Coping with Chronic Illness

Question 1

What are chronic illnesses?

Answer 1

WHO = diseases of long duration & slow progression e.g., heart disease, stroke, cancer, respiratory illnesses, rheumatoid arthritis, LBP
-Can majorly impact quality of life

Question 2

What is the impact of chronic illness?

Answer 2

-Improved treatment people may live for many years
-Focus on management - not cure
-Adjustment & coping
-Balance demands of illness w/ demands of everyday life
-Issue of multimorbidity

Question 3

Recap
What is the link between stress & ill health?

Answer 3

Question 4

What are the main stressors in chronic illness?

Answer 4

External stressors
-Symptoms, consultation, investigations,
-Diagnosis (uncertainty & ambiguity prior to diagnosis), treatment, interference with life (outcomes - will they be able to live ‘normally’?)
-Changes caused by illness - need adjustments made

Question 5

For an elderly retired farmer with osteoarthritis - what may the main stressors be?

Answer 5

-Unable to spend time with grandchildren actively
-Getting to appointments - if live rurally
-Ability to still continue living in rural place & do physical activities e.g., walking he may enjoy
-Debilitating pain - will it get worse - will he need surgery e.g., joint replacements
-Assumed is due to ‘wear & tear’ from active life as farmer - so can say is part of expected life course

Question 6

For a young child with ‘ ‘ - what may the main stressors be?

Answer 6

-Ability to engage in ‘normal’ childhood activities
-Not a part of expected life course
-Independence - is compromised - what will happen in adult life?
-Lower life expectancy
-Will it get worse
-Need for carers

Question 7

What is coping?

Answer 7

“Cognitive & behavioural efforts to manage external &/or internal demands that are appraised as taxing or exceeding the resources of the person”
-Transactional model
-A lot = unconscious

Question 8

What are the 4 stages following diagnosis with a chronic illness

Answer 8

-Disavowal
-False normality
-The New Normal
-Disruption

Question 9

What is disavowal?

Answer 9

Experience of lack of control & normality from the life they could have had

Question 10

What is false normality?

Answer 10

Experience of partial control - could be long-standing but not sustainable
-e.g., trying new treatments - control symptoms

Question 11

What is The New Normal?

Answer 11

Acceptance is achieved - less vulnerable to distress

Question 12

What is disruption?

Answer 12

Exposure to stressful situation (illness-specific or not)

Question 13

What are coping skills (responses)?

Answer 13

= cognitive (thoughts) & beh methods - to manage stressful sit &/or - moderate its emotional impact
-e.g., “If it’s no better by tomorrow, I’ll ring the doctors” (problem-focused coping)

Question 14

What are coping strategies?

Answer 14

= responses adopted to a stressor - may be more/less adaptive
e.g., going to Drs, self-medicating

Question 15

What are coping styles?

Answer 15

= tendency to respond to stressful situations in a certain way
e.g., are likely to go see doctor if have done previously

Question 16

Give 3 types of coping skills (responses).

Answer 16

-Problem focussed
-Emotion focussed
-Appraisal focussed

Question 17

What are problem focussed coping skills?

Answer 17

What someone does about stressor (e.g., take medication, seek medical advice)

Question 18

What are emotion focussed coping skills?

Answer 18

What someone does about their reaction to stressor (e.g., emotional acceptance, seek psychological advice, vent -ve feelings, substance abuse)

Question 19

What are appraisal focussed coping skills?

Answer 19

How someone understands & appraises stressful sit (e.g., logical analyses & mental preparation, wishful thinking, denial)

Question 20

What are the 4 main types of coping styles?

Answer 20

Question 21

What are the 2 main types of people in terms of coping styles?

Answer 21

-Approacher - toward stressor/related emotions
-Avoider - away from stressor/related emotions

Question 22

What are some approacher coping styles - examples of strategies (remember strategies are how you respond & styles are the type of response)?***

Answer 22

-Taking medication
-Seeking advice
-Seeking info about problem

Question 23

What are some avoider coping styles - examples of strategies (remember strategies are how you respond & styles are the type of response)?***

Answer 23

-Wishful thinking
-Alcohol or drug use
-Denial
-Avoidance

Question 24

What are the 2 types of people in terms of information seeking?

Answer 24

-Monitors = info seekers - pay more attention to, scan for, & amplify threatening cues
-Blunters = info avoiders - seek distractions when faced with a threatening event
–> cognitively - don’t respond to illness in same way

Question 25

Do patients need lots of information?

Answer 25

Depends on ind - but Drs tend to underestimate - but too much info can inc stress
-can get info from unreliable sources
-info may be avoidance strategy

Question 26

Why may someone with a chronic illness be in denial?

Answer 26

-Refuse to believe problem or implications that diagnosis comes with (easier to return to ‘normal’ life) - so don’t have to face it
–> to minimise anxiety
-Helps w/ social acceptance
-Can = beneficial in short-term
-Prolonged denial - impacts adherence

Question 27

How stable are coping strategies?

Answer 27

Not - they can change - aren’t fixed - more likely to become fixed longer term
-They are context specific
-Due to prior experience & adapting process

Question 28

What may be part of longer term coping strategies?

Answer 28

-Avoidance
-Normalising
-Resignation - illness seen as central to life
-Accommodation - illness not central to life

Question 29

Is coping important for health outcomes?

Answer 29

Yes!
-Matching stressor & strategy is important:
*Controllable –> problem focussed
*Not controllable –> emotion focussed

Question 30

What are some predictors of coping?

Answer 30

-Timing of illness
*impacts retirement
*impacts career
*point in life where is v. disruptive
-Resources
*Ext - social support, finances, transport, home help
*Int - ind beliefs, skills, coping styles

Question 31

What are the external resources that are predictors of coping?

Answer 31

-If social support = not helpful - can be worse

Question 32

Impact of external resources on coping?

Answer 32

Can enhance or diminish - depends on availability & quality of them

Question 33

How can social support influence coping (external resource of coping strategies)?

Answer 33

-Associated w/ health promoting beh & well-being - i.e., they will encourage you to make ‘healthy’ choices
-May directly lower stress or change pat’s perspective = cog reframing - allows for social comparisons

If not helpful:
-Can act as source of stress - compromise pat well-being

Question 34

What are the internal resources that are predictors of coping?

Answer 34

-Prior exp
-Beliefs
*Religion/faith - as comes w/ people - social support, +ve values due to cultural identity, emphasis on hope & so +ve outcomes
*Self-confidence - believing can accomplish things & will make difference
*Learned helplessness - if see illness as ext - can’t change = depression & lower self-esteem
-Social skills (help seeking)
-Thinking styles
*+ve thinking - optimism
*View difficult events as a challenge
*Normalise events - by cog reframing
*Search for meaning - make sense of sit
*Intrinsic psych flexibility - cog adaption = adjustment

Question 35

Can coping skills be learnt & if so - how?

Answer 35

Yes
–> CBT & ACT - BUT is it that coping skills are taught? or is it just the therapeutic relationship that is beneficial

Question 36

What is adjustment in terms of chronic illness?

Answer 36

= process need to achieve to alleviate symptoms - maintain quality of life - but without recovery
-Achieve +ve view of self & world in face of new problem
-Often takes time

Question 37

What does adjustment involve in chronic illnesses?

Answer 37

-Assessing new info
-Developing adaptive views
-Re-evaluating priorities

Question 38

Give the 4 stages of adjustment in chronic illness.

Answer 38

-Adaptation/adjustment
-Response shift
-Growth/meaning making
-Integration
–> nonlinear as condition changes - so cycle of adjustment might begin again

Question 39

Why may condition change & so adjustment to - in terms of chronic illness?

Answer 39

Go through periods of instability & stability - chronic illnesses can be inconsistent - not static:
-Flare ups = instability - may need hospitalisation & surgery - so may need to begin adjusting again
-Latent phases = stability

Question 40

What is adaptation/adjustment - stage of adjustment to chronic illness?

Answer 40

Question 41

What is the response shift - stage of adjustment to chronic illness?

Answer 41

-Change in perspective & priorities in life
-Realign goals to fit/accommodate new sit/condition
-Can think of as a shift!
-Can = +ve mood & even reduced physical symptoms

Question 42

What is growth/meaning making - stage of adjustment to chronic illness?

Answer 42

Find +ve change due to illness
-e.g., become advocate for their illness - creates meaning - so they grow with it –> using illness to their advantage
-Order & purpose regained
-Perspective change

–> more beneficial in longer term - once processed & worked through crisis

Question 43

What is integration - stage of adjustment to chronic illness?

Answer 43

How new life experiences are resolved w/ past & current identities
-Takes new life experiences into everyday life

Question 44

What does adjustment to chronic illness bring about?

Answer 44

-Role/identity illness requires altering identity (achieving normality)
-Loss of self
-Functioning/Isolation
-Social support
-Future (biographical disruption)

Question 45

What is adjustment to chronic illness - complicated by?

Answer 45

-Limited experience
-Decisions needed quickly
-Unpredictability and uncertainty
-Meaning/implications
-Additional - ext stressors

Question 46

What is self-management of chronic illnesses?

Answer 46

= interventions promoting active involvement of the patient in managing their condition

Question 47

What can self-management of chronic illnesses involve?

Answer 47

-Taking medication, beh changes
-Make decisions about care (adjusting meds based on symptoms or progression of illness)
-Maintain adequate psychosocial functioning (coping w/ emotions)

Question 48

Why may self-management of chronic illnesses be challenging?

Answer 48

-Lifestyle changes = more difficult to make than illness-specific changes
-Patients not see immediate benefits
-Must be part of patient’s normal daily life - so must be able to incorporate

Question 49

Why is chronic illness self-management important & encouraged by healthcare services?

Answer 49

-Clinician demand
-Economic demand
-High no. of chronic illnesses