Coping Flashcards
What physical impact can chronic illnesses have?
Pain
Limited mobility
Etc.
What effects can diagnosis of a chronic disease have on a patient?
Emotional responses including
- shock
- anxiety
- depression
- denial
- anger
- fear
What problems can treatment bring?
Anxiety
Discomfort
Body image
Etc
What problems can hospitalisation cause?
Loss of
- autonomy
- privacy
- status
- removal from usual support network
What adjustments may need to be made with a chronic illness?
Biographical disruption
Change in identity
Chronic nature of illness
Terminal illness - need to accept mortality
What is coping?
A way of managing stressors, finding ways to manage events/experiences that are appraised as threats of demands and which tax or exceed a patient’s available resources
What is problem-focused coping?
Addresses the problem itself. Includes behaviours that manage the problem or find out more about it.
Give examples of problem-focused coping
Reduce demands of stressful situation by finding information about how to deal with the problem, talk to someone, get advice, make a plan
Eg find it now to cope with feelings of claustrophobia in a mask for radiotherapy
Could expand resources for dealing with it eg putting aside other activities
What is emotion-focused coping?
Deals with the emotional feelings caused by the challenge
Give examples of emotion-focused coping
Talking to people about feelings Praying See positives Drinking/drugs/eating Humour
What are the general approaches of helping a patient to cope?
Increase/mobilise their social support
Increase personal control
Prepare patients for stressful events
Stress management techniques
How can you increase/mobilise their social support?
Help patients recognise and mobilise support
Suggest formal sources of support eg social services, community resources, religious/charitable organisations
How can you increase a patient’s personal control?
Pain management
See management programmes eg DAFNE
Give patient choices
Take cognitive control - resources to aid emotional management eg MS society
How can patients be prepared for stressful events?
Reduce ambiguity and uncertainty
Give effective communication
Peer contact - pair a pre-op with a post-op, can reduce anxiety and give an earlier discharge
Be responsive to individual preferences eg not all the details
Consider special cases eg children
What good does effective communication do in giving the patient control and helping them to cope?
Can reduce anxiety, self reported pain, length of stay after surgery, adjustment, recovery
What are the outcomes of successful coping?
Tolerating/adjusting to negative events/realities
Reducing threats and enhancing prospects of recovery
Preparing for the future
Marinating a positive self-image/mastery
Maintaining emotional equilibrium
Continue satisfying relationships with others
What health problems are patients with chronic illnesses at risk of?
Anxiety
Depression
When during chronic illness is anxiety likely to occur at?
Diagnosis, awaiting test results, discharge from hospital, illness progression, lifestyle changes
What is anxiety?
A response to threat. Unpleasant emotional state that may include feelings of panic or dread.
What can sustained anxiety lead to?
Unhelpful thinking patterns
- increased vigilance for threats (eg symptoms)
- interpret ambiguous information as threatening
- increased recall of threatening memories
What anxiety disorders are there?
Phobia
Panic attacks
PTSD
What is depression?
Response to loss, failure or helplessness
Emotional state characterised by persistent low mood, sadness, loss of interest, despair, feelings of worthlessness.
Tends to be long term
What can trigger depression?
Loss of health/physical capacity Loss of identity/social status Reaction to symptoms, negative experiences of illness Physiological changes eg MS Medication side effects
What increases the risk of depression?
Severity of illness
Pain and disability
Other negative life events
Lack of social support
What can comorbid depression do?
Exacerbate the pain and distress associated with physical health problems
Adversely affect illness outcomes
What illness and treatment factors can be barriers to identifying psychological difficulties in patients?
Illness and treatment factors
- psychological responses change over time and may set in after patient has gone home
- symptoms may be attributed to illness/treatment
What patient factors can be barriers to identifying psychological difficulties?
Patient factors
- may believe psych problems are an inevitable result of illness and cannot be alleviated
- may wish to avoid sounding like they are complaining - additional burden
- avoid being judged as inadequate or failing to cope
- stigma
What healthcare profession factors can be barriers to identifying psychological problems in patients?
Outside of psych settings, healthcare professional may a lid asking psych problems because they feel they are our of their role or fear of overwhelming/distressing the patient
If patient gives information about a psychological problem, HP could steer back to physical issues
Reluctance to label patients as having psychological difficulties
How can psychological problems be identified?
Listen/ask about it
Provide opportunity to raise problems
NICE guidelines for treatment and management of mild-moderate depression?
Low intensity psychological interventions such as
- individual guided self help
- structured group
- physical activity
- group based CBT
- peer group support for those with comorbid chronic illness
Treatment of moderate to severe depression?
Combine treatment of mild with antidepressants
High-intensity psychological interventions
Individual CBT
Interpersonal therapy
How can generalised anxiety disorder by managed?
Low intensity psychological interventions
Individual self help (based on CBT)
Psychoeducational group
Medication
How to more severe anxiety disorder?
High-intensity psychosocial interventions
Individual CBT
Applied relaxation
