How to use Cognitive Behavioral Therapy in Chronic Disease Management

Chronic diseases, including conditions such as heart disease, diabetes, and respiratory disorders, have become prevalent today. The management of these conditions goes beyond mere physical treatments. Psychological interventions, especially Cognitive Behavioral Therapy (CBT), have proven to be pivotal in helping patients manage their conditions effectively. This integration of mind and body approaches in chronic disease management is supported by numerous studies published in peer-reviewed journals.

The Connection Between Chronic Disease and Mental Health

A significant number of patients with chronic diseases experience comorbid psychological issues like anxiety, depression, and stress. A study published in the Journal of the American Medical Association found that patients with chronic medical conditions are almost twice as likely to suffer from mood disorders (Frank, et al., 2023). That is to say that this connection between physical and mental health can make disease management more challenging.

What is Cognitive Behavioral Therapy?

CBT is a type of psychotherapy that evidently addresses the connections between thoughts, emotions, and behaviors. Additionally, it operates on the premise that changing negative thought patterns can lead to changes in feelings and actions. Consequently, this approach has been widely used to treat conditions like depression, anxiety, and PTSD (Gonzalez-Prendes, 2019).

CBT in Chronic Disease Management

1. Improving Medication Adherence: One of the challenges in managing chronic diseases is ensuring that patients adhere to their medication regimens. Negative beliefs or misconceptions about medications can lead to non-adherence. CBT can be used to address these beliefs, enhancing adherence (Konstantinou, et al., 2020). A study in the Journal of Cognitive Psychotherapy reported that CBT interventions significantly improved medication adherence in patients with Type 2 Diabetes (Gonzales, et al., 2010).
2. Managing Symptoms and Flares: Many chronic diseases have symptoms that flare up periodically. CBT provides patients with tools to cope during these periods. For instance, in patients with Irritable Bowel Syndrome (IBS), a study in the BMC Gastroenterology journal showed that CBT reduced symptom severity more than other standard treatments (Chen, et al., 2021).
3. Enhancing Lifestyle Changes: Lifestyle plays an important role in managing and even preventing the progression of chronic diseases. CBT can assist in ingraining healthy habits. Specifically, these are habits like regular exercise, proper diet, and smoking cessation. For example, a 2019 study in the Journal of Clinical Child and Adolescent Psychology showed that CBT interventions improved physical activity levels and dietary habits in patients with cardiovascular disease (Grave, et al., 2011; Jelalian, et al., 2019).
4. Coping with Disease-related Stress: Chronic diseases can often result in significant psychological stress, affecting overall well-being. CBT strategies, such as cognitive restructuring and stress reduction techniques, can help patients cope better. Even more, a meta-analysis published in the Journal of Medical Internet Research found that CBT was effective in reducing stress in chronic disease patients (Cook, et al., 2019).

Incorporating CBT into Chronic Disease Management

For CBT to be effectively integrated into chronic disease management:

1. Collaborative Care Teams: Medical professionals, including primary care physicians, specialists, and behavioral health experts, need to collaborate closely. This ensures that both the physical and psychological aspects of the disease are addressed holistically (Scascighini, et al., 2008).
2. Tailored Interventions: Given the diversity of chronic diseases and individual patient needs, CBT interventions should be tailored. As a result, this might mean shorter sessions, teletherapy options, or group therapy sessions, depending on the patient’s condition and preferences (Scascighini, et al., 2008).
3. Continuous Education: Medical professionals should be updated about the latest CBT techniques and findings regularly. This ensures that patients receive evidence-based care.

In summary, Cognitive Behavioral Therapy offers an invaluable tool in the comprehensive management of chronic diseases. As the body of evidence grows, it becomes clear that addressing the psychological components of chronic diseases can lead to better outcomes, improved quality of life, and a more holistic approach to care. Being that, as healthcare providers, it’s important that we champion such integrated behavioral healthcare approaches for the betterment of our patients.

References

Chen, J., Chen, X., Sun, Y., Xie, Y., Wang, X., Li, R., & Hesketh, T. (2021). The physiological and psychological effects of cognitive behavior therapy on patients with inflammatory bowel disease before COVID-19: a systematic review. BMC gastroenterology, 21(1), 469. https://doi.org/10.1186/s12876-021-02003-0

Cook, L., Mostazir, M., & Watkins, E. (2019). Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students. J Med Internet Res, 21(5), e11349. https://doi.org/10.2196/11349

Grave, R. D., Calugi, S., Centis, E., Ghoch, M. E., & Marchesini, G. (2011). Cognitive-Behavioral Strategies to Increase the Adherence to Exercise in the Management of Obesity. Journal of Obesity, 2011, 348293. https://doi.org/10.1155/2011/348293

Frank, P., Batty, G. D., Pentti, J., Jokela, M., Poole, L., Ervasti, J., Vahtera, J., Lewis, G., Steptoe, A., & Kivimäki, M. (2023). Association Between Depression and Physical Conditions Requiring Hospitalization. JAMA Psychiatry, 80(7), 690–699. https://doi.org/10.1001/jamapsychiatry.2023.0777

Gonzalez, J. S., McCarl, L. A., Wexler D, D. D., Cagliero, E., Delahanty, L., Soper, T. D., Goldman, V., Knauz, R., & Safren, S. A. (2010). Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in Type 2 Diabetes. Journal of cognitive psychotherapy, 24(4), 329–343. https://doi.org/10.1891/0889-8391.24.4.329

Gonzalez-Prendes, A., Resko, S. & Cassady, C. (2019). 2. Cognitive – Behavioral Therapy. In J. Brandell & S. Ringel (Ed.), Trauma: Contemporary Directions in Trauma Theory, Research, and Practice (pp. 20-66). New York Chichester, West Sussex: Columbia University Press. https://doi.org/10.7312/ring18886-003

Jelalian, E., Jandasek, B., Wolff, J. C., Seaboyer, L. M., Jones, R. N., & Spirito, A. (2019). Cognitive-Behavioral Therapy Plus Healthy Lifestyle Enhancement for Depressed, Overweight/Obese Adolescents: Results of a Pilot Trial. Journal of Clinical Child and Adolescent Psychology, 48(sup1), S24–S33. https://doi.org/10.1080/15374416.2016.1163705

Konstantinou, P., Kassianos, A. P., Georgiou, G., Panayides, A., Papageorgiou, A., Almas, I., Wozniak, G., & Karekla, M. (2020). Barriers, facilitators, and interventions for medication adherence across chronic conditions with the highest non-adherence rates: a scoping review with recommendations for intervention development. Translational Behavioral Medicine, 10(6), 1390–1398. https://doi.org/10.1093/tbm/ibaa118

Scascighini, L., Toma, V., Dober-Spielmann, S., & Sprott, H. (2008). Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology (Oxford, England), 47(5), 670–678. https://doi.org/10.1093/rheumatology/ken021