Stressed with Asthma? You're Not Alone
Most health practitioners try to use the term “individuals with asthma” instead of asthmatic because most patients don’t want to be defined by their illness. When someone says that they’re an asthmatic, it can mean that they may have even had just one episode. In that case we clarify the attack as a singular historic episode. Individuals diagnosed with severe asthma really have a unique daily life perspective. For them, asthma is an ongoing and day-to-day quality of life issue.
Severe asthma doesn’t just affect your daily lung and respiratory status – it really extends to other aspects of life.
Like other chronic diseases, severe asthma can be quite psychologically debilitating. Symptoms can range from simple manageable fears to severe depression. A person can feel low self esteem because they are struggling daily and cannot necessarily participate with life as they’d like to. This can make them feel inferior and useless at times. They may feel that that appear to be “always sick” to others. The thing is, heightened emotional fears or distress can actually precipitate an acute attack. Psychological feelings can also impact adherence to treatment and that can affect prognosis and long-term outcomes from the disease.
Mental health and asthma
Studies suggest that the consequences of struggling with asthma-related psychological issues can complicate the disease. The individual, rather than aiming for better asthma control to improve his functional status, may reduce physical activity to avoid triggering symptoms. That choice will likely achieve the exact opposite effect on functional status. They move less so they become more physically challenged.
The psychological effect of severe asthma on kids is even more complex since children lack the full understanding of the disease. There’s also the added factor of parental reaction to the child’s symptoms and how the parents transmit those feelings (often unintentionally) to the children. An interesting finding in one study revealed that the parents can experience significant stress themselves and internalize symptoms for the child. This adds yet another psychological effect on children that is not related to the asthma itself, but rather to their parents’ reactions to the asthma.
Finding treatment for asthma-related issues
Psychological interventions can affect the outcome in a positive way, if these effects are identified early enough, before they become deeply embedded in the thought process.
First, there are behavioral therapies that help to identify and reshape behaviors by association of reward and consequences. The goal is to modify behavior with positive reinforcement so that asthma symptoms can be controlled by reinforcing activities that lead to better symptom control. Sometimes just knowing that certain activities are possible with asthma (levels of exercise and social engagement) will go a long way to reducing psychological stress.
Secondly, there is cognitive restructuring to identify and eliminate negative thoughts like perceptions of helplessness that can sometimes lead to a premature asthma attack. There is a clear link between anxiety and developing shortness of breath.
Combining behavioral and cognitive techniques leads to a whole integrated program known as cognitive behavioral therapy (CBT) that offers a great addition to the traditional medical therapeutic treatment model for asthma.
The final element that completes this program is relaxation therapy which can help to allow proper applications of the CBT program. Relaxation is a skillset that sometimes needs to be learned. Many individuals can find it quite challenging. Sometimes learning relaxation requires the addition of biofeedback. Biofeedback teaches individuals how to control stress and anxiety, both of which have the potential to which complicate asthma.
Other approaches to reduce stress from asthma
There are also other strategies that can potentially improve outcomes beyond standard medical care. They include:
Writing or journaling about emotionally traumatic experiences by those suffering from chronic disease such as severe asthma and rheumatoid arthritis has been shown to have beneficial effects. In the case of respiratory ailments research shows improvements in spirometry. It is not however, known, whether these benefits persist after four months.
The beneficial effects of a structured exercise program have been studied in both psychological measures and physiological measures on respiratory function in individuals with chronic asthma. It is hypothesized that exercise, as a measure of reducing psychological stress, will carry its benefits in asthma control beyond the effects of standard therapy.
In one study, a group of subjects that participated in the exercise program, that showed improvement in psychological variables, also showed improvements in their respiratory functions. Measures of functional residual capacity (a measure of trapped air and inability to fully exhale a breath) and histamine tolerance (an indication of airway hyper-responsiveness) showed improvements after participation in the exercise program.
Going beyond breathing ability
It’s also important to mention that the effect of chronic illness on children has been of special interest, particularly in their capacity of psychological adjustment. One study assessing psychological adaptation to asthma showed increased risk for behavioral problems. The study did adjust for age, gender, and socioeconomic status.
It’s important for health care professionals and patients to realize that severe asthma affects more than just breathing ability. It really has psychological implications, so it’s important to go beyond just treating the respiratory issues. We need to strive to identify and treat the quality of life and psychological aspects of the disease as well.
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