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Managing Chronic Illness

Managing Chronic Illness | IBS | IBD | Chron's Disease

Cohesive Integrated Care

A Chronic Condition is Not Just About Your Physical Health…

It is about the underlying stress that you feel when you do not have the energy to do what you
need to do that day.

It is about the feelings of guilt that you have when you watch your loved ones try their best to help.

It is about not knowing how to explain that even though you “look good” on the outside, the pain and fatigue that you feel on the inside are real.

It is about feeling isolated and misunderstood, and not knowing how to move forward in a way that makes you happy in a world that may not understand what you’re going through.

And now, it can also be about hope, because your diagnosis does not define you.

Dealing with a chronic illness is about many factors, and we get it. When you begin to work with any of our therapists, you are offered the possibility of receiving care that is integrated and, with your consent, informed by treatment that you are receiving from your doctors, nurse practitioners, dietician or psychiatrist. We understand that when you are dealing with a chronic illness, collaborating with your other care providers can help us give you the most well-rounded care.

How can integrated-collaborative care be helpful to you? Perhaps you are struggling to comply with taking your medication, or the diet that you have been recommended is strict, causing you to feel resistant or even sadness about the constraints.  Or, you might have been prescribed an antidepressant that might be having a GI-related side effect by your psychiatrist, who is unaware that you are also dealing with GI-related issues such as nausea, diarrhea or constipation.

If you’re struggling with a chronic health issue, whether it’s a digestive disorder like Irritable Bowel Syndrome (IBS), cancer, chronic pain, major surgery, or long-term diseases that we have not yet found a cure for such as Inflammatory Bowel Diseases (Crohn’s Disease or Ulcerative Colitis), the impact on your emotional, social, and mental health is not only substantial, it is also far-reaching.

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Creating a “new normal” is not something that any of us plan for, so for most of us, the transitions do not happen so smoothly. When trying to understand the complex emotional impact of chronic health issues, it may be easier to look at it from the perspective of what is commonly referred to as the biopsychosocial model:

Biopsychosocial Model | Chronic Illness | Managing Chronic Illness | IBD | IBS | Chron's Disease | Cohesive Therapy NYC

When you experience chronic health issues, you may struggle with physical or biological symptoms, such as pain, difficulty moving or doing certain tasks, and sleep issues. Your body may have less energy, less ability, and less independence than it used to.

Over time, these effects of chronic illness take a psychological toll. You may begin to feel hopeless, helpless, and sometimes, invalidated by those who love you most. You might begin to doubt or question yourself, growing more and more cynical about the world and your place in it. To make matters worse, some health complications may compromise your hopes for the future, as well as your feelings of security. You might begin to grieve the loss of meaningful milestones you had hoped to obtain: your dream career, your future relationships, or even having time enough to live to see your children grow old.

These emotional internal experiences can seep into your social life, and you may withdraw from others and fear relational connection. People may also begin to treat you differently and respond to your needs in different ways. You may begin to feel that your calls or texts are being avoided by friends from whom you never would have expected such behavior, or you may experience “feeling smothered” by your loved ones, never getting enough space to breathe and be yourself.

These difficulties can all stem from your health issues, thereby producing additional life stressors. Some of the warning signs that someone is experiencing psychological distress due to a medical condition might include:

  • Loss of purpose or meaning
  • Bouts of tearfulness or sadness
  • Anger or irritability
  • Hopelessness or helplessness
  • Isolation from friends and family
  • Thoughts of death or ending one’s life
  • Poor medication adherence (not taking medicine, skipping appointments, etc.)
  • Difficulty with sleep
  • Loss of motivation
I’m Ready For Help With My Chronic Illness

People suffering from chronic health issues are at a higher risk of developing emotional and psychological difficulties such as depression, anxiety, and even suicidality. Chronic anxiety in and of itself can compound the negative effects on your health, as it can have an impact on your immune, nervous, and digestive systems.

In most cases, an ongoing chronic illness also becomes a “family affair,” as it is almost impossible to manage without the help or support of family or friends. All too often, the need to use or gather a support system leaves you feeling anxious, depressed, and guilty for “burdening” those closest to you.

Without having the right frame of mind, strong coping techniques, and strategies to manage challenges, managing a chronic illness can feel overwhelming, but with the right tools in your coping toolbox, you can reach beyond just “managing” and take back control of your life despite your chronic condition.


We will work together to help you:
  • Modify your reactions to pain
  • Decrease or better manage your worry about medical issues
  • Add new coping skills to your “coping toolkit”
  • Learn techniques to help you sleep better
  • Increase your resilience and self-confidence
  • Navigate family and relational issues
  • Be more mindful, less anxious and a strong self-advocate

IBS or GI Related Anxiety


Irritable Bowel Syndrome (IBS) is a gastrointestinal disorder that can cause a variety of uncomfortable and unpleasant symptoms. Diarrhea, cramping, bloating, gas, and abdominal pain are all common. People who deal with IBS are also known to experience changes in their bowel movements such as constipation, which sometimes means that symptoms of IBS aren’t always consistent.


While the exact causes of IBS remain uncertain, there are some issues that are common amongst people who live with it. Intestinal inflammation, a bacterial infection or overgrowth (SIBO) in the digestive tract, a genetic predisposition, and food sensitivities are common contributing issues.

Psychological elements can also trigger your symptoms of IBS. Stress, depression, anxiety, or traumatic early life events may irritate symptoms even long after the event has passed. This is because your digestive system (or your gut) communicates with your nervous system. Through a set of chemical messengers, your brain and gut interact with one another. If you have stress in one system, it can easily cause stress in the other – this is called the Brain-Gut Connection.


While anxiety doesn’t directly cause IBS, it can – and often does – exacerbate symptoms. Some people may become fearful of eating certain foods and start worrying about getting sick even before symptoms of IBS happen. Others imagine that any outing will result in a bad digestive experience and begin to socially isolate themselves or structure their futures based on symptoms.

Research has also suggested that as you experience anxiety, your mind becomes hypersensitive to the spasms of the colon and decreases the brain’s ability to “buffer” digestive activity, which makes you more aware of (and more anxious about) the activity in your gut.

All of this leads to an unfortunate cycle: stress causes IBS flare-ups which cause heightened awareness of symptoms. This causes stress about IBS, which causes more flare-ups.


One important thing to note is that while anxiety and other psychological disorders don’t cause
digestive illness, there is a link between your brain and your digestive health.

The brain and the gut are in constant two-way communication. The gut tells the brain how it’s feeling, and the brain interprets those signals. For example, when a person without IBS is hungry, the gut sends signals a signal to the brain that tell them it’s time to eat. But if you are a person that deals with IBS, you may not feel hunger and satiation the same way others do.

For example, instead of feeling full, you may experience abdominal pain. Perhaps you become constipated rather than eliminating consistently, or on the other end of the spectrum, you receive signals of urgency and feel the need “to go.” At times, it can even become difficult for you to tell the difference between actually needing to use the bathroom and simply having gas. These different digestive symptoms can be due to a variety of factors, including a disruption in the communication between the brain and the gut.

Brain-gut disruption can happen when a person experiences long-term chronic stress or has trouble managing constant levels of anxiety. Constant anxiety or stress sets up the body up for “fight, flight, or freeze” mode. In that panicked state, the brain-gut connection miscommunicates and interrupts the digestive process.


Dealing with IBS can be incredibly stressful and frustrating. Fortunately, many people who suffer from IBS can greatly improve their symptoms by managing sources of stress and making changes to their diet and lifestyle.

While working with your doctors, keeping a healthy diet, staying active, and having a support group are essential, sometimes you need an additional team member to help manage the psychological side of IBS. If you feel like you are having trouble managing the stress or emotions surrounding your life with IBS, it may be helpful to reach out to a licensed mental health professional.

Therapy provides a safe, supportive, and confidential space for you to work towards your goals with a professional.  Our practice draws from experience in working with people who have a chronic illness to help you identify ways to navigate seemingly ongoing health challenges.  You will have the chance to speak freely about yourself, share your life story, and build a therapeutic relationship.


For those with anxiety and depression related to IBS, Cognitive Behavioral Therapy (CBT) may be helpful. It can teach you techniques that address your thoughts around anxiety and depression, as well as behavioral and relaxation techniques. Learning how to communicate with your body and change certain behaviors can help reduce stress and anxiety, and since stress and anxiety are often linked to IBS, better managing those responses can help to alleviate symptoms.

Another treatment that has been proven helpful in recent studies is Gut-Directed Hypnotherapy. This is a specialized form of hypnotherapy that focuses on creating a healthier line of communication between your gut and your brain. Communication is achieved through guided-imagery sessions of hypnosis. Gut-Directed Hypnotherapy helps you reteach the brain how to correctly interpret the signals being received from the gut. Cohesive Therapy NYC offers Gut-Directed Hypnotherapy in small group sessions and on a limited individual basis based on availability.

If you think your IBS symptoms are linked to anxiety, a licensed therapist who has experience in digestive disorders can help you take your life back. With support and guidance, you can learn how to better manage your life stressors and alleviate some triggers of your IBS.

IBD: Crohn’s Disease and Ulcerative Colitis


Inflammatory Bowel Disease (IBD) is a gastrointestinal disorder caused by chronic inflammation that leads to damage in the Gastrointestinal (GI) tract.

There are two types of IBD:  Crohn’s Disease and Ulcerative Colitis (UC), and each has its own variation of complexities.  While there are differences between the two, on the surface they may present similarly. For example, both conditions can present with:

  • Diarrhea and/or constipation
  • Bloody stools and/or rectal bleeding
  • Sudden urges to have a bowel movement
  • Abdominal pain and cramping
  • Unintended weight loss
  • Fatigue
  • Nausea and loss of appetite

The most notable difference between Crohn’s and UC is that Ulcerative Colitis only affects the colon and not the entire GI tract.  In contrast, Crohn’s can affect any part of the GI tract from the mouth to the anus. They also each have their own unique sets of complications which can
range in severity and treatment options.

We are not sure what causes IBD, but we do know that it is caused by an immune response in “overdrive” that occurs even when there may not be an obvious offender, such as a virus. There is also a genetic component to IBD, as it tends to run in families, although that may not always be the case.


While anxiety does not cause IBD, it can, and often does, exacerbate symptoms. Living with IBD can cause you to experience a substantial amount of anxiety as you deal with the challenges of needing a support system, manage various levels of healthcare, disclose (or not disclose) your illness to those around you, and handle various stages of disease acceptance. All of these new challenges can cause anxiety, which may in turn impact symptoms.

Your changes in lifestyle, physical activity, nutrition, or overall management of your health can also bring about feelings of depression. IBD is often referred to as an “invisible illness” because the symptoms are often “internal” and therefore not always as obvious to our friends and family. Trying to navigate the different areas that need to be addressed while also managing your own expectations for yourself, as well as the expectations of others, can sometimes be accompanied by feelings of sadness or hopelessness.

The Path to Wellness | Managing Chronic Illness | Cohesive Therapy NYC

When dealing with a chronic illness like IBD, taking care of your mental well-being is as important as taking care of your physical well-being.  Working with a therapist who understands your situation can help you to:

  • Learn the necessary tools to manage your anxiety and depression symptoms
  • Figure out the areas in your life where you will need to make changes
  • Learn to confidently advocate for yourself
  • Feel empowered to know that while your IBD is a part of you, it does not define you

Dealing with IBD can be incredibly stressful, anxiety-producing, frustrating, and can even bring about depressive symptoms.  If you feel like you are having trouble managing the stress or emotions surrounding your life with IBD, it may be helpful to reach out to a licensed mental health professional.

Therapy provides a safe, supportive, and confidential space for you to work towards your goals with a professional.  Our practice draws from experience in working with people who have a chronic illness to help you identify ways to navigate ongoing health challenges.  You will have the chance to speak freely about yourself, share your life story, and build a therapeutic relationship where you will learn effective strategies to improve your quality of life.

If you feel that your IBD diagnosis or symptoms are causing you to experience anxiety, depression, isolation, or eating difficulties, a licensed therapist who has experience in digestive disorders can help.  With support and guidance, you can learn how to better manage your life stressors and alleviate some triggers of your IBD.


You can cope with the stressors of having a serious medical issue in a number of ways, and certain things work better for some than others – which is why we like to tailor coping techniques specifically for each of our clients.  Feel free to be creative and find what works best for you! To get you started, here are some of our go-to suggestions for managing stress:

  1. Find space – Your loved ones may not be providing you with enough space to think, reflect, or be alone. You may need time to be more independent and to be your own person, all on your own. This will help you feel more connected with who you are – rather than what is happening to you.
  2. Be a self-advocate – Although they may do it with good intentions, your loved ones may be a bit overbearing or protective in response to your condition. This means that they may be taking care of you in ways that you do not need or doing things that you could do for yourself. Try to be your own advocate, and learn about the support resources available to you and how to get access to them.
  3. Adapt and accept – Find ways to adapt and compensate for your new ability level, but also give yourself compassion for the things that are now beyond your reach. Longing and yearning for a full recovery of your abilities will only bring more stress and grief. Making peace with yourself will ease your adjustment.
  4. Look ahead and make new plans – Many people struggle with dwelling in the past and grieving the dreams of the future they once had. Although the pain of this loss can take time to fade, you can find some relief by looking to your future and finding things to work towards – no matter how small.
  5. Open up – Talk about your thoughts and feelings to a trusted loved one. Many of the people around you want to be a support, and you can unload some of your stress by sharing what you’re going through.  You may also benefit from researching support groups for your condition in your area, as many primary care and hospital settings offer these to patients for free or little cost.

Creating a “new normal” can be a difficult transition. Sometimes the adoption of coping skills alone is not enough to help you deal with the emotional symptoms that so often accompany chronic health issues. It is for moments like these when professional help through psychotherapy is needed.

Cohesive Therapy NYC provides individual and family therapy for adults who struggle with chronic illness or chronic health issues because, no matter how bad things get, you deserve to have a hopeful, meaningful, and joy-filled life. It is an honor for us to help our clients learn how to create and live their lives to the fullest.  That is our desire for you – what is YOUR desire for you? Let’s start there.

Contact us today to set up a free 20-minute phone consultation and take that first step towards change.

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