As we have come to understand that the mind and body cannot be separated when we look to treat chronic conditions, the importance of therapy has become more evident. Being diagnosed with and living with chronic conditions comes with a lot of complex feelings and having someone to support you through those waves of feelings and experiences can be incredibly beneficial. However, much like seeking therapy for anything else, not every approach and not every therapist will be right for your specific needs. Here are 3 evidence-based therapy approaches to consider for chronic pain and illness:

CBT

Cognitive Behavioural Therapy (CBT) has been considered the “gold standard” therapy for many mental health concerns over the last decade due to its evidence-based nature. CBT involves identifying unhelpful ways of thinking and learned patterns of unhelpful behaviour and re-evaluating and adjusting those thought patterns and coping skills to better respond to situations. This can be helpful with those who experience chronic conditions as it is common to get stuck in patterns of cyclical thinking associated with limitations or changes that relate to our conditions.

When working with a therapist that uses CBT you may be invited to incorporate behavioural strategies like activity scheduling, and activity pacing into your routine to help improve the psychological and, in some cases, physical symptoms you experience.

Activity Scheduling:

Have you noticed that you decreased your participation in activities you typically enjoy and limit how often you socialize, go to events, or even leave your house? That’s a completely normal response to a diagnosis of a chronic condition and learning to adjust to a new way of life, activity scheduling helps by encouraging these activities taking into consideration your current needs and levels of functioning. The natural response to isolate or limit enjoyable activities can increase feelings of depression and anxiety and allow you more time to focus on your physical symptoms which in turn increases your disability. Activity scheduling helps you plan events, activities and social activities you enjoy while considering any needs for rest before or after the activity, transportation, etc. It helps to remove the barriers that may easily result in you changing your mind and not going to something you were looking forward to. Activity scheduling can also be used for everything in your life from cooking dinner to running errands, especially when you need to consider your spoons for the day (see previous post on spoon theory).

Activity Pacing:

If your chronic pain or illness is new to you and not something you’ve lived with for a long period of time, one of the most discouraging experiences is learning the limits of your energy have changed. Sometimes this can lead to isolation or not even attempting to do something for fear of having to “give up” earlier than you’d like. Activity pacing teaches you to be mindful of your limits so that you can better balance your needs for rest with activity. Finding the middle ground between doing nothing and doing too much is something we all need help with sometimes, and this is especially true when our bodies are putting some physical limitations on us. However, finding this balance can empower you to return to a place where you feel in control of your life and your body.

ACT

Acceptance and Commitment Therapy (ACT) stems from CBT with greater focus on encouraging clients to pay attention to thoughts that avoid, deny, or force them to struggle with their emotions and instead accept the appropriateness of their responses and reactions to particular situations. ACT places a lot of importance on finding what you value and working towards those things in life rather than worrying about managing and fixing “negative” things or emotions. Over the years ACT has gained more and more research support for a wide range of concerns including chronic pain and illnesses.

ACT promotes psychological flexibility by helping you to acknowledge and accept the full range of your thoughts and emotions while distancing yourself from reactions and focus on distressing thoughts and feelings which often lead to increased symptoms and harm. ACT teaches you not to judge your emotions and responses but understanding why and how those emotions and reactions are appropriate in the present circumstance. Actions and goals should not focus on avoiding distress and discomfort alone, they should be aligned with your values and what you want in life. You may work through activities similar to those in CBT such as activity scheduling, pacing or creating values lists.

MBSR

Mindfulness Based Stress Reduction (MBSR) is an 8-week program designed originally to complement medical treatment in the management of chronic pain and stress-related disorders. It has since shown benefit in a wide range of concerns from depression to people living with cancer. The research shows that MBSR can help improve mood, sleep, fatigue, pain ratings, psychological distress and overall quality of life.

According to MBSR, mindfulness is “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally…” MBSR encourages observation on the changing internal and external stimuli and experiences as they come up. Mindfulness, despite the media’s approach to it, does not always need to mean strict meditation practices, it can be incorporated into daily life in the form of cooking, baking, art, cleaning, and walking.

The 8-week course teaches various ways of incorporating mindfulness into daily life from those mentioned above to yoga, and guided meditations. Mindfulness is practices in each session working from short amounts of time like 15 or 20 minutes up to 45 allowing you to practice different techniques and find what works for you with the support of your therapist. The goal is to leave the program noting some benefit to your symptoms present at the beginning of the program and identifying mindful practices that you will easily and consistently be able to incorporate into your daily life. Conclusion These are by no means the only options available for those living with chronic conditions. Other therapeutic approaches you may want to explore include EMDR, somatic therapy and grief work. Finding a therapist with knowledge in chronic pain/illness will allow you to explore the approaches most beneficial for your experience and needs.

Resources:

What is CBT? https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

What is ACT for chronic conditions? https://www.nami.org/Blogs/NAMI-Blog/April-2020/How-I-Use-ACT-and-CBT-to-Help-People-Cope-with-Health-Conditions

MBSR for Chronic diseases: https://www.researchgate.net/publication/46147351_Mindfulness-based_stress_reduction_for_people_with_chronic_diseases

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