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May, 2009

Patient Meeting GraphicThe Tips for Living and Coping (TLC) Bulletin, offering resources and suggestions to help with the challenges of living with a brain tumor diagnosis, is sent monthly to our subscribers. Let us know what topics you would like to read about in future TLC columns. We want to hear from you!

Please mark your calendars for ABTA’s 9th Biennial Patient, Survivor and Family meeting on July 10-11, 2009 in Lincolnshire, IL. Please click here for more information.

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Active Stress Management: Living Well 
From the moment of diagnosis through treatment and survivorship, brain tumor patients are faced with a number of overwhelming challenges. Some of these challenges can include: having to learn a great deal about brain tumors, treatments, symptoms and side-effects; changes and limitations in daily functioning; and having to contend with anxiety provoking medical decisions. As a result, stress may occur.

As stress is often under-recognized, it is seldom treated. Once an individual is extremely stressed out, stress can become very difficult to manage. Therefore, it is important to incorporate active stress management techniques to help you plan for, anticipate and manage your stress levels. Active stress management techniques can be a powerful, helpful tool as you strive to optimally cope and live with a brain tumor. 

Learning active stress management can help in the following ways:  

  • It can help protect your emotional resilience
  • It can ease the stressful demands of staying functional, especially if you are dealing with new mobility or neurological changes
  • It can help you stay connected to what is meaningful in your life as you go through treatment

Stress versus Distress

Stress PhotographStress management refers to an individual’s ability to manage both psychological and physiological responses to stimuli. A person who is skillful at stress management can use a wide range of strategies to cope with, tolerate, or alter a stressful situation. Distress refers to an acute symptom, resulting in either emotional and/or physical pain. Understanding the stress-distress connection is critical for brain tumor patients. For example, undergoing a chemotherapy treatment can be stressful and can lead to acute symptoms like vomiting, fatigue, or neuropathy (distress). Even when you do work through a distressing episode, there are still life stresses to return to: maintaining work, completing chores, dealing with relationships, and attending to one’s family or finances. In other words, you can cycle successfully through managing brain tumor symptoms and the subsequent side effects of the treatments, but even when you are not in acute distress, you still have to deal with the everyday stressful challenges of your life.  

Brain tumor patients need both sets of skills in their stress management plans: skills for managing acute distressing episodes and skills for handling the daily stressors of negotiating functionality and quality of life. 

The Ins and Outs

It is important to identify your stress management needs based on your sources of stress on two levels. One level is outside-in, referring to one’s social supports or lack thereof, living situation, and work or financial pressures. The inside-out level refers to the person’s ability to cope with unexpected emotions or situations that require emotional energy. 

What are some of my stressors?         

Out-side-In                        Inside-Out  

     1.                                    1.   

     2.                                    2.         

Energy Level

When developing a stress management plan for yourself, it is also important to ensure that the strategies are accessible and doable. Therefore, it is important to develop a stress management activity that matches your energy level. It can also be helpful to brainstorm with other brain tumor survivors on what techniques help them to cope. 

Try to categorize each activity as requiring low, moderate, or high levels of energy.  The following shows how the different levels may be defined: 

  • Low energy (L)—An accessible strategy that can be used daily with little effort and can provide comfort and stress relief (Examples: prayer, deep breathing, or visualization). 
  • Moderate energy (M) —A strategy that requires planning or a weekly strategy that requires scheduling (Example: making lunch dates with friends).
  • High Energy (H)—A strategy that may require time, money, or effort to implement (Example: taking a vacation).  

For example, Lissette, a brain tumor survivor who was diagnosed with anaplastic astrocytoma, formulated her plan with the help of her family.  Lissette categorized her stress management strategies by level of exertion low (L), moderate (M), high (L) providing her with a range of options to use on low-energy and high-energy days. 

  • AromatherapyGoing out with friends (M) - Weekly
  • Aromatherapy (L)  - Daily (lighting a candle, using oils)
  • Reiki (M) - Weekly (attending a Reiki group)
  • Massage therapy (H) - Monthly (due to cost)
  • Calling friends on the phone (M) - When friends are available
  • Watching a favorite TV show (L) -  Daily (watching Jeopardy)

Matching Technique to Need

Lastly, it is important to match the right stress management technique to the right need. Stress reactions can take the form of a wide range of emotional or physical sensations.  Taking a moment to identify what you need is an important step. Each stage of a brain tumor diagnosis has its own specific emotional challenges and stressors. At one phase you may need more social stimulation as a de-stressor; during treatments you may need soothing interventions to alleviate fatigue. The following questions can help you to better articulate your stress management needs:

  • What do I need help with in my daily routine?
  • If I need to release stress, what is the best way to do it, and how often?

Active stress management is a skill that can be learned. Once you adopt this model to your life, you will look forward to using it, and perhaps even enjoy experimenting and discovering new strategies for stress management on an ongoing basis. 

To access a Stress Management Plan worksheet, please click here.

We would like to thank this month’s author, Dr. Reji Mathew. Dr. Mathew is a psychotherapist/clinical instructor at New York University. She is a disability advocate and freelance writer. The main focus of her work is to promote coping skills education for persons with chronic illness and disability. Her clinical expertise is in integrative psychotherapy, particularly cognitive behavioral skills training. Reach her via e-mail at

To learn more about the resources we offer please contact one of our Social Workers at 800-886-2282 or e-mail us at Please also take a moment to visit our ABTA Care and Support Web page. While visiting, be sure to read our latest edition of “The Caring Column,” a monthly column designed to answer your questions. Click here to read more.

The American Brain Tumor Association funds brain tumor research and offers services to patients and family members in the U.S. and throughout the world. Help us spread hope by supporting ABTA in its mission.


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