Coping Flashcards
Who theorised the transactional model of stress?
Lazarus and Folkman, 1984
What happens in the transactional model of stress?
- Potential stressor
- Primary appraisal
- Secondary appraisal
- Stress
What factors can cause stress in chronic illness?
- Diagnosis
- Physical impact
- Treatment
- Hospitalisation
- Adjustment
- Chronic nature of illness
- Socioeconomic illness
What will a person have on diagnosis of a chronic illness?
Lots of worries and questions
What is the importance of the worries and questions a person will have on diagnosis of a chronic illness?
A strong predictor of future anxiety is the number of unanswered concerns
What may the emotional responses to diagnosis be?
- Shock
- Anxiety
- Depression
- Denial
- Fear
What may the physical impact of a chronic disease be?
- Pain
- Limited mobility
- Other symptoms
How may the treatment for a chronic illness cause stress?
- Anxiety
- Discomfort
- Impact on body image
- Burdensome nature of self management
Give an example of where a chronic disease may have an impact on body image
Breast cancer
Why may self management of a chronic disease cause stress?
- Life changes
- Having to take medication
Why may hospitalisation cause stress?
- Loss of autonomy, privacy, or status
- Possible removal from usual support network
What adjustments may need to be made when a person has a chronic illness?
- Biographical disruption
- Change in identity
What is meant by biographical disruption
Disruption to life trajectory
What is the result of the disruption to life trajectory in chronic illness?
- Change in goals
- Have to rethink future
What change in identity might occur in chronic illness?
‘Sick role’
Why may the chronic nature of illness cause stress?
The change may be indefinite, and so it is hard to make plans
What is the socioeconomic impact of chronic illness?
- May cause financial problems if work is affected
- Social problems
- Relationship problems
What is the result of the loss of income if a chronic illness means work is affected?
May struggle with mortgage, childcare etc
What social problems may a chronic illness cause?
- Housing
- Childcare
Who may chronic illness cause relationship problems between?
- Family
- Friends
- Colleagues
What must be considered when thinking about stress in chronically ill patients?
There is a different combination of issues for different patients, but all share the need for adjustment
What does stress depend on?
Perception
How may perception of chronic illness affect stress?
- If they think the illness is very bad
- If they think they can’t cope
What are the categories of life events causing stress?
- Family
- Personal
- Workplace
- Financial
What family events can cause stress?
- Bereavement
- Divorce
- Marriage
- Family health
- Pregnancy
- Family unemployment
What personal events can cause stress?
- Imprisonment
- Personal achievement
- Change in school/residence
- Sexual difficulties
- Change in habits
- Holidays
What workplace events can cause stress?
- Dismissal
- Retirement
- Job change
- Change in responsibilities/conditions
What financial events can cause stress?
- Change in financial state
- Mortgage
What are the types of coping styles?
- Emotional focused coping
- Problem focused coping
What does emotional focused coping aim to do?
Change the emotion/appraisal
What are the approaches in emotional focused coping?
- Behavioural approaches
- Cognitive approches
What is meant by a behavioural approach to coping?
Do something
Give three examples of behavioural approaches to emotional focused coping
- Talking to friends
- Alcohol
- Finding a distraction
What is meant by a congitive approach to coping?
Change how you think about a situation
Give two examples of cognitive approaches in emotional focused coping
- Denial
- Focus on positive aspect of problem
What does problem focused coping aim to do?
Change the problem or your resources, therefore alleviating emotional reaction
What may be done in problem focused coping?
- Reduce demands of stressful situation
- Expand resources to deal with it
How may the demands of a stressful situation be reduced in problem focused coping?
Find out how to cope with feelings
What are the outcomes of problem focused and behavioural focused coping
All may help, but some will be less adaptive long term
What is the best type of coping?
‘Active coping’
What is active coping associated with?
Better adjustment
What is the problem with active coping?
- Chronically ill patients tend to report more ‘passive’ coping strategies
- Depressed individuals struggle with active coping
When considering coping and stress in clinical practice, what is it important to consider when giving information?
A persons coping style
How can coping be aided?
- Increase/mobilise social support
- Increase personal control over condition
- Prepare patients for stressful events
Why is it important to provide patients with social support?
- Some patients may have impoverished social network
- Patient may be reluctant to display problem
- Patient may not have/lost social network
How can a physician increase/mobilise social support?
Suggest formal/informal sources of support
What formal/informal sources of support can be provided for the patient?
- Social services
- Community resources
- Hospital visitors/chaplain
- Other religious and charitable organisations
- Patient groups
How can control over condition be increased?
- Pain management
- CBT and other psychological therapies
- Self management programs
- Involve patients in care-planning
- Facilitate cognitive control
- Resources to aid emotional management
Give an example of a self management program used in a chronic disease
DAFNE (Dose adjustment for normal eating) self management course for type I diabetes
What is the purpose of preparing patients for stressful events
Reduce ambiguity and uncertainty
What stressful events may a patient be prepared for to reduce stress?
Preperation for surgery or hospital visits
How are patients prepared for surgery or hospital visits?
Effective communication as to what they are likely to experience
What are the advantages of preparing patients for stressful events?
- Reduces anxiety
- Reduces self-reported pain
- Reduces length of stay after surgery
- Improves patient adjustment/recovery
Give an example of how patients can be prepared for stressful events
Pairing pre-op patients with post-op patients
What is pairing pre-op patients with post-op patients assoicated with?
Reduced pre-op anxiety and earlier discharge
Give an example of why it may be important to be responsive to individual preferences
Some patients may not want all details
What must be done in the case of helping children cope?
- Important to allow access, e.g. visits prior to admission
- Use social media
What are the outcomes of successful coping?
- 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
What is diagnosis of chronic or life-threatening illness often assoicated with?
Depression and anxiety
How does the prevalence of depression differ in those with a chronic illness compared to those without?
It is 2-3 times more likely in people with a chronic illness
What chronic illnesses are associated with an increased risk of depression?
- Cancer
- Heart disease
- Diabetes
- Musculoskeletal/respiration/neurological disorder
What % of the population is thought to have a chronic illness?
20%
Who is anxiety more common in?
People with heart disease, stroke, and cancer
What is anxiety?
An unpleasant emotional state that is a response to a threat
What threats may anxiety be a response to?
- Threats to identity or well-being
- Threatening events
What medical events may cause anxiety?
- Surgery
- Treatment
- Test results
- Uncertainty with prognosis
What are people anxious of with regards to prognosis?
- Discomfort
- Disability
- Death
What feelings may anxiety include?
- Panic
- Dread
What stages of illness is anxiety likely to occur at?
- Diagnosis
- Awaiting test results
- Discharge from hospital
- Illness progression
- Making lifestyle changes
When does anxiety become a problem?
When it is out of proportion to the threat
What may problematic anxiety cause?
- Feelings of dread and fear
- Panic attack
- Physical symptoms
What physical symptoms may anxiety lead to?
- Sweating
- Nausea
What is sustained anxiety associated with?
- Unhelpful thinking patterns
- Physiological effects
What unhelpful thinking patterns is sustained anxiety associated with?
- Increased vigilance to threat
- Interpret ambiguous information as threatening
- Increased recall of threatning memories
What can increased vigilance for threats lead to?
Hypersensitivity to symptom changes
Give three anxiety disorders
- Phobia
- Panic attacks
- PTSD
What is depression a response to?
Loss, failure, or helplessness
What events may cause depression?
- Loss of physical/health capacity
- Loss of identity/social status
- Reaction to symptoms, or negative experiences of illness
- Physiological changes
- Medication side effects
What is depression?
A emotional state characterised by;
- Persistent low mood
- Sadness
- Loss of interest
- Despair
- Feelings of worthlessness
How long does depression last?
Tends to be long term
How common is depression?
Very
What groups are at higher risk of depression?
- People with illnesses that are more severe, painful, or disabling
- In the context of negative life events
- When lacking resources to cope
What can co-morbid depression do?
- Exacerbate the pain and distress associated with physical health problems
- Adversely affect illness outcomes
What states the negative effect of depression on illness outcomes?
NICE 2010
How does depression worsen illness outcomes?
- Via direct mechanisms
- Via indirect mechanisms
What is a direct mechanism by which depression leads to worse illness outcomes?
Decreases adherance to treatment
What is an indirect mechanism by which depression causes worse illness outcomes?
Associated with factors such as smoking, alcohol etc
Why may psychological problems not be recognised?
- Symptoms may be inadvertently missed by person or professional
- Patients may not disclose symptoms
- HCPs may avoid asking
Why may symptoms be inadvertently missed by person or professional?
- Attributed to illness or treatment
- Experienced outside the consultation
What is meant by the symptoms being experienced outside the consultation?
May not occur when in contact with HCP
Give an example of a symptom of depression that may be attributed to the illness or treatment
Tiredness
Why may a patient not disclose their psychological symptoms?
- Perception of inevitability
- Desire to avoid stigma, feeling judged, or a burden, or seen as failing to cope
What is meant by a perception of inevitability?
The patient thinking ‘anyone would feel depressed in my situation’
Why may HCPs avoid asking about psychological problems?
- Perception that it is out of their role/expertise
- Feel they haven’t been adequately trained
- Capacity/time constraints
- Reluctance to label people
What is it important to be aware of, regarding psychological problems?
- The possibility of psychological problems
- Ways of helping
How can the possibility of psychological problems be explored with a patient?
Listen/ask/provide opportunity to raise problems
How can a physician help someone with psychologial problems?
- NICE guidance
- Referrals
- Suggestions for mobilising support and engaging in self help
