Living with a long-term or serious respiratory illness can be stressful. There can be frustration at your current circumstances, grief at the loss of the life you once had, fear at what the future holds, and ongoing anxiety triggered by breathlessness. The good news is that there are ways to manage those stresses and to continue to find joy in your life.
We asked two health professionals, Te Whatu Ora Taranaki Clinical Psychologist Fran James, and Hutt Valley-based Physiotherapist Colleen Stevens, for their advice on how to manage the stresses of a respiratory condition.
Be physically active
Both Colleen and Fran agree that exercise is key to managing both your mental wellbeing and your respiratory condition. “Regular exercise is the thing that's going to make you feel less breathless and get you stronger. It will enable you to do more, and if you can do more, then you're going to feel better about yourself,” explains Colleen. “It also builds confidence, so people realise that they are capable of doing things they might have thought impossible; like doing the shopping or attending a child’s sports game.”
Learn breathing control techniques
Breathing control techniques can help control breathlessness and calm your mind. When you are breathless, your body sends danger signals to the brain, making you feel anxious. That anxiety can make you even more breathless. Breathing control techniques will allow you to get your breath back more quickly and stop that negative anxiety/breathlessness cycle. Fran points out that sometimes when you are breathless, your brain can automatically ‘switch on’ feelings of anxiety, even when you are not stressed. "In this situation, you need to ask yourself: ‘What’s going on in my body?’. Perhaps I just need to concentrate on my breathing to feel calmer.”
Understand and accept your condition
Understanding your condition, its symptoms, your triggers and the treatments available is essential to managing stress. This knowledge will help take away the fear of the unknown and allow you to help yourself. It is also vital to accept your diagnosis. No one wants a respiratory condition but accepting that this is your reality can allow you to move on with your life. “The only place you can recover from is where you are at right now,” explains Fran.
Are my thoughts helpful or harmful?
Your brain is always thinking and what you think affects how you feel and what you do. Often the first step to reducing stress and anxiety is mindfulness; to become aware of your thoughts, and then ask; are these thoughts helpful or harmful? Some thoughts can make you feel more stressed. “We need to learn how to say I’m not going to pay attention to that unhelpful thought, or I’ll just let that one go past,” explains Fran. Colleen encourages people to take the ‘glass half full approach’ to their lives. “Instead of focusing on the things you have lost, think about what you can do.”
Be kind to yourself
While a positive attitude to life will help your mood, it’s also OK to have bad days. “Self-compassion is really important,” explains Fran. “Research shows that we do better with health conditions when we are kind to ourselves rather than beating ourselves up when things don’t go as planned.” Instead of getting angry with yourself, Fran recommends reminding yourself that you are doing your best and living with a respiratory condition is challenging.
Good things still lie ahead
Many people believe when they are diagnosed with a respiratory illness, they can no longer do the things they love. Fran explains that this doesn’t need to be the case. “You need to think about what matters to you the most and find ways to adapt those things, so you can continue to enjoy them.” She gives the example of tramping. It could be that what a keen tramper enjoyed most about that activity was being in nature or the companionship of certain friends. While they might no longer be physically capable of going bush, they could still drive somewhere and sit in nature, or catch up with those friends over coffee.
Prioritizing and planning
One of the hardest things to learn when managing a respiratory disease is how to use limited energy wisely. Fran and Colleen suggest looking at the whole day and prioritizing what you need to do and then planning for the day or week ahead. For example, if you have a doctor’s appointment in the afternoon that you know will be draining, then you might need to have a quiet morning.
They warn against trying to push through when you’re struggling or doing extra when you are having a ‘good day’ as this can lead to exhaustion and worsening symptoms. They also warn about prioritising work or tasks and forgetting about social time and hobbies. “If you fail to make time for the things you love it can lead to feelings of frustration, low mood and irritability,” Fran explains.
Talk about what’s going on
Your family and friends may not understand what it means to have a respiratory condition. They could either underestimate or overestimate how your condition is affecting you. For example, you may feel stressed by expectations to continue to look after grandchildren or it could be that you may stop getting invited to events, as people think you won’t be able to cope. Openly explaining your condition and how you are managing it, will help everyone to understand what you can manage.
Find people who get it
Joining groups with other people who have respiratory conditions can be incredibly powerful (see page 2 for an example). “You’ve got people around you that have a shared knowledge and a shared understanding in a really deep way of what you’re going through. The groups that are the most successful are the ones where you can have fun and laugh a lot. Nobody wants to sit around and talk about misery!” says Fran. A list of pulmonary rehabilitation classes can be found on the Foundation’s website here.
Fran emphasises that stress is part of life and the way our body responds to what’s happening around us. The stress response can be useful when we need to step up to meet a challenge, but when we feel stress all the time it can become a problem. She explains: “The goal isn’t to never feel stressed. The goal is to be able to recognise when you are stressed and to take action to deal with it.”
Colleen cautions that when it comes to dealing with stress there is no one solution. “You need to take a holistic approach. It’s doing exercise, it’s setting goals and it’s being aware of your thoughts. It’s putting all those things together.”
COVID and stress
COVID has heightened stress levels across the world, particularly for those people already dealing with respiratory conditions. Fran says the recent impact of the ‘twindemic’ (COVID and flu) on our hospitals has been another stress for the respiratory community this winter. Her advice is to keep protecting yourself from COVID, but to find ways to keep living and enjoying your life. Colleen encourages those who are staying home to avoid COVID, to keep moving. “If you stop exercising then you will become more symptomatic and that will cause more stress.”
For more information on improving your wellbeing check out this TedTalk from psychologist Lucy Hone on getting through tough times and the Mental Health Foundation’s has great tips on wellbeing, including these tips for dealing with COVID-19.
Fran James is consultant clinical psychologist based in Taranaki who presents at pulmonary rehabilitation classes on managing stress.
Colleen Stevens is a physiotherapist based in the Hutt Valley who has taught pulmonary rehabilitation classes for the last 20 years.