Coping with Cancer and How CBT Can Help


A cancer diagnosis can feel like a crashing wave of change, affecting your body, your lifestyle, even your very identity.   How do you cope without letting negativity take over?

There are well-established techniques to help stay afloat and honor your complex emotions while keeping intrusive thoughts at bay. CBT, or Cognitive Behavioral Therapy, is a framework built to manage the relationship between your thoughts, emotions, and behavior. 

An evidence-based strategy, CBT helps those dealing with cancer navigate what Dr. Ian Sadler, psychosocial oncology specialist at the Columbia Pancreas Center, calls the five vital symptoms of treatment: fatigue, pain, insomnia, anxiety, and depression.

“It is really about learning to become the strategic manager of sad, painful, anxious thoughts,” says Dr. Sadler. “Intrusive thoughts lead to sad emotions and those emotions lead to negative behaviors. It’s about catching yourself at the thought level.”

This form of psychoeducation empowers you to explore why you’re having the thoughts in the first place. “Your nervous system just got 1000 volts, and you’re operating on this fight or flight level; you can’t sleep or think straight,” says Dr. Sadler “We can’t control our thoughts, but we can learn to manage them in a more adaptive way.”

We don’t have to believe every thought we have. Many of them are based in feeling instead of fact. Instead of falling into well-worn patterns, give yourself a break and find more compassionate ways of talking to yourself. When an intrusive thought plunges forth, catch it and give it air for a moment, then put it on trial:

  • Monitor the thought. Identify it as it occurs, say hello. Write it down.
  • Observe when it happens. When do you tend to have a negative thought? Is it triggered by an event or conversation?
  • Acknowledge your feelings. Allow the feeling to fill you and identify how you feel when these thoughts take over. What happens to your body?
  • Gently challenge the thought. Is it based in feeling or fact? Is it helpful?
  • Develop a relaxation cue. Use negative thoughts as a cue to start breathing deeply until all your muscles relax. Lower the volume in your head, open up your posture.

“Intervene at the right time, before the thought takes hold. Challenge the evidence and activate new behavior,” says Dr. Sadler. “Behavioral activation is based on the theory that we become depressed when we tend to increase avoidance and isolation. That isolation then maintains or worsens the symptoms.”

CBT is not meant to be a one-size-fits-all approach. Treatment is different for everyone. Sometimes mindfulness meditation and self-compassion training are key components or making yourself take a walk outside every day, other times CBT techniques can be supplemented with antidepressant or antianxiety medications to provide much-needed relief.

Everyone learns to cope with a cancer diagnosis in their own way, but integrating guidance from mental health experts into a comprehensive approach to cancer treatment can help.  Dr. Sadler recommends a few office visits to explore your feelings and immediate challenges, and together develop the right strategy for you. “Our goal is to take the stigma and self-blame out of being ill, and help you feel as calm and comfortable as possible at every stage of your journey.”

Learn more about the Psychosocial Oncology Program at the Pancreas Center.