Bethany Davis, LSWAIC

In my work as a social worker, I’ve been thinking about the capacity and abilities each of us has to withstand hard times amidst COVID-19. A huge part of my role in the medical field is examining the inner strengths and supports that individuals have that can be a major factor in carrying on amidst chaos.

My curiosity beckons me when I am working with someone that is processing a diagnosis, planning for treatment, undergoing treatment, recovering and oftentimes doing it all over again. There is a vibration, a tune that people I work with seem to be listening to, one that I can’t hear but I know is being played.

I think that the internal pulse, that methodical beat, is resilience. We hear a lot about resilience in conversations about battling cancer, and the dexterity it requires to fight the diagnosis. Resilience involves internal regulation of our reactions to difficult situations in order to survive.

I am wondering if people with acute and chronic illnesses, such as a cancer diagnosis, may have some, if not more, expertise in regulating emotions to live in this resilience, something called Emotional Regulation. 

Emotional Regulation involves how we can manage and, in some ways, guide the emotions we have, good or bad. Knowing when to act on emotions and not act can work to our advantage and benefit us in the long run and can be a preventative measure. Emotional Regulation acts as a stabilizer, a referee for all of the emotional triggers and stimuli we experience every day.

occurs when we struggle to moderate emotional stimuli and our responses don’t fall within socially accepted ranges, or helpful ranges. Our emotional responses can lead to risky behavior, addictive behavior to avoid these emotions we feel that we can’t control in attempts to feel better.

Am I saying that it’s bad to cry? Of course not.   

What I am saying is that we can stand in the truth that we have the capacity and capability to regulate the state of our feelings and emotions without letting them take over and take us down. Overall, it can work in our favor to monitor how we react to emotional stimuli.

The One You Feed: Befriending Our Difficult Feelings 

podcast(ep.328) was discussing the process of mindfulness in dealing with uncomfortable emotional states.

Limbach talks about how our minds look for exits, not from anything extremely distressing, but just enough to not have to be present, just enough to find “something a little better”. She gave examples like scrolling through social media, daydreaming or reaching for food 

Our internal state of that ‘looking for an exit’, is a system we operate under in order to tolerate, cope and manage uncomfortable emotions. This internal process leads us into Distress Tolerance.

can be defined as someone’s ability to withstand, manage uncomfortable emotions amidst triggers without reacting to those triggers in that present moment. When we have higher distress tolerance skills, we can more effectively cope.

“I find that I get better with planning for my symptoms of chemo. I know that after 3 days; I will get sick. I know if I hang on, just hang on for that day, it will pass. This was awful at first, but over time I have adjusted,” explained a patient. Whoa. How does this process happen for people?

If I can be blunt, I am proposing that people with cancer are actively using distress tolerance skills when they may not even realize it.

Distress tolerance is highlighted in a therapy framework called Dialectical Behavior Therapy (DBT). DBT, founded by Dr. Marsha Linehan, is an evidence based therapy that is often used to help with emotional regulation. DBT has been proven to radically impact individuals with Borderline Personality Disorder, suicidality, mood disorders and eating disorders. DBT finds itself revealing the importance of accepting negative emotions and balancing change-oriented work all at the same time.

Here are some elements of DBT I’ve picked up on in my work with people with cancer: 

When we get too attached to negative thoughts or reactive to them, it can be unhelpful and increase suffering. Thought Diffusion, a mindfulness element of DBT, is an exercise of noticing the thought, and changing the framework of the thought, with the hopes of detaching from it.

“Today I am sad”. vs “Today I am noticing that I am feeling sad”.

Changing how we preface the thought can help us get “unstuck” from the thought. Increasing our ability to examine the thought, challenge the thought, and let it go. This increases our regulated state and can prevent us from unnecessary emotional pain.

“I am humbled by my symptoms from after chemo...there’s no way out of them”.

This is the point of this article that I recognize may come across as lacking empathy and compassion for physical and emotional pain, especially for an individual experiencing a cancer diagnosis. 

Make no mistake, I do not write about Radical Acceptance lightly or as if I have it down.

Radical Acceptance is accepting life as it is, as it is completely. When we fight emotional pain and experiences, it can lead to suffering. We can see pain and see it for what it is and be less likely to suffer. I want to emphasize that this takes 

When we have acceptance, we are more likely to experience moments of joy, instead of avoiding feelings and emotions altogether. We can experience continual struggle when we are actively pushing away negative emotions. “I can’t feel like this now...I shouldn’t feel like this”.

Spiritual practice and exercising acceptance can be difficult during moments of physical and emotional pain. We find that through acceptance, there isn’t cognitive frustration that can lead to continual suffering. We let go of what we can’t control and leave room for hope and serenity.

Living in Radical Acceptance may look like a spiritual practice for you, it may look like journaling about what is happening in your life right

Bringing an awareness of your urge to fight reality or painful emotions

Turning your thoughts toward acceptance by just being willing.

Moving into a physical posture of acceptance by relaxing your body, opening your hands in acceptance, or drawing a slight smile

Please note, Radical Acceptance doesn’t mean we’re giving up or living passively to our goals, challenges and choices. What it does mean is that we have space to live presently and live empowered, without the emotional and cognitive struggle that can come with fighting reality. 

“I think about what I do have in my life, what I can focus on. My grandchildren mean the world to me, and I will knit them hats until I get to see them next after all of this." 

Feelings and thoughts will pass. Doing something else that brings you joy and requires attention can be really powerful and relief amidst emotional dysregulation.

 I’ve witnessed individuals with cancer practice utilize self-soothing and self-care techniques on a daily basis to comfort themselves during treatment and emotional crises. Again, this takes 

A few examples of soothing techniques individuals have shared with me are taking baths, journaling, and muscle relaxation exercises.

The option of knowing what we can and can’t control is life-changing. We can see that with the pandemic, this is what the majority of the world is struggling with internally.

If you are going through cancer, I commend you, I commend you for your strength and ability to cope with distressing situations.

Your ability to accept life as it is, enjoy each day, and not avoid pain. 

Your intentional efforts to challenge the status quo, to utilize realistic mindsets in order to live in resilience. If you’re reading this and you think this is meant for you, it is, this one’s for you.  

I wonder if the relief and the answers we are seeking lie within us. I propose that we have what it takes to experience freedom and relief in our lives amidst emotional chaos and uncertain times. 

When the global, collective anxiety is screaming at me ‘

Articles

Patients with cancer have a unique skill that not only aids them through their own cancer journey but a global pandemic like COVID-19. 

The Cue Card Patients with Cancer Hold During a Global Pandemic: Emotional Regulation

I slept 4 and a half hours last night. My coffee intake has gone from 2 cups per day to 6. My Netflix binging and compulsiveness to mentally check out has skyrocketed. But I think there’s something deeper going on than just my increase in caffeine. 

COVID-19 has demanded of me and the entire planet to experience an internal shift, a large emotional adjustment that is unexpected. Lately I’ve experienced wanting space but not wanting space from people. Feeling hopeful and then experiencing moments of panic. Going through stages of denial, anger and acceptance. The world right now has the existential questions of “Am I happy, am I safe, am I loved?” being echoed over and over again. 

I work in an outpatient oncology unit in Seattle as a Clinical Social Worker.  I have the opportunity to observe, assess and support all aspects of an individual’s life: financial, emotional, mental health, family support and community. I sit with people as they experience denial, anger and acceptance with a cancer diagnosis, all emotions that occur with being human. 

Facing the fragility of our existence comes in waves and requires continual adjustment. With a cancer diagnosis there are constant adjustments that are required with the physical and emotional discomfort individuals experience due to pain and symptoms of treatment.  These symptoms vary day by day. 

I wonder if people with cancer have been emotionally and spiritually prepared for a global pandemic, like what we are experiencing, better than anyone, better than me. Is that ok to say?

Let’s face it, I have no idea what I’m doing, how I should feel, how I should respond to what’s happening in our world on most days. This overwhelming moment has allowed me to make the choice to take one step in front of the other, with hope and desperation for a change in events.

If I can be honest, I have been looking forward to conversations with individuals at my clinic regarding their perspective of the pandemic, and how it has impacted their lives. The truth is, I have been surprised to find an 

 perspective of strength, hope and wisdom of the clients I work with: 

“Well this is what we do: we carry on, we keep on going.”

“I’m used to social distancing when I’m going through treatment, I already got this down.”

“You see Bethany; this too shall pass.”

For many people with cancer, a familiarity of the unknown is ever-present. A confidence and an acceptance occur when a person practices letting go of what they cannot control. 

I hope I can grow an awareness that allows me to be calm during a storm and teaches me how to remain composed when the world is crumbling around me. The constant unknown, the overwhelm of information &#8209; how do I face it all?

The complexity of cancer with the uncertainty, the unknown, the rollercoaster ride of emotions can be strenuous on any individual.  A lot of the work I do with an individual is providing support in coping with the physical and emotional hurdles. 

Skills with managing the emotional turmoil I have discussed with clients include:  

Learning to not run from your “shadow”

Facing the reality of our mortality as human beings

Noticing feelings of abandonment and loneliness

Doing one thing a day that gives you joy 

With the uncertainty that COVID-19 has brought to the world, these themes of awareness are vital in our current climate with the emotional ups and downs and the lack of control that we are experiencing as a society, similar to individuals with cancer. 

Make no mistake, this pandemic requires a lot of resilience and courage. Pursuing growth amidst a crisis is not an easy feat. This comes from a place of strength that doesn’t develop in a day; strength grows steadily over time. 

It’s a muscle of awareness that not all of us have but learn to exercise. Being mentally present in a time of crisis goes against our adaptive behaviors as a society of do-more behaviors in order to cope. Social Distancing and self-isolation lately have appeared to be the antagonists of our busy-body routines.  

The mountains ahead of us seem large and daunting. But I don’t think it’s the size of the mountain that we are questioning, but the grit, the tough, the fight inside of us that we hope is enough to make it to the summit. Not knowing what we can live through, physically, mentally and emotionally, fuels the majority of our worry with the virus. 

People with cancer have flourished through living in the unknown for years. The present is what they thrive on. They are our leaders, our teachers and our guides. They are the leading light in the storm, the Masters of the unknown, people who know what it’s like to look life in the eyes and say, “Let’s do this”.

Bethany Davis, LSWAIC

The Cue Card Patients with Cancer Hold During a Global Pandemic: Emotional Regulation

Why People with Cancer are My Guides During a Global Pandemic

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