Emotional stages of a breast cancer diagnosis

Many people ask themselves, “Is what I’m feeling normal?” or “Is it all right to feel this feeling?” Just asking those questions is normal. Each person’s response to breast cancer is different, and it is possible to feel many different emotions at the same time.

Some people realize that all they want to do is move forward. This may be a time when you put your feelings aside, sometimes without even knowing it, to focus on your treatment and other decisions.

Know that however you’re feeling, many people have felt the same way you do at this moment. Be patient with yourself. This is a significant part of the breast cancer coping journey, and it will help you take the next steps with your treatment.

The feelings that come up after a breast cancer diagnosis can sometimes mirror the five stages of grief identified by psychiatrist Elisabeth Kübler-Ross in 1969. These may be familiar to you, and include denial, anger, bargaining, sadness and depression, and acceptance.

Although the stages of grief are sometimes labeled with numbers, people don’t always experience them in a certain order or for a certain amount of time. “When diagnosed with breast cancer, it is common to experience a loss of certainty, security, innocence, and contentment,” says expert Kelly Grosklags, LICSW, BCD, FAAGC. “The five stages of grief, as we know them, are a familiar foundation. However, this is not necessarily how everyone processes. We’ve come to learn that grief reactions do not happen in a timely or organized manner. Some have believed you only experience an emotion once and then done. It is important to embrace all the feelings, no matter how many times they surface. Grief is more of a spiral: an ever-moving and evolving experience related to loss.”

Here, you can learn more about the stages of grief and how they sometimes play a role in emotionally processing a breast cancer diagnosis.

Denial

Being hit with news of a breast cancer diagnosis can be completely overwhelming. The overwhelm can trigger what’s known as denial, which can feel like shock, numbness, or disbelief.

Denial: Things to consider

Denial is a normal response to an abnormal situation. It’s not something we always consciously choose. Denial can be a self-protective way of pacing ourselves in processing an overwhelming event. As psychiatrist Elisabeth Kübler-Ross wrote, “Denial and shock help us to cope and make survival possible… It is nature’s way of letting in only as much as we can handle.” As denial starts to fade, it becomes more possible to feel emotions such as fear or anger.

If you’re experiencing shock and numbness for an extended period after your breast cancer diagnosis and it feels difficult to move forward with breast cancer treatment planning, it’s important to let your healthcare team know. Ask them to connect you to supportive resources, such as your cancer center’s social worker, to help you move through the feelings of denial.

Anger

Anger is a necessary stage of grief, and a normal feeling to have after a breast cancer diagnosis. Anger can surface at any time during or after diagnosis or treatment. Sometimes a diagnosis triggers anger because it feels like life is no longer under your control. You may feel anger if friends and family react in a way you don’t expect, or because cancer can change your daily life as you know it.

If it feels like you’re experiencing anger all the time about things in your life besides breast cancer, take a moment to see if those things are the true source of your anger. For instance, are you suddenly angry about something that doesn’t normally make you angry? Figuring this out can be challenging sometimes, but it can also bring a greater sense of control. A therapist or social worker can be supportive in helping you process anger.

Anger: Things to consider

Anger can be expressed in healthy or unhealthy ways. For some people, it can feel safer to express anger than more vulnerable feelings such as sadness or fear. Other people can feel very uncomfortable about expressing anger. But it’s important to express anger as soon as you realize you’re feeling it. Holding onto anger increases the risk of expressing it in a way that’s not healthy, such as taking it out on someone you love. Unexpressed anger can lead to depression.

Here are some safe ways to release anger:

• Physical activity such as exercise
• Sharing your feelings with someone you trust
• Writing down your feelings

Bargaining

Bargaining is another way the mind tries to find a sense of control after a breast cancer diagnosis. Psychiatrist Elisabeth Kübler-Ross introduced the idea of bargaining as feeling like “we want to go back in time: find the tumor sooner, recognize the illness more quickly, stop the accident from happening… if only.”

Bargaining comes from a place of pain and loss. It’s normal to think about things we “could have” done to prevent what’s happening now. Focusing on “could haves” or things you can try to do “next time” is a way of trying to find some control over feelings of regret and loss. It can even result in blaming yourself for what happened. But being diagnosed with breast cancer is not your fault — at all.

Bargaining: Things to consider

If you find yourself in an emotional place of “could haves” and “should haves,” it’s important to know that nothing could have prepared you for a breast cancer diagnosis. There is nothing you did that was wrong.

If you can, experiment with simply sitting in the present moment: feel your feet on the floor, notice your surroundings, feel your breath as it passes in and out of your nose. Sometimes this can make it easier to come out of a “what if” focus and feel more grounded in the now. However you are feeling right now, know that there’s space and time for you to make decisions about your path forward.

Sadness & depression

Sadness, emptiness, and depression are natural responses to the feelings of loss that can come with a breast cancer diagnosis.

Depression can include feeling hopeless, numb, or irritable. With depression, you may feel like crying more than you normally would. There can be a lack of motivation or an urge to withdraw from family and friends. Physically, there can be a lack of energy or trouble sleeping. Sometimes depression happens because you feel powerless, helpless, or guilty about needing help from loved ones.

Sadness & depression: Things to consider

It’s OK to feel sad or empty after a breast cancer diagnosis. Being able to feel sadness is a normal part of grieving after a sense of loss. If sadness and depression are difficult to tolerate, there are ways to ease these feelings:

• Reach out to trusted friends and family and let them know how you are feeling
• Spend time with a pet
• Express your feelings through writing, art, or music
• Nurture yourself with healthy food or a hot bath

Feelings of deep sadness and depression that can be diagnosed can be different, and it’s not always easy to tell the difference. If you’re struggling with ongoing sadness or depression, it’s important to let your healthcare team know. Your team can refer you to supportive professionals such as a therapist. A therapist can help you work through your feelings, and help determine whether antidepressant medication is appropriate for you.

Acceptance

The idea of acceptance doesn’t mean that what happened is OK. It's a word that describes coming to terms with a new reality, and slowly adjusting to this new reality as it is. As Elisabeth Kübler-Ross wrote, “Finding acceptance may be just having more good days than bad ones.”

Acceptance also does not mean that other feelings such as fear, anger, or sadness are gone, or that they’ll never return. It’s a feeling that you can start to piece together decisions for your future, even if other emotions come and go. It may be easier to reach out to loved ones and connect.

Acceptance can also be a feeling that you’ve grown a lot in a short amount of time — you may feel very different than you did when you first received the news. You may even feel an inner strength you didn’t know you had.

Acceptance: Things to consider

When you start to experience acceptance, often, hope follows. Some people feel as though they’re regaining a sense of personal power as they start to make decisions about next steps. It can also feel empowering to read or watch stories about others who’ve been diagnosed and are leading active lives.

Remember to take time to treat yourself well through these emotional phases and to realize how far you’ve come already. Allow yourself to keep doing the things you like to do and spend time with the people you love as you plan your next steps.