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Understanding the Emotional Life
of Those Living with Pulmonary Disease
the Emotional Impact on Respiratory
Health Care Professionals
The Emotional Life of Patients
Learning to live with a “new normal” often
means learning to live differently.
Living differently may involve living with “less”.
Ninety percent of chronic illness is ‘invisible’.
Pulmonary disease is often very visible.
Emotional Life
Patients have two lives--the ‘outer life’ representing the physical and
the ‘inner life’ representing the psychological
and spiritual realm.
The ‘inner life’ is the life we don’t often get to
see but is the true center of the individual’s
Psychological and Behavioral Issues
• Anxiety
• Depression
• Major Depressive Disorder
• Non compliance
• Alcohol and drug misuse/abuse/dependence
Patients with chronic illness have a 15-20%
greater incidence of depression.
Depression is a chronic illness that complicates
physical illness re: treatment compliance and
Treatment compliance and healing are impacted by
disrupted sleep, poor nutrition, lack of
exercise or movement.
Physical illness and uncontrollable pain as well
as a felt sense of lack of control in general are
major factors in up to 70% of suicides.
Empowering patients through knowledge and
encouragement decreases depression and
increases compliance…”team work”.
The patient is the ‘expert’ on THEIR illness in
THEIR life.
How is the pulmonary disease impacting your
patient’s physical AND emotional life?
Facets of Anxiety
Anxiety is not just a response
o to ‘the unknown’
o irrational fear
o learned response
o chronic ‘nervousness’
o being afraid
….a GOOD thing…….
It gets our attention and let’s us know that
something VERY important is going on.
Anxiety is a signal. It can be caused by steroids,
lack of oxygen, anemia, low Hgb, drug side
effects, weaning off of steroids too quickly,
daily diet.
Signs of Anxiety
Rapid speech
Diminished eye contact
Weight loss, diarrhea, reported sleeplessness
Silence (deer in the headlights)
Signs of Depression
Depression and sadness are not the same
Many of the signs of depression are similar to
anxiety and may include:
• Frequent and prolonged crying
• Flatness of affect
• Suicidal/homicidal ideation
• Non-compliance with treatment/meds
• Isolative behavior
• psychosis
Possible Causes…
Re-awakening of early ‘issues’/traumas
Alcohol abuse/addiction
Prescription abuse/addiction
Family issues (marriage, children)
Sexual issues
Alienation from family, friends,
loneliness…”Living on the Moon”.
Post Traumatic Stress Disorder (B. van der
Traumatic Stress Syndrome(Pasik,1993)
Post Traumatic Growth
Traumatic Stress Syndrome is very similar to PTSD
but a “milder version”
PTG is a positive change experienced as a result of
the struggle with a major life crisis or traumatic
More PTG…..
“Highly emotional events in psychologically
healthy people may produce less illusion and
more wisdom” (Calhoun & Tedeschi)
“Looking at life with the blinders off…”(ibid)
PTG (cont’d.)
New opportunities and new possibilities arise
from the crisis or illness experience.
An increased sense of one’s own strength…
A greater appreciation for life in general
A deepening of one’s spiritual life or significant
change in one’s belief system.
Emotional Growth and Connection
Exactly the Same-Completely Different
Is a gradual process/phenomena including:
• Job strain
• Erosion of idealism
• A void of achievement
• An accumulation of intensive contact with
Symptoms of Burnout
 Fatigue
 Sleep disruption
 Somatic problems: gastro., headaches,
frequent colds
 Irritability, anxiety, depression, guilt, sense of
Burnout Symptoms (cont’d.)
 Aggression
 Callousness, pessimism, defensiveness, cynicism
 Substance abuse
 Withdrawal from clients or co-workers
 Dehumanizing/intellectualizing patient/coworkers/self problems
Compassion Fatigue and Secondary
Traumatic Stress
“The professional work centered on the relief
of the emotional (and physical) suffering of
patients automatically includes absorbing
information that is about suffering. Often it
includes absorbing that suffering as well”.
A Word from St. Francis…
“Start by doing what’s necessary; then do what’s
possible; and suddenly you are doing the
“What is ours to do….?
Some Good News: Resiliency
• The ability to put events into less stressful
perspectives….immediate ‘reframing’
• Proactive behavior to move toward the event
and not away from the event…make it “work”
for you.
More Good News: Hardiness and
Resilience (Kobasa& Maddi)
• Commitment, Control, and challenge
• H & R function as a resistive resource in the
encounter with stressful conditions.
• Many individuals and caregivers dealing with
chronic illness posses the ability to function well
and adapt to continuously stressful events.
• Includes courage and motivation to turn stressful
circumstances from potential disaster to multiple
chances to grow.
Components of Hope
Confidence in the outcome
Embracing reality
Relationships with others
Belief in the possibility of a future
Spiritual beliefs
ACTIVE involvement
(Wishing and Hoping are different…)
• Inner readiness
Spanky is Hope
More on Hope…
Patients with chronic illnesses need to maintain
hope that there is a future though the path may
be different from others…
”Different” does not mean “bad” or “less than”.
Farfal is different but greater
Even if you’ve dealt with a condition personally,
everyone’s experience is unique.
It is OK not to be able to relate to a patient’s
condition or experience. Your job is to be
‘present’ to the experience. We practice the
ministry of presence and absence.
(Henri Nouwen, “The Wounded Healer”)
Questions, Comments, Thanks