Cognitive Distortions Experienced in Chronic Illness

Source: Image by Steve Buissinne from Pixabay

In previous posts, I’ve written about the cognitive side of cognitive behavioral therapy (CBT). The main technique involves identifying negative automatic thoughts and reframing those thoughts into more realistic, more helpful thoughts. One area where the use of cognitive therapy can seem somewhat counterintuitive is for people with medical or chronic illnesses. If the person has a medical illness, how is cognitive therapy going to help?

The cognitive side of cognitive behavioral therapy can help in several ways. The first is that having any chronic illness can be stressful, and reframing thoughts about the illness can help reduce that stress. Some negative automatic thoughts are common to all forms of stress, chronic illnesses included, and cognitive therapy can be helpful for addressing those thoughts. Another way cognitive therapy can help is how people think about their chronic illness. Negative automatic thoughts can be about any part of life (work, school, family, friends, hobbies), and having a chronic illness is no different. Thoughts about the chronic illness can lessen or exacerbate the stress. How cognitive therapy can be helpful for people with chronic illness often makes more sense with some examples. Here are some of the most common negative automatic thoughts:

• I caused my illness, or I made my illness worse. Cognitive distortion: emotional reasoning, inappropriate blaming. With these thoughts, the person is assuming that because they think they caused or exacerbated their illness, that it is true. The person could be blaming themselves for an illness that could not have been prevented.
• Because I’m at fault for my illness, I do not deserve good things. Cognitive distortion: overgeneralizing. In some cases, a person might reasonably believe that they contributed to their chronic illness. This becomes a problem when they begin to believe that they, therefore, do not deserve medical care, to be treated nicely, or other good things.
• No one is going to believe me or help me. Cognitive distortions: Mind reading, fortune telling. It is a sad reality that people with chronic illnesses and/or disabilities do not always receive the help they need. However, not everyone is the same; some people will help, some will not, and some will help only sometimes.
• I can’t do anything, or I am not really disabled. Cognitive distortion: All-or-nothing thinking. Disability and having a chronic illness are often treated as what scientists call dichotomous or only existing in two states. In this case, the assumption is that people can be disabled and not disabled or chronically ill and not chronically ill. But ability and level of illness actually fall on a continuum from Olympic athletes with a doctorate degree to severely ill.
• I won’t be able to be independent. Cognitive distortions: Overgeneralizing, overestimation. For people who were once healthy or not disabled and then become chronically ill or disabled, it can be very common to focus on what has been lost and what they can no longer do independently. However, with adaptive equipment or accommodations, people with chronic illnesses are often able to lead very independent, if different, lives.

One of the reasons I am writing is because I have tried for several years to find a good example online of cognitive distortions that apply to people with chronic illnesses. Most lists are focused on people who are not just healthy but very healthy and athletic. The lists could also be interpreted as blaming the person with a chronic illness for events outside their control, which would not be therapeutic. A standard cognitive behavioral therapy protocol is unlikely to be helpful for someone with a chronic illness without some adaptation.

Another note of caution is that cognitive therapy, even when adapted for people with chronic illnesses, should not be a substitute for medical care or medical treatment. A person with a chronic illness should still work with a physician or team of physicians to identify the physiological causes of the signs and symptoms of their illness and figure out a treatment plan. But adapted cognitive behavioral therapy can still be very helpful as an adjunct.