Despite significant advances in the field of psychology due to increased research, the complete rejection of the Cartesian dualist notion of a separate and distinct body and mind, and the exponential growth of psychoneuroimmunology, the usual care of people with chronic medical conditions still often neglects the psychological issues associated with the physical dimension of the disease.
This is the unfortunate reality of some places such as Portugal, a good example of a European country with top research and medical treatment and departments– including oncology, radiotherapy, gastroenterology, or rheumatology departments – that somehow still operate without a single psychologist. This is particularly surprising and alarming especially considering the very well-known impact chronic medical conditions, which affect around a third of the world population, have on mental health and quality of life. Chronically ill people face functional impairment, decreased quality of life, and significant mental health difficulties. Moreover, the interplay between psychological processes and the nervous and immune systems, may contribute to a further decrease in psychological health, in a self-perpetuating cycle between psychological suffering and physical distress.
“…people with illness would benefit the most if they had evidence-based psychological interventions available as soon as needed, which is often from the diagnosis.”
I have the strong belief that it is in part on the hands of clinical psychology researchers to advocate for the inclusion of psychological interventions in the usual treatment of chronic medical conditions. To be able to advocate such need, research should focus on developing and improving the efficacy of and access to psychological interventions for populations in need – and this is what drives me to conduct research in this field.
The research I have conducted has aimed to contribute to a better understanding of the psychological mechanisms that influence the vulnerability and persistence of psychological, social, and physical impairment in chronic illness. It has given further support to the pertinence of contextual and contemplative approaches in behavioral medicine, particularly Acceptance and Commitment Therapy (ACT) and mindfulness- and compassion-based therapies, and their integration in the treatment of chronic medical conditions. These approaches aim to change the relationship individuals have with their internal experiences (rather than changing the content of those experiences) by stimulating willingness to be aware, open and accepting about any type of internal events, while holding a nonjudgmental and compassionate attitude towards difficulties. This is particularly relevant in illness contexts – where some thoughts about one’s disease or prognosis may very well be realistic; where, it seems more useful to learn how to deal with those thoughts instead of battling their accuracy. Further, interventions based on these approaches have been found to effectively improve functioning, mental health, and even physiological markers (e.g., inflammation) in diverse medical populations.
It can thus be argued that such contextual and contemplative-based interventions should be integrated in the usual healthcare of people with chronic illness and that all interested individuals should be able to enroll in this type of intervention, as soon as they can or want. This has actually been pointed out by a participant in the preliminary efficacy study of the Mind Programme (a mindfulness, ACT, and compassion-based group intervention for cancer we have developed and tested). A 58-year-old woman with breast cancer stated, after completing the program:
“This program made me feel emotionally stronger and more able to face life’s adversities. Learning to accept mine and other peoples’ problems is a step to recovery. After all, problems may just as well be only ghosts of our mind. I would have liked to have come in contact with this program years ago. But it’s never too late to trace the path of self-knowledge.”
Although it may be in fact accurate that it is not too late to learn new tools (in this case, contemplative-based) to improve one’s mental health and well-being, people with illness would benefit the most if they had evidence-based psychological interventions available as soon as needed, which is often from the diagnosis. Given the evidence we now have available, this should be seen as a right each chronically ill person should have. Everywhere.
Dr. Inês Trindade is a Clinical Psychologist and Research Fellow at the University of Coimbra, Portugal
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