It is common for people to search for an explanation to help them make sense of a situation and why it may have happened to them. Within a cancer context, people often want to understand what caused their cancer and what they did that may have resulted in a diagnosis.
In this episode Charlotte explores the thinking behind causal beliefs and breaks down the common elements and lifestyle behaviours people think may have contributed to their diagnosis. We also learn about risks associated with casual beliefs and discover the acceptance model.
This podcast was recorded in February 2023
We recommend that listeners exercise self-care when listening to this podcast, as some may find the content upsetting. BCNA’s Helpline provides a free confidential telephone and email service for people diagnosed with breast cancer, their family and friends. Our experienced team can help with your questions and concerns and direct you to relevant resources and services. Call 1800 500 258 or email email@example.com.
Upfront About Breast Cancer is a production of Breast Cancer Network Australia. Our theme music is by the late Tara Simmons and this episode is proudly brought to you by Sussan.
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Ad: [00:00:00] This podcast is proudly brought to you by Breast Cancer Network Australia. Looking for practical information to help you make decisions about your diagnosis, whether DCIS, early or metastatic breast cancer. BCNA’s My Journey features articles, webcasts, videos and podcasts about breast cancer during treatment and beyond to help you, your friends and family as you progress through your journey. It also features a symptom tracker to help you manage the changing symptoms you may encounter during your own breast cancer experience. My Journey, download the app or sign up online at myjourney.org.au. Welcome to Upfront About Breast Cancer - What You Don't Know Until You Do: Unlimited with Dr. Charlotte Tottman.
Kellie [00:01:02] Welcome back. I'm Kelly Curtain and you're with Dr. Charlotte Tottman as well and it's good to be upfront with you. Episode three is all about causal beliefs, and that translates to theories about what caused my cancer and believe me, everyone has one. But why does it matter? We're going to explore how your beliefs can affect your behaviour both positively and negatively during and after treatment and provide some strategies to help.
Charlotte [00:01:30] Yes we are and there's more of these than probably anyone realises.
Kellie [00:01:35] Before we get started, a reminder that this podcast series is unscripted and doesn't replace medical advice nor represent the full spectrum of experience or clinical option, so please exercise some self-care when listening as the content may be triggering or upsetting for some. Charlotte, causal beliefs. Why does it matter what we think caused our cancer?
Charlotte [00:01:58] It usually matters because it can affect how we then think, feel and behave in the not so much during treatment, but particularly in the aftermath of treatment when we're trying to kind of, like, live in that post cancer world. So just to explain a little bit, first of all about our title, which is sugar, stress and misdemeanours, that kind of reflects the big three that I see in my clinical work. It's really common for humans to reflect on the period before they were diagnosed and come up with an explanation as to what caused the cancer. Because if they can come up with an explanation and eliminate that from their life, so for example, if it's stress or sugar and eliminate that from their life, then they can feel safe and so people like that feeling of control. They like an explanation. It allows them to feel like their risk of recurrence is less and that their fear of recurrence is then less as well. So there's a really big link between causal beliefs and fear of recurrence.
Kellie [00:03:02] So there are top three of perhaps what people believe cause their cancer.
Charlotte [00:03:07] Well, the research and I've looked this up recently because I always like to find out whether the research is consistent with what I see in my clinical work and it absolutely is. So in a big meta analysis that was done in recent research, the finding was that nearly half women who have a breast cancer diagnosis attribute the cause of their diagnosis to stress and that's huge. That's like nearly one in two. So what people usually do, and I see this in my therapy room all the time, is they reflect on the couple of years before diagnosis and just about all of us can find some stress in the last couple of years. You know, it might be a rocky relationship period, it might be something that's happened within the family, it might be a nasty situation at work, it might be more than one thing, or it might be like a traumatic event. So people can really easily identify a period or an event that they perceive as particularly stressful and then they make a link between that and their cancer diagnosis. And that's not unreasonable and I'm not here to in any way kind of dispel people's, the reality of their stress. That's all very real and and likely to have had a negative impact on them. What we don't know for sure, and you know, if we're all alive in 50 years time, we'll be having a different conversation about this, but what we don't know for sure is what is the impact of stress on cancer definitively. And I've got a little bit more to say about that in terms of some other research, but we'll come to that in a minute.
Kellie [00:04:40] So there's stress, which in some ways is out of your control because no one intentionally stresses. What about those that beat up on themselves about either their lifestyle behaviours, their weight, their alcohol or other things that are in their control but choose to have done anyway?
Charlotte [00:04:59] Yeah, I think that that kind of falls into two categories. Sometimes it's those lifestyle behaviours where it might be things that we've chosen to perhaps, you know, overindulge in. So it could be things like alcohol, it could be smoking, could be a poor diet, you know, perhaps being not very mindful about our nutrition and exercise habits. And the second category falls under the classification of sort of misdemeanours, which is where people kind of look back over their life and think, have I been a really bad person? Have I broken some rules, have I crossed some lines?
Kellie [00:05:38] That's karma.
Charlotte [00:05:39] Yeah, exactly. It's karma. In fact, I was only reading a post by a young guy in Adelaide who was diagnosed with not with breast cancer, with another cancer in the last few weeks and his line was like, in terms of his explanation for what had happened was like, have I really been that bad a person? And so we're very good as humans at A, wanting to find an explanation for things, but B, we're very good at using negative situations as opportunities to bash ourselves and this is another one of those. And, you know, I don't think that self-reflection and replaying the tape is all bad. For some of us a little bit of that, you know, I can review my behaviour and perhaps be a bit more accountable to myself and maybe look for opportunities to grow and improve, you know, there's nothing really bad about that. But you can have, like anything, you can have too much of a good thing and if you're already going through something as tough as a cancer experience, I'm not sure that it's a really grand scheme to self-regulate.
Kellie [00:06:46] Is there anyone that doesn't have a theory about what caused their cancer?
Charlotte [00:06:51] I mean, sometimes people will say it's just random chance. It's like the opposite of winning lotto. I mean, I guess, you know, you could interpret that as not a theory, but I mean, if you like, that's a theory in itself, you know, so it's still an explanation. It might not be a link between anything that they've done themselves and it might not be a link to an external factor like stress, but I haven't met a person who hasn't thought about it. I mean, it's one of the things I cover in a first session with clients. I sort of poke around after we've gone through their whole cancer sort of story and then I ask them like, have you got any theories about why this happened? And everybody has. Yeah, I don't think it's only for some people or only for most people, I think it's a for everyone.
Kellie [00:07:37] So there's nothing to suggest at this stage that stress actually causes cancer. Can it make it worse?
Charlotte [00:07:45] And this is the study that I'm going to talk about. It’s done in 2010 and I do use this study in therapy quite a lot because I don't want to invalidate anybody's experience or perspective or perception of their own situation. I really don't want to ever do that, but I also want to help people, you know, engage their rational brain and give them good information. Because sometimes when we're looking for information, we rely on past experience, we rely on doctor Google, we rely on maybe not really high quality information. So this is a study that was done in 2010 and it's a mice study, and the reason it was done with mice is because we'd never get ethics approval to do this sort of study with humans. And mice physiologically and somewhat bizarrely are quite close to humans. So this group of researchers got a bunch of mice, healthy mice, and they divided the group of mice into two, and they put one group of healthy mice in a stressful condition and the other group of healthy mice in a non stressful condition for the same duration. And at the end of the duration they tested the mice to see how many mice had grown tumours and they found no significant difference between the mice in the stressful condition and the mice in the non stressful condition, so that was a little bit interesting. Then they took all the tumour mice, so all the mice who'd grown tumours and they divided that group in two and they put half the tumour mice in a stressful condition and half the tumour mice in a non stressful condition for the same duration. And at the end of the duration they tested how much the tumours had grown and they found that for the mice in the stressful condition, their tumours had grown at a faster rate than the mice in the non stressful condition. So the conclusion that the researchers came to was that stress probably doesn't cause cancer, but if you've got cancer, it's not good for you.
Kellie [00:09:49] So that would apply to those, whether it's early breast cancer, but also for someone with metastatic.
Charlotte [00:09:55] Definitely. And when we do see this in, you know, conversations often that oncologists have with patients, once they've kind of got through the hospital based treatment, so you know, you've got through the surgery and the chemo and the radiation. And, you know, during that time, most people, including your oncologist, probably feeling like you're fairly safe because you're in active treatment, this stuff is known to work so we probably don't need to be too worried about conversations about stress going forward until you get to the end of that period and you starting to talk about the period post treatment adjustment, reclaiming your life, going back to things like work, study, caring obligations. And that's where it's important to start thinking about your stress levels. And that can be conversations with your oncologist, it can be conversations with people like me and principally what I guess the foundation part of it is, is that stress is a part of life. I've had a lot of clients come in to me at this sort of juncture at the beginning of post treatment adjustment, at the end of hospital based treatment, and more or less say, I want you to help me live a life with no stress. I don't want any stress in my life because they're scared of stress, because they believe that the stress caused the cancer. And my first gentle response to that is kind of a version of, well, good luck with that, because life is stressful. It just is. And even if you arrive at a moment, and it really would only be a moment, when you could honestly say, and I'm not sure I've ever had one of these where you could honestly say, Oh, I'm there now, I'm in that place, I've got no stress. That will only last for probably minutes to hours, and then something will happen and you'll be back in a stressful situation. You know, you'll be running late to pick up one of your kids from school, and there'll be a red light that you'll feel stressed.
Kellie [00:11:39] I was going to say, What's the yardstick for stress? Is it being stuck and late for a meeting? Is it having your flight cancelled? Is it something more dramatic? I know it's all relative, but how if someone does have cancer, if someone is worried about recurrence and they are wanting to reduce stress, how can they make it like real life for them?
Charlotte [00:12:09] So the point about it being relative is is correct and like so many things to do with cancer, but to do with life generally, you know, it is very individual. And what is very stressful for one person may not be felt is very stressful for another, and what feels stressful today in me might not necessarily evoke the same stress response in another week's time. So you know, it's usually what we say multifactorial. There's usually a lot going on that contributes to how stressful something feels. When we feel stressed, as humans, we often have stress hormones or stress chemicals released in our system, things like adrenaline and cortisol, and in small amounts for short amounts of time, that's not all bad. Things like adrenaline can sharpen your focus. It can be actually quite helpful in a threatening situation. But if it goes on for too long, it can feel very unpleasant. It can do bad things to you physically and the let down after a big spike in adrenaline leaves you feeling absolutely wrung out and exhausted. So we don't, if we can help it, none of us want to have a whole lot of stress and a whole lot of those chemicals flooding our system. Then there is a big difference between what we call acute stress and chronic stress and the sort of stress that we're talking about trying to manage better is probably more chronic stress. So acute stress is that sort of thing of like, well, you get bad news about a family member and things are really tricky for a week and then things settle down. And it doesn't mean it's easy or in any way pleasant, but it's relatively short term. That's a very different model than chronic stress, which is where you're living with a high level of anxiety or stress or what we call your stress load burden, which is like, you know, how many rocks are in the rucksack that you're carrying on your back every day, trying to develop ways to maybe on one level, reduce the number of rocks you're carrying and on another another level, get you in the best shape you can to carry those rocks.
Kellie [00:14:11] So am I right in thinking that stress, for example, of the bad news of the family member. That's completely out of your control and you can't see that coming. So that comes and like you said, it moves on versus almost your daily life being completely stressful. When someone wants to try and reduce that stress or reduce the cause of what they believe was the cause of the cancer, whether it was stress, whether it was lifestyle behaviours, too much of good things, or not enough of good things. Then that could possibly prompt a very radical reaction. They want to remove those threats.
Charlotte [00:14:53] Yes, like an overcorrection. Exactly. And people can, and that's one of the reasons that I poke around in this space with clients is exactly that, where people are so scared and may not even really realise how scared they are of what they believed to have been the cause of their cancer, that they then develop a very rigid belief that unless I live a life without that thing in it, then I'm not safe. And so they can then spend a large amount of time and energy, emotional, physical, practical, even financial, trying to get their life in a place where there isn't any stress or there isn't any sugar or there aren't any chemicals. A little bit of that isn't a bad thing, you know, reducing your processed sugar intake. No one’s going to say that's a bad thing, but trying to live a life where there is not a single ounce of sugar, that's almost impossible. And the problem then is that if you've developed a rigid belief that says I can only be safe, I can only cope, I can only feel okay, if I do not have a single grain of sugar in my life, and then for circumstances beyond your control, you end up having some sugar, your whole system will feel like it's going to crack and you will feel absolutely like you're going to come undone for something that really, in the whole scheme of things, probably shouldn't cause that reaction. And it's not really about the sugar per say, it's about the belief that you've developed around the need to not have it in order to feel safe.
Kellie [00:16:20] And in addition to that, I would imagine that that new rigid lifestyle or whatever changes you've made to try and protect yourself also has a flow on effect to those around you.
Charlotte [00:16:32] Yeah, because most people aren't living in isolation and that's so much of what this issue is about, is that if you can live in an environment where you can control all of the variables, then I guess, sure. I mean, make as many changes as you like if you can have that 100 per cent control, but I don't actually know anybody who's got that sort of life. We often live in social groups, with family members, even sometimes with housemates and friends, but if you are then in a situation where you've got a bunch of now very rigid rules that you've got in place to protect you, you may then find that the people around you who are not engaging with the same rigid belief, and whose behaviours haven't changed and still want to have pizza and Coca-Cola on a Friday night, that they struggle with your newfound evangelism in this space. That sort of evangelistic, you know, we are going to do things differently and it's going to be 100 per cent this way forever and ever can be quite hard to live with. But the other thing that can set up in the person who's dealing with the causal belief and the fear of recurrence is frustration that other people aren't getting it and aren't on board with their plan because that can feel like, well, doesn't it matter that I'm, you know, we need to do this to keep me safe? Aren’t I worthy of that sacrifice? And secondly, it can set up worry about your family members because the belief that may be stress or sugar or something else has caused your cancer is often not limited to you. It can feel like, well, if I don't do this for our whole family, then my loved ones might also be at risk. And so it's not just about keeping me safe, it's about keeping everybody else safe.
Kellie [00:18:17] And again, that's pushing your causal beliefs onto others... Learn from my experience.
Charlotte [00:18:27] Right. Learn from what I've been through. And I think it places the person who's gong through and been through the cancer experience in that, sort of, position of having to almost persuade other people to like, you know, why can't you understand why this is important? Why can't you make the sacrifice to, you know, maybe eat more vegetables and drink less alcohol? And certainly I have heard many, many women in my consulting room frustrated with worry about the health of their husbands, because having been through their stuff and kind of stared death in the face, which is what you do on diagnosis, they then don't just worry about, well, what if something happens to them further down the track? They start to worry about, well, what if something happens to my husband? And, I mean, broad generalisations, but, you know, there would be a lot of husbands, middle aged husbands, who probably haven't also looked after themselves, and that can again then be the source of relationship tension where there wasn't any before.
Kellie [00:19:30] And stress.
Charlotte [00:19:30] Exactly. And so, again, in our quest to have less stress, often the rigidity around that in fact, creates more stress. And so we end up, and this is one of the fascinating things in psychology generally, is so often our behaviour ends up getting us more of what we don't want. So I get caught in this loop where I'm so scared about the thing I think cause my cancer that my main reason for being now, my mission on earth, is to keep that thing away from me, out of my life, but that takes so much emotional and physical energy that that causes stress. And so then I'm caught in this, kind of, vicious cycle.
Kellie [00:20:17] It reminds me also of the snow globe theory that we talked about in series one, that when you get a diagnosis, your whole life is shaken up like a snow globe and the pieces come down in a different way in your life. And that makes sense for you but it often doesn't make sense for everyone around you.
Charlotte [00:20:39] And I think this is a really important connection between causal beliefs and snow globe stuff, and snow globe and causal beliefs in small, flexible doses are fine. You know, there's no problem going, I need to do better with stress or I need to have a bit less sugar or drink a bit less alcohol or do a bit more exercise or change my work hours a bit. They are modest and that's representative of what we call psychological flexibility. The issue with this stuff is when it becomes, kind of, 100 per cent and it's all about control and rigidity. So if people are listening and they're thinking, yeah, I mean, I hope Charlotte's not saying that I shouldn't, you know, reduce my alcohol or I shouldn't, like, do more exercise. Oh, no Charlotte's very happy if you want to make some healthy lifestyle changes. What Charlotte is going to be concerned about is with anything if it's rigid. So if I say to myself, even with something as healthy as exercise, if I said to myself the only way I can cope and feel safe for the rest of my life is that if I walk 10kms every day. Now, that's alright, that sounds pretty good, doesn’t sound too dangerous. The problem then is that if I have a busy week or I hurt my ankle or I have to suddenly drop everything to tend to somebody else's needs and I can't walk my 10kms on one particular day, my whole system will start to shudder because of the rigid belief that that's the only way I can be safe. So the issue isn't the exercise, it's the rigidity of the causal belief.
Kellie [00:22:19] I'm a little loathe to say it, but the old moderation and balance.
Charlotte [00:22:24] Yeah, exactly.
Kellie [00:22:25] Which sounds a bit sort of twee, doesn't it? Especially for someone who is trying their very best to make sure that their cancer doesn't return or it doesn't progress. So it's understandable to want to do that but you really are saying you've got to find the middle ground.
Charlotte [00:22:43] You've got to find the middle ground. And that flexibility and really psychological flexibility, is something that we're going for generally in all aspects of life. And that's the idea that we can have desires. We can have the imperative to make some some healthy changes to our life, cancer related, non-cancer related, but as long as we maintain that flexibility because that allows us, if you like, wriggle room and then we can cope with interruptions and changes, and that's what life is full of.
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Kellie [00:23:47] When we talk about having a theory as to what caused your cancer, your causal belief, is it probable that you're never likely to really know for a fact?
Charlotte [00:24:00] Yeah, You're really never likely to know for a fact. I mean, in breast cancer, we really don't have causal factors other than genetics. You know, if you've got a gene mutation that you're aware of, so something like a BRCA gene, you might be at very high risk, but other than that, in general, there's very little else that's causal. It's not like lung cancer where it's kind of like, you know, smoking causes lung cancer. We are learning more about alcohol and certainly there are some research out at the moment that does indicate that with any big number of breast cancer diagnoses, there are a small number that can be kind of more directly attributed to alcohol. But it's certainly not the case that if you drink any alcohol, you will get breast cancer. I mean, if that were the case, you know, every single person I know would have breast cancer, so it's not that simple, but it's also known to be a risk factor.
Kellie [00:24:59] That's a really interesting point, because when we see things in the media, when we hear health messages, you know, smoking causes cancer, drinking causes cancer, so that really prompts a fear response.
Charlotte [00:25:16] And it’s meant to, it’s meant to.
Kellie [00:25:18] Is the message here then though, increases your risk doesn't cause.
Charlotte [00:25:23] Yes and look, it's a very delicate area and I don't want to in any way dilute the health messaging around things like, you know, obesity, drinking, smoking, healthy lifestyle behaviours. But I also don't want people to then use their previous behaviours as definitive evidence that that's what caused their cancer, because that can lead to tons and tons of self-blame and that's very psychologically damaging. So, you know, most people, not everybody, but most people who will have had a breast cancer diagnosis will probably have had some alcohol in their life and so if all of them attribute their breast cancer diagnosis to that alcohol, I think that would be a flawed conclusion. But the other risk is that if we misattributed one explanation for the breast cancer diagnosis, the risk is that we then take our eye off things that actually otherwise might be important. So again, it comes back to that kind of flexible thinking and everything in moderation. If I think that, you know, I could eat and drink anything and do no exercise and have a really stressful life, and that wouldn't have any consequences. That's probably not really smart thinking. If that's at one end of the spectrum. If the other end of the spectrum is like, I have to never have any stress, don't drink any alcohol, don’t eat any sugar, exercise like a demon, then that's also not really workable. So it's about kind of finding, as you said, the middle ground where I can do a bit of everything healthy and a little bit ideal as long as it's only a little bit.
Kellie [00:27:19] And I would suggest also that it's a gradual thing so if you are overweight, you don't go and start running marathons.
Charlotte [00:27:27] Yes. Integration into your life. Absolutely.
Kellie [00:27:30] You are a trained clinical psychologist specialising in cancer related distress. Did you have a theory about what caused your cancer?
Charlotte [00:27:42] Mine probably fell into the, at least for a for a few moments, probably longer than a few moments, to be honest. It probably fell into the camp of misdemeanours. So I had a really dreadful relationship with my mother in particular, and not a great one with my dad and they both died from cancer when I was in my twenties, so I haven't had them around for a long time. But you know, I did some of the reflection and review and you know, as we do, beat myself up and went, I said to my therapist, you know, do you think this is Mum and Dad getting me from the grave? And he set me straight. He validated and said, you know, I completely understand why you think that, because he'd been seeing me for, you know, a very long time and he understood the horror of my family relationships. And he said, Now, pop, you rational back on. And, you know, so he gently just reminded me that my parents may have had a lot of power over me while they were alive but, you know, I don't think that they really think...
Kellie [00:28:50] They can wave the cancer stick.
Charlotte [00:28:51] I don't really think that but it was interesting how my brain just did it anyway. You know, it's that whole thing between the emotional mind and the rational mind. My rational mind knew what my emotional mind was doing, but my emotional mind just did it anyway.
Kellie [00:29:07] And I'm sitting here thinking, if a clinical psychologist who specialises in cancer distress, with so many years of experience, can still be vulnerable and at some point can't stop her mind racing to that point, then it makes it very understandable that your causal beliefs are your causal beliefs, and that could be just about anything.
Charlotte [00:29:28] It could be just about anything. And that's where it is really important, obviously, as part of my job but even for people going through cancer, to understand that, you know, this stuff might not sound like it makes much sense.
Kellie [00:29:39] Yeah, I'm sure many people go, oh don't be ridiculous.
Charlotte [00:29:41] Exactly. And that can feel very isolating and dismissive. And actually, the most helpful thing that my therapist could do was say to me, I completely understand why you think that because then I could kind of let go of it a bit more easily. In terms of, like, you know, do I think what else might have caused it... We have a lot of cancer in our family. When I was younger, when I was about 30, I actually went to the genetics people and said, you know, what do you think? We've got, you know, two parents and four grandparents all dead from cancer. Got to be a chance and they were like, yeah, no, I think you're all good. Well, we've revisited that but interestingly, even when we revisited it four years ago and actually did the testing this time, it was not found to be genetic. So I suppose that was my, kind of, my scientific theory and that didn't stack up either. And this is what I do find, and this is the causal belief stuff, is where people do often partly because they've sort of reflected on life before cancer and thought, well, if I've only got one life and I don't know how long that life is going to be, you know, do I want to live it exactly the same way as I was before? And some of that might be just because of how much fun they were getting out of it, or not. And some of it might be because they've made this link between things like stress or lifestyle choices and the cancer diagnosis. And yes, I think if we all had an unlimited budget and the freedom to, you know, make large scale changes to our life without any consequences, well, maybe some people would. But if you're in your middle years and you've got kids and a partner and a mortgage and a life. And I know, you know, I certainly went through this where it was a big part of me that just wanted to chuck the whole lot out and just, you know, start again. I've no idea what that looks like and I have clients who feel the same way, but it's not practical. And so then that again, sets up some frustration because it's like, Whoa, okay, well then how do I get the happiness and the life that I want? But also how do I get the safety and how do I feel like I can safely live the next part of my life? And that's where I work with clients to do probably a combination of change and acceptance. So some is about making the changes that you can reasonably so like, in my case, I took my workdays down to four out of five of my consulting days, down to four out of five, and I say no to things and I garden like a maniac and do a lot of exercise. And I encourage clients to make those sorts of what I'd call, you know, very workable, modest changes that fit within the framework and the structure of their lives. Once you start looking at changes that are going to cause, you know, more like little tremors or even earthquakes in the structure of your life, that's when I start to get a little bit uncertain with my clients. And we work to maybe come back from that because that can create more problems than you've already got.
Kellie [00:32:43] So little changes for the good and to reduce the stress.
Charlotte [00:32:48] Yeah, and we've got a whole episode where we're going to talk about behaviour change and the principle sort of underpinning theory of that is small incremental change over time is sustainable. If you do the big structural change, often that isn't sustainable. It's like a crash diet. You can do it for a week, but then after that you get back to how you were behaving before. It's like, you know, I use the language a lot, lean into things, but it's finding a way to work with the situation rather than really push back hard against it. Pushing back hard against something is resistance and is more likely to cause energy or fracture, whereas leaning into something and finding a way to work with something means that it is that analogy of like kind of riding the wave, you know, finding the way that works for you.
Kellie [00:33:34] Charlotte, you mentioned acceptance. What do you mean by that?
Charlotte [00:33:37] So when we get to a point where we've maybe identified some modest changes that we can make and we might even actually get on and make them, then it's kind of back going, Alright, well we've got a life that then feels a bit safer, it feels a bit more manageable, it feels a bit less stressful but I still then want to encourage my clients to incorporate the reality of some stress in their lives. So then it's about going, okay, well if we accept and that's the acceptance bit. If we accept that there is going to be some stress. Some stress is going to be acute and that's that stuff we can't control, and some stuff is going to be chronic and that's some of the stuff where we might have made some changes. What can we do to actually give ourselves the best chance of coping? And that's where I talk about the four pillars of coping. And they are, and none of this will be news to any of you who've listened to the first series, they are sleep, exercise, nutrition and activities with purpose and meaning. What that looks like for everybody is a bit different. Sleep, for me of those four, is probably like my number one vulnerability. So if my sleep is off then look out, the rest of it is all important and I pay attention to all of it, but sleep is like my number one. And so I guess in this series, what we're looking to do is raise everybody's awareness about things. And so sometimes it's good to just reflect on that and think, okay, we'll have sleep, nutrition, exercise and activities with purpose and meaning, what feels like your number one vulnerability and therefore the one that perhaps deserves the most attention. Nutrition and exercise are fairly self-explanatory. Activities with purpose and meaning is very individual. And so what works for me is not necessarily going to work for somebody else. And that's where my gardening obsession is probably my activity with purpose and meaning. You know, I come home from work and I get into my gardening clothes and I'm out there for a couple of hours in the twilight and it's just glorious. I connect with nature and I forget about work and I forget about other stress in my life. I'm grounded and all my senses are ignited and it's really good for me. But I mean, some people would think that that sounds dreadful.
Kellie [00:35:46] I'm sure many would. So can I be the, you know, the thorn and say, what about activities that are possibly a little bit more indulgent?
Charlotte [00:35:57] Yes. Well, and that's where I think the, when I say activities with purpose and meaning is the important language, purpose and meaning is essentially about things that are aligned with our values that kind of speak to us about being important in the way that we think and feel and view the world. So doing things that are just indulgent doesn't necessarily reduce stress. It might make you feel good in the moment. You know that Tim Tam or that glass of wine, but that's not really what I'm talking about. The activities with purpose and meaning that bring stressed down are where you do something and you feel good about it. You feel like that's filled up my cup a bit. Not my wine glass. Now, having said that, just a clarification. I definitely, in terms of, you know, my own changes to my life, I definitely drink less now than I used to and I'm much more mindful about it and I'm more comfortable about saying out loud, I'm not going to drink alcohol this week or I'm going to have one glass rather than two. But I'm no saint and I don't want to in any way be that evangelist because that would be completely disingenuous. But it also occurred to me when I was talking before that, you know, we can get into that mindset of thinking I drank too much alcohol and that's what caused my cancer. But we haven't yet conclusively proven that if you don't drink alcohol, that you don't get cancer. It goes back to the thing that we said before, which is kind of everything in moderation.
Kellie [00:37:26] Yes, some really helpful and useful discussion and you'll be able to find some links to those points, including BCNA resources in the description of this episode, in your podcast app or wherever you're listening. This podcast series has been made possible with thanks to Sussan. If you found it helpful, you might like to share it with someone you know, and we would love your feedback too. So make sure you leave your review and a rating. Coming up in our next episode with Dr. Charlotte Tottman is living with metastatic disease. We're going to be upfront about what it means to live with an incurable disease. It's the reality for many, and it's really important to have these conversations. I'm Kelly Curtain, we hope you'll join us.
Ad [00:38:19] BCNA’s Online Network is a friendly space where people affected by breast cancer connect and share their experiences in a safe online community of support and understanding. Read posts, write your own, ask a question, start a discussion and support others. You're always connected, which means you're never alone, as our Online Network is available to you at every stage of your breast cancer journey, as well as your family partner and friends. For more information, visit bcna.org.au/onlinenetwork. Coming up in episode four of Upfront About Breast Cancer - What You Don't Know Until You Do: Unlimited with Dr. Charlotte Tottman. Bittersweet: Living with Metastatic Disease.
Kellie [00:39:06] Is there room for hope?
Charlotte [00:39:07] So hope is really important, but you can have too much of a good thing. So I make the distinction between what I call realistic optimism, which is hope and unrealistic optimism, which I call denial. So one of the other things that I see in women living with metastatic disease is that they are incredibly resilient to keep going in the face of a very high degree of uncertainty about your life like, so it's not just uncertainty, but it's uncertainty about how long you might live and what the quality of that time looks like. Living in that space is really challenging and it does require, if you're going to kind of cope best with that, it does require fairly high attention to being able to engage in things that do fill up your cup and that do make you feel good and get you out of your head because otherwise you can spend way too much time with the shot clock.
Ad [00:40:03] This podcast is proudly brought to you by Sussan. Our theme music is by the late Tara Simmons. Breast Cancer Network Australia acknowledges the traditional owners of the land and we pay our respects to the elders past, present and emerging. This episode is produced on Wurundjeri land of the Kulin Nation.
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