Chronic Physical Symptoms Involve Patients' Psychology

A large part of Western medical therapy involves the expectation often held by physicians and patients alike that a medication prescription be given to help treat an illness. However, as described in this blog a better approach involves consideration of a psychological intervention for every patient with a chronic illness.

Such an intervention sometimes reduces or eliminates the need for medications and can be associated with dramatic improvement in symptoms.

When patients develop chronic physical symptoms, their psychology is always involved. Either their symptoms cause them to develop a psychological reaction such as anxiety, depression, or adaptation to a changed lifestyle, and/or their psychological issues can lead to the onset or perpetuation of physical symptoms.

Source: Lopolo/Shutterstock

A Patient With Asthma

For example, I treated a 9-year-old who presented with cough, wheeze, and shortness of breath that were triggered by colds, exercise, changes in weather, exposure to environmental allergens, and strong emotions. He improved with the use of short-acting asthma therapy (albuterol) including at night, when he frequently awakened with cough. Pulmonary function testing revealed a pattern diagnostic of asthma (Anbar & Sachdeva, 2011).

This patient’s presentation was completely consistent with a diagnosis of asthma. When his symptoms persisted despite the use of albuterol, he was prescribed medium-dose long-acting inhaled steroids, which are supposed to help improve the control of asthma. However, he did not improve. His mother stated that she was administering his medications as prescribed.

According to the 2024 published Global Strategy for Asthma Management guidelines, there are many additional medical and environmental interventions that should be considered in such a patient. But there is only a brief mention in the guidelines that relaxation strategies and breathing exercises may be helpful.

Given that chronic symptoms usually are associated with psychological issues, I believe that the next step with a patient whose asthma is incompletely controlled with first-line preventive medical therapy is to teach the patient emotional self-regulation techniques. Therefore, I taught this patient how to use self-hypnosis to calm himself, which took less than 10 minutes of instruction. By the next day, all his symptoms had resolved.

Thus, a 10-minute psychological intervention allowed the patient to resume a symptom-free life and prevented the need for further invasive testing to evaluate why the patient did not respond well to therapy and/or prescription of much more intensive and expensive asthma therapy.

Takeaway

It appears that this patient’s chronic symptoms largely were driven by anxiety, as they resolved immediately after self-calming. In my experience, it frequently occurs that symptoms develop because of a physical issue, but then they persist even when the triggering physical issue improves or resolves.

The reasons for this perpetuation include psychological issues. For example, patients may benefit from their on-going symptoms because the symptoms help prevent them from doing something they dislike (e.g., going to school), or their worry about their health may be expressed through their physical symptoms, which leads to a catch-22 situation.

While most patients will not benefit so quickly with hypnosis therapy as did the patient in this blog, I have worked with hundreds of patients who have responded quickly once they employed enhanced self-regulation with the aid of hypnosis.

There is no downside to offering a brief psychological intervention. Therefore, I believe that every patient with chronic illness should be given the opportunity to help themselves similarly.