Guest blog by Toni Lindsay
The nature of working with people living with cancer is that anxiety and by extension uncertainty is ever present. This arises from the time of diagnosis, when people find their sense of knowingness to be turned upside down, all the way through to the end of treatment, or conversely the end of life. Many people seeking support at this time will be experiencing anxiety for the first time in their lives and want to know how to stop it.
If we use acceptance and commitment therapy (ACT) as a framework in this context it can provide a language and anchor for clinicians (and their patients) to draw from to develop a different relationship with not knowing. When used in this space, it can become a super power for your patients, and provide a deepening of therapy. When the emphasis is able to make space for the anxiety without the struggle of fixing it, therapy has much more room to explore the broader impacts of the cancer such as the shift in emotions, changes in relationships and the complexity of values and hope.
It’s worth being precise about what is meant by acceptance here. This is not passive resignation or ‘putting up with it’. It is a courageous, compassionate turning toward the internal experience, even when that experience is physically painful, when turning toward it is workable and helps the person keep engaging with their life. It stands as an alternative to the struggle to fix, suppress or eliminate the experience, a struggle that, however well-intentioned, tends to exacerbate suffering and pull people away from living choicefully.
ACT invites us to notice the cost of the struggle for certainty. Efforts to control anxious thoughts, suppress difficult emotions or wait until things feel safe will offer temporary relief, but they can also narrow behaviour and disconnect us from what matters. The clinical task is therefore not to persuade someone that everything will be okay, but to support them to make room for uncertainty while remaining able to engage meaningfully with their life. In an oncology context, this is key.
The cost of pursing certainty in an oncology patient is huge. The temptation is to lean into the control agenda or fixate on the things that do feel controllable (one example is restrictive diets). Creative hopelessness is often an important part of this work. It involves gently examining whether the nature of control is congruent with how they want to live their lives, even with the cancer present. A patient may have spent considerable energy analysing possible outcomes, deep diving into research, seeking reassurance, avoiding decisions or attempting to control their internal experience.
Commonly people will speak about ‘just needing to accept it’ about their cancer without connecting with the emotions of their experience. These strategies, albeit helpful in the short term often result in an increase in suffering, somewhat like the idea of the ‘second arrow’ being the one that causes more pain.
The first arrow is the pain that comes directly from the cancer and its treatment, the physical symptoms, the fear, the losses. It can’t be avoided. The second arrow is the suffering added on top by the struggle against that pain, the fighting, fixing, controlling and avoiding. ‘Just accepting it’ can itself become a second arrow in disguise, a kind of quiet suppression rather than the workable, felt acceptance ACT is pointing to.
ACT helps us recognise that courage is rarely the absence of uncertainty; it is the capacity to move with it.
ACT for cancer: Skills for supporting individuals across the cancer journey
Toni joins us in 2027 for an ACT for cancer training session. Explore how to provide structured, compassionate, and practical interventions with this diverse and often complex population, using the tools from acceptance and commitment therapy (ACT).