CBT for Long-Term Health Conditions and Persistent Symptoms

Living with a long-term health condition or persistent physical symptoms can affect far more than your physical health.

You may be dealing with ongoing pain, fatigue, digestive symptoms or other physical difficulties while also trying to manage work, relationships, family life and everyday responsibilities.

It can be difficult to know how much to push yourself, when to rest or how to adapt to changes in what you are able to do. You may also experience worry, frustration, low mood or a sense of loss around the life you had expected to have.

CBT can help you understand the relationship between your physical symptoms, thoughts, emotions and behaviours. It can help you to develop strategies for managing the impact of your condition on your every day life.

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What difficulties can CBT help with?

I can offer psychological support to adults living with a range of long-term health conditions and persistent symptoms.

This includes:

Irritable Bowel Syndrome (IBS)
Chronic pain and fibromyalgia
Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME)
Persistent or unexplained fatigue and related difficulties
Other long-term health conditions or changes in health where psychological support may be appropriate

The focus of therapy is not on treating the underlying physical condition. Instead, we will look at how your symptoms are affecting you and identify ways of making life more manageable.

Living with persistent symptoms

When symptoms continue over a long period of time, it can be difficult to adjust to the uncertainty and changes they can bring.

You might find yourself:

Worrying about when your symptoms will flare up
Feeling frustrated or angry about the limitations your condition creates
Avoiding activities because you are worried about making your symptoms worse
Pushing yourself on better days and then struggling afterwards
Feeling guilty about resting or saying no to other people
Finding it difficult to balance activity and rest
Worrying about how symptoms will affect work or relationships
Feeling low because your life has changed
Becoming increasingly focused on physical symptoms
Feeling that other people do not understand what you are experiencing
Struggling to accept changes in your abilities or circumstances
Feeling uncertain about what your future will look like

These experiences can be understandable responses to living with a long-term health condition.

How can CBT help?

CBT can help you understand the patterns that develop around your symptoms and identify ways of responding that may make everyday life more manageable.

Together, we can explore the relationship between your physical symptoms, thoughts, emotions, attention and behaviours, while taking your individual circumstances into account.

Sometimes, the ways we respond to symptoms can unintentionally keep difficulties going. For example, you may find yourself closely monitoring your body, checking whether a particular activity has made your symptoms worse, avoiding activities because you are worried about triggering symptoms, or repeatedly thinking about what your symptoms might mean.

These responses are understandable, particularly when symptoms are painful, unpredictable or frightening. However, increased attention to symptoms can make sensations more noticeable, while avoidance and other protective behaviours can reinforce the sense that symptoms are dangerous or that you are unable to cope with them.

CBT can help you identify these patterns and consider whether there are different ways of responding.

Therapy may involve:

Understanding how your condition is affecting your thoughts, emotions, attention and behaviour
Exploring worries about symptoms, flare-ups and the future
Understanding how paying close attention to symptoms can affect your experience of them
Identifying patterns of avoidance, checking, monitoring or other protective behaviours
Exploring patterns of overdoing things and struggling to recover
Developing more sustainable approaches to managing activities and responsibilities
Working with unhelpful thoughts and beliefs about your health, symptoms or abilities
Gradually reducing behaviours that may be maintaining fear or preoccupation with symptoms
Finding ways to remain engaged with activities and relationships that are important to you
Developing a more compassionate and flexible approach towards yourself and your limitations

For example, you may find yourself caught between pushing yourself to complete everything on a better day and then needing significant recovery afterwards. Or you may avoid activities because you are worried that they will trigger or worsen your symptoms. We can explore these patterns together and consider whether there are alternative ways of responding that fit with your medical needs and circumstances.

We can also explore how you respond when symptoms increase, including what you think they mean, how you respond emotionally and what you do to try to manage or control them. This can help identify patterns that may be increasing distress or keeping you focused on your symptoms.

The aim is not to suggest that your symptoms are caused by your thoughts or that you can simply think yourself better. Nor is it about ignoring symptoms or pushing through them.

Instead, CBT focuses on helping you distinguish between responding appropriately to your physical health and responses that may inadvertently maintain fear, distress or preoccupation with symptoms. The goal is to help you develop greater flexibility and confidence in managing the impact of your symptoms while continuing to live a meaningful life.

Therapy will be adapted to your condition, your current level of functioning and the guidance you have received from your healthcare team.

What if my symptoms are unpredictable?

Unpredictability can be one of the most difficult aspects of living with a long-term health condition.

You may find yourself constantly planning around the possibility of a flare-up or avoiding commitments because you are unsure how you will feel.

CBT can help you explore how uncertainty is affecting your life and develop ways of making decisions that allow for flexibility without your condition having to determine everything that you do.

Sessions can also be adapted with your health condition in mind. For example, adjusting the length or frequency of sessions.

What if I am struggling emotionally with my condition?

It is understandable to experience difficult emotions when living with a long-term health condition.

You may feel grief for the things you used to be able to do, frustration about your limitations, anxiety about the future or low mood when your symptoms interfere with your life.

Therapy provides a space to explore these experiences without assuming that you should simply "accept" everything or be positive about your situation.

We can work towards finding helpful ways of responding to what has changed while identifying what remains important and meaningful to you.

What can I expect from therapy with you?

We'll start by understanding how your health condition or persistent symptoms are affecting your life and what you'd like to be different. We'll consider your current circumstances, your medical needs and any guidance you've received from your healthcare team.

Together, we'll identify patterns that may be making things more difficult, such as overdoing activities, avoiding things because of fear of worsening symptoms, focusing closely on physical sensations, or struggling with guilt and self-criticism.

We'll then work collaboratively on realistic changes that fit with your individual circumstances, regularly reviewing what is helpful and adapting therapy as needed.

Frequently Asked Questions

Will CBT tell me that my physical symptoms are caused by anxiety?

No. CBT does not assume that physical symptoms are caused by psychological factors.

The focus is on understanding how you are affected by your symptoms and whether thoughts, emotions or behaviours are contributing to difficulties in managing their impact.

Can CBT cure my chronic pain, IBS, fibromyalgia or fatigue?

CBT is not a cure for these physical conditions and is not intended to replace medical treatment.

Instead, therapy focuses on helping you understand and change some of the patterns that develop around persistent symptoms and manage the impact of symptoms. CBT can support you to manage difficulties in a way that is more sustainable and consistent with your individual circumstances. The aim is to help you work towards a life that remains meaningful and manageable alongside your condition.

What if my symptoms are currently very severe?

We can consider your current circumstances and whether therapy is appropriate for you. If you are experiencing significant symptoms or a recent change in your health, it is important that you remain appropriately supported by your medical team.

Can CBT help with the fear of making my symptoms worse?

Yes. We can explore fears about symptoms or flare-ups and how these may influence your behaviour, including avoidance or repeatedly seeking reassurance.

Any changes to activity or behaviour will be considered carefully in the context of your individual condition and medical advice.

Do I need to have a diagnosis to have therapy?

No. You don't necessarily need a formal diagnosis to have therapy. We can discuss the difficulties you're experiencing, how they are affecting your life and whether psychological support is appropriate for you. If your physical symptoms have not been medically assessed or you have experienced a significant change in your health, it's important to seek appropriate medical advice alongside considering therapy.

Take the first step

Living with persistent symptoms can be challenging, particularly when they affect the things that matter to you. Therapy can help you explore ways of managing the impact of your symptoms while working towards a life that remains meaningful to you.

If you'd like to discuss whether therapy could be helpful for you, you can book a free 15-minute initial consultation.

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