Managing your feelings about body changes

How concerns about body changes may affect you

Body image and appearance concerns may begin before your treatment starts, during treatment or after treatment finishes. How much they affect you will vary from person to person.

Before treatment, your doctor and nurse should explain what to expect. This can help you feel more prepared and may make you less anxious. Understanding more about treatment side effects and how to manage them can also help.

Some people feel more self-conscious about their body but find it manageable. Others feel their concerns are on their mind a lot of the time and find this upsetting.

You may feel:

less confident
anxious about people’s reactions to you
worried about going out and meeting people
as if you have lost a part of yourself or are not the person you used to be
worried about your relationship or about starting a new relationship
less feminine or less masculine.

You may also feel angry, anxious or sad. These are normal feelings when you are coping with cancer and changes to your body. You may feel a sense of loss.

Talking openly with people close to you about how you feel can be helpful. This could be your family, close friends, cancer doctor or nurse. Talking to another person who has been through something similar can also help. There are different types of support to help you to cope.

Some people may come to value how their bodies coped with cancer and its treatment. They may see their changes as signs of their survivorship. Other people find it reassuring that people close to them appreciate them for who they are, not for their appearance.

Getting used to body changes

It takes time to adjust to and get used to body changes. Try to allow yourself time for this to happen and be kind to yourself.

If you have a visible body change, such as a stoma, your specialist nurse should show you how to manage it. There are also support organisations that can usually put you in touch with someone who has been through a similar experience. Or you could look for support online.

Try not to put off looking at visible body changes, such as a scar or stoma. You can do this with someone close to you, your nurse or doctor, or on your own. Do not be afraid to ask others for support when you look at it for the first time. Delaying it often makes it more difficult to accept the change. At first, you may feel shocked and upset. But these feelings can lessen as you begin to get used to the change.

You could try dealing with it by looking at your body change in stages, for example:

start by looking at the area covered up
move on to looking at it uncovered
slowly build up to touching the area.

Some people find it helpful to use a mirror when they start to look at the change in their body. If you find it is not getting easier, always ask your nurse or doctor for help.

Anxiety

This is a common feeling when you are concerned about your body. Everyone feels anxious at times. But it becomes a problem when it interferes with your day-to-day life.

You may try to avoid situations or things that make you feel anxious. This may be a relief in the short term, but can make things more difficult in the long term.

Getting help to understand your fears and working towards taking back control can help reduce them. You may also realise that other people see you in a different and more positive way than you would have imagined.

There are different resources that give advice on managing anxiety. The NHS has information on stress and anxiety, and there is information on Anxiety UK's website. They also have booklets, DVDs, CDs and podcasts to help guide you at home.

Depression

It is natural to feel sad and low at times when you are coping with cancer and body changes. If this continues or gets worse, you may be depressed.

If you think you might be depressed, talk to your GP, specialist doctor, nurse or other healthcare professional at the hospital. They can listen and refer you for professional support from a counsellor or psychologist. They may talk to you about also taking prescribed drugs to help treat depression.

What you can to do help you cope with body changes

When you feel ready to start taking control of some situations, there are different approaches that may help.

Setting goals

If you have body image concerns, you may avoid social activities or doing things you enjoy because of anxiety. Setting goals can help you overcome anxiety and help you do things that are important to you. Here are some ways to help you decide which goals to set and how to achieve them.

Each goal should be:

personal – this means it important to you
realistic – this means you feel ready or able to deal with it
achievable – this means it is realistically possible
measurable – this means you will know you have achieved it
specific – this means you have thought about the details that will help you achieve it.

You can break your goal into short-, mid- and long-term goals.

Problem-solving

Struggling and worrying about problems can make you feel more anxious. Dealing with them in a structured way helps make them more manageable.

You can do this through a series of steps:

Step 1: Identify the problem as specifically as possible and write it down.

Step 2: Think of possible solutions and write down ones that may help. Think about what has helped you to solve problems before.

Step 3: Decide on possible solutions and their benefits and disadvantages to help you choose the best one. Choose one to begin with. You can always go back and try others later.

Step 4: Break the solution down into smaller steps to make it easier or more manageable.

Step 5: Try it out and follow the steps at your own pace. If it does not work well, try another of your solutions.

Dealing with one problem successfully can help you overcome bigger problems.

You may want to identify a problem and think of the solutions that can help you overcome it.

Challenging negative thoughts

It is not unusual to have negative thoughts when you are coping with cancer and body changes. But if this becomes a usual way of thinking, it can affect your mood. It can make you feel less confident and more anxious. You may ignore positive things about yourself and believe all your negative thoughts are true.

Becoming more aware of your thoughts and beliefs can help you see unhelpful patterns. You can then see the effect they have on your feelings and behaviour. This is the basis for cognitive behavioural therapy (CBT).

Recognising unhelpful thoughts helps you challenge them and think in a more positive, balanced way. Try asking yourself the following questions:

Is what I am thinking definitely right? What is the evidence for and against my thinking?
Am I jumping to conclusions, seeing the negative, forgetting the positive or getting things out of proportion?
How could someone else see this situation? What would I say to a friend in a similar situation?
What would be the effect of thinking about things less negatively?
What can I do to change my situation? Am I overlooking possible solutions to problems?

There are different unhelpful thinking patterns. We have included some examples of these and how you can change them into more balanced, positive thoughts below.

Over-generalising
When something has gone wrong in our lives, we may see it as a sign that everything will now go wrong.

Negative thought: ’Everyone will stare at me if I go to the pub.’

Balanced, positive thinking: ‘Some people will stare, probably out of curiosity. But I will have my friends with me for support.’
Taking things personally
When we feel anxious or low, it is easy to make assumptions. For example, you may think everything is related to your appearance or body change.

Negative thought: ’I didn’t get the job because of my appearance.’

Balanced, positive thinking: ‘I didn’t get the job because there was someone better suited to it.’
Mental filtering
This is when we focus on the negative and ignore the positive.

Negative thought: 'The woman in the shop didn’t understand me as my speech is so poor now.’

Balanced, positive thinking: ‘Although the woman didn’t understand me the first time, she did when I repeated it. So I can make myself understood.’
Jumping to conclusions or mind-reading
This is when we think we know what someone else is thinking without checking that we are right.

Negative thought: ’My partner will think I’m unattractive because of the changes in my body.’

Balanced, positive thinking: ‘I have other attractive qualities that my partner loves about me.’
Black and white thinking
This is when we think in extremes of all or nothing, with no grey area in between.

Negative thought: 'If I can’t eat a full meal, there is no point in going to a restaurant with my family.’

Balanced, positive thinking: ‘It would be nice to go out with my family and I can ask for a small portion of food.

When you may need help with body image concerns

If your body image concerns are difficult to cope with, talk to your doctor or nurse. Tell them if you feel anxious or upset a lot of the time, or think you may be depressed. These are normal reactions. But if they do not improve or are overwhelming it is important to get help.

You may need help if you:

find it hard to look at yourself after treatment
avoid socialising or doing hobbies or sports you did before because of body changes
feel very unhappy with your appearance or spend a lot of time ‘fixing’ your appearance
are having difficulties in your intimate relationship with your partner.

Your doctor can refer you to a counsellor or psychologist. They usually refer you for a type of talking therapy. This can help you understand your feelings better and learn new ways of managing your problems. They may also prescribe medicines to help.

Cognitive behavioural therapy

CBT is a talking therapy that helps you understand how to change your thinking. It helps you to identify and challenge unhelpful thinking patterns and behaviours.

You learn to replace unhelpful thoughts with more realistic balanced ones. You develop skills to help you react more positively in situations that make you feel anxious. This can help you to cope more positively when you feel anxious, helpless or depressed. It can be a helpful therapy for people with body image concerns.

There are online CBT services approved by the NHS that you can do yourself. Check online NHS information services in your area to see what is available.

But if you are struggling with difficult feelings it is best to talk to your doctor or nurse for advice. They can refer you to a psychologist or counsellor trained in CBT. CBT and other forms of therapy are available on the NHS. A psychologist will talk to you about what you need and set goals with you.

Mindfulness

Mindfulness helps you become aware of your thoughts and feelings without judging them or becoming overwhelmed by them. It uses techniques like meditation, breathing exercises and yoga to help you focus on the present moment.

Mindfulness-based cognitive therapy (MBCT) uses the techniques of mindfulness with CBT. Some hospitals may offer MBCT classes on the NHS.