Therapeutic Approaches for Supporting Mental Health 

ConclusionEmotional RegulationLove and let go (ACT)Investigate your thoughts (CBT)MindfulnessSelf Compassion & Self careIntroduction

Introduction


At Smile, we support the wellbeing of people managing chronic health conditions by empowering them to find the approaches that work best for them.  In this article, we will delve into the various therapeutic approaches we use to do this, and their strong evidence basis. 

Self Compassion & Self care


When  living or caring for someone with a chronic health condition, self compassion is paramount. Beyond the more obvious physical symptoms associated with chronic health conditions, there are a myriad of impacts to someone’s wider life. 

Self compassion encompasses how you speak, treat and act towards yourself, and is used at Smile to alter someone’s outlook towards dealing with the impacts of a difficult diagnosis. Speaking to yourself in a non-judgemental loving way by acknowledging the achievements and good things you are doing for yourself and others, are associated with lower levels of depression and anxiety in adults  with chronic illnesses, as well as in their caregivers (Finlay-Jones et al., 2023). 

We model our philosophy off of Dr Kristin Neff, who explains that self compassion should be thought of as treating every ‘part’ of ourselves with respect and love. As Dr Neff explains, we ought to think of ourselves as multiple parts, and when a particular part is triggered, we tend to get tunnel vision around that particular worldview. For example, if one’s ashamed part is triggered, they may feel unworthy (Neff et al., 2011).

Fortunately, using compassion can allow us to relate to all our parts in an accepting way. ‘When we relate to a triggered part from a place of compassion, we become disidentified with that part’, Dr Neff explains; through feeling compassion towards a part of me that was ashamed, I realise I am  bigger than this feeling and the tunnel vision begins to disappear. Applying this philosophy facilitates an acceptance of the impact of these conditions on one’s wider life.


Mindfulness


Today there is a greater appreciation of the link between stress and physical conditions.  It is well known that most common physical diseases can occur alongside mental health problems, and both are  exacerbated by stress.  In fact, chronic stress can cause such extreme ‘‘wear and tear,’ that over 60% of visits to primary care doctors are linked to stress-related symptoms (Avey et al., 2003).  Mindfulness is  a state of observing the present moment and being completely aware of your body, mind and environment to enable a more effective evaluation of potential stressors and prevent unhealthy emotional reactions. Mindfulness behaviours vary from meditation, to mindful eating, mindful stretching and a mindful ‘body scan’.

Mindfulness is therefore used at Smile to address the stress-related physical symptoms in those that suffer with chronic health conditions. It is believed that the principles of mindfulness may provide a buffer against mechanical and biological processes which contribute to stress-related disease, potentially alleviating physical symptoms and allowing the individual to better cope mentally with their condition (Creswell, Lindsay et al., 2014).  

Markers of cardiovascular and metabolic disease such as BMI and blood sugar decreased as mindfulness levels increased, whilst another pilot study of women with heart disease reported decreased levels of anxiety and coping behaviours post implementing a regular mindfulness practice. Mindfulness has also been shown to reduce pain and symptom severity, decrease anxiety, depression and the impact of fatigue on functioning in chronic fatigue syndrome. Similar benefits have been found in the caregivers of those with chronic diseases; researchers found that greater mindfulness was associated with decreasing rates of depression and anxiety (Erard, 2021), and that caregivers were more able to be ‘all in’ with their responsibilities (Tolea et al., 2023).  


Investigate your thoughts (CBT)


Perhaps the most well recognised therapy is Cognitive Behavioural Therapy or CBT. The basic premise of CBT is that a person’s thinking patterns, mood, physical symptoms and behaviours are all related. CBT recognises that context is necessary for a person to interpret their traumatic events, especially including how these are related to chronic health issues. For example, a woman who experiences chest tightness with a family history of heart disease may interpret it as a heart attack, despite it likely being an anxiety attack. CBT training ultimately allows individuals to develop more healthy thinking habits, whilst equipping them with behavioural skills to help them cope with stressful situations (Kwon et al., 2017). 

CBT is effective in managing these psychological issues in those with chronic health conditions. For example, numerous trials have reported the efficacy in improving anxiety, depression and other psychological symptoms in those with cancer (Greer, Moorey and Baruch, 1992) and rheumatoid arthritis (Sharpe, Sensky and Timberlake, 2001).  CBT also positively impacts the financial and socioeconomic health of the patient, with those who had CBT therapy returning to work earlier and better able to mentally cope with their physical ailments (Petrie et al., 2001). 

At Smile, we also apply CBT in our content for caregivers of those with chronic health conditions. Many have unmet psychological needs and increased anxiety and depression due to their role (Kwon et al., 2017), and only few interventions have been developed to support caregivers’ mental health needs (Hovadick et al., 2021).

Love and let go (ACT)


At Smile, we use Acceptance and commitment therapy (ACT) techniques with those suffering from chronic health conditions. ACT focuses on taking immediate action to provide better thinking habits and its foundation is accepting the person and their experiences. 

Clients learn to stop avoiding, denying and struggling with their inner emotions but to instead accept their deeper feelings as appropriate responses to certain situations in their lives. People learn to observe their own self-talk regarding traumatic events and make the decision to adopt a more optimistic, confident behaviour towards their traumas which is aligned with their own personal values and goals. 

The application of ACT in those with chronic health conditions and their caregivers is extremely well researched; multiple studies have found ACT was consistently associated with improvements in psychological health (Ye et al., 2023). 

Across terminal health conditions such as some cancer cases, Arch et al suggested ACT be used to create an atmosphere of compassion and acceptance, which provides the patient the correct environment to sit with potentially painful private thoughts surrounding the circumstances and consequences of their potential death (Krafft, 2021). The effects of ACT compare more favourably to standard cognitive behaviour treatment packages in treating chronic pain (Akerblom et al., 2020; Hann & McCracken, 2014, Scott et al., 2016, Vowled et al., 2014), as numerous research studies have also found.

ACT has also been found to be helpful in improving the psychological wellbeing of caregivers to those with chronic health conditions, as a previous meta-analysis found, it was found to be superior to traditional cognitive behavioural therapy in caregivers for patients suffering with certain mental health conditions.


Emotional Regulation


Studies have proven that more adaptive emotional regulation strategies are associated with decreased stress levels and fewer mental health conditions in those with chronic disease (Wierenga et al., 2017). Only, what is emotional regulation? It describes the act of controlling your emotions and reactions to behaviours.  Emotional regulation and illness-focused coping strategies have demonstrated better subjective health and wellbeing for both patients and caregivers. Conversely, a lack of emotional regulation increases the risk of a more negative mood, depressive symptoms and perceiving any pain to be greater than it usually is for that individual. 


As part of our emotional regulation practice, we emphasise strategies such as breathwork and grounding techniques. An analysis of many trials found that breathwork may be effective for improving mental wellbeing (Fincham et al., 2023). Similarly, grounding (bringing the body into contact with the earth and being aware of our senses) has been proven to improve the self-reported mood (Chevalier, 2015) of forty adult participants compared to regular relaxation positions. 

These strategies may be applied in more urgent anxiety-inducing settings which require a faster intervention rather than a talking therapy such as CBT, for example when waiting in a doctors’ office for the results of an impending medical scan. Through employing varied emotional regulation tactics, we encourage a personalised and holistic approach to supporting carers for and those with chronic health conditions.

Conclusion


We understand the need for a tailored, holistic approach, so work with a variety of mental health professionals ranging from clinical psychologists to counsellors and clinical hypnotherapists. This allows us  to provide the best support possible and empower people to build their own personalised toolkit of coping strategies.




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