Coping with chronic health conditions with ACT- Acceptance and Commitment Therapy- and CBT- Cognitive Behavioural Therapy

Venetia Leonidaki July 2023

Coping with chronic health conditions with ACT- Acceptance and Commitment Therapy- and CBT- Cognitive Behavioural Therapy

Authored by Dr Venetia Leonidaki

Saying goodbye to treasured activities due to ill health can be extremely painful and leave you dealing with a living loss (non-death related loss). Coping with chronic health conditions with ACT -Acceptance and Commitment Therapy – or evidence-base CBT – Cognitive Behavioural Therapy- can hopefully help you adjust to your condition more smoothly. Here, I mainly focus on practical tips and ideas from ACT and CBT about how to ease the process of giving up beloved habits as a result of poor health. There is also a sprinkle of the philosophy underpinning adjustment counselling.

Read here about unique challenges found in letting go of things that you love due to a change in health

After the news of a life-changing diagnosis or a deterioration in an existing long-term condition sink in, the reality kicks in. This new reality often requires drastic lifestyle changes, including leaving behind cherished activities. So how are we expected to cope with such changes? Active coping is the way forward. Active coping is a coping style that helps emotional adjustment to a chronic illness through resourceful adaptations; helpful changes in attitude; and embracement of the full range of our feelings, including any so-called negative feelings. The ultimate goal is to continue to enjoy a meaningful life that is in line with one’s values even after being forced to give up certain things.

A clinical psychologist’s tips on coping with the loss of beloved activites after a change in health

Here are some tips to help you cope with giving up cherished activities due to an illness:

Double check which activities are actually okayto continue versus those putting your health at risk. This first point is as obvious as it sounds. However, fear of causing harm to your health and the old motto “better safe than sorry” could result in you limiting yourself unnecessarily without even realising. If you suffer a degenerative disc disease, for instance, your doctor may have advised you to quit high impact exercise. Sadly, you may have to withdraw from the next marathon that you had dedicatedly practising for in recent weeks. Yet, this is not the end of the road for you. Instead, look for low impact exercise options which are compatible with your condition. Take your time to do your research and don’t hold back from asking your doctor questions.

Focus on what you can do; ignore what you cannot do. Your doctor may have given you a long list of things that you cannot do as a result of your long-term condition. Focusing on this list could easily make you feel depressed. Therefore, draw your attention to things that you can do instead. So, if your favourite cakes are all over sudden out of reach due to your newly diagnosed diabetes, focus on the range of dried fruits that you can eat as a treat. If you have never tried dried fruits, this may be the time to experiment. They may not give you the same sugar rush that you used to enjoy with cakes of course. However, dried apricots and pineapple can taste delicious and are highly nutritious.

Set up manageable and realistic goals: A physical illness may change your long-term goals and how you envisage your future. If you were a success-driven person aiming high, a diagnosis of curative cancer could radically change your plans. You may have to give up a big project and focus on short term-goals about how to get through your day and attend your next treatment appointment instead. Adjust your expectations and plan accordingly. Nobody expects you to perform 100% while you are having treatment for cancer. If they do, then the problem lies with them, not with you.

Get your loved ones and colleagues on board: Don’t be afraid to ask for reasonable adjustments at work or discuss a change in your role in your household. Your environment needs to adjust to the new reality too. You may no longer be able to work long hours or carry the shopping. Your important people won’t know where your physical limits lie without you explaining, You don’t have to adopt a “grin and bear it” attitude. Being strong is not only about stoically putting up with what life throws at you. In fact, talking openly about our vulnerability takes loads of courage.

Re-negotiate your values. A long-term condition is a reminder of our mortality and brings up big questions about past, present and future. What do you want to be remembered about? What do you value the most in your life? Your illness could increase clarity over your values and even transform them. Perhaps a change in your financial circumstances stemming from your illness changes your relationship with money and makes money less important. Instead, you might start appreciating spending time with your loved ones more than ever before. Thus, be prepared to lose certain things and gain new ones over the course of an illness.

Tackle self-blame. Our anger and disappointment about losing habits that we love could easily turn inwards and transform into self-blame. If you call yourself names (“useless”) and accuse yourself of your predicament (“if only I had not been a smoker”), take a minute to pause. This type of thinking and self-talk could lead to depression, so tackle them early. Look after yourself and praise yourself for each achievement, no matter how small. Even finding the energy for a nice walk on a bad day is noteworthy.

Embrace your emotions. Losing habits that you love can set off a reaction similar to grief. You may feel sad, angry, resentful, anxious and even lost. Accept all your emotions without shying away from them. Label them, feel them, and allow your emotions to wash over you like a wave. Bottling emotions up could always backfire in the future. Further, keep in mind that people around you may not realise that you are grieving for having lost something. This is because our society is not very good yet at recognising non-death related loss. This is okay, we will eventually catch up.

Express your emotions. Open up to people close to you who are good at understanding how you feel. Whatever you feel is real and valid. Suffering with a long-term condition is life changing and extremely tough. If your loved ones do not get it, consider keeping a journal. In this way you could express yourself without needing anyone there. Alternatively, seek out people who have gone through a similar experience, as it may be easier to talk with them about your experience of giving up cherished activities.

Coping with chronic health conditions with Acceptance and Commitment Therapy (ACT) and CBT. Can therapy help adjustment to illness?

Adjusting to a chronic illness is extremely hard. In fact, there are two things that research points out. Firstly, anxiety and depression are more common in individuals suffering from health issues. Secondly, individuals with physical health problems who have therapy for anxiety and depression may not benefit as much as those in good physical health. Thus, therapy for those with a chronic illness should be specifically tailored to their unique needs in order to be effective.

In particular, psychotherapy for health issues needs to go beyond helping with managing symptoms of physical illness or the accompanying distress. Adjustment to illness counselling or CBT for physical health problems needs to approach each individual, their illness, and their environment holistically. Emotional adjustment to a chronic illness entails coming to terms with the loss of beloved habits, grieving, and coping with change. This is true for psychotherapy for cancer; psychological help for heart conditions, CBT for irritable bowel syndrome (IBS), or psychological help for diabetes to mention just a few.

What psychological therapy is best for physical health problems?

Coping with chronic health conditions with Acceptance and Commitment Therapy (ACT) and CBT CBT is particularly useful for managing symptoms of anxiety and low mood and chronic pain treatment. CBT focuses on lifestyle changes and working through thoughts and misconceptions which could make your experience of your illness worse. ACT is also useful for coping with chronic pain and illness. ACT focuses on how to live a life in line with your values and adopt an accepting attitude towards the things you cannot change. A common question is CBT versus ACT for chronic pain. However, experienced therapists will draw both on CBT and ACT techniques. Finally, adjustment to illness counselling may be most useful with offering you space to talk and process your experience and emotions. Integrative Therapy is also common for helping psychologically those adjusting to a chronic illness and the loss of treasured habits.

Book therapy for physical health problems.

Are you thinking of taking the next step and booking psychological therapy for physical health problems? Book an online therapy session to receive psychological help with pain and discuss your psychotherapy goals. We are based in Central London and offer online therapy across the UK and internationally.

If you have any more specific requirements about the therapist that you are looking for, our assessment and matching service will help you find the right therapist for you. We will reach out to our network of trusted therapists to find the best possible match. We take into account each therapist’s location, fees, and availability among other factors.

Colm Gallagher draws on CBT, narrative therapy and ACT for supporting clients with physical health problems.

Dr Venetia Leonidaki offers adjustment to illness counselling; integrative therapy for non-death related loss; and CBT for breaking old habits.