Key 9: Honor Your Emotions

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(From the series Ten Keys to Successful Coping: 2001)

By Bruce Campbell

Strong emotions like fear, anger, grief and depression are normal reactions to having chronic illness. Such emotions are a normal response to being in a situation that isolates, creates tremendous uncertainty, brings loss and imposes limits.

Unfortunately, ME/CFS and fibromyalgia seem to make emotional reactions even stronger than before and harder to control. This reaction seems part of the physical basis of the illness. The strength of emotions can create a vicious cycle. Emotions can intensify symptoms, which in turn may increase worry and depression. This process applies even to positive emotions.

But, just as in other aspects of illness discussed in this series, self-help can play a role in managing the emotional aspects of chronic disease. We will discuss two in this article: depression and anxiety. The final article treats grief.

Depression in Chronic Illness

Depression is a common and normal reaction to chronic illness, an understandable response to the losses, dislocation and uncertainties produced by illness. It is not surprising that depression would occur in people who have an illness as disabling as ME/CFS or fibromyalgia.

In addition, sometimes depression may be part of our illness, with real physical causes. Prolonged stress may alter the biochemistry of the body, causing depression.

Depression is often divided into two types: situational and biochemical. Both may apply to people with ME/CFS and fibromyalgia. Situational depression, which means depression that occurs as a response to a particular set of circumstances, lends itself to self-management strategies such as those described below.

But not all depression is best handled this way. If you are deeply depressed about your illness or you have biochemical depression, which has its roots in the chemistry of the brain, medication and professional help are indicated. Self-management strategies may also be helpful.

Depression can be particularly invidious because it may intensify illness symptoms, creating in a vicious cycle in which symptoms and depression reinforce one another. There are many things you can do to improve your situation. If you are depressed, you may not want to try, but remember that depression feeds on itself.

Your attitude becomes a self-fulfilling prophecy. If you believe you can get better, you will take actions such as the twelve listed below that have a good chance of helping. If you're like most people, some may appeal to you but not others. I suggest you try what you think fits your situation. The important point is that there are usually actions we can take to help improve our mood.

Rest: Some depression seems to be associated with physical symptoms such as fatigue and pain. Resting to reduce these symptoms can also improve mood.

Reach Out to Others: Simple human contact is often very soothing. Calling a friend or getting together to talk, share a meal or see a movie counteracts the sense of isolation, preoccupation with problems and the low mood often associated with chronic illness. Just explaining yourself can often give you perspective. Fellow patients can be very helpful.

Get Out of the House: Just like contact with others, getting out of the house counteracts isolation and boredom, provides stimulation and can reduce depression.

Consider Medications: Tranquilizers and narcotic painkillers intensify depression. If you are depressed, it may be in part a medication side effect. Check with your doctor. On the other hand, if your depression is bio-chemical in origin, you may be helped by an anti-depressant.

Exercise: Exercise is a natural anti-depressant. It relieves tension, lessens stress and improves mood. Most exercise also involves being out of the house, thus bringing the adding benefits of a change of scene.

Practice Problem-Solving: Taking action to solve a problem lifts the spirit as well as having practical benefits. Doing something counteracts the sense of helplessness and replaces it with a sense of control and power.

Change Your Thinking: Being ill over an extended period of time can be associated with a sense of helplessness. Changing your habitual ways of thinking to be more positive can change your mood. You can help yourself by celebrating your successes. Notice what's going well and what you have accomplished. This shift in perspective can raise your spirits.

Do Something Pleasant: Pleasurable activities counter depression and help create a good mood. Doing something in which you can become absorbed distracts from bad moods and puts you in touch with positive forces. Such activities might include reading, playing or listening to music, sitting in the sun, solving jigsaw puzzles, doing needlework, spending time with friends, being out in nature and laughing.

Get Help: If you are seriously depressed, suicidal or have been depressed for some time, get help now. Phone a suicide prevention center, talk to your doctor, see a psychologist or call a friend. If your problems are less severe, consider seeing a psychotherapist. Look for one who has experience working with people who have chronic illness. If you have family tension because of illness, you might also consider couples or family counseling.

Establish Good Daily Habits: Keeping to a daily routine regardless of how you feel can help counteract depression. Your daily round of activities will depend on the severity of your illness, and might include things like getting dressed every day, making the bed, cooking meals, taking a walk and watching a favorite TV program. Forcing yourself to do these things even if you don't want to counteracts the inertia of depression.

Help Others: Get involved with something larger than yourself to counteract the isolation and preoccupation that often accompany illness and to rebuild self-esteem. We usually feel better if we do something for another person.

Manage Your Stress: Controlling stress can help you manage your emotions, because stress tends to make emotions more intense. Living within your energy envelope and managing the stresses in your life will make emotions more manageable.

Fear and Anxiety

Fear and anxiety often accompany chronic illness. These reactions are common in situations in which we feel an increased vulnerability in combination with a decreased sense of power.

You will find below eight strategies that are often helpful with fear and worry reactions. For more suggestions, see "Fifty Tips on the Management of Worry without Using Medication" in the book Worry by Edward Hallowell.

Use Problem-Solving: Taking action to solve a problem has a double payoff. You reduce or eliminate a practical concern that is bothering you. Also, the process of taking action often reduces worry.

Practice Stress Reduction: Learning relaxation and other stress reduction techniques can help reduce the intensity of your emotional reactions and, by doing so, reduce the echo effect in which emotions and symptoms amplify one another. A regular stress reduction practice can also lower "background worry," the ongoing anxiety that results from long-term stresses like chronic illness.

Change Your Thinking: If you have a tendency to think of the worst that might happen, you can take steps to short-circuit the process in which your thoughts increase your anxiety. One antidote is to retrain yourself to speak soothingly when worried, saying things like "I've been here before and survived" or "this is probably not as bad as it seems."

Connect with Other People: Feeling that you are part of something larger than yourself counteracts worry. Also, contact soothes worry, distracts you from preoccupation with problems, and provides reassurance.

Exercise: One of the best treatments for worry, exercise is both relaxing and distracting.

Pleasurable Activity. Reading, music, good conversation and other activities in which you can become immersed help change mood.

Don't Worry Alone: The act of sharing a worry almost always reduces its size and emotional weight. Discussion may help you find solutions, but almost always makes the worry feel less threatening. Putting a worry into words translates it from the realm of imagination into something concrete and manageable.

Medications: Just as drugs can help with depression, some people find that medications help them deal with anxiety. A drug will not be a complete solution to problems of anxiety, but it can be an important part of a comprehensive response.

Panic

About 10 percent of people with ME/CFS experience an especially severe and frightening form of fear called panic attacks. These are brief episodes of terror in which a person may feel he or she is about to die. Symptoms may include chest pain, heart palpitations and dizziness.

In spite of overwhelming fear, people survive but may live a life of dread, apprehensive about when the next attack may occur. This kind of fear is treatable. For discussions on how to conquer panic, see Edward Hallowell's book Worry or Martin Seligman's What You Can Change and What You Can't.

Summary

In sum, you aren't crazy to experience strong emotions in reaction to having your life turned upside down. It would be surprising if you didn't respond that way. Emotions like fear, anger, grief and depression are common responses to situations of loss and uncertainty. But there are many things you can do to reduce the strength of the emotions associated with chronic illness.