Anxiety, Depression, and Cystic Fibrosis: When Chronic Illness Affects Your Psychological Health

Dr. Danick Blanchet, D. Psy. ,
clinical psychologist
Sherbrooke (Quebec)

September 2021

ANXIETY

“I coughed... is it a symptom of my worsening illness or a simple cold? Is my situation starting to worsen? Will I need to consider a transplant shortly? Will I be able to be there for my children? ” are all questions that a person with cystic fibrosis may ask themselves. Is that normal? Absolutely. That's pretty good news! Asking questions about your future and trying to foresee the challenges you will encounter is first and foremost a sign of intelligence. This allows for better preparation and facilitates the search for solutions, i.e. the ability to anticipate. It refers to “taking part in advance” and thus provides the means to think now about what is still only an eventuality (Berta, 1999).

So what distinguishes good ability to anticipate and anxiety? Anxiety causes suffering.

“... when the cognitive, physical, and behavioral symptoms of anxiety are persistent and severe and anxiety causes distress that interferes with the ability to work or study, socialize with friends, and complete daily tasks, anxiety is no longer within normal limits.” (Rector, Bourdeau, Kitchen, Joseph-Massiah, Laposa, 2005)

In other words, either you sometimes have thoughts and reflections on this subject that allow you to consider the future and find solutions and that's perfect; or you no longer sleep at night, you cry every time you think about it, you feel terrified and you need to do something, but what? Here are some possible solutions that can be very effective in helping you regain your inner calm without losing your ability to anticipate.

You have great questions!

And you don't know how important it is to answer them! For example, the question mentioned earlier “is it a cold or a symptom of the disease? could be translated as “what change in my condition should I expect?” ”. Don't try to say to yourself “don't think about it” or, in other cases, “that's not going to happen.” You are not stupid enough for that! Imagine being asked to put your finger into an electrical outlet, would you ask yourself the question “am I at risk of being electrocuted and dying? ” You would think it's crazy to say to yourself “don't think about it” or “that's not going to happen,” right? Anxiety leads to great questions that deserve comprehensive answers. Instead of focusing on thinking about it or not, focus your energy on finding answers and/or finding strategies to take to get them. We can't have answers to everything in life, especially when we think about the future, but we can certainly reduce uncertainty and answer some questions that our brain generates.

Talk about it

“Am I going to need a transplant? ” is again a great question. “Don't think about it,” an unsatisfactory response. Anxiety often takes shape when you don't know, when you don't get answers to your questions, when you don't know where to look for information. So, looking for who can answer you is a reflection exercise that will be much more satisfying and constructive than trying to silence the questions. “I need information! ” Do your neurons scream when anxiety is overwhelming. Dare to ask people who have the expertise. Don't be embarrassed, no question is stupid and the relief it will bring is well worth it. If you have questions about your health, talk to your doctor. Charities can also provide you with good eyeglasses as to what others have experienced in circumstances similar to yours.

It's also important to talk to your loved ones about it. Sometimes, all you have to do is talk about your thoughts out loud to catch a glimpse of a line of thought that you didn't have when you were thinking about it alone. Worried about looking crazy? So, start your sentence with “I know it sounds a bit crazy, but, sometimes, I imagine that...” You will surely discover that your thinking is not so “crazy” and that others have had the same thoughts as you...

In the 21st century, the majority of you are looking for answers to your questions on websites or on social media. Far be it from me to discuss the concept of information here, I think, however, that we must remain critical of the information conveyed on the Internet. Moreover, doing research on the internet can create an anxiety-provoking situation that is greater than that of not having done so at all.

Finally, it can be very beneficial to discuss your anxiety problems with a mental health professional, such as a psychologist or psychotherapist. This topic will be further explored later in this article.

Meditation and relaxation

While it is true that “don't think about it” is not a satisfactory answer for your cerebral cortex, not always thinking about it is also necessary. While anxiety asks good questions, meditation and relaxation can be a way to say to yourself, “That's a great question, but not now”! Have you ever tried it and hated it? Know that there are different methods and I invite you to try several of them in order to find the right one. An example? You can relax by concentrating on distinguishing the different birds' songs in your outdoor courtyard. Simple, no? It is not always necessary to cross our legs while controlling our breathing!

Several therapists offer to guide you in exercising different meditation and relaxation methods. Have you never practiced it? So at least try the bird exercise! Perhaps you will be tempted to deepen relaxation or meditation with a professional later. Or just the birds... that can be satisfying enough!

There are also several websites where meditation and relaxation techniques can be found. I invite you to try them if you feel like it. The important thing is to find the method that brings you well-being.

Finally, be aware that medication can be very useful in alleviating an anxiety problem. This topic will be covered a bit later.

DEPRESSIVE SYMPTOMS AND MAJOR DEPRESSION

Here, it is not the questions that invade us, but the statements. “I am a burden for others, I am causing my loved ones to suffer, everyone would be better off without me” are sentences that indicate that your brain may have taken a turn for a major depression. You often feel tired or exhausted. You have problems with appetite and sexual interest. You are suffering from physical pain such as headaches or pain with unexplained causes. In these cases, don't be ashamed, you're not choosing the symptom (s) of depression. In 2017, the World Health Organization estimated the number of people with major depression at over 260 million (WHO, 2020). Nearly a third of people living with a chronic illness will suffer from depression during their lifetime (Rabin, Smith, Godet, n.d.). But what is major depression? Let's say it's as if the brain goes into “depressive” mode. It's not you! It's your brain. There is a difference between the two.

It's not you, it's your brain

Have you ever asked yourself the question “What do I have to be so negative about today?” ”, after sleeping poorly the night before. You respond stupidly to the people around you and find that they did nothing to deserve your exasperation. It's a bit the same principle when it comes to major depression. You can tell your mind from that of your brain. As if your brain reacts by always taking a pessimistic perspective before you even think about the situation. As if you now have to look at the world through “dark” glasses. With a good night's sleep, you can sometimes catch up later. But that won't be enough to manage these “glasses,” as our brain chemistry may require much more than restful sleep to regain the way you see life through clear glasses.

A distinction must also be made between depression and bereavement. Much like anxiety, struggling with a loss of mobility or functionality is completely normal. Accepting the new limits imposed by cystic fibrosis requires time to adapt. Consulting a psychologist or health professional can be very useful in distinguishing between the two. This topic will be covered a bit later.

Healing and depression

No, you are not making the symptoms of the disease worse because you are depressed. You have the right to express your pain, whether others like it or not. Don't feel guilty for being sad, frustrated, or negative at times and, above all, remember that there are solutions.

Ask for help

You don't have to suffer like that! I cannot tell you how important it is to consult health professionals if you recognize yourself in these lines. It is extremely difficult to fight your brain alone and pharmaceutical products and psychotherapeutic treatments can greatly help you get through this stage of your life. Depression can also be a crossroads where you become aware of the things that make you unhappy that you decide, at that moment, to focus your energy and time on changing them. Depression can push you to make big changes that will benefit the rest of your life. But for this you have to ask for help. So, give yourself this gift and consult!

MEDICATION

Is medication absolutely necessary for an anxiety or depression problem? No And neither is suffering. Think of this test as a ball game where the objective is to catch it. Now imagine that depression or anxiety was a condition similar to having one hand less to catch that ball. Medication is an orthosis that allows you to catch the ball while you regain the use of your injured hand.

You should also know that medication is not magical and will not prevent you from thinking for yourself. You don't become a “vegetable” with medications, or at least not in the 21st century! They help alleviate the emotional burden associated with anxiety and depression, making it much easier to get through these challenges. If you are concerned about the side effects of the medication or its interaction with other medications you are taking, take the time to discuss your concerns with your doctor. He or she will be a much better advisor than social networks or the Web!

Do not hesitate to consult a doctor about your psychological problems and to discuss them with a psychologist. Again, know that there are no stupid questions. Getting the right information will allow you to make better medication decisions. It is possible to get help if you have difficulty understanding medical jargon (it's normal, not everyone speaks Latin; so don't be embarrassed!). Finally, remember that suffering is not necessary and that medication can greatly facilitate well-being.

PSYCHOTHERAPY

When should you consult? Whenever you want it. A psychologist or psychotherapist can be an excellent ally in your search for solutions and in supporting you through the challenges that cystic fibrosis brings to your life. The professional will be able to:

• guide you in your questions and to help you
support you in your thinking;
• provide you with lots of information and tools to
help you better manage your anxiety;
• support you in your emotions and take care of yourself
when the mood is depressed.

Know that there are four theoretical orientations in psychotherapy and a myriad of approaches to apply them. Some approaches are said to be passive (the professional speaks little), while others are based on interaction (the professional speaks more!). A little thing? Instead of asking the psychotherapist for guidance, ask if he or she is interactive or passive. It will be easier for you to determine if this is going in the direction you are looking for. In terms of theoretical guidelines, which is the best? The one that's right for you. Feeling comfortable in therapy with your psychotherapist is more a guarantee of success than the approach itself (Krupnick, Sotsky et al., 1996). In particular, on the site of the Order of Psychologists of Quebec (www.ordrepsy.qc.ca), you will find a reference bank of psychologists and psychotherapists in your region with the types of problems in their expertise.

Published in SVB number 45

References:

Berta, M. (1999). 6 — The clinical limits of the Anticipatory Test. In Garcia-Orad, The Anticipation Test: A Test of the Personal Imaginary (pp. 79-88). Toulouse, France: Eres.

Krupnick, J.L., Sotsky, S.M., S.M., Simmens, S., S., S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P.A. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64 (3), 532—539.

Rabin, H., Smith, L., & amp; Gaudet, E. (n.d.). Cystic Fibrosis CANADA. Cystic Fibrosis Canada. https://www.fibrosekystique.ca/about-cf/vivre-avec-la-fibrosekystique/sante-mentale.

Rector, N.A., Bourdeau, D., D.,, Kitchen, D., Kitchen, K., Kitchen, K., K, Joseph-Massiah, L., & amp; Laposa, J.M. (2005). Anxiety Disorders Information Guide. https://www.camh.ca/-/media/files/guides-and-publications-french/anxiety-guide-fr.pdf.

World Health Organization. (2020). Depression. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/depreSession.

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