When it comes to chronic conditions such as endometriosis, we are often quick to think about the physical, often times painful, symptoms first. Endometriosis is characterised by varying degrees of intense pain in the pelvic and back area, bowel issues like constipation, and infertility (read in more depth about these symptoms in our blog Endometriosis 101). But another hugely overlooked aspect of the condition is the mental tole it can take.
Our minds and bodies are deeply connected and chronic conditions have been shown to have a direct effect on our mental health. Research even suggests that a negative cycle can form, wherein chronic pain can cause mental health issues, and in turn mental health issues can make pain feel even worse. This can be due to a number of reasons, from hormonal factors to coming to terms with your diagnosis.
You are not alone if endometriosis, or any chronic condition, has caused you to suffer emotionally. People with chronic illness are 15% to 20% more likely to be depressed than those without one. Endometriosis specifically can increase your chances of having anxiety, depression, and other mental health issues. The long road to diagnosis – it takes on average 7.5 years to be diagnosed with endo in the UK – can leave many feeling misunderstood and alone.
Depression & Anxiety
There is no one-size-fits-all depression or anxiety diagnosis, they can manifest in different ways depending on the individual. If you notice you are troubled by persistent and extreme negative feelings and a sense of hopelessness you could be experiencing depression. It can also feel like you have lost interest in things that used to excite you, you may struggle to concentrate and even sleep or eat on the same schedule you used to.
Anxiety usually presents itself in intense fear and worry that often doesn’t go away with reassurance. It may cause you to over-think and avoid activities or places you used to have no problem with. Anxiety can also be a very physical type of mental health issue; you might notice a racing heart-beat, rapid shallow breathing and sweating. This can also lead to a lack of confidence in your decision making and knowing what to trust.
Some struggles associated with endometriosis which are connected with depression and anxiety are:
· The long diagnosis process (possibly involving multiple doctors and a lot of back and forth).
· Coming to terms with your diagnosis and managing lifestyle changes.
· Managing chronic pain and other challenging physical symptoms.
· Hormonal treatment which can affect overall mood.
· Disruption of treatment such as surgery and unsuccessful treatment.
· Financial struggles, difficulty working and taking time off for treatment.
· Accepting the possibility of infertility or being infertile.
· Inadequate support and social understanding of endometriosis.
Body image and self-esteem can have a huge influence on our mental health. One study on endometriosis and psychological health showed that out of 74 women an overwhelming number struggled with body image and stated they were impacted by the symptoms and treatments of the condition. Physical symptoms like pain, bloating, fatigue, painful sex, and bowel problems, contribute to feeling unconfident and out of touch with your body. This disconnection can make you feel uncomfortable just being yourself and put you in a negative headspace.
Another common problem associated with endometriosis is stress. Stress happens as a result of feeling overwhelmed and unable to cope with a situation or environment. We all complain that we are stressed out from time to time, but when there is no relief from the stress it can become too much to handle. Stress can even cause physical responses like nausea and undereating/overeating. The symptoms of endo can be stressful enough and many find the battle with doctors to get a diagnosis to be exhausting. In fact, the All Party Parliamentary Group (AAPG) reported that in the UK, 58% of people visited the GP more than 10 times before being diagnosed.
Whether depression, anxiety, stress or low self-esteem, whatever struggle you are facing you do not need to do it alone. The most important thing you can do for your mental and physical health is to seek the support you deserve so you don’t suffer in silence.
Cognitive Behavioural Therapy
One option that can help individuals to manage mental health issues associated with chronic conditions, such as endometriosis, is cognitive behavioural therapy (CBT). The NHS defines CBT as: “a talking therapy that can help you manage your problems by changing the way you think and behave.”
CBT is based upon the idea that everything is connected; your thoughts, feeling, physical sensations, and actions. If you get caught in a negative pattern with one of those elements, it’s easy for all of them up to get swept up into the cycle. CBT therapy is about breaking up those negative patterns to interrupt this cycle so that it doesn’t become overwhelming.
The therapy involves doing exercises to notice the discouraging thoughts you have and learning how to stop and replace them with healthy thoughts. The body is integrated in this practice too, often meditation, yoga, and muscle relaxation techniques are recommended. Essentially it boils down to this; how you think changes how you feel.
CBT For Endometriosis
While endometriosis pain is undoubtedly real, so too is the connection between the brain and the body. By shifting focus away from the pain and switching to a more positive mental approach, it is possible to get some control over the experience, making it more manageable overall.
Christine Sieberg, an Assistant Professor of Psychiatry at Harvard Medical School, with expertise in CBT and endometriosis, told the Endometriosis Foundation of America “Pain is a complex biological, psychological, and social experience. There’s a lot of overlap between pain, depression, and anxiety. Activation of the stress-response network has been found to lower pain thresholds in both animals and humans, and high levels of anxiety are consistently related to higher pain sensitivity.”
We experience physical pain to a worse degree if we are also going through emotional pain, like anxiety or depression. Approximately 65% of depressed people describe being in pain to their doctors. Our nervous system, constantly transmitting signals across our body, also responds to our mental state, and it has a lot to process when we experience pain. If we can remain positive, we can interrupt the cycle of physical to emotional pain and back again.
Now of course, this is not an easy task, and can be difficult to get started on your own. This is where a CBT therapist comes in to help you build your emotional toolkit so that you feel strong enough to manage whatever endometriosis (and life in general) may throw your way. Here are just a few of the ways CBT can support you:
1. To get relief from feelings of anxiety and depression and to know how to work through it when they arise. Research has shown CBT to have significant positive effects both short-term and long-term for many types of anxiety disorders and the symptoms of depression, such as hopelessness and sadness.
2. To change how you think about your pain. The pain that comes with endometriosis can be extreme and it’s understandable that many might even fear the moment the pain kicks in. In CBT you will learn to remember that the negative thoughts are stemming from a physical condition. You can then learn coping strategies that work for you, such as a personal mantra or meditation.
3. To empower yourself. With CBT you are in control of your recovery, keeping records of how you feel and what works for you, as well as completing your therapy homework. This boosts self-confidence and can realign you with your body as you sow the seeds of your wellness.
4. To take a hands-on problem-solving approach. There is no question that the pain of endometriosis can feel impossible to manage some days. CBT gives you the tools you need so you won’t feel helpless and stuck when this happens. When you learn coping strategies for endo pain, you know you can cope with any tough mental health moments or challenging situations you come up against along the way.
Taking that first step to reach out for support is one of the most important things that you can do for your wellbeing. Our Syrona licensed therapists can help you create coping skills to interrupt that negative cycle and manage both pain and mental health.
Every individual’s experience is unique so we offer support that is tailored to you with a personal wellness plan. CBT gives you the opportunity to learn more about yourself emotionally too, through tracking your thoughts and feelings with activities like journaling. We will make sure you are happy and comfortable, with online sessions meaning you can benefit from CBT in your own home. Physical pain, anxiety, depression, stress, and low-self-esteem can be incredibly tough but they do not need to rule your life, there is always a way to take back your control.
Feeling better can start with a single conversation – book your first session with our discount code WELLNESS