Understanding The Seven Stages of Grief and Chronic Illness
It is essential to understand the Seven Stages of Grief and chronic disease if you plan to work with clients living with a chronic disease. Many individuals have heard of the five stages of grief created by Elizabeth Kubler-Ross in 1969. This model is used to explain the stages of grief over the loss of a loved one. There has been an updated model called the Seven Stages of Grief for Chronic Pain and Chronic Illness by Dr. Jennifer Martin, PsyD of www.imaginelifetherapy.com.
According to imaginelifetherapy.com, there are seven stages of grief for chronic disease: denial, pleading, bargaining and desperation, anger, anxiety and depression, loss of self and confusion, and acceptance. Clients can go from one stage to another until finally reaching acceptance. An individual, for example, can go from denial to anger and back to denial. Everyone will go through the stages in their own way and timing. There is no set time for anyone to reach acceptance of their situation. If your client can see positive changes after working with you, their outlook will be more positive. As they become stronger and learn more skills, clients will become more ambulatory and be able to move more over time.
Many times, clients will be experiencing their symptoms (chronic disease symptom cycle) and the stages of grief simultaneously. We usually think of grief with respect to the loss of a loved one. With chronic disease, your client may be grieving the life they used to live. Knowing that their lives may changed because of an illness is very stressful. In addition, the individual may be thinking about the future and how their health will be ten years from now. As a health fitness professional, you need to help your client to be present and in the moment. Help them understand and focus that the work they do today will influence how mobile they are ten years from now. If they are discouraged by the big picture, it will be harder for them to stay focused.
Each stage of grief has its own parameters and can give you insight as to which stage the client is currently in. Empathy and support are a critical part of helping a client to get through the stages of grief. Tailor exercise programming to what your client can handle each time they train. If they are having a rough day, you can offer the client a meditation session instead of a training session. Having options to meet them where they are each session may improve compliance if they are not mentally or physically ready for an exercise session.
Adapted from: Pratt, Amanda. “7 Stages of Grief for Chronic Pain and Chronic Illness: St. Petersburg Therapist.” Chronic Illness Therapy, 3 Aug. 2018, imaginelifetherapy.com/7-stages-of-grief-for-chronic-pain-and-illness/.
To know which stage of grief a client may be in, you must have an understanding of each stage.
Denial: The individual has just been diagnosed and is in shock. They cannot believe that they have been diagnosed with a chronic disease. They start to wonder how they will make changes and live a good life. Shock can help the person to decide to move on to the next stage and start working through the stages. It may also backfire if the individual chooses to think that the condition will eventually go away or be okay. Sometimes denial presents as pretending the chronic disease is not happening.
Pleading, Bargaining, and Desperation: In this stage the client tries really hard to bargain or plead to not have a chronic illness. The individual also wishes really hard that they could go back to their previous life. They may feel guilty and blame themselves for becoming sick and wondering if they could have done more to prevent their illness. Guilt usually comes with bargaining as the person blames themselves for their situation.
Anger: This is a crucial stage for individuals to begin the healing process. There is no specific timeline for the client to get through the anger stage. Please note that a client may come in angry some days when training. Try to remain empathetic and patient as the individual goes through this stage. Keep in mind that everyone on the healthcare team often sees anger from the newly diagnosed individual. It is normal for the client to be angry at their doctor, caregiver, family, friends, and even you, their trainer. However, they will most likely apologize after showing you that they are visibly angry. Anger typically comes later in the process when the disease progresses, and the individual realizes that life will change.
Anxiety and Depression: These will set in next as life changes are solidified. The feelings of depression can be substantial and seem to the client like they will never go away. If a client starts to withdraw, offer meditation instead of a training session to keep the client on track. Try to also be understanding about their condition and how they are feeling. If they must cancel with you, ask that they do so within a certain amount of time as your time is valuable as well. There may be anxiety about the future and the unknown as the person wonders what will happen to them.
Loss of Self and Confusion: This can be very real for individuals with a chronic illness. In this stage, life has changed so much for this individual that they do not recognize themselves. Some people define and understand themselves by what they can do. Due to the chronic illness, they can no longer do what they used to do in the same way and they have to figure out how to redefine themselves. This stage may happen at the same time as anxiety and depression or separately.
Re-evaluation of Life, Roles, and Goals: The client will be thinking about how they can move forward as a wife, mother, husband, father, sibling, and friend. They are forced to re-evaluate how they fit into the picture of their new life and what that means in daily life, figuring out how to go about daily activities, and what work will look like for them.
Acceptance: This is the final stage in which the client accepts his or her new reality. The client is not usually happy with it, but they learn how to deal with their new norm. They strive to learn new skills to make life better and discover new things that bring joy into their lives. In this stage, the client will be most accepting of trying new exercises and stress relief modalities in their training sessions.
References:
Adapted from: Pratt, Amanda. “7 Stages of Grief for Chronic Pain and Chronic Illness: St. Petersburg Therapist.” Chronic Illness Therapy, 3 Aug. 2018, imaginelifetherapy.com/7-stages-of-grief-for-chronic-pain-and-illness/.
Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 20 years of experience in medical-based fitness.