Coping with the stress of a chronic condition
Adam Lawrence, Chairman of the UK HSP Support Group, and known to the Australian HSP community through his annual global surveys, has reviewed a book ‘Living with the Enemy: Coping with the stress of chronic illness using CBT, mindfulness and acceptance’ by Dr. Ray Owen. Dr. Owen is a clinical psychologist who has worked in hospital, community and hospice settings for the past 20 years.
Here is Adam’s review from his regular blog …
At the HSP Support Group AGM in 2017 Robin Pajmans recommended the book “Living with the Enemy” by Ray Owen. I got this from my library to read. I found that there were a load of useful things in this. This post is a review of the book with a few points that I found useful from each chapter.
Overall the book covers several approaches for coping with the stress of a chronic condition or long term condition. It uses Cognitive Behavioural Therapy (CBT), Mindfulness and acceptance, and Acceptance Commitment Therapy (ACT).
The first chapter “knowing the enemy” is about understanding what people are dealing with in the case of a chronic condition. Whatever coping strategy is adopted, it cannot depend on finding a cure or a solution which sends all the symptoms away. With a chronic or long term condition these are not possible. It is better to avoid being in a fight with your condition.
The second chapter “getting stuck in the struggle” describes that having a long term condition (LTC) can have a huge impact on people, physically, practically and psychologically. When in a stressful situation our natural response is either to fight or flight – both of these can be difficult with an LTC. If you are the type of person who urges to control, but your LTC is uncontrollable, it can set into unhelpful thinking patterns. The urge not to feel bad is strong, and many take the choice to miss out on things to do this – but the consequence of this is a more narrow life, missing out on things you enjoy. If you supress unwanted thoughts they will often reoccur. This chapter introduced me to the “hot cross bun model” which differentiates out what is a thought, a feeling, a behaviour and a physical symptom – and identifies which of these are in your control, and which are not.
Chapter 3, “troubling thoughts” identifies that having troubling thoughts can cause additional problems on top of an LTC. Some of those troubling thoughts are likely to be incorrect or at least distorted. Those who get caught up in such thoughts often stop noticing what is real. The chapter introduces setting up ‘rules of thumb’ to assess situations by and having a period of “worry time” each day to help resolve troubling thoughts.
Chapter 4, “unwanted feelings,” moves on to starting to accept the presence of unwanted thoughts. If you can accept some of these thoughts being in your mind, even if you dont like them, then you can avoid making them the centre of attention and free up your mind to do something more useful!
Chapter 5, “living in the present”, notes that the mind tends to wander during the day, sometimes looking at the past, at the future or other places. Whilst the mind wanders of its own accord, if you get lost in unwanted thoughts this isn’t a happy place to be and by not paying attention to the present you miss out on what is happening in the here and now. The chapter introduces present moment awareness and mindfulness as techniques to help you focus on the present moment.
Chapter 6, “who am I now? a sense of self” separates out you as a person from the LTC that you have. It is the condition that is the burden, not you. The chapter sets out the concept of accepting the present and mourning the past. If you get stuck in a set story about yourself, the changing nature of an LTC means that this has potential to end up focusing on your limitations rather than your abilities.
Chapter 7, “living with purpose” sets out a method for working out your personal goals and purpose, but in the framework of LTCs being able to get in the way of some of your important goals. Knowing your values can help set your direction and give your life a better sense of purpose/fulfilment. It is important to note that goals are not the same as values. Once you know your values you can make sure that you not continually neglecting any of these.
Chapter 8, “taking action”, has the central premise that you need action in order to make a change. Base your actions on your values, choose goals that will matter to you personally, and make sure that they are smart (specific, measurable, achievable, relevant, time-bound). Note that you cannot change the behaviour of other people (but you can influence it).
Chapter 9 “putting it together” gives example action statements to make as a commitment: “I will do [action] in service of [value] and am willing to experience [unwanted thought/feeling] if that is what it takes”.
Regular readers of this blog will note that I’ve covered similar things like this before:
It also reminded me of Stephen Covey’s Seven Habits of Highly Effective People, in which there is much more on values, prioritising tasks and focusing on what is important.
The book is widely available in book stores and online in Australia for around $30.