We sat down with Megan Nogasky, JD, LCSW, Director of Compass Health Center’s Mental Health, Pain, and Illness Program, to unravel frequently asked questions about how pain and illness can affect mental health.
Interviewed by: Alexander Perez, Social Media & Multimedia Manager
Two things that people might not draw an easy connection between are mental health and physical pain or illness. Research shows that mental and physical health are deeply connected. For example, according to Mental Health America, chronic pain was linked to a worsened mental health status across a variety of mental health conditions – 54 percent of screeners with chronic pain experienced severe anxiety versus 43 percent without; 54 percent with chronic pain were experienced symptoms of bipolar disorder versus 39 percent without; 47 percent with chronic pain experienced severe depression versus 36 percent without.
Why is this important? Because the more we understand, the more options we might have to address our well-being. That’s why we sat down with Megan Nogasky, JD, LCSW, Director of Compass Health Center’s Mental Health, Pain, and Illness Program, to answer a few questions and give us insight into the connection between mind and body.
Interviewer: How can pain or illness impact someone’s mental health?
Megan Nogasky, JD, LCSW:
In some ways, this is common sense: if someone is experiencing pain or symptoms of illness (such as fatigue or nausea), it’s understandable that they might feel more irritable, down, or fearful. Similarly, if someone’s mental health is negatively impacted – by an argument with their significant other, bad news at work, or self-criticism, for example – they are likely to feel more physical pain, tension, and discomfort than they would if those things were not present. The impact goes in both directions: pain and illness can negatively affect mental health, and mental health challenges can affect the perception and intensity of symptoms.
Interviewer: What are some common misconceptions about pain, illness, and mental health?
Megan Nogasky, JD, LCSW:
One that immediately comes to mind is that individuals with invisible or less-visible conditions are lazy or not working hard enough or have more of a problem with being underactive. I’ve worked with many people whose main obstacle lies at the other extreme – overactivity. Those folks end up making their symptoms worse in the short- and long-term because they push themselves too hard, have trouble delegating, or struggle with perfectionism.
Another misconception is that physical pain or illness and mental health are separate issues. There are numerous studies that have shown the impact that the mind has on the body and vice versa. We know that pain, for example, is “in your head.” It’s not that what you’re feeling is fake or made up; it’s that sensory information is sent to and then interpreted by the brain. Pain can also be moderated by other things that happen in your brain, such as thoughts and emotions. Your head is where it all happens.
Interviewer: What is the Mental Health, Pain, and Illness Program?
Megan Nogasky, JD, LCSW:
At Compass, we have Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) for patients across the lifespan. The Mental Health, Pain, and Illness PHP/IOP came about when we found that approximately 20% of the adult patients at Compass were also managing physical pain or illness that impacted their mental health. The Mental Health, Pain, and Illness PHP run from 9:30 AM to 2:30 PM Monday through Friday. Patients typically start at that level of care, then step down to IOP – which runs from 9:30 AM to 12:30 PM Monday through Friday.
Every person in the program is assigned a primary clinical therapist to work with individually and a prescriber to manage psychiatric medication. It is highly recommended that patients also work with a family therapist while they are in the program. Importantly, our prescribers do not manage pain medication; that is handled by a patient’s outpatient team. The program is primarily group-based and feels much like being in a classroom. In the Mental Health, Pain, and Illness Program, we use Cognitive Behavioral Therapy, and Dialectical Behavior Therapy, with a particular focus on Acceptance and Commitment Therapy and Mindfulness-Based Stress Reduction.
Interviewer: When should individuals seek mental health treatment for their pain or illness?
Megan Nogasky, JD, LCSW:
As soon as they can. Mental health treatment for physical conditions often comes as a last resort in the United States – if people have tried medication, surgery, and physical therapy and those things haven’t worked, they are sent to a therapist or psychiatrist. But that flies in the face of research: we know that patients have better outcomes if they work on training their brain – for example, by reframing distorted thoughts – before they have a surgical procedure. The gold standard of care for pain and illness is interdisciplinary, collaborative, and takes into account the whole person. We’re aiming to add the missing psychological and mental health piece to the treatment of physical conditions.
People should consider this level of care in a few different scenarios: (1) a recent inpatient hospitalization for mental health concerns; (2) difficulty functioning at work, home, or school with only outpatient support; (3) more severe symptoms, such as suicidal ideation, mania, or psychosis.
Interviewer: Can you tell me anything else that you think would be helpful for patients to know?
Megan Nogasky, JD, LCSW:
You do not need a specific physical diagnosis for this program to be a good fit. There have been individuals in the program who are going through the process of getting a diagnosis by exclusion, such as fibromyalgia, as well as individuals whose symptoms are unexplained. Part of coping with pain and illness is managing uncertainty – about diagnosis, symptom progression, treatment, and the future. In the face of fear, sadness, and struggle in the wider world and in individual people’s lives, I feel fortunate to be a part of a program that provides stability and compassion.
Learn More About Compass Mental Health, Pain & Illness PHP/IOP Programs
Did you learn something? We hope so, and if you still have questions or want to learn more about
treatment to address pain, illness, and mental health, click here.
