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Z ESA 3- HPHD > Coping > Flashcards

Coping Flashcards

1
Q

Who theorised the transactional model of stress?

A

Lazarus and Folkman, 1984

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2
Q

What happens in the transactional model of stress?

A
  1. Potential stressor
  2. Primary appraisal
  3. Secondary appraisal
  4. Stress
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3
Q

What factors can cause stress in chronic illness?

A
  • Diagnosis
  • Physical impact
  • Treatment
  • Hospitalisation
  • Adjustment
  • Chronic nature of illness
  • Socioeconomic illness
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4
Q

What will a person have on diagnosis of a chronic illness?

A

Lots of worries and questions

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5
Q

What is the importance of the worries and questions a person will have on diagnosis of a chronic illness?

A

A strong predictor of future anxiety is the number of unanswered concerns

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6
Q

What may the emotional responses to diagnosis be?

A
  • Shock
  • Anxiety
  • Depression
  • Denial
  • Fear
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7
Q

What may the physical impact of a chronic disease be?

A
  • Pain
  • Limited mobility
  • Other symptoms
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8
Q

How may the treatment for a chronic illness cause stress?

A
  • Anxiety
  • Discomfort
  • Impact on body image
  • Burdensome nature of self management
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9
Q

Give an example of where a chronic disease may have an impact on body image

A

Breast cancer

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10
Q

Why may self management of a chronic disease cause stress?

A
  • Life changes
  • Having to take medication
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11
Q

Why may hospitalisation cause stress?

A
  • Loss of autonomy, privacy, or status
  • Possible removal from usual support network
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12
Q

What adjustments may need to be made when a person has a chronic illness?

A
  • Biographical disruption
  • Change in identity
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13
Q

What is meant by biographical disruption

A

Disruption to life trajectory

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14
Q

What is the result of the disruption to life trajectory in chronic illness?

A
  • Change in goals
  • Have to rethink future
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15
Q

What change in identity might occur in chronic illness?

A

‘Sick role’

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16
Q

Why may the chronic nature of illness cause stress?

A

The change may be indefinite, and so it is hard to make plans

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17
Q

What is the socioeconomic impact of chronic illness?

A
  • May cause financial problems if work is affected
  • Social problems
  • Relationship problems
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18
Q

What is the result of the loss of income if a chronic illness means work is affected?

A

May struggle with mortgage, childcare etc

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19
Q

What social problems may a chronic illness cause?

A
  • Housing
  • Childcare
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20
Q

Who may chronic illness cause relationship problems between?

A
  • Family
  • Friends
  • Colleagues
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21
Q

What must be considered when thinking about stress in chronically ill patients?

A

There is a different combination of issues for different patients, but all share the need for adjustment

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22
Q

What does stress depend on?

A

Perception

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23
Q

How may perception of chronic illness affect stress?

A
  • If they think the illness is very bad
  • If they think they can’t cope
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24
Q

What are the categories of life events causing stress?

A
  • Family
  • Personal
  • Workplace
  • Financial
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25
Q

What family events can cause stress?

A
  • Bereavement
  • Divorce
  • Marriage
  • Family health
  • Pregnancy
  • Family unemployment
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26
Q

What personal events can cause stress?

A
  • Imprisonment
  • Personal achievement
  • Change in school/residence
  • Sexual difficulties
  • Change in habits
  • Holidays
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27
Q

What workplace events can cause stress?

A
  • Dismissal
  • Retirement
  • Job change
  • Change in responsibilities/conditions
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28
Q

What financial events can cause stress?

A
  • Change in financial state
  • Mortgage
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29
Q

What are the types of coping styles?

A
  • Emotional focused coping
  • Problem focused coping
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30
Q

What does emotional focused coping aim to do?

A

Change the emotion/appraisal

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31
Q

What are the approaches in emotional focused coping?

A
  • Behavioural approaches
  • Cognitive approches
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32
Q

What is meant by a behavioural approach to coping?

A

Do something

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33
Q

Give three examples of behavioural approaches to emotional focused coping

A
  • Talking to friends
  • Alcohol
  • Finding a distraction
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34
Q

What is meant by a congitive approach to coping?

A

Change how you think about a situation

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35
Q

Give two examples of cognitive approaches in emotional focused coping

A
  • Denial
  • Focus on positive aspect of problem
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36
Q

What does problem focused coping aim to do?

A

Change the problem or your resources, therefore alleviating emotional reaction

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37
Q

What may be done in problem focused coping?

A
  • Reduce demands of stressful situation
  • Expand resources to deal with it
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38
Q

How may the demands of a stressful situation be reduced in problem focused coping?

A

Find out how to cope with feelings

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39
Q

What are the outcomes of problem focused and behavioural focused coping

A

All may help, but some will be less adaptive long term

40
Q

What is the best type of coping?

A

‘Active coping’

41
Q

What is active coping associated with?

A

Better adjustment

42
Q

What is the problem with active coping?

A
  • Chronically ill patients tend to report more ‘passive’ coping strategies
  • Depressed individuals struggle with active coping
43
Q

When considering coping and stress in clinical practice, what is it important to consider when giving information?

A

A persons coping style

44
Q

How can coping be aided?

A
  • Increase/mobilise social support
  • Increase personal control over condition
  • Prepare patients for stressful events
45
Q

Why is it important to provide patients with social support?

A
  • Some patients may have impoverished social network
  • Patient may be reluctant to display problem
  • Patient may not have/lost social network
46
Q

How can a physician increase/mobilise social support?

A

Suggest formal/informal sources of support

47
Q

What formal/informal sources of support can be provided for the patient?

A
  • Social services
  • Community resources
  • Hospital visitors/chaplain
  • Other religious and charitable organisations
  • Patient groups
48
Q

How can control over condition be increased?

A
  • Pain management
  • CBT and other psychological therapies
  • Self management programs
  • Involve patients in care-planning
  • Facilitate cognitive control
  • Resources to aid emotional management
49
Q

Give an example of a self management program used in a chronic disease

A

DAFNE (Dose adjustment for normal eating) self management course for type I diabetes

50
Q

What is the purpose of preparing patients for stressful events

A

Reduce ambiguity and uncertainty

51
Q

What stressful events may a patient be prepared for to reduce stress?

A

Preperation for surgery or hospital visits

52
Q

How are patients prepared for surgery or hospital visits?

A

Effective communication as to what they are likely to experience

53
Q

What are the advantages of preparing patients for stressful events?

A
  • Reduces anxiety
  • Reduces self-reported pain
  • Reduces length of stay after surgery
  • Improves patient adjustment/recovery
54
Q

Give an example of how patients can be prepared for stressful events

A

Pairing pre-op patients with post-op patients

55
Q

What is pairing pre-op patients with post-op patients assoicated with?

A

Reduced pre-op anxiety and earlier discharge

56
Q

Give an example of why it may be important to be responsive to individual preferences

A

Some patients may not want all details

57
Q

What must be done in the case of helping children cope?

A
  • Important to allow access, e.g. visits prior to admission
  • Use social media
58
Q

What are the outcomes of successful coping?

A
  • Tolerating or adjusting to negative events or realities
  • Reducing threats and enhancing prospects of recovery
  • Maintaining a positive self image
  • Maintaining emotional equilibrium
  • Continuing satisfying relationships with others
59
Q

What is diagnosis of chronic or life-threatening illness often assoicated with?

A

Depression and anxiety

60
Q

How does the prevalence of depression differ in those with a chronic illness compared to those without?

A

It is 2-3 times more likely in people with a chronic illness

61
Q

What chronic illnesses are associated with an increased risk of depression?

A
  • Cancer
  • Heart disease
  • Diabetes
  • Musculoskeletal/respiration/neurological disorder
62
Q

What % of the population is thought to have a chronic illness?

A

20%

63
Q

Who is anxiety more common in?

A

People with heart disease, stroke, and cancer

64
Q

What is anxiety?

A

An unpleasant emotional state that is a response to a threat

65
Q

What threats may anxiety be a response to?

A
  • Threats to identity or well-being
  • Threatening events
66
Q

What medical events may cause anxiety?

A
  • Surgery
  • Treatment
  • Test results
  • Uncertainty with prognosis
67
Q

What are people anxious of with regards to prognosis?

A
  • Discomfort
  • Disability
  • Death
68
Q

What feelings may anxiety include?

A
  • Panic
  • Dread
69
Q

What stages of illness is anxiety likely to occur at?

A
  • Diagnosis
  • Awaiting test results
  • Discharge from hospital
  • Illness progression
  • Making lifestyle changes
70
Q

When does anxiety become a problem?

A

When it is out of proportion to the threat

71
Q

What may problematic anxiety cause?

A
  • Feelings of dread and fear
  • Panic attack
  • Physical symptoms
72
Q

What physical symptoms may anxiety lead to?

A
  • Sweating
  • Nausea
73
Q

What is sustained anxiety associated with?

A
  • Unhelpful thinking patterns
  • Physiological effects
74
Q

What unhelpful thinking patterns is sustained anxiety associated with?

A
  • Increased vigilance to threat
  • Interpret ambiguous information as threatening
  • Increased recall of threatning memories
75
Q

What can increased vigilance for threats lead to?

A

Hypersensitivity to symptom changes

76
Q

Give three anxiety disorders

A
  • Phobia
  • Panic attacks
  • PTSD
77
Q

What is depression a response to?

A

Loss, failure, or helplessness

78
Q

What events may cause depression?

A
  • Loss of physical/health capacity
  • Loss of identity/social status
  • Reaction to symptoms, or negative experiences of illness
  • Physiological changes
  • Medication side effects
79
Q

What is depression?

A

A emotional state characterised by;

  • Persistent low mood
  • Sadness
  • Loss of interest
  • Despair
  • Feelings of worthlessness
80
Q

How long does depression last?

A

Tends to be long term

81
Q

How common is depression?

A

Very

82
Q

What groups are at higher risk of depression?

A
  • People with illnesses that are more severe, painful, or disabling
  • In the context of negative life events
  • When lacking resources to cope
83
Q

What can co-morbid depression do?

A
  • Exacerbate the pain and distress associated with physical health problems
  • Adversely affect illness outcomes
84
Q

What states the negative effect of depression on illness outcomes?

A

NICE 2010

85
Q

How does depression worsen illness outcomes?

A
  • Via direct mechanisms
  • Via indirect mechanisms
86
Q

What is a direct mechanism by which depression leads to worse illness outcomes?

A

Decreases adherance to treatment

87
Q

What is an indirect mechanism by which depression causes worse illness outcomes?

A

Associated with factors such as smoking, alcohol etc

88
Q

Why may psychological problems not be recognised?

A
  • Symptoms may be inadvertently missed by person or professional
  • Patients may not disclose symptoms
  • HCPs may avoid asking
89
Q

Why may symptoms be inadvertently missed by person or professional?

A
  • Attributed to illness or treatment
  • Experienced outside the consultation
90
Q

What is meant by the symptoms being experienced outside the consultation?

A

May not occur when in contact with HCP

91
Q

Give an example of a symptom of depression that may be attributed to the illness or treatment

A

Tiredness

92
Q

Why may a patient not disclose their psychological symptoms?

A
  • Perception of inevitability
  • Desire to avoid stigma, feeling judged, or a burden, or seen as failing to cope
93
Q

What is meant by a perception of inevitability?

A

The patient thinking ‘anyone would feel depressed in my situation’

94
Q

Why may HCPs avoid asking about psychological problems?

A
  • Perception that it is out of their role/expertise
    • Feel they haven’t been adequately trained
  • Capacity/time constraints
  • Reluctance to label people
95
Q

What is it important to be aware of, regarding psychological problems?

A
  • The possibility of psychological problems
  • Ways of helping
96
Q

How can the possibility of psychological problems be explored with a patient?

A

Listen/ask/provide opportunity to raise problems

97
Q

How can a physician help someone with psychologial problems?

A
  • NICE guidance
  • Referrals
  • Suggestions for mobilising support and engaging in self help

Z ESA 3- HPHD (7 decks)

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