Facts and Figures - Chronic Health Conditions in Canada

Chronic health conditions are common.

• More than nine million Canadians — 33% of people 12 years and older — have one or more of seven chronic health conditions:
  • 16% of Canadians report having arthritis and 15% have high blood pressure, the two most common conditions included in the study.
  • 5–6% of Canadians have diabetes, heart disease, or mood disorders.
• Chronic health conditions are more common among seniors age 65 and older (77%), among women (36%), and among lower-income Canadians (40% in the one-fifth of Canadians with the lowest incomes, compared to 27% among the wealthiest)

Chronic health conditions affect quality of life.

• 36% of people with one chronic condition experience moderate to severe disability in daily living, compared to 19% for people with none of the chronic conditions studied.

• More than half (51%) of people with two or more chronic conditions report moderate to severe levels of disability. This includes problems with things like vision, hearing, speech, mobility, emotional well-being, and pain.

Source. These data are based on Statistics Canada’s Canadian Community Health Survey in 2005.

Dr. Angen says:

The success of modern medicine has turned many life-threatening illnesses into chronic conditions; such that people diagnosed with, for example - cancer, heart disease, diabetes, autoimmune or digestive diseases - must find a way to live, sometimes for years, with the disruptions and disillusions of illness. Challenges also arise when pain has ceased to serve as a warning sign of some underlying medical problem and has become a problem in itself. This type of chronic (headache, neck, back, jaw or muscular) pain can last for months or even years and creates significant distress.

Those who suffer from a chronic illness or live with chronic pain often experience disturbing emotions, cognitive difficulties, as well as disrupted roles and relationships. Psychology has an important role to play in supporting those dealing with such on-going conditions.

In my practice I may see a person when their physician has suggested they seek psychological support for overwhelming emotional distress, anxiety or depressive symptoms arising from the fears and losses associated with their health condition. I also have individual’s access my services as an adjunct to medical treatment, because they are aware of the ample evidence showing that those who take an active role in their health care can positively impact their condition, prevent further deterioration, and improve their overall well-being. Sometimes people come to me when their treatment has ended or the medical system has little left to offer them and they are feeling lost, abandoned, and/or unsure of the next step.

Research has made us aware that people dealing with chronic conditions are grieving multiple losses at a variety of levels – physical, emotional, financial, lifestyle, relational, and identity losses are not uncommon. I have seen personally how support in confronting these issues makes them less overwhelming.

In my initial session I listen to the client’s “illness story” to understand the meanings they have given to the experiences and disruptions it has caused. We now have good evidence that psychotherapy can improve the quality of life of those living with chronic conditions (and their family system) through a variety of interventions. My goal is to help the individual and, when indicated - their family members, to access their own inner resources and resilience for maximal coping. I tailor specific approaches to suit each individual case.

For many people I see, Stress Management and Relaxation Strategies will provide immediate benefits. High and continuous levels of stress, or poor ways of responding to stress, can worsen chronic conditions and intensify pain. This is a vicious cycle as the condition itself causes worry and stress, disrupting daily activities and interactions with others, which in turn creates more stress – feeding the cycle in an escalating pattern. In therapy I can help determine the triggers and behaviour problems associated with stress and strategize with an individual or family ways to improve coping responses. I teach skills such as breathwork, deep and progressive muscle relaxation, guided imagery and self-hypnosis. If appropriate, I will facilitate training in a Mindfulness Meditation-based approach to stress reduction. All of these skills and strategies induce immediate physiological changes (slowed breathing, pulse and brainwave activity, decreased blood pressure, lowered pain intensity, reduced stress hormones, improved sleep patterns) that serve to lower overall arousal levels interrupting the stress cycle. I have witnessed how these approaches allow us to tap into our own body-mind resources for facing and working with pain and illness.

The effect that I find is perhaps most important to my clients, is that learning coping strategies and stress management skills provides a sense of control within the vortex of uncertainty that is part of dealing with chronic health concerns. When we feel like we have some control over our experiences both our mood and our motivation improve significantly.

I also explore cognitive approaches in sessions with clients. It is useful to consider the beliefs, attitudes, and feelings a person has regarding their experiences of health and illness. Thoughts and emotions can impact experiences of illness and pain in both direct and indirect ways. Our mental and emotional state directly influences our body’s physiological responses (breath rate, muscle tension, blood flow and levels of stress hormones) impacting our well-being. Our attitudes and feelings also have an indirect effect on our suffering by influencing how well we cope, how hopeless and helpless we feel, how we interact with others, as well as how we manage the varying life-roles we play.

I have seen that with guidance, misperceptions and detrimental attitudes can be reconsidered, feelings of helplessness and fear can be addressed, and negative interactions with family members, friends, co-workers, and health-care providers can be explored and improved. Without exploration these psychological factors continue to create problems. I am not suggesting that one has to maintain a positive attitude all the time, but understanding our feelings and gaining insight into their causes can bring relief and resolution. Over time, finding a pathway to acceptance is essential, as denying the diagnosis or negative impacts of the condition (a state that might be helpful in the beginning), in the long run keeps us from moving forward.

I think it is important to note, while mental and emotional factors impact our experiences of pain and illness, they are rarely if ever causally implicated. Sorting out the detrimental effects of self-blame and guilt is often part of the healing process I undertake with clients.

In this discussion of chronic conditions I would also like to add a few words about facing one’s death.

The importance of addressing this concern, not only for the person facing death but for the entire family system, has been increasingly recognized in the research literature. Death, however, can be the scariest topic and discussing it seems to validate what everyone fears the most. From my experience, even if the individual facing death has a need to talk, family members often find it overwhelming and resist any overtures. Yet, I have seen that communication between the client and his or her family, especially as it relates to the anticipated death, promotes closeness and eases both the dying process and the grief of the loved ones.

With over a decade of working with those dealing with cancer and other chronic conditions, I have found that training in stress management, emotion and problem- focused coping strategies and exploring the meaning we make of our experiences of chronic conditions helps establish important new pathways leading to a life well-lived. Each of us has an inner spirit, strength, and wholeness that, in times of illness and pain, we can access with the help of supportive counselling.