Chronic Illnesses
& Health‑Related Issues

Understanding the psychological impact of chronic illness and supporting effective management and coping through evidence‑based interventions.

Chronic illnesses and health challenged don’t just affect the body- they deeply influence our emotional lives and touch everyone in our circle of care. The winding path to diagnosis, the medical tests, the uncertainty, the symptoms, the lifestyle changes, and the daily adjustments to a “new normal” can create anxiety, sadness, fear, or that unsettling feeling of losing control. It’s no coincidence that nearly half of all adults live with one or more chronic conditions, navigating daily challenges such as managing difficult symptoms, loss of independence, or the need for ongoing self‑care.

Living with a chronic illness carries both physical and psychological weight, yet the emotional and psychological toll often remains invisible and overlooked in treatment planning. Research reveals a bidirectional relationship between physical and mental health: chronic conditions affect our mental health and emotional wellbeing, and mental health difficulties can, in turn, make illness management more challenging (e.g., Huang et al., 2023).

People living with chronic conditions such as cancer, diabetes, heart disease, neurological or rheumatic illnesses, chronic pain or medically unexplained symptoms face a higher risk of developing depression and anxiety compared to healthy individuals/ people without such diagnoses (e.g., Scott et al., 2023). Importantly, research shows that it is not always the severity of the illness that determines mental health outcomes. In other words, people with the most severe conditions are not necessarily the ones who develop psychological difficulties. Many individuals adapt successfully to their diagnosis and new circumstances.

What is it?

Chronic illnesses are conditions that last for a long period of time (at least one year) and require ongoing medical care, affect daily functioning, or limit everyday activities. The term “chronic illness” does not have a universally accepted definition and covers a wide range of conditions, ranging from cardiovascular and respiratory diseases to metabolic, neurological, rheumatic, and mental health disorders, as well as conditions such as chronic pain, chronic fatigue syndrome, or medically unexplained symptoms. There is significant variation in which conditions fall under this umbrella and how long a condition must last to be considered chronic. Increasingly, long‑term functional disabilities, such as developmental disorders or vision impairments, are also included (Bernell & Howard, 2016).

According to the CDC, WHO, and other organizations, chronic illnesses include:

• Cardiovascular: Heart disease, coronary artery disease, hypertension, stroke, atrial fibrillation, heart failure, peripheral artery disease, Postural Orthostatic Tachycardia Syndrome (POTS)
• Respiratory: COPD, asthma, respiratory allergies, sleep apnea, cystic fibrosis, Long COVID
• Metabolic: Type 1 and type 2 diabetes, high cholesterol, obesity, metabolic syndrome, thyroid disorders (e.g., hypothyroidism, Hashimoto’s)
• Cancers: Various types (e.g., breast, lung, colorectal cancer)
• Neurological: Alzheimer’s, dementia, Parkinson’s disease, epilepsy, autism spectrum disorders, multiple sclerosis, neuropathies
• Musculoskeletal / Rheumatic: Arthritis, osteoporosis, Crohn’s disease, Sjögren’s, fibromyalgia, lupus, ankylosing spondylitis, psoriatic arthritis, scleroderma, vasculitides, Ehlers‑Danlos syndromes
• Mental & Behavioral: Depression, bipolar disorder, anxiety disorders
• Other Conditions: Chronic pain, chronic liver disease, chronic kidney disease, HIV/AIDS, hepatitis, chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), ulcerative colitis, etc.

Chronic illnesses don’t affect only the body. They reshape daily life, habits, relationships, and emotional wellbeing, for patients, caregivers, and families alike. Living with a chronic condition profoundly impacts mental health, creating a bidirectional relationship between physical and psychological wellbeing. This isn’t a coincidence but a complex interplay of biological, psychological, and social factors.

Research shows that people living with chronic illnesses are at significantly higher risk of developing mental health difficulties such as anxiety or depression (e.g Gruber et al., 2022). For example, in conditions like diabetes, hypertension, rheumatic diseases, neurological disorders, cardiac problems, and respiratory illnesses, depression and anxiety are remarkably common. Patients may experience sadness, worry, hopelessness, reduced motivation for self care, and social withdrawal. Physical limitations can trigger feelings of helplessness and diminish one’s sense of control. Meanwhile, the reactions and emotional responses of family and social networks can strongly influence psychological wellbeing.

How psychotherapy can help

Psychotherapy can be a valuable source of support for individuals living with chronic illness. It creates space to process and make sense of their experience, develop greater acceptance of the condition, learn ways to manage stress and illness-related challenges, set realistic goals, and build a meaningful, fulfilling life. It can reduce anxiety and depression while improving quality of life. Psychotherapy may serve as a short- or long-term resource depending on individual needs, helping people develop new skills and adapt to life with a physical condition (e.g., Miguel et al., 2021).

For example, for those experiencing depression alongside their physical condition, psychotherapy provides an important non-drug based option, particularly valuable for patients already managing multiple prescriptions. Research demonstrates that therapy can effectively reduce depression symptoms and improve quality of life. Because many physical illnesses are long-term, psychotherapy may be especially beneficial for sustained wellbeing by teaching practical skills, supporting adaptive coping, and helping people adjust to living with their condition (e.g., Miguel et al., 2021).

Support from a health psychologist proves crucial in managing chronic illness. It can help individuals better understand their condition, cope with anxiety, sadness, anger, or confusion, and manage daily challenges more effectively. Therapy can also improve and strenghten communication with partners and caregivers, enhancing both quality of life and overall wellbeing.

Lifestyle changes, including balanced nutrition, physical activity, quality sleep, stress management, social connection, and avoiding harmful habits, can significantly improve health and quality of life while reducing the social and economic burden of illness. These areas form the key pillars of Lifestyle Medicine. Integrating evidence‑based lifestyle interventions into a treatment plan empowers individuals to take an active role in their health. This process unfolds through ongoing education, addressing barriers to behaviour change, and continuous progress monitoring (e.g., Sadiq, 2023) In this way, psychological support and lifestyle interventions work together to provide truly holistic care for those living with chronic conditions.

What is it?

Our bodies are complex, and as a result most conditions have multiple contributing or aggravating factors. The World Health Organization (WHO) defines psychosomatic medicine as “the study of biological, psychological, and social factors in health and illness,” emphasizing that all these factors interact and influence our wellbeing.

A psychosomatic condition involves physical symptoms that are influenced, triggered, or worsened by psychological and emotional factors. The symptoms are real and can be intense and severe, however, their cause is strongly linked to stress, emotional strain, or other psychological difficulties rather than solely to measurable physical damage. The term “psychosomatic” itself combines “psycho” (mind/spirit) and “somatic” (body), highlighting the close relationship between mind and body and how mental processes can affect bodily function.

Many physical illnesses are influenced by psychosomatic factors and often worsened by stress. Examples include arthritis and other inflammatory conditions, diabetes, fibromyalgia, heart disease, hypertension, irritable bowel syndrome (IBS), obesity, headaches, skin conditions (such as psoriasis, and eczema), seizures/ spasms, and sleep disorders, among others. For instance, anxiety often manifests through physical symptoms like chest pain, rapid heartbeat, insomnia, exhaustion, headaches, dizziness, trembling, high blood pressure, muscle tension, jaw clenching, stomach problems, appetite changes, sexual dysfunction, and weakened immunity. Anxiety may not be the sole cause of an illness, but it often exacerbates it and makes it worse.

At the same time, 1 in 5 patients who visit a general practitioner presents with unexplained physical symptoms; bodily symptoms without a clear medical explanation (Kaur et al., 2022). These may include dizziness, pain, numbness or tingling, tremors, headaches, vision changes, or other neurological‑like symptoms. When symptoms persist for weeks or months without a medical cause being identified, they are often referred to as “medically unexplained symptoms.”

How psychotherapy can help

Psychotherapy can offer meaningful relief to individuals experiencing psychosomatic or unexplained symptoms. It helps people understand and address the psychological difficulties they are facing and can often reduce the intensity of physical symptoms (e.g., Cevelicek et al., 2023). Therapy frequently focuses on improving daily functioning, even when symptoms persist. Research shows that when psychosocial factors are taken into account and appropriate psychological treatments are applied, individuals with unexplained symptoms can experience significant improvements in overall quality of life (Kaur et al., 2022).

Psychotherapy doesn’t dismiss symptoms; rather, it acknowledges and respects them, helping individuals manage them in ways that reduce burden, increase control, and enhance wellbeing, while also reducing the uncertainty and stress that accompany the experience.

What is it?

Cognitive functions include complex attention, learning and memory, language, perceptual‑motor skills, executive functioning, and social cognition- all crucial determinants of quality of life (McDonald, 2017).

As the population ages, the number of people experiencing neurocognitive disorders, such as delirium, mild neurocognitive disorder, and major neurocognitive disorder (also known as dementia), continues to rise. We now know that dementia cases double every 20 years and are expected to exceed 115 million worldwide by 2050, making early recognition and intervention especially important (McDonald, 2017).

This makes it critical not only to identify vulnerable individuals early and understand their disease trajectory, but also to intervene with effective pharmacological and non-pharmacological therapies. The earlier a disorder is recognized, the greater the opportunity to develop personalized interventions that can shape the disease course and slow its progression. While these disorders appear more frequently in older adults, they can also affect younger people, for example, following traumatic brain injury, in people with HIV, or in cases of psychiatric disorders, and can contribute significantly to disability. For instance, in patients with schizophrenia, cognitive decline can predict the disorder’s course and may be independent of psychotic symptoms (McDonald, 2017).

Similarly, neurodegenerative diseases are conditions that gradually damage and destroy parts of the nervous system, primarily areas of the brain. This is an umbrella term encompassing numerous illnesses including dementias (such as Alzheimer’s, frontotemporal dementia, Lewy body dementia), Parkinson’s disease and other forms of parkinsonism, demyelinating diseases (such as multiple sclerosis/MS), motor neuron disease/ALS, Huntington’s disease, and prion diseases. Many of these conditions share common symptoms and similar mechanisms, which is why they often overlap. For example, individuals living with dementia may experience confusion, memory loss, difficulty thinking or concentrating, and behavioural changes, while those with demyelinating diseases may experience fatigue, pain, muscle spasms, weakness or paralysis, coordination problems, and numbness or tingling.

Beyond physical symptoms, these diseases carry significant psychological impact. As illness progresses, people experience changes such as reduced functionality, shifts in social roles, and loss of independence, often leading to anxiety and depression. It’s not only patients who are affected, but also their caregivers, who frequently experience exhaustion, anxiety, and depression, particularly when the illness is more severe, progressing, or accompanied by psychiatric symptoms (e.g., Pinto et al., 2023).

Psychological distress can emerge either early or later in the disease course and negatively affects quality of life for both patients and caregivers. Although there are currently no treatments that lead to complete cure of neurocognitive and neurodegenerative diseases, there are options that can help manage and slow their progression. The encouraging news is that many non-pharmacological approaches can support mood, strengthen mental wellbeing, and facilitate adaptation and daily management of neurocognitive and neurodegenerative diseases, both for those living with them and for their caregivers.

As the condition progresses, individuals may experience changes such as reduced independence, difficulties in communication, changes in personality or behaviour, increased confusion, or challenges in daily functioning. These changes can be emotionally painful both for the person and for their family, often leading to sadness, frustration, grief, or a sense of loss. Caregivers may also experience high levels of stress, exhaustion, and emotional burden as they navigate the demands of care.

How psychotherapy can help

Psychotherapy is flexible and can be adapted to each person’s particular needs, considering symptoms, disease stages, coping strategies, and the personal preferences of each patient or caregiver. For example, depending on the context of each illness, it can help individuals with neurocognitive disorders and/or neurodegenerative diseases and their caregivers with understanding, accepting, and managing the condition, managing anxiety, sadness, and emotional burden, reducing psychological distress, improving communication and the relationship between patient and caregiver and enhancing resilience and quality of life.

Psychotherapy can help people understand and process the emotional impact of cognitive decline, develop coping strategies, and maintain a sense of identity, dignity, and connection. It can also support individuals in adapting to changes in memory, thinking, and daily functioning, while strengthening their remaining abilities and promoting engagement in meaningful activities. For caregivers, therapy provides a space to process stress, grief, and emotional fatigue, to learn communication strategies, and to develop skills that support both their loved one and their own wellbeing.

Non-pharmacological interventions, such as psychotherapy combined with caregiver education/psychoeducation, cognitive strengthening, and daily functioning strategies can make a substantial difference both for people living with these conditions and for those who support them. Such supports can significantly improve quality of life, slow functional decline, and support families in navigating the challenges of these conditions with greater clarity and resilience.

What is it?

A major surgical procedure, even when not life-threatening, can trigger intense emotions like fear, anxiety, or anger. In many cases, uncertainty, lack of adequate information, and negative thoughts often lead to feelings of being overwhelmed, while personal issues or difficulties may worsen the situation further.

These psychological challenges impact mental health as well as the recovery process itself and surgical outcomes. Research shows that individuals with anxiety, depression, or post-traumatic stress before surgery often experience slower recovery, greater risk of complications, and increased rates of post-operative depression, highlighting the need to integrate psychological support into care protocols. Understanding the psychological aspects of surgery is critical for improving recovery and overall quality of care, bridging the gap between surgical and psychological support (Hsu et al., 2025).

Mental health substantially affects surgical outcomes. Patients with pre-existing psychological difficulties, such as anxiety, depression, or post-traumatic stress, often experience prolonged recovery, increased risk of complications, and higher rates of post-operative depression. Despite this evidence, psychological support in surgical procedures remains insufficient or absent from care protocols (Hsu et al., 2025). Psychological preparation may help reduce pain, negative emotions, and negative emotional burden after surgery, while potentially shortening hospital stays and contributing to improved recovery (Powell et al., 2016).

In many cases, surgical procedures are accompanied by intense physical and mental stress. Key psychological burdens include:

• Pre-operative anxiety: fear of anaesthesia, complications, and the procedure itself
• Post-operative depression: frustration due to slow recovery or (temporary) loss of functionality
• Post-traumatic stress (PTSD): particularly in high-risk procedures, with long-term emotional consequences

Studies show that approximately 1 in 3 patients experience moderate to severe anxiety before surgery, while nearly 1 in 4 develop depressive symptoms afterward, a reality that complicates recovery and increases the risk of complications.

How psychotherapy can help

Contemporary studies show that psychotherapy before and after surgery isn’t a luxury but a necessary and essential part of care. Psychotherapy before a surgical procedure can make a substantial difference. It helps reduce anxiety, lowers the risk of complications, and contributes to smoother, faster recovery. It also strengthens patient cooperation with the medical team and patient compliance while improving overall quality of life.

Before surgery, patients can speak openly about their fears and concerns, recognize, express, and manage their emotions, better understand the surgical process, and develop coping strategies for before and after the procedure. They can also be trained in behavioural changes, such as exercise, nutrition, and medication adherence, taking an active role in their care and contributing to the design of a personalized support plan (Clay, 2020). In this way, psychological support can help patients develop realistic expectations, prepare for potential difficulties, and manage pain and worry so they feel more prepared, calmer, and stronger facing the surgical experience (e.g., Hsu et al., 2025). After surgery, patients can learn relaxation techniques and strategies that strengthen mental resilience and accelerate the healing process

With appropriate psychological support, the surgical experience becomes more manageable, more humane, and less frightening. When patients feel prepared and supported, recovery becomes smoother and the overall surgical experience changes substantially for the better.

What is it?

Medical trauma isn’t a term frequently used by healthcare professionals. It describes a very significant phenomenon that deserves attention: the psychological and physical effects someone may experience after difficult medical procedures (such as surgery or intubation), hospitalization or treatment experiences in hospitals or clinics, or diagnoses of serious illnesses (such as cancer) (Flaum Hall & Hall, 2013; Schmoyer-Edmiston, 2024).

A natural disaster or accident isn’t the only traumatic event. Although we don’t often discuss it and the word “trauma” is associated with wars, natural disasters, violence, terrorism, torture, and traffic accidents, equally traumatic can be life-threatening illnesses, threats to wellbeing and loss of control, or the experience of watching someone you love in danger. These very situations can occur in a hospital, for example, a diagnosis, an emergency procedure, a stay in intensive care. Such an experience can be traumatic, profoundly affect mental health, and leave long-lasting psychological effects.

Symptoms vary from person to person and include persistent thoughts or flashbacks to the event, avoidance of hospitals or tests, anxiety, depression, anger, feelings of helplessness, or physical symptoms like headaches, insomnia, and fatigue (Schmoyer-Edmiston, 2024). In some cases, medical post-traumatic stress disorder (PTSD), anxiety, depression, complicated grief, or physical symptoms (such as pain and fatigue) may develop. Medical PTSD appears when someone develops symptoms after a medical experience, such as diagnosis of a serious illness, surgery, or medical error. For example, it may occur after a heart attack, stroke or brain hemorrhage, childbirth and gynecological procedures, ICU hospitalization, or HIV diagnosis.

While not everyone experiences it, a significant percentage of patients develop symptoms of anxiety, fear, or flashbacks. For instance, approximately 2–3% of women develop PTSD symptoms after childbirth even with normal delivery. However, when a woman loses her child at birth, PTSD rates soar to 77%. In a study of 500 women with gynecological procedures, 100 described them as “terrifying” or “very painful,” and 30 met full PTSD criteria, half of whom had no previous mental health problems. At the same time, an ICU stay can leave deep psychological marks. Research shows that 18–59% of patients developed PTSD even 9 years after the experience (Flaum Hall & Hall, 2013).

Medical trauma can also affect children (pediatric medical trauma). It can appear in children when they experience pain or injury, serious illness, medical procedures (such as surgery or tests), or invasive or frightening treatments. Pediatric medical trauma is the mental and physical distress that a medical experience can cause a child and their family. It may appear after a difficult treatment or accumulate over time. Recognition and support are important to help the child and family feel safe again.

Beyond this, secondary crises may arise that affect development, physical condition, relationships, work, spirituality, and self-image (Flaum Hall & Hall, 2013), and can evolve into more complex forms of trauma and other mental difficulties if not recognized and supported in time.

How psychotherapy can help

Psychotherapy can play a decisive role in recovery from medical trauma. It can help individuals process what happened safely and without judgment, reduce anxiety, flashbacks, and physical symptoms, rebuild a sense of control and safety, strengthen resilience and self-confidence, adapt to new health realities, and gradually reclaim their daily life. Through therapy, individuals can explore their experiences at their own pace, understand how trauma affects their thoughts, emotions, and body, and develop strategies to regain a sense of safety and control.

Therapy can help people work through frightening or overwhelming medical memories, feel less afraid of hospitals and doctors, and lower anxiety, constant alertness, and muscle tension. It can help rebuild trust in your body and in health care providers, teach you how to understand and manage emotions tied to trauma, and prepare you to face future medical procedures with calmer and confidence.

Psychological support can also function preventively, helping with early recognition of symptoms and avoidance of more serious effects. With appropriate psychological support, people can recover, feel safe again, and continue to maintain control over their health.

Evidence‑based approaches such as trauma‑informed therapy, cognitive‑behavioural techniques, grounding strategies, and mind‑body interventions can support healing and reduce the long‑term impact of medical trauma. Psychotherapy can also help caregivers and family members process their own emotional responses and develop healthier ways to support their loved ones.

What is it?

Caring for a loved one with a health condition, whether chronic, acute, progressive, or unpredictable, can be both meaningful and deeply challenging. Caregivers often carry a heavy emotional, physical, and practical load. They may navigate medical appointments, treatment decisions, daily care tasks, and sudden changes in their loved one’s condition, all while trying to maintain their own wellbeing, work, and personal life. Undoubtedly, this is often “invisible” work that constitutes a demanding process, both physically and mentally. The caregiving role is usually assumed by parents, children, partners, relatives, friends, and in many cases, extended family and neighbors.

Although the patient-caregiver relationship can be close, deep, and supportive, and providing care is considered a heroic act that caregivers often perceive as their moral obligation, it nevertheless often significantly burdens the health and mental health of the person providing it. In many cases, they themselves become “patients.” Many caregivers experience mental difficulties and emotional pressure (such as anxiety, sadness, fear for the future), intense stress from dedicating so much time to caregiving, and physical exhaustion that may be accompanied by burnout, sleep disorders, or psychosomatic symptoms. They often limit their personal lives and distance themselves from their social circle or are forced to leave their jobs and lose part of their income.

Daily life may include increased responsibilities, difficult behaviours from the patient, illness relapses, and in many cases the psychological burden of watching the patient’s condition worsen. All of this makes them more vulnerable to mental difficulties and stress-related health problems, intense fatigue, and the “burden of care,” causing negative consequences for both their physical and mental health and emotional exhaustion (burnout) (e.g., Cejalvo et al., 2021). Family members may also experience grief, both anticipatory and ongoing, as they adjust to changes in their loved one’s abilities, personality, or independence. Many caregivers may also experience stress, exhaustion, guilt, sadness, frustration, or a sense of being overwhelmed. They may feel torn between responsibilities, worry about the future, or struggle with the emotional impact of seeing someone they love in pain or distress. Over time, caregiving demands can affect sleep, mood, relationships, and overall quality of life.

These emotional experiences are common and valid. Yet caregivers often feel they must “stay strong,” which can make it harder to seek support. The heavy and unavoidable burden of care can reduce caregivers’ ability to recognize their own needs and prevent them from seeking help. Their psychological support, however, is essential to protect their own mental health (e.g., Ye et al., 2023).

How psychotherapy can help

Psychotherapy can provide valuable support for caregivers. It can help caregivers significantly reduce the psychological burden and impact of caregiving, such as anxiety and depression. Caregivers may need help expressing their feelings openly and effectively and recognizing and finding meaning in their contribution to the patient’s therapeutic journey.

Psychotherapy can help caregivers understand and work through stress, grief, guilt, or frustration, learn healthier coping skills and set emotional boundaries, manage and prevent burnout, communicate better with their loved one and healthcare teams, handle family roles and shared responsibilities, and reconnect with their own needs, identity, and wellbeing; when caregivers get support, the whole family benefits emotionally, practically, and in their relationships.

They may also need to learn coping and problem-solving strategies, gain a sense of control, improve their caregiving ability, and strengthen their self-efficacy and self-esteem. Psychotherapy can contribute to their self-care and strengthen their psychological flexibility, helping them process and accept their emotions, live according to their values, be more present in the moment, and distance themselves from negative emotions, reducing symptoms of anxiety, stress, and depression. Psychological interventions and psychoeducation can also help caregivers feel more capable, more confident, and more prepared (e.g., Panzeri et al., 2019). Access to support services is crucial, as the caregiver’s health is equally important as that of the patient. A caregiver cannot provide quality care without first taking care of themselves.