CBT to Help With Chronic Pain Associated with Endometriosis
Niamh Macdonald
Niamh Macdonald

What is Endometriosis?

Endometriosis happens to 1-in-10 women worldwide and it’s where lesions and endometrial-glands begin to develop outside the uterus. According to the NHS, the tissue which is similar to the womb lining starts to grow in other places, such as the ovaries. Endometriosis diagnosis often involves laparoscopic inspection of the pelvis. The typical clinical symptoms of Endometriosis can be different for each woman, depending on their age.Some typical symptoms include severe pelvic pain, pain during sex, constipation during your period, and difficulty getting pregnant .For more information, read our blog about understanding endometriosis and its symptoms.

Impact of Endometriosis on Mental Health

A diagnosis of Endometriosis can be challenging for a number of reasons even before a diagnosis is made. According to the NHS, Endometriosis takes on average 7.5 years to be diagnosed with many women often left feeling unheard, with severe pain, and in some cases, infertility issues without actually not knowing what is wrong with them.According to the Royal College of Obstetricians and Gynaecologists, Endometriosis can be very difficult to diagnose because every woman has different symptoms and presentations that overlap with other health conditions, such as irritable bowel syndrome or pelvic inflammatory disease.Syrona is working with leaders of Endometriosis around the world to help reduce the time to diagnosis for women with potential Endometriosis. 

According to the Diagnostic and Statistical Manual of Mental Disorders (2013), anxiety can develop when a person is feeling tensed and on edge constantly. These anxious feelings can worsen to a point where an individual may not be able to do their regular activities, such as going to work. Common anxiety disorders include generalised anxiety disorder, panic disorder and social anxiety disorder. It is estimated that there are 8.2 million individuals who suffer from anxiety. On the other hand, depression involves feeling sad and low for an extended period, constantly.

These feelings are intense, which impact daily life significantly. For example, a person who is depressed may not enjoy the activities they previously enjoyed, may isolate themselves, lose confidence, feel guilty and in some severe cases, suicidal thoughts. It is estimated that around 24 percent of women in England are diagnosed with depression – you’re not alone.Research has shown that diagnostic delay in Endometriosis among women have led them feeling like they are not ‘normal’. Karen Ballard and colleagues showed that women were told continuously before diagnosis that their symptoms are typical, even though they were in excruciating pain. This made many women lose their self-esteem and confidence, negatively impacting their mental health. Research conducted in Australia showed that women who were diagnosed with Endometriosis had moderate levels of clinical anxiety and depression. These women also reported having poor overall well-being, which was worse than the general population who had other chronic conditions such as HIV. Additionally, the results also showed that women aged 25 and under had a more severe impact on their mental health and well-being due to endometriosis. This study shows suggests that mental health problems are prevalent in women who have Endometriosis, and are more severe for younger women.

Another study the factors that affect the mental health of women with long term Endometriosis. The findings from this study showed that pelvic pain, self-esteem, body esteem and emotional self-efficacy predicted the severity of mental health conditions in women. These women reported high anxiety and depression, but rumination was low for women who were in a stable relationship. This was because these women were always told that there is no cure. This made them feel hopeless and severely disheartened. However, there were some factors, such as healthier self-esteem, body esteem, and emotional self-efficacy, which correlated with improved psychological outcomes. Hence, women who have endometriosis can help reduce their mental stress by improving their self-esteem, body esteem and emotional self-efficacy.But have you ever wondered how this could be done? Continue reading to find out!

Talking Therapies and CBT for Endometriosis

Talking therapies are a set of psychological treatments such as counselling and cognitive behavioural therapies. Here, an individual sits down with a mental health professional to talk about their concerns. The therapist listens to you and helps you come up with solutions without being judgemental. This can be a safe place for an individual to sit, cry, shout or vent who is going through mental health problems. These talking therapies can be helpful for anxiety, depression, eating disorder, and even for chronic conditions such as Endometriosis. Cognitive-behavioural therapy (CBT) refers to a class of medicines which share the fundamental concept that cognitive factors sustain mental disorders and psychological distress. The core premise of CBT states that negative thoughts contribute to the maintenance of psychological and behavioural problems. According to Beck’s (1970) model, these negative cognitions include beliefs about the world, the self, and the future. Hence, we need therapeutic strategies to change these negative cognitions to reduce emotional distress and problematic behaviours. 

The overall goal for all CBT protocols is symptom reduction, improvement in functioning and remission. To achieve this, the client becomes an active participant in a collaborative problem-solving process to test, challenge the validity of negative cognitions and, modify undesirable behavioural patterns with the help of a therapist.CBT for chronic pain involves changing the way people view their pain. For example, CBT can change the negative thoughts linked with pain, improve coping strategies, and put the discomfort in a healthier context. Allowing people to recognise their pain, which enhances their long term well-being and function. CBT can also help change the pain related response in the brain, as it impacts brain chemicals, norepinephrine and serotonin. This, in return, makes the body’s typical pain relief response more powerful. Benefits of CBT in EndometriosisCBT can be very beneficial in chronic pain treatment for Endometriosis. The following are the benefits you can expect during and after your CBT session:

  1. CBT can significantly reduce your anxiety and depression symptoms: research has shown that CBT can help relieve sadness, hopelessness, stress and worry, in both short-term and long-run.
  2. You become aware of the inaccurate and negative thinking responses to pain: an individual will realise that their negative thoughts are due to a physical condition. This will help them come up with rational coping strategies, such as doing some meditation and yoga to help with the pain. Thus, the individual will not feel hopeless in pain, as they will know there is a cause for it.
  3. You learn how to respond to challenging situations more effectively: chronic pain in endometriosis is severe. Once a woman learns healthy coping strategies for such severe pain, she will be able to manage other difficult, stressful situations which may cause her distress in the future. She will also be able to control her anxiety and depression symptoms more effectively.
  4. Encourages a problem-solving attitude: women are taught to overcome their sense of learned helplessness. For example, if they think “there is nothing we can do about this pain”, CBT teaches them to think positively where they feel more in control of their pain.
  5. Helps you keep track of your emotions: CBT involves you doing a lot of homework at home, this may include keeping track of thoughts and feelings related to pain in a journal. These are then reviewed in the session to come up with coping strategies, such as breathing exercises and relaxation.
  6. Foster life skills: CBT overall teaches the client to overcome their problems more healthily. You can use these skills in other situations, for example, childbirth!

Online CBT by Syrona

Overall, the benefits of CBT for Endometriosis are limitless. However, the main one mentioned in this article is that they reduce your anxiety and depression symptoms. They provide you with new healthier coping skills for pain and foster life skills such as resilience and endurance. Furthermore, they help you keep track of your emotions which can help you in the long-run as you develop new habits such as journaling.

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