June 2021 – Chronically Living

How Can I Improve My Self-Efficacy with My Chronic Illness?

Back in the summer and fall of 2016 I wondered how much I would be able to accomplish in my life. Can I even manage through the situation I’m in? Particularly with my physical health, having recently been diagnosed with an autoimmune disease, and then the mental health consequences (mainly anxiety) that had come along with it? My partner and I were fighting a lot, despite having only moved in together a few months earlier. What would happen to my dreams of being a filmmaker if I can’t be active on set for 12+ hours straight? My self-efficacy was falling and falling…

Since 99% of the photos I have from that summer/fall are of my dog (RIP) I can tell what it was like for me.

Self-efficacy is our beliefs in our ability to cope or succeed during a difficult situation. Those with higher self-efficacy, have higher beliefs in their abilities, and those with lower have, well, lower. I see this a lot within the chronic illness community, and it makes sense, because as the opening story pointed out, I’ve been there too. The pain, and discomfort or disability from having one or more chronic illnesses messes with one’s self-efficacy because of the drastic changes it makes to our lives. However, having high self-efficacy has been linked to better quality of life and less disability from illness, so it’s important for us to find ways to improve it. But how do we go about doing this?

Drastic improvements in self-efficacy by the time I took this solo trip to LA in 2018.

I looked at a number of research studies to find some answers, because it is a good and important question. The studies were all from 2010-2021 and the illnesses included ranged from COPD to diabetes to people with multiple chronic illnesses. These are some of the ways to improve self-efficacy, which is directly linked to self-care ability, and you’re about to see why:

more physical activity – yes, this can be hard for people with chronic illness, which is why I recommend starting slow and building up, and working with appropriate professionals such as physiotherapists and personal trainers.
healthy eating – eating a nutritious diet can improve our ability to cope, but this can be a struggle if you’re not used to eating one, so take this slow, one meal at a time.
a lower emotional response to your illness – this is because of the mind-body connection (check out that podcast episode here). This can be accomplished with the help of a psychotherapist and by practicing things like meditations (like these).
having less perceived consequences from your illness – I think this is much more difficult to accomplish and can take much more time -change is slow! This will likely improve as other areas improve, and working with a whole team of healthcare professionals was helpful for me.
problem solving – our ability to problem solve is linked to self-efficacy in a variety of contexts. Working with appropriate healthcare and mental healthcare professionals on problem solving is a helpful way to learn to problem solve so that you can do more of it on your own in the future.
having more social support – build that network! I find that online support groups aren’t always the most helpful because sometimes it’s negative feeding negative, but if you find it is helpful for you then go with it. Also utilizing your family, friends, and any local peer supports you have is important.
having a good understanding of your illness – and this means not just the bad parts, the terrible outcomes, but also looking for success stories, as in people who have a good quality of life with your illness. The full range of human experience is important to consider. I call myself a realistic optimist.
having doctors who use person-centred communication – I’ll admit this can be hard to find, and if you have the ability to “shop around” for one that does use this then that might be a good idea. This type of communication includes fostering healing relationships, exchanging information, responding to emotions (yes, doctors should understand that you will have an emotional response to your illness), helping you manage your uncertainty about your illness, making decisions collaboratively, and enabling you to be able to self-manage your illness.

As my self-efficacy increased, my drive to help others did too! Masters degree convocation grad pictures June 2021.

Cut to summer 2021 and my self-efficacy is high. I’ve traveled, both with others and by myself between 2017 and 2019. I exercise regularly, try to eat healthy, problem solve well, cope with my emotions, don’t perceive myself as having a disability, am always learning more about my illness, have a great support system, and while I don’t currently have a doctor because I’m going to be moving soon (for the last time for a while) I know that I can find one like the previous ones I had. I utilized a full team of healthcare professionals and took a lot of ownership over my own health in my journey the past 5 years. However, if you told me 5 years ago that I could get here, I probably wouldn’t have believed you. Change is slow. You can keep making the most of it though!

New (and much more refined) season of the podcast launched this week! Available everywhere you get them (here’s the web link!)

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Daily Exercise: Ankle Pumps

https://videopress.com/v/cclIE3CA?preloadContent=metadata

It’s important to move our bodies as much as we can, even just to get the blood flowing! Sometimes chronic illness warriors find it difficult to get up and about, so this is an easy practice to get some movement in – either sitting or lying down – without putting too much strain on the body or taking too much energy. Plus it can be done multiple times per day if needed and only takes about 20-30 seconds each round.

Keep making the most of it!

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How to Self-Esteem & Self-Worth Effect My Chronic Illness?

Back when I was first diagnosed with an autoimmune disease, I noticed that my own self-esteem dropped. The person I was in a relationship with at the time didn’t help that, but then again, it wasn’t really up to her to help it. The disability I had from my illness was also very intense at the time. I missed a lot of work, I couldn’t go on long walks, I felt a lot of pain, and that all definitely hurt my self-esteem and self-worth. And that’s where my story ends…

Just kidding, if you’re reading this then you know that is not where my story ends! Actually, it’s where it begins. I was reading something a few weeks ago about self-esteem and chronic illness, just a brief paragraph, and it got me interested in doing a little more research on the topic, because, well, I noticed a correlation between my own self-esteem and self-worth and disability in my illness. I can’t be the only one, right? First of all, let’s define self-esteem and self-worth so we are all on the same page.
Self-esteem: our individual universal positive and/or negative feelings about ourselves.
Self-worth: basically another word for self-esteem.
In general, self-esteem effects our quality of life, which includes our overall life satisfaction as well as how much positive and negative affect (emotion) we experience.

When we are looking at chronic illness, there are some important considerations. First, how we evaluate and view our own bodies is important, often because of the changes our bodies go through because of illness (and/or medications we have to take). Having a perception of body-self unity and positive thoughts about our illness can improve self-esteem (we’ll get to how to do this in a minute). Second, acceptance of disability is related to self-esteem in people who have disabilities (chronic illness is a disability). Acceptance doesn’t just include accepting the diagnosis, but acceptance all that comes with it (pain, lifestyle changes, loss, etc.). The better we are at accepting… the more we are able to do? (Well, yes, but that would actually be another post, so back to the main topic)…

People tend to use different coping strategies when dealing with illness. Though none of these strategies should be categorized as “positive” or “negative” I prefer to think of them as “toward moves” (helping me live a good life) or “away moves” (taking me away from the good life). Away moves would include things like catastrophizing, which has been linked to pain-related disability (yes, it makes your pain worse), higher levels of depression, and overall lower health and well-being. Other away moves include avoidance strategies, like using drugs or alcohol to cope, denial of illness, or staying in bed all day everyday. If you do these things, understand that no one is judging. These are probably natural coping strategies for you as they are for many, many people. However, if we want to improve self-esteem (and thereby improve quality of life with our illness) we want to look at toward moves.

I can even see the change in these pictures, can you? (June 2019)

These toward moves coping strategies include hope (goal-directed energy plus planning to meet goals), humour (reframing distress), psychological appraisals (meaning of the stressor, ability to cope, and emotion-focused coping, such as seeking support), and approach behaviours such as seeking social support and positively reframing the situation (yes, the research supports mindset). These are all associated with better well-being, better mental health, and better illness outcomes. This all comes from the cognitive adaptation to chronic illness theory, which in addition to self-esteem, looks at making meaning of illness, and regaining mastery.

I think it’s important to assess which coping strategies you are using, and make changes if needed. If our self-esteem improves, and therefore our disability decreases, then our quality of life is also better. Sounds good to me! To finish my beginning story, I did a lot of personal development work, that led me to starting this blog, and along the way my self-esteem and self-worth drastically improved again, and my levels of disability have shrunk and shrunk and shrunk. My illness may not be cured, but my quality of life is so much better. This experience is also known as posttraumatic growth, which happens when positive change results from adversity, giving the individual better mental health.

I continue to use “toward moves” coping strategies to this day (June 2021).

New season of the podcast (totally revamped show!) coming June 28. Check out the trailer here.

Keep making the most of it!

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Daily Mindfulness: Leaves on a Stream

This meditation can help us distance ourselves from our thoughts, feelings, sensations, urges, or memories. The point is not to get rid of these, but to create some space so we can go on with our lives. This meditation is helpful for anxiety, depression, substance use, chronic pain, and other physical and mental health conditions.

“Deep Into Nature” composed by Music of Wisdom – Licensed from http://www.meditationmusiclibrary.com

For more of my guided meditations, relaxation exercises, grounding techniques, and acceptance practices, check out my YouTube channel: Kelsey L Harris Meditations.

Keep making the most of it!

Can Acting “As If” Help Us With Chronic Illness?

No, we’re not talking about Cher from Clueless (did I date myself?). We’re talking about Alfred Adler, who was an early psychoanalyst, and whose work has contributed to the development of current psychotherapeutic techniques, including Cognitive Behavioural Therapy. CBT, it turns out, has been incredibly helpful for people living with chronic pain and illness. One of the many techniques Adler developed was acting “as if” which got me wondering, can this help with chronic illness and pain? I’m going to start off by saying, there is not a lot of research in this area, so we don’t really know, but I’m going to do a bit of theorizing today, with the research that I did manage to find on the subject.

Great movie, but not what we’re talking about today.
Image from: https://www.refinery29.com/en-us/2015/07/90743/best-clueless-quotes-movie

First, let’s maybe determine what acting “as if” means. This technique has the client make up a new story about themselves, their lives, their ability, or whatever else, for themselves and behave in the way that they would need to in order for this story to be true on a daily basis. (If you’re familiar with CBT you might recognize the cognitive and behavioural components here). Initially it was used for things like giving empathic responses, and being more assertive, or making decisions. The idea is, that by acting differently, and getting different responses from other people in your life because of it, your brain changes so that you can be more like this “new” person. I kind of thinking it as a mindset change.

Alfred Adler
Image from: http://famouspsychologists.net/alfred-adler/

Okay, I have a story before we move on. I was always a very shy person. To the point where I had some social anxiety as a child (literally would never answer questions in class, and was terrified of doing presentations, though I always had friends). That continued right into my twenties. In my twenties (and early thirties) I worked in retail, so naturally some of that social anxiety went away, but to be honest, a good portion stayed. That is, until I was in my early thirties. Then I decided I didn’t want to be so shy anymore. I set myself down a path where I would either be in situations where I couldn’t be as shy, or I would force myself to just talk more in situations I normally wouldn’t. I was essentially acting “as if” I was outgoing. Guess what? At 36, I can say that while I do get some butterflies in new situations, I definitely would not be considered “shy” or “awkward” or “socially anxious” anymore.

But can this apply to chronic illness? And if it does, how exactly does that work? When we’re looking at chronic illness treatment, it’s always best to take a holistic, biopsychosocial approach. Typically, you’ll have a doctor (or team of doctors) that focuses on the biological aspects. Having a mental health care professional can assist with the psychosocial parts. There is a known association between self-efficacy, which is our beliefs about our ability to handle life’s challenges, and chronic illness and chronic pain disability. In other words, if we believe we can’t handle our illness or pain, then we won’t be able to and our illness and pain will actually be worse. This is where I think acting “as if” applies to us. We need to shift our mindset and starting acting “as if” we can handle the pain, we can handle the illness and the symptoms that go along with it. We replace self-pity with self-compassion. We are mindful of what we are doing and saying, and we start to take control of treatment (as holistically as possible). By doing so, our self-efficacy grows, and our pain lessens, and our illness has less control over our lives.

I would not be able to do most of what I can without self-efficacy.
2 years after diagnosis. Toronto -> Los Angeles. Solo Trip.

Okay, full stop. I know this might be a lot to take in, and you can’t even necessarily do this work on your own (though depending where you’re at with that self-efficacy thing, maybe you can). This is where having a support team, including a mental health professional might be helpful. At the very least, working on growing that mindfulness muscle and noticing what we’re doing is free to do (here’s the link to my meditation page which can help with that), until you can find (or afford) to have a professional help you. I truly believe in our abilities to live great lives, even with pain and illness. And, so, keep making the most of it.

New season of my podcast, Chronically Living and how to make the most of it, coming June 28, 2021.

Daily Stretches: Lats

https://videopress.com/v/cc9c67cK?preloadContent=metadata

Probably most of us don’t stretch enough, which is why taking a few minute breaks during the day to do so is so important. A nice side body stretch is a great one to incorporate into your day. I know my body feels great when I do! Check out this podcast episode with Danielle Potvin, RMT, who talks about the importance of stretching. Hopefully this video gives you another idea on how to keep making the most of it!

Why is Emotion Regulation Important For My Physical Health?

I’m going to be the first to admit that when I was younger I often struggled with my emotion regulation. This often came to the forefront in the context of relationships, because I had a “short temper.” I would get angry and yell, pretty quickly. I could always calm down, but I came to realize the older I got that I had to remove myself from the situation in order to get myself to be more calm. I had a really bad breakup geez, almost 5 years ago now, that I also had a difficult time controlling my emotions, especially sadness and rumination. That last time, that was the lesson for me. But we’ll get to that in moment…

A transition from a poor emotion regulation period to a better one.

First, let’s talk about what emotion regulation is, because I know that some of you may never have really heard the term before. Emotion regulation is our attempts to control the experience, expression, time and scale of our emotions. It has been long known to be important for our mental health, and only more recently explored for physical health. These are also skills that many of us learn as children, but often do require practice throughout our lifetimes. I worked in retail for a long time and as I reflect back I can see how customers yelling at me, for let’s be honest, very small things (I had a lady yell at me once because a competitor had an item for a dollar less but she didn’t tell me before she paid – I happily would have matched it… and by yelled I mean screamed bloody murder) and I realize they were exhibiting very poor emotion regulation, which is more harmful for themselves than the stress it caused me.

If you’re yelling at retail workers (or servers, etc) you might want to check on your emotion regulation skills.

Here’s what we know about emotion regulation and physical health:

better emotion regulation impacts our overall physical health positively
difficulties with emotion regulation, especially with prolonged negative emotion, can make you more at risk at developing heart disease
emotional suppression and rumination (part of poor emotion regulation) cause lower energy, greater physical pain, greater disability, and overall lower quality of health
difficulties with emotion regulation make it difficult to engage in self-care and health-related behaviours necessary for managing chronic illness
better emotion regulation makes it easier to manage stressors in our lives, meaning less flares and relapses of illness
better emotion regulation increases medication adherence and sticking with diet and exercise regimes

Back to my story. So, I had this breakup and this very poor emotion regulation following it, and then I had a flare so terrible I ended up in the hospital for pain. I was released the same day, and the pain came down a bit, but it really went back to normal levels when I was able to come out of the depressive funk I was in. I can safely say I have not had a problem regulating my emotions since… and I mean really who wants a flare like that again? So, we’ve answered the question why, and there are lots of “how tos” in regulating emotions, but I’m going to leave you with one to try out.

A much more emotionally regulated period

Learning to self-soothe. Again, many of us learn this skill as children, but not everyone does, and often we do less of it as we get older. Some ideas for practicing self-soothing are to do meditations such as loving kindness (click here) or a relaxation practice like progressive muscle relaxation (click here). Expressive writing about the experience (click here), breathing exercises (click here), and self-care strategies like taking a bubble bath, are more ways to lear to self-soothe. There are many other strategies online so I suggest a Google search if you’re looking for more!

Take care, and keep making the most of it!
–Kelsey

Daily Exercise: Kayaking

https://videopress.com/v/rCMjv1ee?preloadContent=metadata

Okay, so kayaking may not be a daily exercise for most of us, but it is a great way to switch things up. I love kayaking because it can be as intense or relaxing a workout as you want it to be. Plus you can choose to work your arms or your core more. A podcast episode I would recommend checking out if you haven’t yet is the one about Movement with Tania Clarke from Move Deeply Wellness.

Until next week, keep making the most of it!

Book Review: Man’s Search for Meaning

This month I read the book, Man’s Search for Meaning by Viktor Frankl. The book is actually one of the top selling “self-help” books of all time. I put self-help in quotations because I’m not sure if that was the original intention behind Frankl writing it, but it seems that he might have recognized what it became between the years it was first published in 1946 and his death in the late 1990s. The first half of the book chronicles his experiences as a prisoner in concentration camps during the second World War, including Auschwitz. While this could be just read as an intense, heart-breaking story (and it is), the way that Frankl writes about his life experiences doesn’t come off that way. Instead, you can see his reflection and growth in his writing. It’s kind of hard to explain how that works, unless you read it for yourself. The story is also not chronological but instead jumps back and forth across his timeline in the camps to highlight pieces of the story that are connected to each other in some way.

While I don’t want to give away too much from the story, because I highly recommend that everyone read it, there were two main takeaways that I had from the first half of the book. First, is that if we believe our lives have no meaning, then we are more likely to give up when faced with difficult circumstances – and that meaning doesn’t have to be grand or anything, as the beauty of a sunset or holding the hand of a sick friend can bring some meaning for that day. Of course, as Frankl admits, in the concentration camps there was a huge element of dumb luck that you ended up in this line instead of that line (whereas that line led you to the gas chambers and this one didn’t), but for those with that luck, meaning became important. The other takeaway I had is that meaning is created by each other us, and is different for each person. It is solely up to us what that meaning is.

The second half of the book is about Logotherapy, which is a psychotherapy modality that Frankl (who was a psychiatrist) invented. It was kind of based on psychoanalysis, but with a heavy emphasis on existential philosophy, particularly meaning-making. During the second half of the book, Frankl does tell more stories from his time in the camps, integrating it with his theories about human existence and how helping people find meaning can aid with the treatment of many mental health problems. Frankl is considered one of the leaders of existential psychotherapy. Though logotherapy isn’t really used anymore, as there isn’t a huge amount of empirical evidence supporting it, it has influenced many other existentially-based therapies, including Acceptance and Commitment Therapy, which I practice. My personal beliefs are that life meaning is incredibly important, as are other existential concepts, which all humans ultimately deal with, and our ability to deal with contributes, at least partially, to our overall well-being.

Even if you aren’t interested in psychotherapy or existentialism, I highly recommend giving this book a read. There’s a reason that this is a best-selling self-help book. Many people struggle with finding meaning in their lives, especially at transitional periods, and this book can really open your eyes on how to find meaning, even in incredibly difficult circumstances. There are so many amazing quotes from this book, but I’m going to leave you with this one: “The helpless victim of a hopeless situation, facing a fate he cannot change, may rise above himself, may grow beyond himself, and by doing so change himself – he may turn personal tragedy into a triumph.”

For a podcast episode on meaning making with chronic illness, check out this one. Everyone, thank you as always for reading my posts. If you end up reading this book, let me know what your takeaways were. For now, keep making the most of it!