CAT for Physical Health Problems

Why psychological therapy for physical health problems?

When we have physical health problems, particularly when they impact our ability to live our lives the way we always have, change the way we look, cause chronic pain, or even be life-threatening, this can change the way we feel about ourselves and our bodies. It’s common to feel anxious or depressed about it.

Knowing the cause of the physical problem can help, but very often, whether the cause is known, or the symptoms we experience are unexplained, we are living with uncertainty. We may feel unclear about the future and how best to manage. Often we may feel as if we are the only ones who can understand what we are going through. Living with long term physical health issues can be a lonely and life changing experience. Psychological therapy can’t cure medical conditions, but it can help us make sense of what’s happening. It can help us to find good ways to live with and adapt around the limitations of our bodies. In turn this can help us get a better quality of life.

The Mind Body connection

This is a two-way process, with emotional distress and trauma having an impact on the body. For example adrenalin can cause a racing heart and high blood pressure. Physical symptoms in the body may also have psychological effects, such as a fear of illness and a sense of being out of control.

In addition, for all of us, the way we take care of our health and respond to physical symptoms is a reflection of the relationship we have with ourselves. An example of this is the different way that we react to a sprained ankle. One person might feel that they have to soldier on and not have any time off their usual activities. Another may take a week off just to rest, while a third person may rest for a few days and then gradually get back to usual. These ways of responding will, in turn, have an impact on the recovery process.

Why might CAT be particularly helpful?

We all have a relationship with ourselves; the way I feel about myself, the way I think about myself, the way I treat myself. We may not always be aware of it and often most people have not needed to really think about it. This relationship is often a mixture of positives and negatives. It is very much influenced by the things that have happened to us as we grow up, have relationships with parents, peers and then on to relationships in our adult lives. All of these things influence the way people cope with life and with physical problems such as pain. What we understand in CAT, is that in the same way that we have a relationship with ourselves, we also have a relationship with our physical health.

Physical health problems can interfere with coping patterns that previously worked well. When faced with things like fatigue, pain, or physical restriction, these can stop us from being able to cope in the way we used to. Consider, for example, what maintains your self esteem (whether you feel good about yourself or not). Depending on what you base yours on, your physical health may influnece this in poweful ways. For example, yours might be based on things like:-

how much you can do for others
how much you can achieve at work
how busy you are
how much emotional support you give to others, or
perhaps you only feel good when you know you’re being ‘strong’. (This is often defined by not feeling stressed or emotional).

Your physical health might mean you can do less of these kinds of things. If this is the case then it can have a big impact on how you feel about yourself.

Trauma, CAT and physical health problems

Physical health issues can lead to treatments, procedures and investigations that can ‘mirror’ other difficult events that have happened in our lives. Such similarities can sometimes trigger a sudden flood of memories of traumas that have happened in our early life, or early adulthood. For example, treatments can be invasive, which can remind us of times when our physical space was invaded or we were physically hurt. Treatment regimes can feel very controlling, reminding us of relationships where we felt bullied, side-lined or ignored. Sometimes, we can experience a lack of care, or there isn’t anything medically that can help. This can be a reminder of experiences that have felt uncaring or abandoning.

CAT is a really helpful therapy for working with all of these things and helping to make sense of them. It can help us to better understand how we are feeling now. In turn, understanding helps us feel a bit more in control and gives us more choice about better ways to cope.

CAT and the language of coping

CAT can help us to better understand the social context that we have developed within. For example, in the western world there are some common themes around how we ‘should’ cope with our problems. The language surrounding physical illness can be unhelpful. The idea that we should appear strong and not complain too much can be really silencing. This can lead to bottling up feelings, emotions and experiences because we feel we should cope ‘better’. We often end up with distorted ideas about what good coping looks like. Sometimes it can even feel as though we are blamed for our illness or health issues if we don’t act as if we are feeling positive about it. Or worse, we can be told that not being positive might make things worse.

It can be particularly difficult to manage how we feel if the physical health problem is not visible to others. Or perhaps the problem may feel overly noticeable, and be shaming, embarrassing or disfiguring. All of these can impact the way we and those around us can relate to it.

Medically unexplained illness

If someone has a medically unexplained illness, then this means that a physical cause for their symptoms has not been identified. This can be particularly hard to deal with. Sometimes our bodies will generate symptoms that can be extreme, for example seizures, severe pain, etc. Even when the symptoms are milder, they can still be highly distressing. In CAT, we understand the powerful link between the body and the mind. Sometimes, when the mind is unable to make sense of something, it has to send a different kind of signal to let us know it needs some help. Therapists work with patients to help them make sense of what is happening. Understanding the impact and meaning of the physical symptoms can sometimes lead to those symptoms reducing. This is not usually the goal of therapy, but can be a welcome 'side-effect'.

Supporting carers and family members

The person with the illness is not the only one who may have to make adjustments and cope with loss. Often, their loved ones are also affected. It can be helpful for the person, or (with consent) the therapist, to share what's being learned and understood in therapy with partners or carers. This can enable them to make changes too.

Supporting staff working in physical health

CAT can be useful in supporting staff who work with patients with physical health problems. Research suggests that staff working in complex health settings where illness can’t necessarily be cured, can experience higher rates of burnout. Additionally, staff often say they feel they lack skills in working with the psychological consequences of illness. CAT can offer some really useful ways of supporting staff to understand all of this. Through doing so, we would hope that this enables staff to feel more supported so that they can continue to support their patients. We see CAT in a physical health setting having a role in improving patient care.