In this blog series, we will define health psychology, explore the relationship between mental and physical health, and provide tools to help cope with the impacts of chronic illness.

Health psychology is the study of biological, psychological, and socio-environmental processes that impact physical health and illness. The field places great emphasis on examining the bidirectional relationship between mental and physical health. Chronic illness refers to illnesses or conditions that are of long duration and generally slow progression (WHO, 2018). Common chronic illnesses include heart disease, diabetes, cancer, asthma, arthritis, autoimmune disorders, and neuromuscular disorders. Research shows that individuals with chronic illness are more likely to experience mental health issues including anxiety and depression. But did you know the reverse is also true? Individuals with mental illness are more likely to experience chronic illness. Research shows that individuals with anxiety, depression, and trauma experience higher rates of chronic illness. We will discuss the pathways underlying the relationship between mental and physical illness in the second part of this blog series.

Chronic illnesses can impact our lives deeply and can make us feel alone. In health psychology, we support clients throughout their health journey from the onset of symptoms, to advocating for themselves within healthcare, receiving a new diagnosis, coping with physical limitations or loss of independence, navigating impacts on identity and relationships, and adjusting way of life and plans for the future. We also help clients modify health behaviours such as appetite, exercise, alcohol/substance use, and address barriers to treatment that may be contributing to or worsening physical symptoms.

Health psychology providers utilize a biopsychosocial approach, that aims to recognize the biological, psychological, and social factors contributing to or worsening health issues. Treatment approaches may include: Cognitive-Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-based techniques.

If you or a loved one are facing health challenges, please know we are here to support you.

Dr. Megan Dann, C.Psych. (Supervised Practice) is a Clinical and Health Psychologist nearing the end of supervised prac8ce. She is currently supervised by Dr. Lila Hakim, C.Psych. and Dr. Natalina Salmaso, C.Psych. She provides assessment and treatment services for adults and couples. Dr. Megan Dann, C.Psych. (Supervised Practice) utilizes a holistic, biopsychosocial, integrative and trauma-informed approach to help clients with a wide range of issues including: depression, anxiety, trauma, sleep difficulties, alcohol/substance use, chronic illness and pain.

References

Andrasik, F., Goodie, J. L., & Peterson, A. L. (Eds.). (2015). Biopsychosocial assessment in clinical health psychology. The Guilford Press.

Bobo, W. V., Grossardt. B. R., Virani, S., St Sauver, J.L., Boyd, C. M., Rocca, W. A. Association of

Depression and Anxiety with the Accumulation of Chronic Conditions. JAMA Netw Open. 2022 May 2;5(5):e229817. doi: 10.1001/jamanetworkopen.2022.9817. PMID: 35499825; PMCID: PMC9062691.

Herrera, P.A., Campos-Romero, S., Szabo, W., Marenez, P., Guajardo, V., Rojas, G. Understanding the Relationship between Depression and Chronic Diseases Such as Diabetes and Hypertension:

A Grounded Theory Study. Int. J. Environ. Res. Public Health 2021, 18, 12130.

hgps://doi.org/10.3390/ijerph182212130

National Institute of Mental Health. 2024. Understanding the Link between chronic disease and depression. NIH Publica7on No. 24-MH-9018.

hgps://www.nimh.nih.gov/health/publications/chronic–illness–mental–health#part_6118

World Health Organization [WHO]. (2018). World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva, Switzerland: WHO Press. 

by: Dr. Lila Z. Hakim, C.Psych.

The rehabilitation and health psychologists at CFIR can help you to address the psychosocial impact of pain, injuries and disabilities in your life.

Pain

Acute and chronic pain can be a serious and debilitating life issue. Pain is often associated with physical limitations that require life adjustments. Pain tends to be accompanied by a wide range of emotional issues including depressed mood, low motivation, hopelessness, grief, anger, or anxiety. In addition, we may experience problems with concentration or memory as a result of pain and low mood or anxiety. The experience of pain can have an impact on how we view our selves and our sense of autonomy, which can affect our couple, family, and work relationships.

Disability and Injuries 

Regardless of the manner in which a person is injured, whether gradually through a work-related task, or suddenly such as through a slip-and-fall or motor vehicle accident, there are a host of emotions that can occur that can affect engagement in everyday life activities (e.g., socializing). In the case of a sudden injury, a number of traumatic stress symptoms can occur, such as nightmares and flashbacks. Avoidance of important activities, such as driving, can also serve to worsen our emotional state and sense of autonomy, and affect our recovery. 

Regardless of the manner in which a person is injured, whether gradually through a work-related task, or suddenly such as through a slip-and-fall or motor vehicle accident, there are a host of emotions that can occur that can affect engagement in everyday life activities (e.g., socializing). In the case of sudden injury, a number of traumatic stress symptoms can occur, such as nightmares and flashbacks. Avoidance of important activities, such as driving, can also serve to worsen our emotional state and sense of autonomy, and affect our recovery. 

Engagement in physical treatments can be affected by emotional issues such as traumatic stress, low motivation, hopelessness, or anxiety. Considerations about returning to the workforce and how to engage in life roles (e.g., parental, couple) are important to resolve. Accessing support from friends and family can be difficult at times, resulting in the feeling that nobody understands your pain and limitations.

How We Help You

At CFIR, we help you to cope and manage your experience of pain and adapt to your injuries and disabilities. In terms of your pain, your experience of pain is influenced by our thoughts, emotional reactions, and everyday stress. Certain ways of thinking and emotionally reacting to the world can heighten the perception of pain and intensify the pain we are experiencing. Environmental stressors, relationship problems, and a lack of social support can also influence how we view our pain and limitations. We will help you to address these psychological challenges, including making lifestyle adjustments, to support you to cope with your pain. In terms of your injuries and disability, we will also help you deal with the psycho-social aspects of your injury and disability by supporting you to adapt your lifestyle and build new skills to deal with your physical incapacities. We’ll also help you deal with the grief, helpless, hopeless and anxious feelings that can accompany changes to your physical health status.

Read more about our Neuropsychology, Rehabilitation & Health Psychology Treatment Service.

Health psychologists at CFIR can help you to cope with a wide range of health concerns.  

Chronic Illness:

Individuals experiencing chronic illnesses, such as diabetes, HIV, hypertension, and irritable bowel syndrome (IBS), suffer from debilitating physical symptoms that influence how they function in everyday life. Management of these medical conditions requires medication and lifestyle modifications. A psychologist can support individuals to adapt to the lifestyle changes necessary to manage chronic illness, including adhering to treatment regimens as well as dealing with the psychological and emotional aspects of the debilitating side effects of treatment or the disease itself. Often overlooked is the importance of our mental and emotional well-being in dealing with a chronic illness. Depression and anxiety can emerge as we adapt to our new medical realities. Our psychological and emotional functioning can exacerbate or worsen our experience of a chronic, manageable illness.

Life-Threatening Illness:

Individuals experiencing life-threatening illnesses experience physical health issues associated with the disease process and treatment that can influence their emotional well-being and psychological functioning. Being calm and relaxed and maintaining a positive sense of emotional well-being during medical treatments, while challenging, can buffer clients from the distress associated with medical procedures and hospitalizations. Making sense of, and coping with, the adverse emotional reactions related to uncertainty can alleviate our emotional distress during these problematic life moments. Adapting to treatment regimens and medical appointments can create emotional distress. Treatments can also affect our psychological functioning, which alters our sense of self and the world around us. Anxiety and depression can also grow out of the uncertainties of our medical circumstances.

Terminal Illness: 

Facing a terminal illness precipitates a wide range of emotional reactions, including fear, anger, sadness, and grief. Moving toward acceptance is an internal journey. The disease process and treatment of the disease can bring about debilitating side-effects, and can also affect our emotional and mental health status, and our psychological functioning. Making sense of our circumstances and lives, and dealing with the emotions associated with a terminal diagnosis can be overwhelming.

Smoking Cessation, Weight Concerns, Healthier Lifestyle: 

Whether you’re looking to quit smoking, lose a few pounds, or make healthier lifestyle choices, there are several stages one goes through to change behaviours. Whether contemplating change or actively attempting to change, maintaining healthy practices requires us to be attentive and mindful to the self and environmental triggers that stimulate us to engage in these behaviours. Learning how to manage healthy behaviours, including adopting new coping strategies to address underlying stress and emotions, is an essential component of behavioural change. When motivation to change an unhealthy behaviour wanes, deeper issues associated with self-esteem, self-worth, trauma, and abuse may also be present. Sometimes unhealthy behaviours serve as a source of soothing the self and dealing with difficult emotions from our past and present-day life. 

How We Help You:

You don’t have to be alone while struggling with the physical and psychological aspects of your condition. A health psychologist at CFIR can meet with you for a free consultation to help you better understand how he or she may support you through your journey with a health-related or lifestyle adaption. We offer clients comprehensive assessment and psychological treatment to address the psychological aspects of managing chronic, life-threatening or terminal illnesses or promoting healthy behaviours. Clinical and health psychologists at CFIR work with clients to treat a wide range of psychological issues that may emerge as we encounter challenges in our efforts to manage our physical health concerns or face life-threatening or terminal illnesses. We provide you with knowledge and emotional support to diminish your sense of isolation and to assuage distress associated with fear and hopelessness as you face challenges related to health and illness. Regarding lifestyle adaptations, we can help you manage these stages of change, deal with underlying self and relationship, or past traumatic issues, and help you to find more adaptive coping mechanisms to allow you to live the healthier life you desire.

Read more about our Neuropsychology, Rehabilitation & Health Psychology Treatment Service.

by: Dr. Julie Beaulac, C. Psych.

According to the National Center for Chronic Disease Prevention and Health Promotion, ‘physical activity’ is “any bodily movement produced by skeletal muscles that results in energy expenditure” (National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997).

Regular physical activity is linked to a wide range of important health benefits – from weight management, reduced risk of stroke, cardiovascular disease and cancer, to the prevention and management of anxiety, depression, and stress.

For most people, it’s safe to start slowly and gently increase your activity. If you have a health condition and are not currently active, it’s highly recommended that you talk to a physician before starting a new exercise regimen.

How Much is Enough?

The Canadian Society for Exercise Physiology released guidelines on physical activity that suggest the following standards as a minimum for health benefit:

• Youth (5-17 years): 60 minutes of daily moderate- to vigorous-intensity activity
• Adults (18- 64 years and older adults 65+): 150 minutes of moderate- to vigorous-intensity activity per week

You can also build up activities in periods of at least 10 minutes each. Here are a few examples:

• Low-intensity effort: Light walking, stretching, or easy gardening
• Moderate intensity effort: Brisk walking, raking leaves, or biking
• Vigorous-intensity effort: Aerobics, jogging, or fast swimming or biking

How Do You Know an Effort is Moderate?

If your breathing and heart rate are a bit higher, and you feel a bit sweaty by the end, you are using moderate effort or are being moderately active.

For managing anxiety or depression, research suggests that physical activity should be in bouts of at least 25 minutes 3-5 days a week (Smits & Otto, 2009) and add up to the following amounts weekly:

• Moderate-intensity for minimum of 150 minutes (i.e., 2 hours and 30 minutes) weekly or; 
• Vigorous-intensity for minimum of 75 minutes (i.e., 1 hour and 15 minutes) weekly

In terms of types of physical activity, it is recommended that we aim to include a mix of endurance, flexibility, and strength and balance activities.

• Endurance (4-7 days per week): Continuous activities that make you breath deeper and increase your heart rate

• Flexibility (4-7 days per week): Reaching, bending and stretching

• Strength and Balance (2-4 days per week): Lifting weights or own body, resistance activities.

So, if we know it is so good for us, why is it so hard?

Lots of things keep us from being active – work and family responsibilities, feeling tired, low motivation, pain or health conditions, the weather and low confidence, to name just a few. There are some strategies that we can use to overcome barriers. Some ideas include:

• Fit activity into smaller chunks throughout the day, such as walking 10 to 15 minutes three or four times a day or taking the stairs instead of the elevator.
• Choose activities that you enjoy and are familiar with so that they can be more easily integrated into your life, such as walking to run errands instead of driving, walking the dog, active play with children.
• Invite friends or colleagues for a walk during lunch hour at work.
• Do activities like biking, swimming, or bowling, instead of going out for dinner with your family or friends.

If you want to increase your physical activity, the top five tips for success are to:

1. Plan ahead
2. Start slow & gradually increase
3. Do something you enjoy
4. Build it into your life
5. Get family and friends involved

When working to make changes to your activity level, it is important to set goals that are:

• Behaviourally-anchored (“I will walk for 15 minutes 3x/week is a behavioural goal”; “I will lose weight” is not a behavioural goal)
• Realistic – Ask yourself, “Is this goal doable?”
• Important – Set goals that are important to you right now.
• Specific – The most useful goals are specific and concrete (e.g., “I will walk for 15 minutes 3 times per week” as opposed to, “I will walk more”)
• Scheduled – Schedule your goals. Write them goals down. Post them somewhere you can see them and tell others about them.
• Reviewed – Goals change. Review your goals often.

For more information, see the following resources:

• Canadian Society for Exercise Physiology Guidelines on Physical Activity
• Exercise for Mood and Anxiety Disorders by Michael W. Otto & Jasper A.J. Smits (2009). New York: Oxford University Press

The psychologists of CFIR’s Health Psychology Treatment Service can help you create a strategy for increasing physical activity and improving your overall wellbeing.

Read more about our Health Psychology Treatment Service.

Do you find that you turn to food when you feel stressed, guilty, angry, bored or some other emotion? We all eat in response to our emotions from time to time. 

When is emotional eating a problem? When eating becomes one of the main strategies you use to respond to your feelings, when you feel weight becomes a problem, and/or when parts of your life are affected by your eating. 

Managing weight is not as simple as eating healthier and exercising more. We know now that our emotional experience plays an important role in weight management. Psychological treatment for weight and emotional eating will often involve helping you set behaviourally-anchored goals and explore patterns of eating related to your thoughts, feelings, relationships, and environment.

Some areas to explore if you are concerned about weight and/or emotional eating. 

1. Get a sense of any patterns in your eating? You can do this by logging your eating behaviour across the day for a week or two. Do you tend to skip breakfast or earlier meals and then find yourself overeating later in the day? Are certain emotional experiences more likely connected to times when you overeat (e.g., anger, sadness)? Or, certain situations (e.g., after conflict with a family member, when alone, after the kids go to bed)?

2. We all experience urges to eat food that we would like to limit and are surrounded by temptation. Consider removing certain foods from your home and ask your family to support your efforts. Otherwise, we are putting ourselves at risk of overusing our ‘willpower muscle’.

3. Practice taking an observer stance to your internal experience (e.g., feelings, thoughts) when the urge to eat shows up. What do you notice? Take a few minutes to just observe what’s going on inside of you (e.g., thoughts, feelings, physical sensations), without following any judgments that come up, before choosing what action to take (e.g., continue to reach for the bag of chips or chocolate bar or go for a walk or call a friend)? 

4. When working to make changes to weight and/or eating habits, it is important to set goals that are:

• Behaviourally-anchored (I will eat three meals a day is a behavioural goal; I will lose five pounds is NOT) 
• Realistic – ask yourself, is the goal doable? 
• Important – set goals that are important to you right now 
• Specific – the most useful goals are specific and concrete (e.g., half of each meal will be vegetables NOT, I will eat more vegetables) 
• Scheduled – schedule your goals. Write your goals down. Post your goals and tell others about them. 
• Reviewed – Goals change. Review your goals often.

Clinicians at CFIR can support you in working with issues of weight and emotional eating.

Read more about CFIR’s Neuropsychology, Rehabilitation & Health Psychology Treatment Service.