Coping with chronic and terminal Illness Flashcards
What is MS?
Disease of CNS: communication between neutrons not well, myelin sheath destroyed
Theory of pathway of reaction to chronic disease (Schontz, 1975)
Shock
Encounter reaction
Retreat
Reality orientation
Common reaction to diagnosis of chronic disease
Shock, disorganised thinking, loss and hopelessness
How can health psychologists try to reduce uncertainties?
Allow them to explain disease
Increase sense of personal control
Influence coping strategy
Depression and chronic disease comorbid relationship increased
Severity, pain and disability
Helgeson (2004) breast cancer and depression likelihood
12% decline in psych functioning
NICE Guidelines for depression (APA, 1994)
Stepped care model (low intensity first then increase if not effective)
Illness cognition and AIDS (Weitz, 1989)
25 gay/bi in Arizona with AIDS
Issues of uncertainty: what do my symptoms mean? Why have I become ill and will I be able to beat AIDS?
Leventhal (1980) 5 dimensions of beliefs about illness
Identity Perceived cause Timeline Consequences Curability and controllability
Leventhal’s self regulation model of illness behaviour 3 stages are:
Interpretation, coping, appraisal
Stage 1: Interpretation (Leventhal’s self regulation model)
Interpretation (symptom perception and social messages); emotional response to threat (fear, anxiety, depression) + representation of health threat (5 dimensions of beliefs)
Stage 2 (Leventhal’s self regulation model)
Coping: approach coping/avoidance coping
Stage 3 (Leventhal’s self regulation model)
Appraisal: “was my coping strategy effective?”
Strengths of Leventhals self-regulation model
- meta-analysis found that perceived control correlated with psych well-being and vitality
- believing in weaker control linked to higher depression and anxiety
- includes coping strategies and even denial
Models of illness behaviour are
Self regulation model (Leventhal, 1980) and Taylor’s cognitive adaptation theory (1980’s)
Taylor’s cognitive adaptation theory (1984)
Search for meaning
Search for mastery
Process of self enhancement
Breast cancer study by Taylor et al (1984)
95% offered a cause e.g stress, diet, hereditary
In those with HIV (Taylor et al 1998)
Illness progression related to negative HIV experiences
More optimistic and less realistic perceptions lived longer
Finding meaning in friend’s death predicted immune function
The chronic disease self management programme (developed in Stanford uni)
Workshop for 2 1/2 hours a week for 6 weeks.
Facilitated by 2 trained leaders who have disease
What do they go through in chronic disease self management programme
Techniques to deal with problems, appropriate exercise, use of meds, communicating effectively with family
In the UK- Expert patient programmes
Based on CDSMP
2004-2008 £9 million
Widely used
Criticism of CDSMP and EPP
May be strong and independent individuals who don’t like to be told what to do (they might not benefit)
Terminal disease characteristics
Slow and painful
Associated with depression and anxiety
Age is an important factor (Weizman)
Kubler-Ross (1969) on death and dying
Interviewed 200+ dying people .
5 stages of adjustment:
Denial, anger, bargaining, depression and acceptance
Evaluation of Kubler-Ross’ 5 stages of adjustment (1969)
Widely accepted and used in hospice movement
Little empirical support
Hospice movement
Place of choice for death Immediate medical and social support Enable patient to maximise potential Address all family members Follow up case for family
