By Maya Coseo
Studies suggest suicidal ideation among people with chronic pain is twice as likely; they also are more susceptible to anxiety and depression. But the interrelationship between mental health and chronic illnesses such as autoimmune diseases is not yet fully understood. Providers often oscillate between overemphasizing and underemphasizing mental well-being—with patients stuck in the middle.
The mind-body divide
Clinical psychologist Rachel Zoffness, MA, MS, PhD, believes physicians unfamiliar with chronic, sometimes-invisible diseases often focus only on a single aspect of care. “There’s no such thing as a condition that affects a human being that only targets the body and doesn’t impact how we’re doing or feeling,” says Zoffness, who has personal experience with a chronic condition and whose subspecialty is pain psychology.
Pain is biopsychosocial, Zoffness says: Biological, psychological, and sociological factors all influence its manifestation. Neuroscience has revealed that the limbic system—the emotional center of the human brain—is connected to pain. So negative emotions, experiences, or trauma “actually amplify the pain you feel,” she says. Without considering this, doctors may struggle to provide effective care.
Lucy Dunning, BS, MEd, EdS, is a therapist and owner of Blue Sky Family Counseling and Coaching, which serves North Carolina, South Carolina, and Georgia. Dunning, who has type II complex regional pain syndrome (CRPS) and neuropathy, believes some doctors overemphasize or misunderstand psychological symptoms. Anxiety and depression can be pre-existing conditions, but they aren’t always. Doctors may read pain-related psychological symptoms as psychiatric rather than as resulting from a chronic health condition.
Zoffness and Dunning concur that people with chronic health conditions experience anxiety and depression differently, and as such, medical professionals must alter their approach to care for those patients. “I have yet to meet anyone with a life-changing condition who is not anxious and depressed,” Dunning says.
Treating the whole person
For treatment, Zoffness recommended finding a pain or health psychologist, since they receive specialized training. Cognitive behavioral therapy (CBT), which seeks to change thinking and behavioral patterns, has been useful for her both personally and professionally. Biofeedback, which empowers patients to learn to control body functions like heart rate and breathing, and mindfulness-based stress reduction are also useful.
Zoffness underscores the importance of socializing, rest, and regular movement. Inactivity is “the worst possible thing because our mood crashes, and stress and anxiety goes up. And our bodies get stiffer over time with lack of movement,” she says. Gentle activity, as well as physical and occupational therapy, can be useful antidotes.
“Setting small goals is huge,” Dunning says, as is finding acceptance, because “that’s where the real growth starts to happen.” Alongside individual therapy, family work can provide extra support and education to loved ones. Dunning also suggests acceptance commitment therapy (ACT), which “uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility,” according to the Association for Contextual Behavioral Science.
Other modalities include art therapy and the coaching model approach, which focuses on goal-setting and finding quality of life. Yoga and massage can improve mental health, too.
Self-education is also useful. Zoffness’ The Pain Management Workbook helps readers navigate painful conditions, and Dunning suggests Amy Orr’s Taming Chronic Pain: A Management Guide for a More Enjoyable Life. Self-advocacy is vital, too. Dunning stresses the importance of finding a therapist whose beliefs align with yours and with whom you have a good rapport. Asking potential providers about their experience treating people with chronic health issues, preferred methods, and feelings on working alongside other doctors can be helpful. Most importantly, Dunning says, people shouldn’t be afraid to seek treatment if they have feelings of anxiety, depression, or hopelessness.
Regardless of the specific strategies used, if doctors want to more effectively help patients with chronic illnesses, they have to take a comprehensive approach.
They must “target all the things, the biological stuff, the cognitive stuff, the emotional stuff, the behavioral stuff, the social stuff, and the sociological or the environmental stuff,” Zoffness says. •