Imagine being told that all the things you plan, all the moments you hope to have and all the achievements you aspire to may not happen. That’s what it is like when you hear a doctor say, “You have cancer.”
While many people know others who have battled or are currently battling some form of cancer, hearing those words never gets easier. Just because medical advancements have greatly improved the chances of remission and a long, healthy life doesn’t mean that diagnosis won’t drastically change your life. Because that’s the thing about life-changing diagnoses like cancer: They change everything.
When people imagine the experience of a typical cancer patient, what often comes to mind are physical symptoms like hair loss, nausea and fatigue. However, some of the biggest challenges a patient and their loved ones have to face are mental.
“When I was diagnosed with stage 3 breast cancer, I had a six-week-old baby. I wondered whether I’d see her grow up, whether she’d remember me when I was gone,” my mom explains. “I was told to get my affairs in order and hope for a year. What did that mean for my family? How would my 12-year-old son cope?” Fortunately, my mom beat the odds and is now entering her 24th year of cancer survivorship.
The types of thoughts my mom had after receiving her diagnosis can take a toll on a patient’s mental health and overall well-being, according to Dana Nolan, a licensed mental health counselor in central Florida.
Being diagnosed [with cancer] does not make someone mentally ill. But, in my experience, most cancer patients develop symptoms of anxiety and depression at some point during or after their treatment. While it is normal to experience mental health challenges, it is not necessary to simply suffer through it.
No two people respond the same way to difficult news, but there are several common mental health issues that may develop after any type of cancer diagnosis.
Cancer offers plenty of chances to worry both during and after cancer treatment. After you or someone you love is diagnosed with cancer, anxious thoughts and worries like these may become impossible to ignore:
- Is my prognosis accurate?
- What if I made the wrong treatment decision?
- What if my next scan shows the cancer has grown?
The last question represents a special category of anxiety nicknamed “scanxiety” by the cancer community. In an article on Medscape, author Nick Mulcahy explains, “Scanxiety is cancer patients’ fear and worry associated with imaging, both before and after a test (before the results are revealed).”
It’s normal to worry about the future sometimes, but when those worries begin to impede your ability to fully live your life, it’s time to ask for help.
A mental health counselor or therapist can help you determine what you are dealing with and how you can manage it. They may also recommend anti-anxiety medications such as Ativan or Xanax.
Depression affects an estimated 15% to 25% of cancer patients, according to the National Cancer Institute. Patients and their loved ones may develop depression because of the diagnosis itself, anxiety about the future, a changing self-image or even the side effects of certain cancer treatments.
It’s important to note that depression is not the same thing as feeling sad. Clinical depression often manifests in mood swings, fatigue, feelings of emptiness that last for more than a few days and feelings of helplessness or worthlessness. This may require medical attention.
Depression can affect all those around, not just the patient. Melanie Ball, who lost her dad to mesothelioma in 1993 when she was only 14 years old, also had to witness her mother sink into a deep depression that lasted for years after his death. Melanie’s mother chose to suffer in silence, but no one should have to face a life-changing illness, such as cancer or depression, alone.
If you or someone you love is suffering from depression, there is help. Many kinds of medical professionals can treat this condition through counseling, therapy or medication. Joining a support group can also make a big difference for those affected by cancer. In fact, studies show people with terminal cancers who participate in support groups have higher survival rates and increased quality of life.
People may grieve at many different times during and after a cancer battle, and grief is often shared by a patient’s entire support network. Lorraine Kember, a mesothelioma widow, explains how a cancer diagnosis can start the grieving process:
Anticipatory grief is the name given to the mix of emotions experienced when we are living with the expectation of a personal loss and grieving because of it. Anticipatory grief is particularly relevant to anyone who has received a terminal medical diagnosis and for people who love and care for that person.
Living with the expectation of death or loss can cause us to experience the same array of emotions that develop after the loss actually happens, including shock, denial, helplessness, sorrow, anger and physical pain.
While grief is normal during and after a cancer battle, you don’t have to grieve alone. Spend time with your family; they may be experiencing the same thing. Seek out grief support groups, which are often available at local hospices. And above all, remember to take things one day at a time.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HELLO to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.
Wrapping our head around a mass shooting: Post-traumatic Stress Disorder in victims and those that care for them
As a therapist, I am certainly not immune to emotional distress and trauma. The biggest mass shooting ever to occur in the United States just took place in my hometown of Orlando at a nightclub that I have been to before. My friends/colleagues in mental health work at the very hospital where over 53 injured victims were taken and they are frantically trying to comfort distraught shooting victims and the family members who are looking for their loved ones who may be injured or dead. All the first responders who attended the scene may have trouble getting the picture of what they saw in the nightclub out of their heads. My own brain is struggling with the enormity of it all as this huge loss to our community sinks in even though I was safely home in bed when the whole event occurred.
A big part of my practice these days involves using a type of therapy called Eye Movement Desensitization and Reprocessing (EMDR) in my work with clients who have survived a trauma of some kind like rape, plane crashes, car crashes, physical abuse or witnessing a violent death. These clients have developed post-traumatic stress disorder (PTSD) and their symptoms include:
-Experiencing intrusive flashbacks or re-experiencing the traumatic event
-Avoiding the place where the trauma occurred or anything that reminds them of the event
-Feeling hyper-aroused which means they have trouble sleeping and feel jumpy and/or irritable
-Dreaming about the traumatic event
-Having panic attacks
When I think about all the recent victims of this mass shooting, I know that many of the survivors will develop PTSD in the coming weeks and months. Family members and loved ones of those who perished may also develop PTSD as a result of having to identify their bodies of their loved ones and grieving their unexpected and tragic loss. Not everyone develops PTSD as a result of experiencing or witnessing a traumatic event and we don’t really know why that is. But, what I do know is that many people with PTSD suffer in silence for a long time before they go to their physician or a mental health professional for diagnosis and help.
If you or a loved one begins experiencing symptoms of PTSD after a traumatic event or loss, please don’t ignore the symptoms or tell yourself that you just need to “suck it up and be strong.” PTSD is a very treatable condition and the impact that untreated PTSD has on one’s quality of life is profound.
My thoughts and prayers go out to all the victims of this senseless tragedy. I work with a lot of LGBT clients in my practice and I take comfort in knowing that our local LGBT community is very strong and that they will support each other as they heal.
Dana Nolan MS LMHC NCC
Licensed Mental Health Counselor
Altamonte Springs — Orlando
April is Child Abuse Prevention Month. Sadly, child abuse occurs far too often. Some families seem to pass on the legacy of physical, sexual and psychological abuse because many times victims of childhood abuse grow up to abuse their own children. This pattern can be halted if victims of abuse seek and receive professional help to deal with their trauma.
Commonly, a survivor of abuse will “stuff” their emotions and the memories of the traumatic events when they arise. They may turn to drugs or alcohol to numb the pain or to make the memories of their abuse disappear. These strategies work in the moment, but the thoughts, feelings and memories will keep coming up unless they are processed therapeutically. Quite often, my clients have told me that they have tried on their own for many years to get rid of their traumatic memories, anxiety and negative thoughts before they seek counseling.
There are a variety of therapeutic models to deal with the trauma of childhood abuse.
Trauma-Focused Cognitive Behavioral Therapy– helps victims of abuse to reframe the irrational and negative thoughts/beliefs that are often formulated after surviving childhood abuse.
Eye Movement Desensitization and Reprocessing (EMDR)-a very specialized form of trauma treatment developed to address the flashbacks, memories and negative thoughts common in those with post traumatic stress disorder (PTSD).
Dialectical Behavior Therapy-a collection of therapeutic interventions that focus on helping victims of abuse learn to manage their emotions, cope with stress in interpersonal relationships and tolerate emotional distress.
Play Therapy-a therapy for children that helps them express and process their emotions and memories of abuse in a safe environment. Play therapy uses dolls and toys to teach about healthy relationships and boundaries.
Pharmacologic Therapy-many times survivors of childhood abuse develop sleep problems, anxiety disorders (generalized anxiety disorder, post-traumatic stress disorder or phobias) or a mood disorder. Psychiatrists can prescribe medications to help manage symptoms which allow the survivor of abuse to work through trauma in counseling.
In my practice, I work with adult survivors of childhood abuse and utilize trauma-focused cognitive behavioral therapy, EMDR and dialectical behavioral therapy and have found these modalities very successful. It takes a great deal of courage and trust to reach out and seek help. If you are a survivor of childhood abuse and are ready to start feeling better, ask you primary care physician for a referral to a mental health care professional in your area that specializes in post-traumatic stress disorder and interview a few therapists to make sure you feel comfortable talking with them
We all tried very hard to pretend that the foamy bubbles floating from the sky were really snowflakes even though it was a balmy 65 degrees. It was fun to see the facial expressions of the young children in the crowd as the dancing lights came on for the first time! We told some families who had never seen the lights before about finding the Disney characters hidden within the lights. As a family we don’t have too many holiday traditions, but the few that we have mean a lot to us and we have always tried to find the time to make them happen and to be mindful as we celebrate.
During my work as a psychotherapist (mental health therapist), I find that this time of year brings a burst of clients wanting to get it in to see me. It is usually due to depression, anxiety or family/relationship stressors which seem to increase during this busy time of year. Why would so many of us feel emotionally distressed during a time that is supposed to be a joyous? Most of us already have busy schedules and too much on our plate without adding on gift shopping, annual holiday parties and decorating our homes for the season. It is easy to get wrapped up in our “to-do” list and feel stressed so that we aren’t really present during this time of year.
You may have heard of “mindfulness.” It refers to being as aware as possible in your current situation and place. Sometimes we float through life spending too much time ruminating on the past or worrying about the future which means that we aren’t enjoying today. There are many books and research articles about mindfulness and the emotional and physical benefits of practicing it. Rather than try and summarize all that information, I’d like to offer a few tips to help you be mindful during the holidays and all year round, as well.
1. Let go of trying to keep up with the “Jones” this season. Some people feel overwhelmed by trying to have the biggest or best holiday yard decorations or to make the perfect-looking Christmas cookies to give away to friends. Others feel pressured to get their children the latest must-have toys or gadgets (which are always on back order with Amazon!) Comparing our lives and possessions to others usually leads to a lower self esteem and feeling inferior which feeds pressure to “out-do” each other and can sometimes exacerbate underlying issues such as depression and anxiety. It is less stressful and more healthy to simply focus on those few activities that have the most meaning to your family and forget about trying to win the “best holiday decoration” award in your community.
2. Put reminders on your calendar to “Stop what you are doing and be aware of life around you.” Re-read my description above about my family’s visit to see the dancing lights. We stopped and watched the lights and listened to the music. We felt the temperature outside. My husband and I danced and sang in the middle of the crowd and didn’t care what anyone thought about us. We made the effort to interact with people around us that we didn’t even know and will never see again. THAT was how we were mindful…we stopped and simply paid attention and connected with what was around us.
3. Accept that you will probably feel some stress and anxiety in the next coming weeks. If we try to be more self-aware of our thoughts and feelings, then we can better cope with them. Unhelpful thoughts (I like to call them “shoulds”) can lead us to feel pressured to do too much or try and make too many people happy. It is a good idea to question where these “shoulds” come from because they lead us to feel stressed out and also keep us from enjoying the moments of the season.
I hope that all of you have a happy, healthy and MINDFUL holiday season this year!
Licensed Mental Health Counselor
All too often, there are reports in the news of children being abused or neglected. My heart breaks as I try to fathom what could possess an adult to physically or sexually harm or to fail to provide even most basic care to a child. As a psychotherapist, I am a mandated reporter of abuse or neglect and have made numerous reports to the Department of Children and Families (DCF) over the years. Those calls are never easy to make, but I take comfort in knowing that I may be the only person in a vulnerable person’s life to try to protect them.
Sadly, we tend to hear about reports incidents of abuse where DCF wasn’t able to help a child quickly enough or there wasn’t enough evidence at the time to warrant removing a child to prevent further abuse. However, reports that I have made to DCF have been investigated and acted on properly to further protect the child(ren) I was concerned about.
Governor Scott recently enacted legislation in Florida requiring ANYONE who suspects that a child is being abused or neglected to make a report to DCF. Failure to make a report in those cases is now a felony. I believe that this is a step in the right direction in making everyone accountable to report child abuse.
So what exactly do you do to make a report to DCF? Most people want to do the right thing but don’t know what steps to take. Some people are reluctant to make a report for fear of retaliation from the suspected abuser if they find out who reported the abuse. Others are unsure if they have enough “proof” of abuse and would feel terrible if they falsely accused someone of abuse without being absolutely sure there is abuse going on.
How does DCF define abuse or neglect of a child? According to the Florida Statute 39.01, child abuse means abandonment, abuse, harm, mental injury, neglect, physical injury or sexual abuse of a child. If you are unsure if a particular incident meets the criteria of abuse, review the statute online which provides a very detailed explanation of each term listed above.
Reports to DCF can be made anonymously unless you are a mandated reporter (for example: a physician, nurse, teacher, mental health professional, etc.) However, even if you give your name when you make a report, that information is NOT shared with anyone except the investigator who doesn’t disclose who made the report to the accused or the victim. It is usually helpful to provide your name in case the DCF investigator has further questions about the abuse allegations or has trouble locating the child.
You cannot be held liable if you make a report to DCF in good faith. Let’s say that your child’s friend discloses to you that her uncle molested her last week. It is not necessary to have observed the incident or to investigate if it really happened. All you are required to do is to make the report based on the information you have at that time.
Intentionally and maliciously making a false DCF report is a third degree felony and also carries a fine up to $10,000 per violation.
Making a report to DCF in Florida
There are three ways to make a report to DCF.
Before you make your report, it is helpful to write down as many details as you can about the incident of abuse and risk of further abuse. Here are some things you will be asked to provide to in your report:
Name, age or DOB, race, gender for all adults and children involved
Addresses or other means to locate the adults and children involved
Relationship of alleged perpetrator to the child
What abuse or neglect you observed or were told by the victim (when it happened, where it happened, extent of injuries, etc.)
If you do not have all the details listed above, don’t delay making a report using any information you do have. However, it is very helpful to provide as much detailed information as possible to help the investigator do their job. Personally, I prefer to call the Abuse Hotline (1-800-96-ABUSE) and speak to a person about my concerns rather than make a report online or by fax. When you call, you may have to wait on hold for a while before you speak with a DCF representative. After you provide all the details about the suspected abuse, the DCF representative will inform you during your call if your report was “accepted” and will be investigated. If your report was not accepted, it is because what you are reporting is not considered abuse or neglect according to DCF or there is insufficient information to proceed with an investigation.
There are more than 1 million children each year who are victims of abuse or neglect in Florida according to child protective agencies. Many of these victims don’t ever receive help because their abuse wasn’t reported. When parents don’t, won’t or can’t protect or care for their children, the Department of Children and Families step in to help in many ways. But, DCF can’t help if they don’t know about the abuse. Protecting our children is protecting our future!
As a licensed mental health professional, I’ve worked in a variety of hospital settings where I have worked with adults and teens who have tried unsuccessfully to commit suicide. The vast majority of those who survived their suicide attempt were so grateful to have survived their attempt. Almost all of them want to learn how to better cope with life so that they never reach a point that they feel so hopeless, desperate and impulsive again. In working with family members after a loved one’s suicide attempt, it has been challenging to explain how their loved one could reach such a hopeless state of mind that suicide was the only or best option.
As a mother to two teenage boys, one of my goals is to teach them how to manage life’s emotional challenges like not getting that job they really want, not making the varsity team, or the breakup of their first true love. Recently, I was assessing a teenage patient in the ICU who barely survived a very serious suicide attempt after the breakup of his first serious relationship. As I talked to him and his family, I couldn’t help but to ask myself “What if that were my son?” This particular young man had a very bright future academically, yet he felt so emotionally distraught that the only solution in his mind was to take a bottle of pills.
Throughout my years of practice, I’ve learned that when people are unable to acknowledge, understand or cope with emotional pain, anger, sadness, or grief in a healthy way that they typically turn to unhealthy ways of coping like misusing drugs or alcohol to numb their pain. Alternatively, they may engage in impulsive and dangerous behaviors including cutting and suicide. As a therapist, my work with these clients is to help them recognize, understand, and better cope with their emotional pain in a healthier way.
Emotional intelligence is a term that relates to one’s ability to recognize their own emotions, other people’s emotions, AND to manage unpleasant emotions in a healthy way. Studies show that people who have high emotional intelligence and emotional resiliency are much less likely to self harm either by cutting or attempting suicide or to misuse drugs and alcohol. When children demonstrate high emotional intelligence, they are more likely to use healthy coping skills and have healthier relationships with others. However, it is rare that our children’s school curriculum includes teaching about emotional intelligence, so it’s one of those things that we have to learn on our own.
How can parents influence their children’s emotional intelligence?
There are many things that parents can do to teach and model emotional intelligence and emotional resiliency to our children. In addition to teaching our children how to read, tie their shoes, and how to drive a stick shift, we need to also teach them about emotions. We need to show them that it’s okay to ask for help when we are struggling. We can normalize their emotions when they are sad, lonely, or down on themselves. We can be brave enough to share our own pain as children and teenagers like not getting asked to the prom. We can talk to our children as we watch news stories about people who deal with their anger or fear in an unhealthy or illegal way. We can support and encourage our children when they talk to us about something that is bothering them. We can avoid labeling or degrading those who seek counseling or psychiatric care for anxiety, depression or to simply improve their mental health. We need “walk the walk” and not just “talk the talk.” We need to model to our children healthy ways of coping with life’s stressors, challenges and heartbreaks. We need to have conversations about ways to manage stress with our children and encourage them to find their own healthy stress management skills. We need to talk with them about how to forgive ourselves if we make a mistake. We need to teach them to problem solve so that they don’t repeat mistakes. We need to talk to them about healthy relationships and what makes a relationship abusive. These types of conversations may not come as easily to some parents as conversations about their homework and chores. But, the payoff to your child is well-worth your effort.
It is normal to want to protect our children from both physical and emotional pain in life. Of course, most parents acknowledge that we cannot protect them from everything, but we can prepare them for life. We need to do more than tell our children not to cry, to just suck it up, to get over it, to forget about it, or to be strong. As parents, we need to acknowledge and talk about ALL the emotions we experience in life. We need to be human and share with our children how we learned to cope with our disappointments, break-ups/divorces, job losses, financial crises, and deaths of loved ones. When children, teens, and adults feel supported and capable of handling life’s emotional ups and downs, they are much less likely to reach a place of hopelessness, helplessness, and desperation where self-harm or suicide feels like the best option.
From the desk of Dana Nolan, Licensed Mental Health Counselor…
April is Child Abuse Prevention month. In my practice, I have way too many clients who suffered childhood abuse and/or neglect and now have ongoing emotional or psychological issues related to trust, self-esteem, depression, anxiety/PTSD and unhealthy relationships. My job as a therapist is to help survivors of childhood abuse work through the abuse to become happy, well-adjusted adults. Ideally, it is always better to prevent a problem than to try and fix it later on.
Florida Governor Scott recently approved laws aimed at reducing childhood abuse. Today, anyone who fails to report incidents of child abuse, neglect or exploitation can be charged with a felony. Previously, only “mandated” reporters (doctors, nurses, mental health professionals and teachers) were obligated to report known or suspected abuse of a child or vulnerable adult. The purpose of this law was to make EVERYONE responsible for reporting abuse. Historically, child abuse was considered a private, family matter and many adults failed to report abuse they observed or suspected because they believed it was “none of my business.” This new Florida law means that it is EVERYONE’S business to look out for our youth and vulnerable adults.
It is really quite easy to make a report to the Department of Children and Families services here in Florida. You simply call 1-800-96-ABUSE (1-800-962-2873) or log onto https://reportabuse.dcf.state.fl.us. It is important to have specific information ready to provide in making the report: Name, date of birth (or approximate,) race, gender, address or location of child and what exactly you observed that leads you to believe that a child is being abused, neglected or exploited. All reports to DCF are confidential and you cannot be held liable for making a report provided it is made in good faith.
Most of my clients who suffered childhood abuse or neglect have said they always wondered why no one ever stuck up for them or reported the abuse when it was observed. Please know that you CAN make a difference in the life of a abused or neglected child by being that ONE person who does stick up for them and makes that phone call to make a report.
Many people use this time of year to get a “fresh start” and make some changes in their lives. Most of the time these changes involve self-improvement like losing weight, exercising more, quitting smoking or addressing an emotional or relationship problem that has been worrisome. It is natural to use the ending of one year and the beginning of another to reflect on our lives, where we are headed and where we have been.This self-reflection can be a very insightful and positive exercise.
Regardless of what kind of change you may want to make, it is important to have realistic expectations of ourselves and to have a plan of action. When we are motivated to make a change, we are pumped up and want our excitement to translate into quick results! Unfortunately, this just does not happen as our habits are formed slowly, weight is put on over months and years, emotional and relationship problems evolve over time. But, DO NOT GET DISCOURAGED and stop your efforts to feel better and live better if you don’t see or feel results within a few days!
Here are some tips to help you be more successful with your New Year’s Resolutions:
1.Get rid of the words “always” and “never.” Don’t say that I am “always” going to go to the gym after work as there will be days that you simply can’t go every day at the same time. It is then too easy to say that “I blew it! I give up!” and just quit going to the gym altogether. Sometimes when people are going to lose weight they say “I am never going to eat chocolate again!” These statements are too rigid and absolute and don’t allow for the flexibility we all need in our lives.
2.Take your time. Lasting behavior change takes time to sink in and become routine. Additionally, our bodies need time to adjust to changes in physical activity, diet and quitting smoking, alcohol and caffeine.
3.Question why you are making a change. Are you quitting smoking because your spouse is nagging you incessantly? Are you trying to manage anxiety because your family said that you are driving them nuts? Successful life changes happen when we are able to identify what we personally plan to get out of that change. How will you FEEL if you quit smoking? Will you have more energy? Will you hopefully live longer to see your grandchildren grow up? How will your life be better if you finally get that claustrophobia under control? When we are able to connect with what WE will get out of making a change, we are far more likely to stick with it.
Best wishes for a happy, healthy New Year!
Dana Nolan, Mental Health Counselor
Tejal Parekh, RegisteredDietitian
Healthy Living Counseling, LLC
From the desk of Dana Nolan, Licensed Mental Health Counselor: It is that time of year again! We will soon be seeing television commercials or images in magazines depicting families enjoying the holidays. We see artfully decorated trees and beautifully set tables covered with perfectly cooked food. Family members all appear to be getting along and are dressed in color-coordinated festive attire.
Do we ever see a frazzled mother frantically trying to get all the food on the table while it is still hot? Where is that crazy relative who likes to tell jokes that not everyone thinks are funny? We don’t see children running around the house excitedly fueled by too much candy or cookies.
Our lives usually feel stressful enough throughout the year. The holiday season can overwhelm us further if we feel compelled to live up to unrealistic expectations of what our holidays should be like. Those “shoulds” can come from what we see in the movies or on TV. They can come from childhood holiday memories. The “shoulds” can be further fueled by pressure to keep up with the Jones’ down the road in terms how much money they spend on their children’s gifts or holiday decorations or similar stress and anxiety.
Take a moment and think about what is really important to you during the holiday season. Think back on previous holidays and pick out your most enjoyable memories and do more of those things. Stop for a moment when you think or feel a “should” about what you are doing this holiday season. Where is that should coming from? Is it a realistic and meaningful “should” that we have for our holidays? If we can let go of unrealistic holiday expectations and focus on what is meaningful to us during the holidays, then we can get through this time of year more happily and healthfully!
Therapist Dana Nolan and Dietitian Tejal Parekh will be offering presentations at the Leukemia and Lymphoma Society on Saturday, April 13, 2013. The Blood Cancer Symposium is being held at the Citrus Club in Orlando, Florida.
This is part of an educational program series provided by the Leukemia and Lymphoma Society, that provides mutual support and education for family members. If you or a loved one have a diagnosis of Leukemia, Hodgkins Lymphoma, Non-Hodgkins Lymphoma, Myeloma or Myelodysplastic Syndrome, this symposium will provide you with information about making Healthy Food Choices in the Fight Against Cancer, Cancer Treatment, and Survivorship (getting back to normal after cancer treatment). This is a great opportunity to discuss anxiety and concern with others who share the same experiences.
Dana Nolan is a Licensed Mental Health Counselor and Tejal Parekh is a Registered and Licensed Dietitian. Both professionals are members of Healthy Living Counseling which provides counseling services for cancer and other serious illnesses.
Pre-registration for this FREE Cancer Symposium provided by the Leukemia and Lymphoma Society is required. Please refer to the flyer below for more information.