Coping with chronic and terminal Illness

Question 1

What is MS?

Answer 1

Disease of CNS: communication between neutrons not well, myelin sheath destroyed

Question 2

Theory of pathway of reaction to chronic disease (Schontz, 1975)

Answer 2

Shock
Encounter reaction
Retreat
Reality orientation

Question 3

Common reaction to diagnosis of chronic disease

Answer 3

Shock, disorganised thinking, loss and hopelessness

Question 4

How can health psychologists try to reduce uncertainties?

Answer 4

Allow them to explain disease
Increase sense of personal control
Influence coping strategy

Question 5

Depression and chronic disease comorbid relationship increased

Answer 5

Severity, pain and disability

Question 6

Helgeson (2004) breast cancer and depression likelihood

Answer 6

12% decline in psych functioning

Question 7

NICE Guidelines for depression (APA, 1994)

Answer 7

Stepped care model (low intensity first then increase if not effective)

Question 8

Illness cognition and AIDS (Weitz, 1989)

Answer 8

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?

Question 9

Leventhal (1980) 5 dimensions of beliefs about illness

Answer 9

Identity 
Perceived cause 
Timeline
Consequences
Curability and controllability

Question 10

Leventhal’s self regulation model of illness behaviour 3 stages are:

Answer 10

Interpretation, coping, appraisal

Question 11

Stage 1: Interpretation (Leventhal’s self regulation model)

Answer 11

Interpretation (symptom perception and social messages); emotional response to threat (fear, anxiety, depression) + representation of health threat (5 dimensions of beliefs)

Question 12

Stage 2 (Leventhal’s self regulation model)

Answer 12

Coping: approach coping/avoidance coping

Question 13

Stage 3 (Leventhal’s self regulation model)

Answer 13

Appraisal: “was my coping strategy effective?”

Question 14

Strengths of Leventhals self-regulation model

Answer 14

• 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

Question 15

Models of illness behaviour are

Answer 15

Self regulation model (Leventhal, 1980) and Taylor’s cognitive adaptation theory (1980’s)

Question 16

Taylor’s cognitive adaptation theory (1984)

Answer 16

Search for meaning
Search for mastery
Process of self enhancement

Question 17

Breast cancer study by Taylor et al (1984)

Answer 17

95% offered a cause e.g stress, diet, hereditary

Question 18

In those with HIV (Taylor et al 1998)

Answer 18

Illness progression related to negative HIV experiences

More optimistic and less realistic perceptions lived longer

Finding meaning in friend’s death predicted immune function

Question 19

The chronic disease self management programme (developed in Stanford uni)

Answer 19

Workshop for 2 1/2 hours a week for 6 weeks.

Facilitated by 2 trained leaders who have disease

Question 20

What do they go through in chronic disease self management programme

Answer 20

Techniques to deal with problems, appropriate exercise, use of meds, communicating effectively with family

Question 21

In the UK- Expert patient programmes

Answer 21

Based on CDSMP
2004-2008 £9 million
Widely used

Question 22

Criticism of CDSMP and EPP

Answer 22

May be strong and independent individuals who don’t like to be told what to do (they might not benefit)

Question 23

Terminal disease characteristics

Answer 23

Slow and painful
Associated with depression and anxiety
Age is an important factor (Weizman)

Question 24

Kubler-Ross (1969) on death and dying

Answer 24

Interviewed 200+ dying people .
5 stages of adjustment:
Denial, anger, bargaining, depression and acceptance

Question 25

Evaluation of Kubler-Ross’ 5 stages of adjustment (1969)

Answer 25

Widely accepted and used in hospice movement

Little empirical support

Question 26

Hospice movement

Answer 26

Place of choice for death 
Immediate medical and social support 
Enable patient to maximise potential 
Address all family members 
Follow up case for family