Anyone who is diagnosed with cancer — and their close friends and family as well — is strongly affected by this news. It is as important to monitor your mental health during treatment as it is to closely monitor your physical health.

Do you tend to worry more now that cancer is a reality? It is important to focus on what is within your control. For example, consider journaling or writing down your thoughts and feelings. It also helps to actually schedule a time to worry. It may be helpful to allow yourself to experience distress in manageable doses – for example for five minutes at a time. This way you choose what you are thinking about, when it takes place and for how long. You maintain some degree of control even when circumstances can be overwhelming.

Many people benefit from worry time. Set aside five to 10 minutes a couple of hours before you go to bed in which you allow yourself to “worry” or think about the things that typically run through your mind when you lie down for bed. This way you are still in a position to do something about it (if possible) and you choose the time instead of letting intrusive thoughts creep into your mind at bedtime. This can be empowering because you deal with the “worries” at a specific time and ideally stop them from disrupting your sleep.

What has helped you cope with stress in the past? Revisit ways of coping that have been effective for you in the past. You may wish to focus on self-expression during your cancer journey. Do certain movies, music or poetry writings bring you peace and comfort? Have you previously enjoyed crocheting or needlework or always wanted to try it? These activities may include things you do alone as well as activities with other people.

Do not put your wellness on hold. Many people with cancer say to themselves, “I’ll get to it when I feel better” when considering their “to-do list” including practical matters and wellness activities. In many cases it is appropriate to put certain things on hold. For example, this may not be the best time to begin a diet.

In other cases, however, putting things “on hold” can increase distress and the likelihood of feeling overwhelmed. It is important to focus on your wellness throughout your cancer journey.

Stressors can build up (bills, lack of adequate rest, exercise or a balanced diet) and become overwhelming and create a negative cycle. People in your support system (one that is already established or that is newly gained) will likely be honored to partake in your wellness in the midst of a serious illness.

Acknowledge your emotions. Don’t reject them or suppress them. Allow yourself to experience the full range of emotions even when some seem in conflict (for example, fear and gratitude). Realize it’s okay to be distressed and that you can’t always “be positive.”

Actually, “being positive” doesn’t mean you have to feel happy and positive all the time. It’s a positive thing to acknowledge and talk about your feelings — even when you’re tired, worried, depressed or angry. Feeling sad or having unpleasant feelings doesn’t delay a person’s recovery from treatment, make the cancer grow faster or make it more likely to come back.

Feeling sad and being clinically depressed are very different. Untreated depression may decrease compliance with recommended treatments, and thus, influence cancer progression. In both cases, it is important to acknowledge and talk about your feelings with people you trust such as family, friends, church members and professionals.

Mobilize your support team. Include loved ones in your cancer journey. Many people with cancer don’t want to burden others by making requests (asking for help with meals, transportation, a shoulder to lean on, assistance with organizing appointments and medication schedules, etc.).

Realize that your family and friends want to help you in some way. It is important that you and those who care about you are a support for each other. Discuss your symptoms — and this doesn’t have to be the same as “complaining.” Reporting symptoms can help you catch a problem as early as possible, and it helps others understand how you feel and why you feel the way you do. It is important to remember that silence can be the biggest burden. It creates the burden of worry.

Be your own number one support and advocate. Take control of your health — yes, even now when it may seem out of control! Access the help you need when you need it. The support is out there. Your support team at home and your cancer treatment team (oncologist, primary care physician, nurse, psychologist, etc.) are better able to assist you when you are caring for yourself and communicating effectively with them.

How do you know when the normal sadness and sense of being overwhelmed that can accompany a diagnosis of cancer has become something more serious?

When you think about anxiety or depression, please keep in mind that many of the symptoms (loss of energy, appetite and weight changes, difficulty concentrating and trouble sleeping) may actually be side effects of your cancer or your cancer treatment. It is important to watch for the following symptoms as well:

• Depressed mood (feeling down, sad, blue)
• Boredom and a lack of pleasure or interest in activities (e.g. “I’m bored”)
• Brooding (self-pity; pessimism)
• Social withdrawal (being less talkative)
• Lack of reactivity (cannot be cheered up)
• Hopelessness/Helplessness
• Feelings of worthlessness
• Irrational guilt (sometimes resultant from a history of high-risk behavior)
• Thoughts about death beyond what may be expected within the context of your cancer experience

If you are experiencing these symptoms, tell your oncologist or primary care doctor. Or if you are a friend or family member of a cancer patient, make sure the patient’s oncologist knows about your concerns. Your oncologist may refer you to a psychologist for a formal assessment in order to identify the most appropriate treatment.

The Anxiety and Depression Association of America (ADAA) offers online screening tools where you can screen yourself or a family member for an anxiety disorder or depression. The link may be found below. Please note: The screening tests and other psychological self-tests are for educational purposes only and should not be understood to constitute any type of diagnosis or healthcare recommendation:

The American Cancer Society website includes a section dedicated to coping with cancer-related distress. It includes tools to measure your level of distress and a questionnaire that will help you determine whether professional counseling would be helpful to you. To access it, click on the following link and scroll just past the middle of the page to: “Do I Need Professional Support?” Self-Assessment Questionnaire for Patients:

National Institutes of Health (NIH) and National Cancer Institute — For reliable, comprehensive information about specific cancers.

National Cancer Institute — For information about cancers, treatments, clinical trials and resources in your area.

Cancer.net Mobile App - Accurate oncologist-approved cancer information from Cancer.Net, with tools to help plan and manage your cancer treatment and care.

American Psychosocial Oncology Society (APOS) — For information about the psychosocial aspects of cancer treatment and a toll-free helpline for cancer patients and their caregivers.

American Society of Clinical Oncology (ASCO) — For information about the advances in cancer treatment, detection and prevention and breaking news about cancer.

The National Institute of Mental Health (NIMH) — For mental health information about specific issues such as anxiety disorders and depression.

U.S. Department of Health & Human Services and MedlinePlus — For health news and specific information about cancer-related news.