Behavioral Medicine Flashcards
What is BEHAVIORAL MEDICINE?
What are these behaviors?
What therapies play an important role?
Involves the modification of health risk behaviors associated with increased risk of morbidity/mortality.
– Overeating
– Lack of Exercise
– Substance Abuse
– Smoking
Cognitive-Behavioral therapies
What are two treatment approaches that demonstrate good efficacy for smoking cessation?
– Pharmacotherapy
– Counseling (e.g. Cognitive-behavioral therapies)
• The combination of the two approaches results in the highest rates of cessation
What are the 5 steps that people move through to quit smoking?
Step 1: Assessing pt’s Readiness to Quit
Step 2: Assessing Physical Dependence
Step 3: Addressing Psychological & Social determinants
Step 4: Designing a comprehensive Treatment Strategy
Step 5: Providing motivational support & Preventing Relapse
What is Precontemplation
• Person is not considering change at this point • Do not see any problem with behavior
• Tried & failed repeatedly & given up • Health provider’s task:
– Listen with empathy and curiosity
– Educate: Increase awareness of risks/benefits – Raise doubt
What is Contemplation
• Person is considering quitting, but is ambivalent – weighing pros & cons
• Health care provider should:
– Emphasize risks & benefits in relation to
person’s medical, psychological & social status – Help strengthen person’s sense of self-efficacy
i.e., the belief that they can do it
– Focus on past ‘successes’ even if short – Vacillation is to be expected
What is Preparation
• Person intends to take action in near future & are ready to develop a plan of action
• Health care provider should:
– Explore treatment options
– Help set ‘quit date’
– Encourage realistic goals
– Provide support & encouragement – Assist in problem-solving
What is Action
• Person has now made specific modifications in lifestyle – i.e. has quit smoking (6 months)
• Health care provider should:
– Help identify high risk situations for return to
smoking & help develop coping strategies
– Provide reinforcement - promote confidence &
self-efficacy
What is Maintenance
• Person now able to successfully resist
temptation to return to smoking
• Greater confidence, self-efficacy
• Able to anticipate risky situations & prepare coping strategies in advance
• With smoking behavior, relapse is the rule
Step 2:
What is the most important obstacle to quitting
Are withdrawal symptoms specific? When do they first experience them and when are they the most pronounced?
Assessing and managing physical dependence
Physical dependence on nicotine
Withdrawal symptoms are nonspecific & vary widely in intensity & duration
• They tend not to be correctly identified by smokers & are first experienced a few hours after last cig
• Most pronounced 2-3 days later – slowly wane over next few weeks/months
What are nicotine withdrawal symptoms
What type of reinforcement is nicotine associated with?
– Irritability – Anger – Impatience – Restlessness – Difficulty concentrating – Insomnia – Increased appetite – Anxiety – Depression
Negative Reinforcement
What are indicators of physical dependence
What is the rationale?
– Smoking first thing in the morning
– Enjoying first cigarette more than any of the others – Smoking more in mornings than later in day
Physical dependence on nicotine involves some degree of withdrawal during sleeping hours
Thus, upon awakening there is an increased need for nicotine & it is particularly enjoyable to smoke at this time
What are three products that have been approved by the FDA?
What drug has been associated with suicidal ideation?
nicotine replacement products (NRTs): – Gum – Transdermal patch – Nasal spray – Vapor inhaler
– Sustained release bupropion (Zyban) Antidepressant with dopaminergic & noradrenergic activity
– Varenicline (Chantix) Partial agonist – eases withdrawal by stimulating nicotine receptors, blocks them if pt takes up smoking again
– However, Chantix has been associated with suicidal ideation – banned in 2008 by FAA for use among pilots & air traffic controllers
CHANTIX
Step 3: PSYCHOLOGICAL & SOCIAL DETERMINANTS OF SMOKING
What emotions are commonly associated with smoking?
What are 5 examples of alternative treatments for this?
Cigarettes are commonly used to handle
stress, anxiety, depression & anger
– Stress-management training – Assertiveness training
– Relaxation training
– Aversion therapy
– Relapse prevention
Step 4: DESIGNING AN EFFECTIVE INTERVENTION
When do you NOT recommend NRT’s?
When DO you recommend NRT’s?
- few withdrawal Sx
- relapse > 2 weeks
- low FTND
- history of withdrawal Sx
- relapse < 1 week
- high FTND
Step 5: MOTIVATIONAL SUPPORT & RELAPSE PREVENTION
What is AVE?
Abstinence Violation Effect: often seen following unplanned return to use:
– Self-blame
– Guilt
– Loss of confidence
