Chronic medical illness challenges effective coping. Knowledge of the patient's ability to cope with stress and their resiliency are essential to assessing a patient and also helping achieve the best medical outcome.
It’s important for both the clinical team and the family to be aware of the patient’s coping skills and how these are being tested.
Warning signs include: 1) missing medical appointments, 2) skipping doses of prescribed medication, and 3) avoiding necessary visits to a lab for testing. It’s also vital to be sensitive and aware of moods.
Anger, and unprovoked irritability or hostility might be signs of underlying depression. If these emerge, it is important to see professional help from a behavioral health specialist.
Elizabeth Nikol MA, is here to discuss the best ways to cope with serious health conditions.
Selected Podcast
Coping with Serious Health Conditions
Featured Speaker:
Elizabeth Nikol MA, MSW, LCSW
Senior Integrated Behavioral Health Clinician Elizabeth Nikol, MA, MSW, LCSW, ACT, has expertise in depression, anxiety, adjustment disorder, grief, adjustment to cancer diagnosis, weight loss issues, relationship conflicts, anger management, work issues, and stress management. She is a consultant for primary care patients who need guidance on behavioral health options to help manage emotional issues. In addition to her position at Summit Medical Group, Ms. Nikol is a support group leader for Summit Medical Group Breast Center patients who have been newly diagnosed with breast cancer or managing issues of survival. Her support groups include counseling, resources, and referrals Transcription:
Coping with Serious Health Conditions
Melanie Cole (Host): Chronic medical illness challenges effective coping. Knowledge of the patient’s ability to cope with stress and a resiliency are essential to assessing a patient and also helping them achieve the best medical outcome. It’s very important for both the clinical team and the family to be aware of the patient’s coping skills and how these are being tested. My guest today is Elizabeth Nikol. She’s a senior integrated behavioral health clinician at Summit Medical Group. Welcome to the show, Elizabeth. Coping skills, we’re talking about both chronic and sudden kinds of coming on of a medical illness, a problem. How do you tell people the first thing when they come up with this chronic illness or something sudden happens? What’s the best advice you give them, right off the bat?
Elizabeth Nikol (Guest): I think it can be extremely stressful to be diagnosed with a health condition. Generally, there is a period of time that people are trying to get answers as well as going for testing. Anxiety can be quite high during that time until they have an official diagnosis. Certainly, in the case of chronic health conditions, it also may mean that they could be living with their condition for an extensive amount of time, if not forever. For example, in the case of someone that has cancer, while they’re in treatment, they may be dealing with a variety of side effects that ultimately come to an end after cancer treatment and they do manage to recover almost to the way that they were prior to ever being diagnosed, whereas someone who might have chronic pain might actually be in chronic pain for the remainder of their life, and we have to work with the patient in order to manage that. What I suggest I think will vary very much on a case-by-case basis based on how lengthy we perceive the illness will be as well as whether or not there are some amount of trauma that is associated with the diagnosis. Again, in the case of someone who has had a heart attack or in the case of somebody who has been diagnosed with cancer, they’re essentially looking at a life or death situation and may actually have some symptoms of acute stress or even posttraumatic stress after their diagnosis that need to be managed. In the case of someone that has a chronic health condition like chronic pain or fibromyalgia, we’d really be looking at depression to say are they taking care of their illness and doing everything that they can as depression-free as possible. Certainly, the impact of depression requires that then they take a back seat to their own medical care. I think regardless of the situation, there are a couple of general things that I would recommend, the first of which is support. It’s incredibly important to have support while people are going through a health condition. That could be from a variety of different areas in life. For example, support group. Anytime somebody has a chronic health condition that’s going to remain for a period of time, I recommend finding a support group that is near to them. And if there is nothing in their area that they can go to face to face, certainly going to an online platform because there are support groups running online at all hours of the day as well as message boards where people can ask questions and look for support. In addition to that, I would ask them to talk to their doctors about finding someone, a patient who might be in a similar situation and might be willing to talk with them. Certainly, reaching out to faith-based communities, if they are somebody who goes to church or to chapel, going to classes, talking to a therapist. Most of the work that I do is talking with patients who have chronic health conditions and trying to offer them some support and some suggestions on improving their situation at that particular time. Additionally, I would suggest for patients with a chronic medical condition that they take some time off every single month from medical appointment. What I mean by that is unless there is an urgency to the situation, that they schedule all their medical appointments in such a way that they actually get a week’s vacation from going to the doctor. Because sometimes, it can very much feel like a job and that their illness has actually become their entire life. And I think on top of that, I try and encourage them to gather some understanding about their condition. Certainly, some patients I talk to really don’t know what it is that they have and what that means as well as why they’re taking the medications that they’re taking or why their doctors are suggesting certain things. Certainly, doing their own research, I think, is important. Finally, I think these days, it’s been coming up in the media all over the place that mindfulness is extremely helpful. This came up 25 years ago when mindfulness was becoming popular in the work that work was being done in hospitals across the country, helping patients that had chronic health conditions and chronic pain, and that is something that could be an extremely helpful add-on. These days, people can find this many places, not only at their local medical centers perhaps but even at local yoga centers, their libraries, and even for those people that like using apps on their iPad or cell phones. There are many mindfulness apps out there that are designed to help patients do this in a self-study method.
Melanie: I think accepting the critical illness or chronic illness, and I’m thinking along the lines of Parkinson’s and MS, these kinds of things that will affect the rest of your life and possibly debilitate you, how do you teach people to accept that they might end up in a wheelchair or that this disease, unlike cancer, where treatments are possible, what about some of these diseases where treatments jus manage the symptoms? How do you help them with that?
Elizabeth: I think the primary thing is to not get too far ahead. I think oftentimes—and this is where mindfulness can be helpful—it’s a matter of bringing the patient back to this particular day or this particular week in terms of talking about how they’re experiencing their illness right now. It may be necessary ultimately to plan for somebody being in a wheelchair, but if this particular week or month there aren’t symptoms that necessarily bring us to discussing a wheelchair, I would potentially work with them on a couple of different things. First of all, I think one of the things that we all do—and certainly, I’m guilty of it as well—is that when we read about the catastrophic results of certain illnesses where people have written about it, books or magazines or online, we tend to imagine that that catastrophe is definitely going to be ours. But certainly, for patients who have Parkinson’s or MS, their symptoms may end up being more mild than the person that they’re reading about. They certainly could be that significant. I think the other thing that as a cognitive behavioral therapist I tend to work on with patients is really thinking through some of those worst-case scenarios at a time where it makes sense for the patient to sort of say okay, let’s say that that were to happen. Let’s say that in 10 years, you will be wheelchair bound. What do we need to do in the next 10 years to ensure that you have done everything you need to do to ready yourself for that as well as living your life to the fullest while you are still doing well? I also think I would recommend—and certainly those of us that do cognitive behavioral therapy offer this as a suggestion all the time to patients with chronic health condition—we discuss something called worry time, which basically means taking a segment of 10 or 15 minutes every day to worry. And in the case of someone who has a chronic health condition, really sit down and think once a day about all of their concerns about their illness. But when the timer goes off and their 15 minutes are up, that they close the journal for that day. And then until they come back to that same time period 24 hours later, they live their lives for the other 23 hours and three quarters and they don’t spend every single day imagining that they have become their illness.
Melanie: What a great answer. We only have a few minutes left. What about protecting others from the truth? Do you help them tell others, teaching them to tell their children about whatever this illness is? Because I think that goes a long way to helping with coping skills.
Elizabeth: I think again it’s going to depend on a case-to-case basis. Certainly, in the cancer groups that I lead, this comes up a great deal with the younger children. How do you use the word cancer? How do you prevent them from being influenced by maybe what their friends might tell them or what they read on TV? We always really have to think about the family members and what we know about them. Are these particular family members, in the case of children, do they have anxiety? Are they worriers? Do they tend to have behavioral issues? In the case of adult family members, are they the adult family members that you can rely on during times of a crisis, or instead, do they end up in some places being more toxic than helpful? Sometimes we need to work with patients to find the right words for them to describe what’s going on, and that may differ even within a family. What they say to their sister may be different than what they say to their mother, but we absolutely spend time both in support groups as well as in individual therapy talking about this first session or two to help them come up with really the right words and there are a lot of resources out there, particularly for kids, talking with your kids about particular chronic illnesses. And if the patient was interested in that, they could go on the web and simply do a search about speaking with your kids about whatever their illness is.
Melanie: If you would, please, give us your best advice for people coping with chronic illness or serious illness and what you can tell them and why they should come to Summit Medical Group for help.
Elizabeth: I think the main thing is that when you’re diagnosed with an illness, it could very quickly become your life and your identity. But before you were diagnosed, you were a parent, a friend, a spouse, a reader, someone who exercised, someone who went to work and had a job every day. Those pieces of your identity do not go away because you now have been diagnosed with a chronic illness. It just becomes part of the story. And I think a lot of the work I do with patients is to realize that even though now this new piece of an identity has been brought to their life, that they can still focus on some of those other identities that they had beforehand, because they’re equally as important. We just need to now make a little bit of room for this new identity as a cancer survivor or as a patient who has MS. I think in terms of what we can do here at Summit Medical Group, we have three cognitive behavioral therapy centers in three different locations, where patients would work with a therapist like myself in order to tackle some of these issues and really give them ways to not only change their thinking about their illness but also create good and healthy behaviors that will allow them to feel better as they’re adjusting to whatever illness it is that they’ve been diagnosed with.
Melanie: That’s fantastic information and so well spoken. Thank you so much, Elizabeth. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Coping with Serious Health Conditions
Melanie Cole (Host): Chronic medical illness challenges effective coping. Knowledge of the patient’s ability to cope with stress and a resiliency are essential to assessing a patient and also helping them achieve the best medical outcome. It’s very important for both the clinical team and the family to be aware of the patient’s coping skills and how these are being tested. My guest today is Elizabeth Nikol. She’s a senior integrated behavioral health clinician at Summit Medical Group. Welcome to the show, Elizabeth. Coping skills, we’re talking about both chronic and sudden kinds of coming on of a medical illness, a problem. How do you tell people the first thing when they come up with this chronic illness or something sudden happens? What’s the best advice you give them, right off the bat?
Elizabeth Nikol (Guest): I think it can be extremely stressful to be diagnosed with a health condition. Generally, there is a period of time that people are trying to get answers as well as going for testing. Anxiety can be quite high during that time until they have an official diagnosis. Certainly, in the case of chronic health conditions, it also may mean that they could be living with their condition for an extensive amount of time, if not forever. For example, in the case of someone that has cancer, while they’re in treatment, they may be dealing with a variety of side effects that ultimately come to an end after cancer treatment and they do manage to recover almost to the way that they were prior to ever being diagnosed, whereas someone who might have chronic pain might actually be in chronic pain for the remainder of their life, and we have to work with the patient in order to manage that. What I suggest I think will vary very much on a case-by-case basis based on how lengthy we perceive the illness will be as well as whether or not there are some amount of trauma that is associated with the diagnosis. Again, in the case of someone who has had a heart attack or in the case of somebody who has been diagnosed with cancer, they’re essentially looking at a life or death situation and may actually have some symptoms of acute stress or even posttraumatic stress after their diagnosis that need to be managed. In the case of someone that has a chronic health condition like chronic pain or fibromyalgia, we’d really be looking at depression to say are they taking care of their illness and doing everything that they can as depression-free as possible. Certainly, the impact of depression requires that then they take a back seat to their own medical care. I think regardless of the situation, there are a couple of general things that I would recommend, the first of which is support. It’s incredibly important to have support while people are going through a health condition. That could be from a variety of different areas in life. For example, support group. Anytime somebody has a chronic health condition that’s going to remain for a period of time, I recommend finding a support group that is near to them. And if there is nothing in their area that they can go to face to face, certainly going to an online platform because there are support groups running online at all hours of the day as well as message boards where people can ask questions and look for support. In addition to that, I would ask them to talk to their doctors about finding someone, a patient who might be in a similar situation and might be willing to talk with them. Certainly, reaching out to faith-based communities, if they are somebody who goes to church or to chapel, going to classes, talking to a therapist. Most of the work that I do is talking with patients who have chronic health conditions and trying to offer them some support and some suggestions on improving their situation at that particular time. Additionally, I would suggest for patients with a chronic medical condition that they take some time off every single month from medical appointment. What I mean by that is unless there is an urgency to the situation, that they schedule all their medical appointments in such a way that they actually get a week’s vacation from going to the doctor. Because sometimes, it can very much feel like a job and that their illness has actually become their entire life. And I think on top of that, I try and encourage them to gather some understanding about their condition. Certainly, some patients I talk to really don’t know what it is that they have and what that means as well as why they’re taking the medications that they’re taking or why their doctors are suggesting certain things. Certainly, doing their own research, I think, is important. Finally, I think these days, it’s been coming up in the media all over the place that mindfulness is extremely helpful. This came up 25 years ago when mindfulness was becoming popular in the work that work was being done in hospitals across the country, helping patients that had chronic health conditions and chronic pain, and that is something that could be an extremely helpful add-on. These days, people can find this many places, not only at their local medical centers perhaps but even at local yoga centers, their libraries, and even for those people that like using apps on their iPad or cell phones. There are many mindfulness apps out there that are designed to help patients do this in a self-study method.
Melanie: I think accepting the critical illness or chronic illness, and I’m thinking along the lines of Parkinson’s and MS, these kinds of things that will affect the rest of your life and possibly debilitate you, how do you teach people to accept that they might end up in a wheelchair or that this disease, unlike cancer, where treatments are possible, what about some of these diseases where treatments jus manage the symptoms? How do you help them with that?
Elizabeth: I think the primary thing is to not get too far ahead. I think oftentimes—and this is where mindfulness can be helpful—it’s a matter of bringing the patient back to this particular day or this particular week in terms of talking about how they’re experiencing their illness right now. It may be necessary ultimately to plan for somebody being in a wheelchair, but if this particular week or month there aren’t symptoms that necessarily bring us to discussing a wheelchair, I would potentially work with them on a couple of different things. First of all, I think one of the things that we all do—and certainly, I’m guilty of it as well—is that when we read about the catastrophic results of certain illnesses where people have written about it, books or magazines or online, we tend to imagine that that catastrophe is definitely going to be ours. But certainly, for patients who have Parkinson’s or MS, their symptoms may end up being more mild than the person that they’re reading about. They certainly could be that significant. I think the other thing that as a cognitive behavioral therapist I tend to work on with patients is really thinking through some of those worst-case scenarios at a time where it makes sense for the patient to sort of say okay, let’s say that that were to happen. Let’s say that in 10 years, you will be wheelchair bound. What do we need to do in the next 10 years to ensure that you have done everything you need to do to ready yourself for that as well as living your life to the fullest while you are still doing well? I also think I would recommend—and certainly those of us that do cognitive behavioral therapy offer this as a suggestion all the time to patients with chronic health condition—we discuss something called worry time, which basically means taking a segment of 10 or 15 minutes every day to worry. And in the case of someone who has a chronic health condition, really sit down and think once a day about all of their concerns about their illness. But when the timer goes off and their 15 minutes are up, that they close the journal for that day. And then until they come back to that same time period 24 hours later, they live their lives for the other 23 hours and three quarters and they don’t spend every single day imagining that they have become their illness.
Melanie: What a great answer. We only have a few minutes left. What about protecting others from the truth? Do you help them tell others, teaching them to tell their children about whatever this illness is? Because I think that goes a long way to helping with coping skills.
Elizabeth: I think again it’s going to depend on a case-to-case basis. Certainly, in the cancer groups that I lead, this comes up a great deal with the younger children. How do you use the word cancer? How do you prevent them from being influenced by maybe what their friends might tell them or what they read on TV? We always really have to think about the family members and what we know about them. Are these particular family members, in the case of children, do they have anxiety? Are they worriers? Do they tend to have behavioral issues? In the case of adult family members, are they the adult family members that you can rely on during times of a crisis, or instead, do they end up in some places being more toxic than helpful? Sometimes we need to work with patients to find the right words for them to describe what’s going on, and that may differ even within a family. What they say to their sister may be different than what they say to their mother, but we absolutely spend time both in support groups as well as in individual therapy talking about this first session or two to help them come up with really the right words and there are a lot of resources out there, particularly for kids, talking with your kids about particular chronic illnesses. And if the patient was interested in that, they could go on the web and simply do a search about speaking with your kids about whatever their illness is.
Melanie: If you would, please, give us your best advice for people coping with chronic illness or serious illness and what you can tell them and why they should come to Summit Medical Group for help.
Elizabeth: I think the main thing is that when you’re diagnosed with an illness, it could very quickly become your life and your identity. But before you were diagnosed, you were a parent, a friend, a spouse, a reader, someone who exercised, someone who went to work and had a job every day. Those pieces of your identity do not go away because you now have been diagnosed with a chronic illness. It just becomes part of the story. And I think a lot of the work I do with patients is to realize that even though now this new piece of an identity has been brought to their life, that they can still focus on some of those other identities that they had beforehand, because they’re equally as important. We just need to now make a little bit of room for this new identity as a cancer survivor or as a patient who has MS. I think in terms of what we can do here at Summit Medical Group, we have three cognitive behavioral therapy centers in three different locations, where patients would work with a therapist like myself in order to tackle some of these issues and really give them ways to not only change their thinking about their illness but also create good and healthy behaviors that will allow them to feel better as they’re adjusting to whatever illness it is that they’ve been diagnosed with.
Melanie: That’s fantastic information and so well spoken. Thank you so much, Elizabeth. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.