Step 7: Manage Feelings

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By Bruce Campbell

Strong feelings are a normal reaction to serious illness. Emotions such as fear, grief and depression are an understandable response to life being turned upside down.

Managing feelings deserves an important place in your self-management plan, just because they are so common. But there are two additional reasons as well. First, CFS and fibromyalgia often make emotional reactions stronger than they were before and harder to control. The clinical term is labile. As one person in our program said, "My emotions are much more sensitive than ever before. I cry more easily, and I have less emotional reserve." Second, emotions can interact with symptoms in a vicious cycle. Illness can intensify feelings, but feelings, in turn, can make symptoms worse. For example, being ill can trigger worries about the future. Worry leads to muscle tension, which, in turn, increases pain.

The process by which feelings intensify symptoms occurs even with positive emotions, as suggested in a comment from someone in our program who said, "I cried at one of the classes, because I was so happy to be around people who understood me. Almost immediately, I had an attack of brain fog. The experience helped me realize that any experience that triggers adrenaline, whether positive or negative, makes my symptoms worse."

For all these reasons, addressing emotions is an important part of self-management. This article focuses on strategies for handling three emotions: depression, anxiety and grief.
 

Strategies for Depression and Anxiety

1) Professional Help and Medications: Depression and anxiety can have a physical basis in the biochemistry of the brain. Self-management strategies may be useful when feelings have strong biological roots, but treatment normally includes medication as well. If you are deeply depressed or very anxious about your illness, you should get professional help: counseling, medications or both. If you are seriously depressed, suicidal or have been depressed for some time, get help now. If your problems are less severe, consider seeing a psychotherapist. Look for one who has experience working with people who have chronic illness.

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

3) Problem Solving: Taking action to solve a problem counteracts helplessness and worry, replacing them with a sense of control and power. In the words of one student, "I handle emotions better if I do something rather than passively suffer."

4) Changed Thinking: Being ill over for a long time can lead to a sense of helplessness. Changing your thinking using Cognitive Therapy can be a powerful antidote to depression and also reduce anxiety. If you have a tendency to think of the worst that might happen, you can retrain yourself to speak soothingly when you're worried, saying things like "I've been here before and survived." Other ways to counteract negative thinking are to check your fears against facts and to ask for feedback from others. (For step-by-step instructions for Cognitive Therapy, see the article Taming Stressful Thoughts.)

5) Pleasant Activities: Pleasurable activities offer a distraction from symptoms, counter depression and anxiety, and help create a good mood. 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.

6) Staying Connected: Simple human contact is often very soothing. Calling a friend or getting together to talk, share a meal or see a movie counteracts isolation, preoccupation with problems and the low mood often associated with chronic illness. Just explaining yourself can often give you perspective. The act of sharing a worry almost always reduces its size and emotional weight. Discussion may help you find solutions and usually makes the worry feel less threatening.

7) Managing Stress: Controlling stress can help you manage your emotions, because stress tends to make emotions more intense. Learning relaxation and other stress reduction techniques helps reduce the intensity of your emotional reactions and, by doing so, reduces 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 stress. (For more, see the articles in the stress management archive.)
 

Moving Through Grief

Grief is the emotional response to loss. CFS and fibromyalgia usually bring many serious losses. We often experience loss of control over our bodies, loss of friends and loss of valued activities. We may be forced to give up our job and thereby lose income, companionship and challenge. And, often we have to abandon dreams, thus losing the future we had envisioned for ourselves. In sum, we experience the loss of the person we used to be and the person we hoped to become. Here are seven strategies to help you move through grief.

1) Keep Structure in Your Life: Having a routine provides a sense of stability and familiarity, counteracting the feelings of disorientation and uncertainty brought by loss. Routine also offers a distraction from loss. Don't make unnecessary changes in your life, as they can add to your existing instability and anxiety.

2) Avoid Stress: When you are already overloaded emotionally, it's best to avoid people and situations that add more stress.

3) Respond Positively to Self-Pity: Recognize that self-pity is a part of serious illness, one that often waxes and wanes just like symptoms. Counteract it by staying connected to others and by shifting your attention off yourself through helping others.

4) Get Support: Fellow patients can provide understanding, support and models of successful coping. Professional help can give you perspective on your life and help you accept the changes brought by illness.

5) Recognize Grief is Long-Term Process: You may experience grief repeatedly as you move through the stages of life. For example, you may experience grief if you remain single while friends get married or you remain childless while others become parents.

6) Use Problem Solving: Respond to the emotions of chronic illness by problem solving. By adopting self-management strategies, you remedy the circumstances that triggered the emotions.

7) Move toward Acceptance: Loss is often associated with reactions such as denial, anxiety, anger, guilt and depression. The process leads eventually to acceptance. Acceptance means recognizing that life has changed, perhaps permanently and certainly for an extended period of time. It means letting go of your past life and also of the future as you had envisioned it. In their place, you build a new, different life. (For more on acceptance and creating a new life, see Step 4.)