Scientists are discovering more about the role our minds play in chronic illness and chronic pain. Illness mindsets include beliefs and attitudes people hold about their chronic conditions. Mindsets shift as symptoms and care plan success fluctuate, and they often have vast impacts on patient experience and treatment outcome. 

Patients can manage these mindsets to a large degree, and researchers have identified three:  Catastrophe, Management, and Opportunity.

• Catastrophe mindsets cause panic and despair. Patients might feel that their situations will never improve and brace themselves for continued decline. In truth, they may be experiencing a flare—a temporary worsening of symptoms. 
• Management mindsets offer a more balanced view, including acceptance, that can lead to greater adaptability. These patients are more likely to meet flare-ups with perseverance and self-care. They tend to explore their options and empower themselves in ways that may include better dietary choices, research into treatment provider qualifications, and asking questions until they have an adequate grasp of the answers.  
• Opportunity mindsets allow patients to see the good that can come from their situations, including advocacy for themselves and others facing similar challenges. Patients with this mindset often perceive needed lifestyle changes as the means to additional benefits they would not have enjoyed otherwise. 

Our brains send pain signals and determine our response based on our previous pain experiences, memories, and mood and attitude histories. That’s one reason everyone experiences pain differently and that illness mindsets develop.

The Research Behind Illness Mindsets

Researcher Anna Zeidman shows us the effects of mindsets on health-related quality of life (HRQOL). Surveys of gynecologic and breast cancer survivors showed that more than 20.1% considered their cancer catastrophic, 52.4% manageable, and 65.9% opportunities. Respondents in the catastrophic community described lower HRQOL. 

Harvard psychologist Ellen Langer is a prominent researcher of the mind’s power over chronic health conditions. Langer’s first book, Mindfulness, was published in 1989, and she continues to advocate for it as a means of living one’s best life. Langer describes a method called “attention to symptom variability,” which involves noticing symptom changes to tease out their causes and contributing factors. This approach empowers patients through positive results and puts them in charge of a vital healthcare mission.  

In chronic disease, it’s common for the symptoms to align with what we would expect from that disease; in other words, they make sense, and we are not surprised by them. In chronic pain, however, there might not be a clear-cut reason. 

Technological advances are granting deeper insights, and scientists think that some chronic pain could be part of natural degeneration and that malfunctioning brain signals may cause ordinary stimuli to be interpreted as painful. Recognizing that chronic illness and chronic pain fluctuate and then connecting the dots to find the reasons can greatly improve quality of life. 

Journaling twice daily helps patients identify and track symptoms and triggers. Below is an outline of a journal entry for chronic pain: 

• Current pain level
• What, if anything, improved or worsened the pain 
• A description of the patient’s mental state during the time described in the journal entry (high stress, low stress, etc.)

Intersections of Mindsets, Mindfulness, and Whole-Being Approaches  

Patients’ illness mindsets help set them up for matching outcomes. This phenomenon is likely to be at least partly responsible for cancer survivors with catastrophe mindsets reporting lower HRQOL. The placebo effect is another example of how the mind paves the way for specific outcomes. Dr. Langer believes that the body and mind should be viewed as one and that much of mindfulness is the process of actively noticing new things.

Mapping out the connections between neuroscience and chronic conditions, monitoring patient mindsets, and educating patients on mindfulness could improve treatments and outcomes, allowing patients to live as painlessly as possible.