Dr. Linda Carlson is a globally recognized leader in psychosocial and integrative oncology, specializing in developing and evaluating complementary therapies to improve the lives of people with cancer. These include mindfulness-based programs, yoga, acupuncture and creative therapies. Known for her research creativity and productivity, she blends cutting-edge research with clinical expertise to advance holistic cancer care.
What are the psychological impacts of a cancer diagnosis?
Often the stress begins even before that, as people suspect something’s going on. They’re going through testing; often during that waiting period for test results, their mind is racing, all kinds of “what ifs”. There’s a high level of anxiety. And then, when they finally get the diagnosis, hearing those words—’I’m sorry,, you have cancer’—for many people, their mind just goes blank at that point. They don’t even hear what comes next. There’s this complete shutdown and shock, and a whole range of emotions rush through their brain, like fear and sadness, and so much anxiety around the future. For many, what is most upsetting is the fear of dying and what this will mean for their family.
How can people cope with the fear of cancer recurrence or “scanxiety”?
For coping with any kind of anxiety or worry, there’s usually two components to attend to: the physical component—what’s happening in your body with the stress reaction—and the cognitive component—what you’re telling yourself about this, what it might mean. We can calm the physical body using breathing exercises, relaxation or meditation to get the arousal level down. Then, cognitively, it’s about noticing where your mind is going. If you’re thinking, ‘Oh my God, this means my cancer’s back, I’m going to die,’ remind yourself these are only thoughts, not reality. Until you get definitive test results, your mind is just going down roads you may never have to actually travel. It’s important to remember to cross that bridge only if and when you get to it. Otherwise it always feels as if the worst has already happened, when most of the time it hasn’t. Distraction as you wait for test results can also be helpful, like going for a walk or doing something enjoyable with friends or family.
What strategies do you recommend for managing distress during cancer treatment?
I’ve studied conventional psychosocial oncology, supportive care—where you see a counselor or join a professionally led support group. That’s great. For mind-body therapies, I always suggest mindfulness-based stress reduction or mindfulness meditation, which incorporates training in mindfulness practices but also mindful movement. Yoga, Tai Chi, Qigong, relaxation therapies, imagery, and hypnosis can all be helpful. It’s just a matter of personal choice.
How can people rebuild hope during and after cancer treatment?
We need to recalibrate what we mean by hope. It can be as simple as, ‘I want to go for a walk tomorrow,’ or, ‘I hope to enjoy a meal.’ There’s always something to hope for. Tailor it to where you’re at in your life. Even if life is going to be foreshortened, hope can focus on making it to Christmas or attending a graduation, or enjoying a good meal. Hope is important psychologically and helps people live in accordance with their values.
What advice do you have for forming healthy habits during or after cancer treatment?
We need to think of these habits as part of our daily life. Prioritize self-care, schedule it, and tie it to other habits, like stretching before or after brushing our teeth, doing some breathing exercises while walking the dog, or eating a piece of fruit every morning with your tea or coffee. Accountability is also key—have a buddy, join a class, or tell your family what you’re committing to. Habits become easier after about 20 repetitions, so roughly three weeks. Start small, like a 15-minute walk or a simple change in diet. Remind yourself why you’re doing it and how good it feels afterward. And remember, you’re not going to regret taking care of yourself.
Resources Mentioned
- VA’s Cognitive Behavioral Therapy for Insomnia (CBT-I) App
- Shut-I App – A CBT-I-focused app developed by researchers to help improve sleep habits.
- Society for Integrative Oncology (SIO) Clinical Practice Guidelines on pain
- Rebecca Katz and The Cancer-Fighting Kitchen – sign-up for the CancerChoices newsletter for free access to the digital cookbook
- Fear of Recurrence Therapy (FORT) – Empirically tested therapy programs to address fear of cancer recurrence.
Dr. Linda E. Carlson’s Biography
Dr. Linda Carlson, Full Professor in Psychosocial Oncology at the University of Calgary, has held the Enbridge Research Chair in Psychosocial Oncology since 2007 and serves as Director of the Alberta Complementary Therapy and Integrative Oncology (ACTION) Centre. She is also Past-President of the Society for Integrative Oncology. Renowned for her pioneering research in mindfulness-based cancer recovery and integrative oncology, Dr. Carlson has published over 250 peer-reviewed papers and two books, garnered numerous prestigious awards, and remains an influential leader, speaker, and clinical psychologist in the field of psychosocial oncology.
Therapies mentioned
Dr. Mary Hardy, board-certified in internal medicine and a specialist in botanical and integrative medicine, has actively combined complementary and alternative therapies with traditional Western medicine for over thirty-five years in both her clinical practice and research projects. After completing her undergraduate studies at Vassar College, she returned to her hometown, New Orleans, to attend medical school at Louisiana State University. She completed her internship and residency in internal medicine at Tufts New England Medical Center in Boston, Massachusetts.
In 1998, Dr. Hardy founded the Integrative Medicine Clinic at Cedars-Sinai and participated in an NCCAM-funded research project that evaluated the barriers and facilitators of integrative medicine practice based on her clinic. She also has extensive experience in evaluating the evidence base for the efficacy and safety of complementary/integrative medicine as part of her work as a research associate at the RAND Corporation.
She is recognized as an authority on integrative medicine and herbal/natural products by organizations such as the Office of Dietary Supplements, the California Medical Board, the Canadian government, the United States Pharmacopeia, American Medical Association, the American Pharmaceutical Association, National Geographic, CBS, NBC, Discovery Channel, and the Los Angeles Times.
Dr. Hardy, the past medical director of the Simms/Mann-UCLA Center for Integrative Oncology, is a recognized leader in the field of integrative oncology. She has served as a board member of the Society for Integrative Oncology and as co-leader of the Oncology Interest Group in the Consortium of Academic Health Centers of Integrative Medicine. Dr. Hardy is also an active member of the Integrative Oncology Working Group.
She has also helped to establish the Integrative Medicine Health and Wellness Program at the Venice Family Clinic, the largest free clinic in the United States, and served as the co-director of that program. Dr. Hardy was co-director of the successful multidisciplinary clinical program for the management of chronic pain that has been established because of her team’s efforts.
Dr. Hardy is the 2020 recipient of the ABC Fredi Kronenberg Excellence in Research and Education in Botanicals for Women’s Health Award given by the American Botanical Council. She has previously served as faculty for the Georgetown University Masters Program in Integrative Medicine. She is the founder of Wellness Works, an educational and consulting service for integrative medicine.
Dr. Hardy’s current research interests include reviewing the evidence for the safety and efficacy of natural therapies, especially botanicals, as well as conducting clinical trials of dietary supplements and lifestyle choices to reduce toxicity and to improve outcomes of conventional cancer treatment. She also has a long-standing interest in patients who have shown exceptional responses during cancer care.
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