.The Guilford Press

My co-author, Zen master Dr. Marsha Linehan, developed Dialectical Behavior Therapy (DBT) in the late 1980s to treat people who were suicidal or living with challenging situations. DBT is a form of psychotherapy that teaches people how to fully pay attention to their experience (mindfulness), regulate their emotions, communicate with others, tolerate distress, and live meaningfully.

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In 2009, I was trained in DBT by Dr. Linehan. I began Zen mindfulness retreats for clinicians with her. During one of the retreats, it occurred to me that DBT skills would be useful to teach at a cancer support organization I helped start for cancer patients and their loved ones. With Dr. Linehan’s encouragement, I piloted the skills at the cancer support center.

Facing the situation and our response

DBT taught me the importance of facing what’s happened and my reactions. As much as I tried, it’s not possible to turn off our emotions. They always show up. There was no escaping my anxiety, sadness and the guilt that I passed a cancer vulnerability to my treasured children. Avoidance actually makes things worse.

I couldn’t deal with my negative self-judgment until I addressed my assumptions that I had done something to compromise my children’s safety or my belief that requiring assistance implied being weak and helpless. Before I embraced DBT, those ideas got in the way of allowing help and support.

Since then, I discovered that emotions are not simply on OR off. There are effective ways to dial down reactions that are more intense than is in our interest. To do this, I needed to learn ways to balance the four parts of my response: my emotions, thoughts, body and actions.

Balancing emotions and thoughts

While I couldn’t avoid how I felt, I realized it was possible to reign in strong emotions by labeling the feeling. The neuroscience expression is “name it to tame it.” My anxiety, sadness and guilt were less intense when I identified those feelings. Cancer patients who can understand and label their emotions have been found to improve their coping and show health benefits as well.

Balancing my thoughts by taking a big picture view also helped calm powerful feelings. Life with cancer is more complex than simply one way OR the other. Situations are rarely 100 percent devastating OR totally fine. While it was understandable to be worried about cancer, it was also possible to be hopeful at the same time. The fact that I was not in control of the genetic impact on my children did not make me powerless. Indeed, it was easier to accept my vulnerability when I recognized my complete story also included my strength. I realized that there were ways I could try to impact my situation.

Balancing my body and actions

Physically, I learned to manage strong emotions by taking longer exhales to slow my heart rate during times of high anxiety. I was taught how to scan my body and relax tight muscles to ease tension.

I also discovered ways to help balance my sadness. DBT refers to these strategies as opposite actions. I initially viewed cancer as a serious matter with no room for humor. I learned that there was a place for the dark AND light sides of cancer.

Humor can make grief more bearable, protect against the damaging effects of stress, diminish pain, and strengthen immune system functioning. Laughing is contagious and encourages positive connections with others. One study found that the more grieving people laughed and smiled in the early months of a loss, the better their mental health was over the next two years. I want to be clear that I am not simply saying, “just look on the bright side.”

Distress about cancer is understandable, but here’s what I’ve learned:

The key to coping is taking a balanced view that considers the dark AND light sides of things. This eases our anxiety, strengthens our resilience, and builds confidence in our ability to do what we can to navigate the challenges of life with cancer.