The mapping of emotions in a respiratory illness: transferability of illness experience from Pulmonary Arterial Hypertension to COVID-19

Objectives: Covid-19 poses an existential threat that has increased death anxiety at the individual and societal levels. In prior work, we have examined existential conversations in patients with Pulmonary Arterial Hypertension (PAH), an incurable respiratory disease with symptom overlap. In this mixed method study, we analyse the emotional qualities of these conversations in PAH. By understanding the emotions in PAH, we may learn something about the feelings that can also be evoked in people coping with Covid-19. Methods: We interviewed 30 PAH patients from 2016-2018 about the meaning and impact of illness on their lives. We analysed transcripts and audio recordings for heightened emotional moments and categorised the emotional responses and topics that were discussed. A multiple correspondence analysis was conducted to identify the associations between emotions and topics. Clini cal illustrations are provided for interpretation. Results: Mean age and illness duration was 52 and 6 years, and 77% were female. Participants had a mean of 5 emotional moments, each lasting on average 20 seconds. Half occurred in the first 20 minutes. Coping with diagnosis and the healthcare system was accompanied by feelings of shock and unfairness; relational issues involving close others evoked complicated feelings of isolation, worthlessness, and self-blame; and the experience of physical limitations and mortality salience elicited much anger and fear. Conclusion: People confronted by the threat of mortality from disease may have powerful feelings that they would benefit from sharing. These emotions are readily expressed because opportunities to discuss them are rare. Psychoeducation about illness experiences may help healthy people to relate to the medically ill and destigmatise the discussion of illness-related concerns. Research on coping with existential distress may be applied to the illness experience of Covid-19

Conversational avoidance during existential interviews with patients with progressive illness

We examined patterns of avoidance when existential emotional topics were raised during conversations with patients with pulmonary arterial hypertension (PAH), an incurable life-limiting disease. 30 adult outpatients with PAH were recruited for a 20 to 60-minute interview about their illness experience. Qualitative content analysis was used to identify avoidance strategies that patients employed. Participants averaged 58 years in age (SD = 18), 77% were female, and mean length of illness was 6.3 years (SD = 5.3). We found four avoidance strategies: (1) Reversal, when individuals would begin discussing a negative concern and then backtrack to more positive sentiments; (2) Diversion for when patients would sidetrack the conversation to a different and less uncomfortable topic; (3) Diminishment for when a concern is raised and then made to seem unimportant; and (4) Obstruction, when patients refuse to discuss a concern further. Exploration of existential concerns can elicit distress but may be necessary to promote adaptation to progressive illness and to the foreseeable challenges that may affect the sense of life meaning and value. By recognizing when existential concerns may be present but not adequately discussed, clinicians may be better able to assist patients to cope and prepare for the future