Coping with the stress of reopening with Celeste Vaughan-Briggs, LCSW
As millions of Americans get vaccinated against COVID-19 infection, many people have resumed activities and gatherings that stopped during the pandemic. But not everyone is comfortable with the speed of reopening, and not everyone is represented by the guidelines that predict risk of infection in the general population. People getting treatment for breast cancer may be at greater risk, even after vaccination, and after a year of strict safety precautions, it's natural to be hesitant about returning to business-as-usual.
Celeste Vaughan-Briggs, LCSW, is manager of the Free Breast and Cervical Cancer Screening Program at Thomas Jefferson University’s Sidney Kimmel Cancer Center in Philadelphia and a member of LBBC's medical advisory board. Living Beyond Breast Cancer CEO Jean A. Sachs, MSS, MLSP, spoke with Ms. Vaughan-Briggs about the feelings people are struggling with as restrictions are lifted around the country. They discuss the risks that remain, especially for people in cancer treatment, how to discuss concerns with friends and loved ones, and how to get more comfortable with the idea of returning to public activities.
Celeste Vaughan-Briggs, LCSW
Celeste Vaughan-Briggs, LCSW, has more than 25 years of social work experience and now serves as manager of the Free Breast and Cervical Cancer Screening Program at Thomas Jefferson University’s Sidney Kimmel Cancer Center in Philadelphia. Read more.
Jean A. Sachs, MSS, MLSP
Chief Executive Officer, Living Beyond Breast Cancer
Jean began her work with LBBC in 1996 when she became the organization’s first executive director; she was named CEO in 2008. Jean brings a lifetime of women’s advocacy experience to her role as CEO. She lives LBBC’s mission everyday by speaking with newly diagnosed women about their needs and gaps in support. Read more.
Jean Sachs, MSS, MLSP (00:00):
Hello everyone. I'm Jean Sachs, the CEO of Living Beyond Breast Cancer. As you may know, at Living Beyond Breast Cancer, our goal is to provide trusted information and a community of support. And today we're going to discuss some issues that I think most people are facing, which is anxiety and stress about more businesses, schools, vacation, travel, and other public spaces open up after more than a year of dealing with the COVID-19 pandemic. So I'm so pleased to help us think about these issues.
We are bringing back — she's been with us before — Celeste Vaughan-Briggs to help us manage these issues. Celeste has more than 25 years of experience as a social worker, and now serves as the manager of the Free Breast and Cervical Cancer Screening Program at Thomas Jefferson University’s Sidney Kimmel Cancer Center, which is right here in Philadelphia. She's also a member of Living Beyond Breast Cancer’s medical advisory board. And if you want to learn more about Celeste, please go to our website, which is lbbc.org. So Celeste, I'm so happy you're with us. How are you doing?
Celeste Vaughan-Briggs, LCSW (01:19):
I’m doing well, thank you so much for having me. How are you?
Jean Sachs, MSS, MLSP (01:23):
I'm doing pretty well. It's great to have you back.
Throughout the pandemic, Living Beyond Breast Cancer has periodically taken the time to talk to experts about managing stress and anxiety and uncertainty during this really challenging time. And we know, for those impacted by breast cancer, there's really a whole other layer of issues. Fortunately more and more people are getting vaccinated. And I know in many communities, cancer patients have been prioritized and we keep hearing about returning to normal life. What we're hearing from a lot of people is, “I'm nervous about this.” So Celeste, help us understand what might be going on for some people in regards to getting back into the world.
Celeste Vaughan-Briggs, LCSW (02:12):
Okay. Thank you so much for having me to discuss this topic because it's so important. The COVID-19 pandemic in so many ways, disrupted all aspects of our lives, work, home school, and most importantly for cancer patients, their treatment, their interactions with the healthcare system. Even as we learned over the course of this last year what to predict [and] some guidance about what to do, it almost seemed as soon as we learned something, something [else] changed. So that has certainly, I think for many folks, added to a layer of anxiety, discomfort, and unease — so a lot of emotions for a lot of people going through this pandemic and for cancer patients in particular.
So this is a very important topic. And I think the first thing is we're not alone. It is absolutely understandable and common to feel uneasy even as we are getting guidance that things are opening up and for things returning to some sense of normalcy, to not be quite so sure what that really means.
Jean Sachs, MSS, MLSP (03:31):
Right. And of course everybody has been managing this pandemic a little bit differently. So it's understandable that managing the reentry is different.
So I know, Celeste, that you see people with breast cancer, as well as other types of cancer in your practice, and you have been seeing them throughout this year. What may reentry anxiety look like for someone who was also managing a breast cancer diagnosis?
Celeste Vaughan-Briggs, LCSW (04:05):
What’s interesting in many ways, some of the same tools that we had to utilize to deal with the pandemic — uncertainty, unpredictability, changing guidance and how we learn to manage that — are some of the same tools that cancer patients already had in their toolbox, because with a cancer diagnosis, most people don't expect it. They're thrust into a new world. They have to learn a new language. They have to learn what the norms are for their behavior, for their family members on what to expect with new treatments, and that piece of uncertainty.
So I think for cancer patients, one of the things that I remind folks is that some of these tools you have in your toolbox — we may need to shine them up a bit, we may need to dispatch them somewhat differently — but there may be some coping mechanisms and skills that they have used to cope with the cancer diagnosis that can be applied for dealing with the pandemic and what reentry really looks like based on their individual circumstances.
Jean Sachs, MSS, MLSP (05:22):
Right, and we talked a lot about that, that cancer patients really have had to isolate and do a whole bunch of things that the general public has been asked to do.
What are some of the triggers specific to the situation that our community should look out for? If they are invited to go somewhere or something is on their calendar and they're starting to feel anxious.
Celeste Vaughan-Briggs, LCSW (05:46):
So I think one of the good ways to prepare for this is to, one, know yourself. Where they say, physician know thyself, person know thyself. Know what you're comfortable with and not comfortable with. And that would be based on your cancer diagnosis, your discussions with your care team in terms of recommendations they may have made to you regardless of your vaccination status, in terms of how large or small gatherings you need to be interacting with, whether that [applies] to work, how often you go to work, with whom you socialize, do you socialize? So I think balancing the guidance that you've got from your care team and your own layers of dealing with anxiety. For some folks it may feel very comfortable based on the vaccination status of friends and family, in which certain activities that they are OK with going to do. It could be following CDC guidance in accordance with the recommendations from their care team would be the only way that they would feel comfortable. But I think whatever they feel comfortable with is really the good starting place to be. Not to push yourself to do something you really don't feel comfortable doing yet, even if other people are like, “We want to see you.” If you don't feel comfortable, it's OK to say not quite yet.
Jean Sachs, MSS, MLSP (07:21):
Right. It's OK to say no, which I think we always give that advice. And I've heard from some people that maybe start slow. So maybe if you haven't gone to the mall yet, or you haven't eaten outside at a restaurant, like maybe to try one thing, like don't try to do it all. Do you think that's good?
Celeste Vaughan-Briggs, LCSW (07:41):
Absolutely. Absolutely. One thing at a time and see how you feel, and make sure you have, what some folks call kind an out. A way to excuse yourself, almost a regular script. You may have wanted to meet a friend in the park, but on the day of, you just don't feel quite so comfortable. Being able to have some language ready to say, “I'm not ready to do this yet.” Whether you tell that person the whole story or a part of the story to say that, “No, I'm not ready to do this yet.” And maybe start with a smaller step, maybe outside in your backyard first, as opposed to going to a venue like a mall.
Jean Sachs, MSS, MLSP (08:31):
Right. That's good advice. I know part of the anxiety is everyone trying to figure out what is your true risk. And I think you can read 20 different articles and have different information: “you have absolutely no risk if you've been vaccinated” or you have this risk or you have that risk. We know the clinical trials were not done on cancer patients so we, we don't know if it's as effective. But do you think it's helpful for people to try to figure out their risk and then make decisions that way? Or what do you think is most helpful?
Celeste Vaughan-Briggs, LCSW (09:11):
I think what can be most helpful is a combination of factors, because part of any individual's risk assessment really ends up being very personal and then kind of going out in circles. So your first risk assessment is with yourself. Then it goes to others, whether that be your immediate family, people in your bubble. And then, out from that, folks you have to interact with. That could be your treatment team, that could be work if you have to work outside the home. And then a further circle out, maybe the public at large. And it's okay to have different risk strategies for different parts of that circle and to get consultation if needed from your care team, particularly if you are immune compromised. The American Society of Clinical Oncology has dispatched guidelines to different oncologists, so they are up to date on the most recent guidance. You really want to check in with them specifically because they're going to know you, your profile, what your blood work looks like, what your treatment protocol looks like, and then you can have a more informed decision about your medical risk.
Jean Sachs, MSS, MLSP (10:32):
Right. I know I interviewed a doctor a few weeks ago, who said, you need to remember that the CDC guidelines are really for the general public not specifically for cancer patients or other populations. That's really great advice, to talk to your doctor about it.
In what situations would you think someone should seek professional help if they're really feeling a lot of anxiety?
Celeste Vaughan-Briggs, LCSW (10:56):
I'm a little bias professionally, I always think it's helpful to check in with others, but sometimes the things that come to mind where you may want to talk to your care team about a referral to either a social worker, a psychologist, or psychiatrist with the team, either internally in the cancer center or out in the community: if you're having problems sleeping, feeling like you're sleeping a little bit more than normal, a little bit less than normal; if you find that your eating habits have changed, even beyond the eating habit changes that may have come with treatment; you find yourself eating more or eating less; you have weight gain or weight loss; if you are finding yourself, in your interpersonal relationships, having particular difficulty communicating; finding yourself wanting to be more isolated, talking less to loved ones who you may have been normally talking with quite frequently; or finding yourself more on edge, getting into conflicts more frequently with folks in your community of support where that really didn't happen before.
Those might be signs that your level of anxiety, and perhaps depression and losses that you've experienced along the way have really started to add up and impacted in your activities of daily living and functioning. So you really may want to talk to someone about that and see what the best next steps could be.
Jean Sachs, MSS, MLSP (12:38):
Right. That's helpful. It's helpful to know what's different and do that check-in. And for those that are not having as extreme side effects, but are just anxious. Do you have quick tips for things they could do to just kind of reduce the anxiety on the spot?
Celeste Vaughan-Briggs, LCSW (12:56):
Sure. The American Psychological Association has some general guidance, some evidence-based tools and strategies that impact stress and our relationship with stress and anxiety generally. So these are few good things.
For the things that we can eliminate, try to do that. Taking that personal inventory of things that don't need to be as stressful and putting that to the side, cultivating a good support network, finding ways to incorporate gentle movement into your everyday. Everybody's not going to go out and run a marathon, but you may be able to walk around the block and that could be part of your trial of safe, socially distant activities that, especially as the weather's getting nicer, it's a little bit easier to do.
It could be also meditation and mindfulness. And we think about it as you have to be absolutely still and quiet. There are activities that can be meditative that can be enriching and nurturing, like gardening or walking, cooking, that really can help reduce our stress level. And it can be great things that we can add into our day that can make a world of difference, little things, adding up to big things and big changes.
Jean Sachs, MSS, MLSP (14:30):
That's so helpful. I always reflect on, we were asked to shut down so quickly, so we went from this very full life for some of us to OK, now you're really in your bubble. And now that there's the opportunity, it doesn't mean we're then going to a hundred percent change. And I think for some people they've enjoyed maybe some of the having less activity. So I think it's okay to hold on to some of that.
Celeste Vaughan-Briggs, LCSW (14:58):
Absolutely. People have found that there were hobbies and things that they had put down because they were so busy and now that they took up again that have really been enriching and purposeful. There've been people who picked up knitting and started knitting caps and sweaters for newborns and shipping them off and feeling that, wow this is an activity that, that I find personally relaxing, but I also was able to even give back to someone else. So we want to keep some of those things that have really been enriching. Yeah.
Jean Sachs, MSS, MLSP (15:38):
I'm an avid knitter. So any final advice, any final strategies that you want to leave people with?
Celeste Vaughan-Briggs, LCSW (15:46):
One thing I would like to say is to give ourselves grace, to give ourselves a break, to be gentle and kind with each other as well. Because we're so hard on ourselves and sometimes the folks closest to us to be a certain way. That we're supposed to feel more comfortable, we're supposed to be more out there. But to have permission to be exactly where you are, because that's where you need to be in the moment until you can get somewhere else, and to be patient and gentle and kind with yourself. You deserve it, as do the persons who are closest to you.
Jean Sachs, MSS, MLSP (16:30):
That is so helpful. Thank you. I think we all need to remember that, whether you have cancer or not, but this is a good time to give yourself a break and credit for what you are doing.
Thank you so much. We always love talking with you and we know that this is a marathon, it's not a sprint. So it's going to take time for people to start feeling like they can get back to their normal life, whatever that looks like. So, thank you.
And I want to remind all our viewers that if you would like to talk to another woman who's been diagnosed with breast cancer, we have a Breast Cancer Helpline. So go on to lbbc.org. We also have closed Facebook pages if you're more comfortable doing that. So again, log on, and we can connect you with a group who can give you immediate support.
Thank you for joining us and stay safe and stay well.
Celeste Vaughan-Briggs, LCSW (17:28):
Stay safe. Thank you.