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  • Michael Philp

Anxiety and chronic illness

One of the more frequent issues I see at Grove Psychology is the combination of anxiety, stress and chronic illness - be that chronic pain, or other issues related to health, for example digestion problems. Given the amount of clients that we see that present with these issues, I thought it would be useful to go through the connection between anxiety and chronic illness, and how they can feed off each other. I'll also touch on some strategies that may help to manage anxiety for people who experience chronic pain or illness.


Many of our clients are referred to Grove Psychology after they have been experiencing pain or illness for some time. It can become quite difficult to determine which one came first - the anxiety or the pain, and which one influences the other. The reality is that it's a bit of both - sometimes the anxiety makes the pain worse, and sometimes the pain increases the anxiety. What we get is a nasty feedback loop where pain, or illness, becomes enmeshed with anxiety - the two go hand in hand. These are just some of the common phrases I hear in my practice - "What if the pain doesn't go away?", "what if I make it worse?", "will this ever get better?", "I'm not the person I used to be". Does any of these phrases sound familiar to you? In the midst of ongoing pain or illness, it can be very hard to see a silver lining, that things may improve or get better. Naturally, fear and anxiety start because we start to become fearful of activities that may trigger pain or an attack of illness. For example, someone with chronic pain may avoid activities that lead to fatigue of the muscles, as that often then leads to an increase in pain. They tend to say "I can't do that" and the list of things they can no longer do grows. Or someone with a chronic illness, such as a digestive issue, may avoid going out as they become anxious about the possibility of an attack occurring in public.

The problem with anxiety is that sometimes it can cause the very thing we are afraid of. I'll give you an example - let's say person X avoids social engagements because they worry about feeling sick. When person X does have to go out (to the shops or to the doctor for example), they feel anxious, which triggers physical reactions in our body (the fight or flight response) that can bring on similar feelings of being ill. This is because the nerve pathways for feeling sick and feeling anxious are the same and it becomes incredibly hard to distinguish. As our gut has a large number of nerves, it is often termed as our "2nd brain" (as an aside, that is why we say "trust your gut"), and nervousness can set off gut reactions such as the need to go to the toilet, and vice versa gut reactions can lead to anxiety.

In pain, we have similar interactions of anxiety. So person Y has pain and feels anxious about doing a physical activity for fear that they may aggravate their injury, will unconsciously guard and protect themselves by tensing up their muscles, which contributes to ongoing pain.

Other contributing factors to illness and anxiety include personality traits such as perfectionism. People with perfectionism often hold themselves up to an unrealistic standards of things they "should" be able to do. For example, they "should" have been better by now or they "should" have been able to complete all the exercises recommended by the physiotherapist. Because they cannot, the person with perfectionism sees themselves as "failures" and may even give up on doing the recommended exercises, which can maintain the anxiety or even depression, and perpetuates the cycle.

What to do?

More recent evidence suggests that taking an acceptance approach to chronic pain or illness can help in reducing the intensity of anxiety. An acceptance approach to illness is not about taking the pain or illness away, but instead on refocusing on personal values, goals, and strengths. In my practice, I encourage a "kindness" to oneself approach and encourage an understanding that each moment is different from the last moment. That is, rather than "this is forever", we re-frame the thought to "this is this moment. The next moment might be different". As such, we can learn to focus on the subtle differences between an 8/10 pain and a 6/10. Rather than "I can't do anything", we encourage "there are some things I can do when my pain is 6/10". I'll give you another example - I recently saw a parent, who because of their injury was struggling to pick up their newborn child. Rather than "I can't hold my child", we re-framed it to "I can still hold my child, when I am sitting down".

So if you are reading this and you experience ongoing pain or illness, what can you do to help yourself at home? My two suggestions are

1) learn and practice daily mindfulness or meditation (see our blog on mindfulness here)

2) become aware of the language that you tell yourself eg "can't" "never", and substitute it with a real example. Eg. instead of "I can't exercise" change to "I can walk around the block". This small change can make a difference for your mental health.

Of course, there is still the possibility that you may experience ongoing anxiety even when applying these two strategies. If that is the case, please click on the 'book now' button and schedule an appointment with one of our experienced psychologists.

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