As founder of the Health Psychology Clinic, Joanna Konstantopoulou works directly with patients suffering with chronic illness. In this article, she sets out how psychological, behavioural, and cultural factors contribute to physical health and illness, and how psychologists can help patients work through denial towards acceptance.
- Patients with chronic illness often experience a plethora of stress, including from the treatment of the illness and the lifestyle changes it engenders.
- Many sufferers of chronic illnesses have one common obstacle: fear. But the more they learn, the more power they wield over the illness.
- By creating problem-solving approaches that are positive and efficient in helping someone during their suffering, patients are able to handle the significant changes affecting their lives.
According to the Department of Health, around 15 million people in England suffer from chronic disease. To define a condition as chronic it needs to last, regarding its effects and symptoms, for at least three months. Examples of chronic illnesses are asthma, cancer, diabetes, HIV and AIDS, and heart disease. For those suffering from a chronic illness, their lives are often profoundly affected by both the treatment of the disease itself and the stress of changing their lifestyle to meet the demands of the illness.
How can a health psychologist help?
With the support of a health psychologist, patients can learn acceptance techniques and work to address their fears. Health psychology is the study of psychological and behavioural processes during illnesses. It is concerned with understanding how psychological, behavioural, and cultural factors contribute to physical health and illness. Psychological factors can affect health directly, but when health psychology is directly applied to patients who have been diagnosed with a chronic illness, it can lead to breakthroughs in helping the individual challenge unhelpful thoughts. Individual sessions provide strategies to encourage acceptance with the creation of practical solutions and building familial support.
Many may consider the symptoms of chronic illnesses to be purely physical, but they do not understand the emotional burden behind their condition. Many of these illnesses cause a huge shift in a patient’s regular daily routine. Waking up and getting started with their day will now become a much bigger ordeal, and will likely include taking medications, doing physical therapy, struggling to tend to their personal hygiene, and dealing with negative thoughts.
Relationships are greatly affected because those suffering do not like to feel like a burden, and so they distance themselves from those around them. For patients with heart disease and asthma, daily physical activity will be significantly impacted. A regular workout routine, a daily jog, or participation in a team sport might fall by the wayside in an effort to better handle the illness.
Chronic illness lifestyle management helps patients handle these scenarios and much more. Talking to a health psychologist about their queries and concerns can help improve their understanding of what is happening. Health psychology provides the patient with an opportunity to communicate their real feelings about their unique situation.
When patients sit down in my office, my primary duty is to assess any emotional risk of the patient, take their mental and physical history, and discuss their mental and emotional state. All of this helps the patient to remember their status as a human. Regular check-ins with a health psychologist can ensure the patient sees progress throughout their treatment, addressing any difficulties they experience during their journey with a chronic illness, and adhering to self-care behaviours, e.g. meditation, proper hygiene, and physical activity.
Once patients become comfortable creating and sticking to a plan to improve their mental and emotional health, they may use therapy sessions and appointments as a chance to ask questions and better understand their situation. Many sufferers of chronic illnesses have one common obstacle: fear. Humans naturally fear the unknown, but the more they learn, the more power they wield over the illness. Knowing and understanding their condition can soon lead to acceptance of the illness, which in turn shows an increase in the success of psychological treatments.
Cognitive behavioural therapy and chronic illness
Cognitive behavioural therapy (CBT) is ‘a focused, structured, collaborative, and usually short-term psychological therapy that aims to facilitate problem-solving and to modify dysfunctional thinking and behaviour.’ This type of therapy for those suffering from a chronic illness can help patients to accept their condition and radically improve their mental state when dealing with the obstacles that come with living with their illness. An example of this would be living with cancer and undergoing tough treatment regimes such as chemotherapy and radiation. This can have a negative impact on their mental health and the ability to handle their reality. CBT can help them to accept it and come up with ways to deal emotionally with the negative physical, emotional and mental repercussions of the harsh treatments they are receiving.
Creating a problem-solving approach
Those who suffer from chronic illnesses are encouraged to acknowledge obstacles and act on their problems. By creating problem-solving approaches that are positive and efficient in helping someone during their suffering, patients are able to handle the significant changes affecting their lives. According to the National Centre for Biotechnology Information, ‘a number of simple cognitive therapy techniques can be used by primary care physicians to care for their patients with chronic diseases—agenda setting, self-monitoring, experimentation, and changing distressing thoughts.’
Creating a plan of action helps patients to see a future goal and work their way towards it in a progressive manner. They are encouraged to monitor themselves, but also to share any progress in appointments so that their psychologist can further encourage them or offer suggestions to help achieve the desired outcome (usually a state of mind, mood, or ability to adapt). The process can be difficult, it’s an experimental approach to see what works for each patient in their unique situation and environment. Trial and error require patience and hard work, something that is often lacking in these patients.
Managing denial is another crucial responsibility in this area of psychology. In my years as a health psychologist, I have seen many patients who, upon finding out they have a chronic illness, lack the understanding or experience to deal with the situation effectively, and instead deny its importance in their lives.
Some may even deny that it’s affecting them at all. My goal as a health psychologist is to work with patients to come to terms with their condition, but also with the fact that their mental and emotional state is just as important. As previously mentioned, patients may feel the need to push away loved ones when faced with a chronic illness for fear of being a burden, or even because they fear that it will become more real when it becomes an obstacle in someone else’s life.
Facing this denial is an important part of successful treatment. Patients must challenge these unhelpful and distressing thoughts. They must explore why they feel the way they do, determine if it is based in reality or fear, and find ways to deal with the negative emotions in a healthy manner. This too comes with trial and error and requires a lot of support from loved ones.
Specific examples of the ways I help those who are suffering from chronic illnesses include:
Challenge unhelpful thoughts
Patients are encouraged to challenge negative and unhelpful thoughts with rational and active thoughts to look forward, rather than dwell on the past or the present.
This can involve breathing techniques intended to slow down the heart rate and clear the mind of negative thoughts. Some examples include breathing exercises, or biofeedback training, to promote a balanced and relaxed atmosphere. It reduces the patient’s heart rate when they ‘check in’ with their mind and body to make sure they are feeling healthy, and determine where they need to focus their attention for psychological recovery.
Visual imagery exercises
Many patients who suffer from a chronic illness may see a difference in their physical appearance, e.g. gaining or losing weight, losing hair, and skin irritations. It may help them to visualise what they look like when, and if, they feel better.
Visualisation through virtual reality therapy
With the help of technology, patients who visit my clinic may also find it beneficial to experience the visualisation of a happy or relaxed place where they can escape to when their daily routine seems to be too much. It is not avoidance, it is a problem-solving approach.
Practising mindfulness and gratitude is an essential tool in remaining realistic, logical, and positive on a patient’s journey to health and wellbeing. Just taking a moment to remember that their actions and words affect the people around them and, most importantly, themselves is very important for patients to be intentional in their behaviour. Practising gratitude can also help a patient who is struggling in the early stages of their condition, or who have relapsed after a healthy period, remember that things can be good and that the people around them are there to support them.
I use these strategies for those suffering from a chronic illness to help them maintain a healthy mindset during the duration of their illness and not relapse into past negative behaviours and methods of dealing with obstacles during treatment.
While the journey of those suffering from a chronic illness is not an easy one, there are methods available to help. A health psychologist can help those diagnosed with chronic illness to handle issues head-on, build a strong support system, and face their fears, equipped with knowledge and techniques to relax their mind and improve any anxiety.
- University of Oxford. ‘People with chronic conditions are missing out on health management benefits of physical activity’, available at: http://bit.ly/2k4aNNR.
- C. A. White. ‘Cognitive behavioral principles in managing chronic disease’, Western journal of medicine, 175 (5), 2001.