UNIT 5

MANAGEMENT OF CHRONIC ILLNESS

• It involves both medical and psychological interventions

• Aimed at improving the QoL of the individual
• It includes monitoring symptoms, taking prescribed medications and making
lifestyle adjustments to cope with the illnesses
• Effective management requires regular health care check ups

Quality of Life (QoL) and Chronic Illness

Quality of life (QoL) refers to an individual’s overall well-being, including physical health,
emotional stability, social relationships, and the ability to engage in meaningful activities.
For individuals with chronic illness, QoL is often affected due to ongoing symptoms,
treatment side effects, and lifestyle changes. However, with proper management and
support, individuals can still lead fulfilling lives despite their condition.

Importance of Quality of Life:

• Enhances Overall Well-being: Good QoL promotes better physical and mental
health, leading to greater life satisfaction and emotional resilience.
• Improves Health Outcomes: A higher QoL is associated with lower levels of stress,
improved immune function, and better recovery from illnesses.
• Boosts Psychological Resilience: People with a good QoL tend to cope better with
life challenges, including chronic illnesses, disabilities, or difficult life transitions.
• Increases Productivity and Engagement: Individuals with good QoL are more likely
to be productive at work or school and actively engage in their communities.

Emotional response to chronic illness

• Chronic illness can trigger a range of emotional response including frustration, fear,
sadness, anger or helplessness.
• These emotional responses are normal and understandable but they can also
interfere with coping with adherence to treatment.
• Coping with these emotions effectively is key to maintaining mental wellbeing
during the course of the illness.
• Some common emotional responses include denial, anxiety, and depression.

1.Denial
 • Denial is when a person refuses to accept their diagnosis or downplays its
seriousness.
• It’s a defense mechanism that helps them cope with shock and fear.

Example: Someone with diabetes might ignore their doctor’s advice, believing they don’t
need to change their diet or take medication.

2.Anxiety

• Anxiety is feeling constantly worried or fearful about the illness and its impact on
life.
• People may stress about their health, medical treatments, financial costs, or how
the illness will affect their future.

Example: A person with heart disease might feel anxious about experiencing another heart
attack, leading to excessive worry.

3.Depression

• Depression involves persistent sadness, hopelessness, or a loss of interest in

activities.
• Chronic illness can make a person feel helpless, isolated, or like they’ve lost control
over their life.

Example: Someone with arthritis may feel frustrated that they can no longer do simple
tasks without pain, leading to feelings of worthlessness.

Personal issues in chronic illness

Chronic illness affects not just physical health but also a person’s identity, goals,
relationships, and sense of self. The impact can be seen in four key areas: Physical self,
Achieving self, Social self, and Private self.

1.Physical Self

Chronic illness often changes how a person views their body. Symptoms like pain, fatigue,
or disability can lead to frustration or a loss of confidence.

Example: A person with rheumatoid arthritis may feel discouraged because they can no
longer do tasks they once did with ease.

2. Achieving Self

This refers to personal goals, career aspirations, and productivity. Chronic illness can
interfere with work, studies, or hobbies.
Example: Someone with multiple sclerosis may struggle to continue working full-time due
to fatigue and mobility issues.

3. Social Self

Relationships with family, friends, and society may change due to illness. People might feel
isolated, misunderstood, or burdensome to others.

Example: A person with a chronic condition may avoid social gatherings because they fear
judgment or cannot participate like before.

4. Private Self

Chronic illness can impact a person’s inner thoughts, beliefs, and future plans. Some may
feel a loss of control or struggle with their sense of identity.

Example: A young adult diagnosed with a lifelong illness may worry about how it will affect
their dreams of travel, marriage, or having children.

Coping with Chronic Illness

Coping with a chronic illness involves more than just managing physical symptoms—it
requires emotional, psychological, and social adjustments. Several factors influence how
individuals cope, including cognitive appraisal, coping strategies, social support, health
behavior change, illness identity and adjustment, and the biopsychosocial model.

1.Cognitive Appraisal

Cognitive appraisal is how a person interprets their illness—whether they see it as a

challenge, threat, or manageable condition.

Example: Two people with the same diagnosis may react differently—one may feel
hopeless, while the other may see it as something they can adapt to.

2. Coping Strategies

Coping strategies are techniques individuals use to manage the emotional and practical
challenges of their illness. These can be:

• Problem-focused coping: Actively finding solutions (e.g., following a treatment plan,

making lifestyle changes).
• Emotion-focused coping: Managing feelings through relaxation, therapy, or
mindfulness.
• Avoidance coping: Ignoring or denying the illness (which can be harmful in the long
run).
Example: A person with diabetes who learns about nutrition and follows a meal plan is
using problem-focused coping, while another who ignores their condition is using
avoidance coping.

3. Social Support

• Support from family, friends, and healthcare providers plays a crucial role in coping.
• Emotional support (listening, encouragement) and practical support (help with daily
tasks) can reduce stress.

Example: A person with cancer may feel emotionally stronger when surrounded by loved
ones or when participating in a support group.

4. Biopsychosocial Model

This model explains that coping with illness involves three interconnected factors:

• Biological factors: The body’s response to the illness, including symptoms and
treatment effects.
• Psychological factors: Thoughts, emotions, and coping mechanisms that affect how
a person deals with their illness.
• Social factors: Relationships, support systems, and environmental influences that
impact coping.

Rehabilitation

Rehabilitation for chronic illness focuses on helping individuals regain independence,

improve quality of life, and manage their condition effectively. It involves physical,
psychological, and social aspects, ensuring a holistic recovery process. Key components
include:

1.Biopsychosocial Assessment

This assessment looks at biological (physical health), psychological (mental well-being),

and social (support systems, relationships) factors affecting the patient.

Example: A person recovering from a stroke may need physical therapy (biological),
counseling for depression (psychological), and family support (social).

2. Patient Education and Empowerment

Educating patients about their illness, treatment options, and self-care strategies gives
them control over their health.
Example: A diabetic patient learning about blood sugar management can prevent
complications.

3. Pain Management

• Many chronic illnesses involve persistent pain, requiring a combination of medical

and psychological approaches.
• Strategies include medications, physical therapy, mindfulness, relaxation
techniques, and cognitive-behavioral therapy (CBT).

Example: A person with arthritis using both medication and yoga to manage pain.

4. Social Support and Relationships

Strong relationships with family, friends, and support groups provide emotional
encouragement and practical assistance.

Example: A cancer patient benefiting from a support group where they share experiences
and coping strategies.

5. Prevention and Maintenance

• Preventing further health deterioration and maintaining improvements made during

rehabilitation.
• Regular check-ups, medication adherence, lifestyle maintenance, and continuous
support are crucial.

Example: A stroke survivor continuing physical therapy and monitoring risk factors to
prevent another stroke.

Psychological Interventions for Chronic Illness

Managing a chronic illness involves not just physical care but also psychological support.
Psychological interventions help individuals cope with stress, pain, emotional distress, and
lifestyle adjustments. Some key approaches include:

1.Cognitive Behavioral Therapy (CBT)

• Focuses on identifying and changing negative thought patterns and behaviors that
contribute to emotional distress.
• Helps individuals develop coping skills to manage pain, anxiety, and depression.

Example: A person with chronic pain learning to reframe negative thoughts about their
condition to reduce emotional suffering.
2. Acceptance and Commitment Therapy (ACT)

• Encourages individuals to accept their illness rather than fight against it, while
committing to meaningful actions.
• Uses mindfulness and values-based decision-making to improve coping.

Example: A person with multiple sclerosis accepting their condition and focusing on
engaging in enjoyable activities instead of avoiding them due to fear.

3. Mindfulness-Based Interventions (MBSR & MBCT)

Mindfulness-Based Stress Reduction (MBSR)

Teaches mindfulness techniques (meditation, breathing exercises, body scans) to reduce

stress, pain, and emotional distress.

Example: A cancer patient using mindfulness to manage treatment-related stress.

Mindfulness-Based Cognitive Therapy (MBCT)

Combines mindfulness with CBT to prevent relapse of depression and anxiety in chronic
illness patients.

Example: A patient with diabetes practicing mindfulness to avoid excessive worry about
complications.

4. Pain Management Interventions

• Psychological techniques to help individuals manage chronic pain effectively.

• Includes relaxation training, biofeedback, hypnosis, and cognitive reframing.

5.Psychoeducation

• Involves educating patients and their families about their illness, treatment options,
and coping strategies.
• Reduces misinformation, fear, and uncertainty, empowering individuals to take
control of their health.