Life after a cancer diagnosis can be challenging both physically and emotionally. How we work with the difficult thoughts and emotions can influence not only our physical health but how we live our lives. In this seminar, Oncologist Rob Rutledge normalizes the roller-coaster of emotions and distorted thoughts, and offers practical ways to untangle ourselves from the thoughts that don't serve us - allowing us to choose a values-driven life of greater meaning and purpose.

1. T H E P O W E R O F R E F R A M I N G : E S S E N T I A L
S K I L L S O N T H E C A N C E R J O U R N E Y
W I T H D R . R O B R U T L E D G E
O N C O L O G I S T , A S S O C I A T E P R O F E S S O R , D A L H O U S I E U N I V E R S I T Y

2. TA K E H O M E M E S S A G E S
•Difficult thoughts and feelings are normal
•We don’t need to struggle against them
•We can choose to live a values-based life
even when difficult thoughts/feelings show up
•Self-compassion is very helpful in making
changes

3. YO U R G OA L S A F T E R C A N C E R
•Maximize your chance of recovery
•Function better, think more clearly
•Live a more meaningful life
•E.g. connect more deeply
•Grow psychologically / spiritually

4. W H AT I S C O M P L E T E C A N C E R C A R E ?
( I N T E G R AT I V E O N C O L O G Y )
• Understanding what’s happening to you
• Getting the best from the medical system
• Empowering yourself with healthy lifestyle
- Exercise, diet, sleep, relaxation techniques
• Healing with your mind
• Nurturing a spiritual
perspective

5. A G E N D A
• Thoughts are not a problem
• Principles of ACT training
• Setting your intention
• Mindfulness
• Fusion and defusion of thoughts
• Reframing difficult thoughts
• Q+A

6. C O M M O N T H O U G H T S A F T E R C A N C E R
• ‘The medical system sucks’
• ‘This is all too much / I can’t do it’
• ‘I’m all alone /
nobody understands me’
• ‘I have to be the strong one’
• ‘I have to stay positive’

8. E V O L U T I O N A N D T H O U G H T
• Humans plan for the future and learn from the past
• Thoughts are both helpful and not helpful
• Negativity bias increases our anxiety
• Two aspects of your mind: thinking and observing
• Emotions are normal
• E.g. mourn our losses
• Frustration / disappointment with medical system

9. P R I N C I P L E S O F A C C E P TA N C E A N D
C O M M I T M E N T T R A I N I N G
•ACT focuses on increasing psychological flexibility
and living a more meaningful life
•Difficult thoughts and emotions are not a problem,
but our struggle with them causes excess suffering
•‘Feeling good’ is not the goal
•Instead: Act in a way consistent with our values

11. A C C E P TA N C E
• Opening up and making room for unwanted private
experiences (thoughts, feelings, urges, sensations)
• You don’t have to ‘like’ the experience
• Instead of fighting or running away
• We make room for them – free flow, they come and go as
they choose
• This helps us act effectively and improve our life

12. Mindful
Values-guided
Action

13. CancerPEP.org
Spirit PEP
List of 20 most common values
What are your top 5 values?
• Loyalty
• Spirituality
• Humility
• Compassion
• Honesty
• Kindness
• Integrity
• Selflessness
• Determination
• Generosity
• Courage
• Tolerance
• Trustworthiness
• Equanimity
• Altruism
• Appreciation
• Empathy
• Toughness
• Self-Reliance
• Attentiveness

14. CancerPEP.org
Spirit PEP
• Authenticity
• Achievement
• Adventure
• Authority
• Autonomy
• Balance
• Beauty
• Boldness
• Compassion
• Challenge
• Citizenship
• Community
• Competency
• Contribution
• Creativity
• Curiosity
• Determination
• Fairness
• Faith
• Fame
• Friendships
• Fun
• Growth
• Happiness
• Honesty
• Humor
• Influence
• Inner Harmony
• Justice
• Kindness
• Knowledge
• Leadership
• Learning
• Love
• Loyalty
• Meaningful
Work
• Openness
• Optimism
• Peace
• Pleasure
• Poise
• Popularity
• Recognition
• Religion
• Reputation
• Respect
• Responsibility
• Security
• Self-Respect
• Service
• Spirituality
• Stability
• Success
• Status
• Trustworthiness
• Wealth
• Wisdom

15. S E T T I N G YO U R
I N T E N T I O N
• How do you want to be in the world?
• What do you hope of yourself?
• What’s most important to you?
• What really matters, deep in your heart?
• How do you want to treat yourself, others
and the world around you?
• As a ritual, going into difficult situations,
and in the middle of chaos

16. C O N TA C T W I T H T H E P R E S E N T
M O M E N T ( B E H E R E N O W )
• Flexibly paying attention
• Narrowing, broadening, shifting, or sustaining
attention
• Depending on what’s most useful
• Physical world, inner processes, or both
• Engaging fully in our experience

17. M I N D F U L N E S S
• Diverse set of skills (accepting painful feelings,
savoring experience, observing, grounding…)
• “Awarenessing”, not a thinking process
• Attitude of openness and curiosity
• Flexibility of attention – narrow to broad
• Quality of kindness, ‘heartfulness’

18. M I N D F U L N E S S O F O U R T H O U G H T S
• Imagine a transcript of everything you think
• The good, the bad, and the ugly
• When stressed / upset we often ‘fuse’ with our
(negative or exaggerated) thoughts
• We ‘get hooked’ or ‘entangled’
• If we can notice – we can choose to ‘defuse’ from
unhelpful thoughts

19. H A N D S A S T H O U G H T S A N D
F E E L I N G S M E TA P H O R
• Imagine everything you see represents everything that is important
in your life
• Slowly cover your eyes with your hands
• Look around you (through gaps in your fingers)
• How does that affect your view of the world?
• We’re disconnected, hard to focus and do things
• Set hands on lap: Easier to take action when you can see clearly

20. D E F U S I O N : U N H O O K I N G F R O M
T H O U G H T S
• Lots of different techniques to unhook (e.g. ‘I can’t cope’)
• “I am just having the thought that”
• “I’m noticing I’m having the thought that”
• “Thank you, mind, for that thought”
• Thought balloon
• ‘Leaves on a stream’ meditation
• How old is this story
• “Aha, there’s the ‘I can’t cope’ story”

22. C O G N I T I V E B E H AV I O U R A L T H E R A P Y
• Our thoughts influence our emotions
• E.g. ‘I’m useless leads’ to depression

23. Feeling Better by
Examining and Changing
Your Thoughts
With Mindfulness Awareness &
Kindness

24. 10 cognitive distortions:
1) All or nothing thinking
2) Overgeneralization
3) Mental filter
4) Disqualifying the positive
5) Magnification + minimialization
6) Jumping to conclusion
7) Emotional reasoning
8) Should statements
9) Labelling and mislabelling
10) Personalization

25. You can change your mind
• You can change the way you think and
look at things
• You can change your underlying beliefs
and thought patterns
• These will change how you see your self,
your life, others, the world
• This will change how you feel, emotions,
moods, outlook, attitude and productivity

26. STEP 1
Mindful of
Distressing
Thoughts
STEP 2
Awareness and
Inquiry
STEP 3
Kind & Rational
Response
-Acknowledge the difficulty
with kindness
-Look at the situation from
another perspective
-Encourage yourself: “I can …
-Act according to your values
Situation:

27. Mindful of
Distressing
Thoughts
Awareness and
Inquiry
Kind &
Rational
Response
Situation: Tired and irritable during chemo

28. Mindful of
Distressing
Thoughts
It’s no use!
I don’t have the
strength to get
through this.
Awareness and
Inquiry
Kind &
Rational
Response
Situation: Tired and irritable during chemo

29. Mindful of
Distressing
Thoughts
It’s no use! I
don’t have the
strength to get
through this.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &
Rational
Response
Situation: Tired and irritable during chemo

30. Mindful of
Distressing
Thoughts
It’s no use! I
don’t have the
strength to get
through this.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &
Rational
Response
-Acknowledge the
difficulty with
kindness
-Look at the
situation from
another perspective
-Encourage yourself:
“I can …
-Act according to
your values
Situation: Tired and irritable during chemo

31. Mindful of
Distressing
Thoughts
It’s no use!
I don’t have the
strength to get
through this.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &
Rational
Response
Who says you
always have to
be strong.
Sometimes to
cry and fall apart
is the best thing
to do. Then it
seems I find an
inner strength or
higher power.

32. Mindful of
Distressing
Thoughts
Awareness and
Inquiry
Kind &
Rational
Response
Situation: Delay in diagnosis…..

33. Mindful of
Distressing
Thoughts
The medical
system sucks.
Awareness and
Inquiry
Kind &
Rational
Response
Situation: Delay in diagnosis…..

34. Mindful of
Distressing
Thoughts
The medical
system sucks.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &
Rational
Response
Situation: Delay in diagnosis…..

35. Mindful of
Distressing
Thoughts
The medical
system sucks.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &
Rational
Response
-Acknowledge the
difficulty with kindness
-Look at the situation
from another
perspective
-Encourage yourself: “I
can …
-Act according to your
values
Situation: Delay in diagnosis…..

36. Mindful of
Distressing
Thoughts
The medical
system sucks.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &
Rational
Response
This is frustrating
but I can learn
how to get the
best care from
what they offer –
and I can really
make a difference
by empowering
my body

37. Mindful of
Distressing
Thoughts
Awareness and
Inquiry
Kind &Rational
Response
Situation: Tired and needs ride…..

38. Mindful of
Distressing
Thoughts
I hate asking for
help. I’m the
friggin one that
takes care of
everyone else.
I can’t bear
needing their
help. I’ll handle
this myself.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &Rational
Response
Situation: Tired and needs ride…..

39. Mindful of
Distressing
Thoughts
I’m the one that
always takes
care of others.
I can’t bear
needing their
help. I’ll handle
this myself.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &Rational
Response
It is scary but
maybe now it is my
time to receive and
be open to the love
& compassion of
friends and family.
(Spiritual lesson, a
circle of giving and
receiving)

40. Mindful of
Automatic
Thoughts
They say you
are supposed to
stay positive
but I feel awful,
angry, helpless,
filled with
despair, I’m
afraid I am
making it worse
Awareness and
Inquiry
Kind &Rational
Response

41. Mindful of
Automatic
Thoughts
They say you
are supposed to
stay positive
but I feel awful,
angry, helpless,
filled with
despair, I’m
afraid I am
making it worse
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &Rational
Response

42. Mindful of
Automatic
Thoughts
They say you
are supposed to
stay positive
but I feel awful,
angry, helpless,
filled with
despair, I’m
afraid I am
making it worse
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful thought?
4. Exaggerated,
irrational?
Kind &Rational
Response
It’s natural to
have strong and
negative feelings.
I am learning to
comfort myself
and ask for
reassurance from
others. I can work
with my state of
mind and that
helps.

43. Mindful of
Automatic
Thoughts
I hate feeling
weak and
helpless.
I don’t want
everyone
feeling sorry
for me.
Awareness and
Inquiry
Kind & Rational
Response

44. Mindful of
Automatic
Thoughts
I hate feeling
weak and
helpless.
Don’t want
everyone
feeling sorry
for me.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful
thought?
4. Exaggerated,
irrational?
Kind & Rational
Response

45. Mindful of
Automatic
Thoughts
I hate feeling
weak and
helpless.
Don’t want
everyone
feeling sorry
for me.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful
or harmful
thought?
4. Exaggerated,
irrational?
Kind & Rational
Response
I do like how kind
and gentle my
spouse/friend has
become. The
people who reach
out are so kind
and generous, it’s
a privilege to
receive the gift of
their good will
and love.

46. Family Member
Mindful of
Distressing
Thoughts
I have to be
the strong one.
Can’t let him/
her know how
I really feel.
If I fall apart,
that will make
it worse for
him/ her.
Awareness and
Inquiry
Kind & Rational
Response

47. Family Member
Mindful of
Distressing
Thoughts
I have to be
the strong one.
Can’t let him/
her know how
I really feel.
If I fall apart,
that will make
it worse for
him/ her.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful /
harmful thought?
4. Exaggerated,
irrational?
Kind & Rational
Response

48. Family Member
YMindful of
Distressing
Thoughts
I have to be
the strong one.
Can’t let him/
her know how
I really feel.
If I fall apart,
that will make
it worse for
him/ her.
Awareness and
Inquiry
1. What emotions
follow from this
way of thinking?
2. How does my
body feel?
3. Is this a helpful /
harmful thought?
4. Exaggerated,
irrational?
Kind & Rational
Response
It’s best to be honest
with each other about
feelings. Creates more
intimacy, and is truly
supportive. If I fall
apart how do I know it
will make her/him feel
worse. Maybe
consoling me will
make her/him feel
better.

49. C A N C E R PAT I E N T
E M P O W E R M E N T P R O G R A M
•Please join our trial starting in November
•Six month of daily emails with PEP videos
•Exercise, strength training
•Relaxation techniques using biofeedback
•Dietary advice
•Connection / interactive videoconferences

50. Dr. Rob Rutledge, Oncologist
Associate Professor of Medicine
CancerPEP.org

51. C A N A D I A N C A N C E R
S U R V I V O R N E T W O R K
C O N TA C T I N F O
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Instagram: @survivornet_ca
Pinterest: http://pinterest.com/survivornetwork/

52. Q U E S T I O N S F O R D I S C U S S I O N
•What automatic and distressing thoughts come up?
•About yourself, others, world outside
•E.g. medical system, sex life, relationships
•What do you do when they arise?