chological Issues in Chronic illness

Pychological Issues in Chronic Illness

Ursula Bates
Senior Clinical Psychologist
St Vincent’s University Hospital

Challenge of Living with Lymphodema
• Betrayal of the body
• Conflicting medical advice
• Concealing an imperfect body
• Disruption of normal activity
• Sexuality
• Increases in anxiety and depression

Psychological Journey
• Shock and Denial
        Full impact of the reality
• Turmoil in your Heart and Head
        Sad;
        Angry;
        Frustration;
        Depression
        Loss of Meaning
• Adjustment
        Feelings calm down
        Meaning is changed

Stages of Illness
• Diagnosis
• Treatment
• End of treatment
• Check ups
• Recurrence

Coping
• Coping refers to the specific thoughts and behaviours a person uses in his efforts to adjust
• Coping style is the long-term style that an individual tends to use across a variety of life situations
• Coping strategies
    – Problem focused
    – Emotion focused
    – Meaning focused

Coping and Stress
• Is this a threat ?
• Can I cope?

Stress = Perceived Demands

Perceived Resources

From Stress to Distress
Risk Factors
• Social Isolation
• Low socio-economic status
• Alcohol or drug abuse
• Prior psychiatric history
• Recent losses/bereavement
• Prior experience with illness
• Inflexible and rigidity of coping
• Pessimistic philosophy of life
• Absence of a belief system
• Multiple obligations

Cognitive Model

Thoughts
Feelings
Behaviour

Mind Body Interactions
Actively holding back our thoughts and feelings takes considerable energy. Research shows that holding back, effects our immune system, our heart and the biochemical working of our brain, putting people at risk for both major and minor illnesses
Pennebaker 1990

Why Communicate
• In 1983 Sandra Beall and John Pennebaker had 46 students write for 15 minutes a day on 4 consecutive days. Their depression was assessed on mood logs and the number of visits to the doctor used as a measure of health.
• Group A wrote about the emotional impact of a traumatic topic
• Group B wrote about the facts of an traumatic topic
• Group C wrote both about the emotions and the facts
• Group D wrote about superficial topics.

Disclosure
• People who wrote about a trauma felt worse immediately afterwards
• People who wrote about their deepest thoughts and feelings has a 50% drop in visits to the health centre
• Improved mood on follow up
• More positive outlook
• Greater physical health
• Re evaluated the meaning of the trauma
One of the essential components of emotional processing is the full subjective experience of emotions in present moment awareness
Greenberg and Safran 1987

Managing Feelings
• Goal is to be able to feel your feelings fully and express them and move on. They are the weather of your psyche.
• The expression of emotion offers a way to make sense of traumatic experiences and integrate then into a new coherent view of the self.
• This reduces the effort involved in suppression of emotional experiences and is less likely to inter with daily thoughts and activities.

Becoming aware
• Tune into yourself
• What do I feel
• Where in my body
• Expand your awareness around the feeling
• Move towards it rather than away
• Be a friend to it
• Identify the feeling
• Sad, Happy, Fearful
• Breath it in

Self Care
• Create a private space and time each day to allow your feelings to surface
• Breathing
• Checking your thinking
        Catastrophic Thinking
        Self Blame/Blaming Others
• Moving into a more constructive mindset
    I am only human
    I am allowed make mistakes

Finding Balance

• Achieve a better balance between your own needs and the needs of others.
• Going into partnership with your body
• Dealing with Feelings
• Becoming assertive and collaborative