Theory of Competing Antagonists

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

JUNE 13, 2018

The Wisdom of Choosing What to Worry About

I love this theory! Last week at dinner, a friend told me about this concept that was one of her grandmother’s pearls of wisdom. The idea is that it can be helpful to have more than one thing to worry about. When, for example, your anxiety about an upcoming CT scan becomes overwhelming, you can switch to another topic and worry instead about whether your daughter will lose her job as she fears. Note that for this to be effective, the competing concerns have to be fairly major problems. I don’t think it works as well if you are thinking about whether your new sweater will match a particular dress or whether it will rain on a planned picnic.

Believing that this could be a really helpful tool for cancer patients, I tried it out with several this week. One is recovering from intense treatment (chemotherapy, radiation, and giant surgery) for pancreatic cancer and grieving her mother’s recent death. To make her worries even more difficult, it is worth noting that she was going through all the treatment while her mother was dying in Florida. She would have chemo, take a few days to recover, and then get on a plane to be with her family. As we spoke, we realized that, without having this great name for the strategy, it was exactly what she had been doing. She said that she could consciously choose whether to be upset about the cancer or about her mother. Taking on both at the same time was just too much. It worked then, and it is still working.

Another example would be a couple with whom I met a few days ago. Newly married, although long together, one has recently been diagnosed with esophageal cancer and will need major surgery. Hopefully this will be all that he needs, but that decision can't be made until all the information is in. We all remember the stress and anxiety during this period of waiting and not really knowing what lies ahead. We all remember that, once there is a plan, it is a bit easier to cope. They are both feeling overwhelmed and anxious as they contend with the cancer fears as well as a sister's serious illness. Too easily, they fall into the pit of How will our family manage? and Who will die first? Neither of those thought patterns help them, and having this new suggestion to just pick one and stick with that set of concerns gave them a new and useful strategy.

A third woman is contending with a messy divorce and treatment for a Stage III lung cancer. She has not been sleeping well, feels overwhelmed by worries about her children and finances and fights with her soon to be ex-husband on the one hand and terror about mortality on the other. Being able to name this situation and to then think about how to pick and choose which to worry about was a brand new and freeing idea. When we spoke a few days later, she reported that she had slept well for several nights and could be free of at least one problem at any given time. Sometimes she could even be free of both.

And that last sentence is the really remarkable outcome. It seems that being fully aware of competing antagonists and opting to fret about one or another also makes it possible to choose to put them both aside for a while. Try it and please report back as to how well this works for you.

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