Managing long-term conditions: asthma and arthritis
Being diagnosed with a long-term medical condition can have a significant psychological impact, and this can vary hugely from person to person. CBT is used very effectively to help people come to terms with their diagnosis, and improve their wellbeing and functioning. In this blog, cognitive behavioural psychotherapist Daniella Doon-Joseph looks at two long-term conditions – asthma and arthritis – and how CBT can help.
“Arthritis and asthma may not seem to have many similarities, but they’re both common conditions which tend to affect people in very different ways,” explains Daniella. “10 people who are diagnosed with asthma are likely to have 10 interpretations of what it means to them. Whereas some would think ‘I know a few people who have this, and they get on fine’, others might see it as a huge life change that will hold them back, and wonder how they’re going to cope.”
For those people, their diagnosis can lead to worry and anxiety – especially if they’ve already been struggling with their mental health. They might worry about what happens if they have an asthma attack when they’re out with their friends. Would it be embarrassing? Would their friends think they were weak? Would it frighten or inconvenience them, and spoil the evening? They might decide they’d rather not chance it, and stay at home instead, then start avoiding activities they enjoy more and more. Over time this can affect someone’s wellbeing, and even lead to depression.
Being diagnosed with a long-term condition can also affect our sense of self, and shake our confidence and self-esteem. “Hearing you have arthritis, for example, can come as a real shock to the system, especially if you’ve always felt young and healthy,” says Daniella. “You might wonder how you’re going to live your life, and worry about the future: if it hurts now, what’s it going to be like in 10 years? This can lead to a mindset of avoiding activities in case they cause a flare-up.”
The physiological symptoms of the conditions themselves can also affect people’s mental health. For instance the breathlessness that comes with asthma can lead to panic, while being in chronic pain can bring low mood.
When CBT is used to help someone manage the impact of a long-term condition, it focuses on the specific and unique meaning it has to the individual. Daniella describes the process as ‘creating a pause button’.
“The condition isn’t going anywhere, so we help people learn to live well with it,” she says. “The first step is to slow down, notice your thoughts and feelings, and how you react and respond to the physiological symptoms. When you notice the pain, what does it mean to you? We get people to talk about what goes through their mind, to get a sense of the nuances in how their condition affects them.”
The therapist will also explore the impact the condition has on the individual’s daily life, to establish how they’re currently functioning. What do they do on a good day, and a bad day? Is there anything they’ve stopped? It’s important that people continue to engage in meaningful activities, and explore what else they can do that’s in line with their values.
Daniella says: “If someone’s asthma flares up in the summer when it’s pollen season, and their friends suggest a bike ride, instead of saying ‘no’ I’d encourage them to look at what they can do, and what they can control about the situation or do differently. Could they meet their friends in the pub at the end of the ride? Arthritis might stop someone standing up in the kitchen for a long time baking cookies with their grandchildren. Could they get some store-bought cookies, and decorate them together instead?”
Daniella also asks people to write down their specific worries, so they can examine them together. “It’s often less overwhelming when you put pen to paper. We tend to be catastrophic, imagining the worst case scenario – that we’ll pass out if we have an asthma attack, or let everyone down if pain hits while we’re out and about. In that case we often do behavioural experiments to test the prediction.”
Negative self-talk will also have an impact on someone’s mood, which makes it important for individuals to look at how they respond to themselves. Are they self-critical when they can’t do something? Do they question and beat themselves up? In this case, the therapist will help them to develop more self-compassion, for instance by imagining how they would speak to a friend in a similar situation.
Importantly, CBT helps people to get perspective – understanding that their condition is just one part of them. As Daniella puts it: “You are still yourself, you can see friends, be a caring person, bake a lasagne! You can choose what defines you.”
You can find out more about how CBT works here.