Emotion regulation and chronic illness : The roles of acceptance, mindfulness and compassion in physical and mental health

Sammanfattning: Introduction: Chronic illness is an increasingly predominant problem among the world population which vastly impacts on physical and mental health, quality of life and social functioning. Although chronic illnesses merit a long-term and complex response which would be ideally delivered by a multidisciplinary team of health professionals, most of the current healthcare for chronic illnesses still focus on acute episodes of illness. The third wave of cognitive and behavioural approaches on psychological problems, in particular mindfulness, Acceptance and Commitment Therapy, and evolutionary and compassion-based approaches have presented promising perspectives on behavioural medicine. Nevertheless, the efficacy of third wave interventions in improving well-being and mental health in chronic illness, although promising, is not yet clear. This doctoral dissertation aimed to contribute to a greater understanding of the psychological mechanisms that influence the vulnerability and persistence of psychological, social, and physical impairment in chronic illness. The role of verbal and emotion regulation processes aligned with third wave approaches’ conceptualizations of psychological problems in the comprehension of psychosocial and physical problems in chronic illness was thus explored in this dissertation. With this information, this thesis also aimed to develop, apply and test the efficacy of a new integrative acceptance, mindfulness, and compassion-based intervention for cancer.Methods: This dissertation includes 18 empirical studies with cross-sectional and longitudinal designs, including the development and test of efficacy of the MIND programme for cancer patients. The majority of these studies were conducted in samples of inflammatory bowel disease patients and breast cancer patients. Some studies also included individuals from the general population, as well as mixed samples of chronic patients. Generally, participants were recruited via internet or from hospital outpatient units. Data was collected through self-report measures and, in some specific studies, from medical records.Results: Overall, the studies revealed that: i) The Engaged Living Scale and its new shorter version (ELS-9), and the Committed Action Questionnaire are valid measures of engaged living and committed action for the Portuguese population. ii) The new chronic illness-specific measures – the Chronic Illness-related Shame Scale (CISS) and the Cognitive Fusion Questionnaire - Chronic Illness (CFQ-CI) – are robust and valid instruments that enable the assessment of chronic illness-related shame and chronic illness-related cognitive fusion, respectively. iii) The studied verbal and emotion regulation processes (cognitive fusion,experiential avoidance, self-criticism, fear of compassion from others, and lack of committed action) seem to be more important to the comprehension of psychosocial problems in chronic illness than physical symptomatology and contextual variables, and seem to mediate the effects of these variables, as well as the effects of chronic illness shame and body image dissatisfaction, on psychological, social, and physical health outcomes. Cognitive fusion and experiential avoidance in particular were identified as fundamental causal processes in the determination of the level of psychological health and perceived physical health in chronic patients. iv) The integration of acceptance, mindfulness, and compassion-based approaches in chronic illness seems to be feasible. The MIND programme for cancer patients presented a seemingly increased efficacy on the improvement of psychological health in relation to other mindfulness-based interventions in the context of breast cancer. Preliminary results suggested that the programme is a feasible, useful, accessible and cost-effective complement to the treatment of breast cancer.Conclusions: This dissertation clarifies the role of verbal and emotion regulation processes in chronic illness, presenting particularly innovative data in inflammatory bowel disease. The findings give support to the pertinence of acceptance, mindfulness, and compassion-based approaches, as well as their complementary integration, in behavioural medicine. The findings were integrated in a new transdiagnostic model for the comprehension of psychosocial and physical impairment in chronic illness. This dissertation provides new opportunities for future research, especially regarding the application of the MIND programme in other chronic illness populations.