Dr. Bergfield’s Guest Lecture Flashcards
Chronic Diseases in AMERICA
- Leading causes of death and disability
- 6 in 10 adults have a chronic disease
- 4 in 10 adults have 2 or more
Prevalence of Major Depressive Disorder with:
- Cardiovascular - 17%
- Cerebrovascular - 23%
- Diabetes - 27%
- Cancer - 42%
- Parkinson’s - 51%
1/4th of people with chronic medical problems have significant psychological concerns
- Alexithymia
- Anxiety
- Depression
- Trauma
- Psychological distress
- Sleep quality
- Emotional dysregulation
- Cognitive dysfunction
UTI’s look like
- Psychosis
Referrals
1: Health Related
- Adjusting to/accepting new diagnosis
- Medical trauma
- Health anxiety
- Depression from disability
- Functional Neurological Disorder (FND)
- Somatic Symptom Disorders
2: Not as obvious
3: Not Health Related
- Adjustment Disorder
Referrals/Resources
Modality
: Individual/family/couples therapy
: Group therapy
: Support group
Other Referrals
: Nonprofits
: Occupational therapists
: Alternative pain treatment
Comprehensive Intake
: to figure out what we’re treating because chronic illness isn’t experienced the same way
CBT for Chronic Illness
Fundamentals
- Thoughts, physical symptoms, behaviors, and emotions are interrelated
- What happens to us is less important than our appraisal of the event
Look for unhelpful beliefs about illness
- Self-worth - Ableism – - Toxic Positivity -Hierarchy of suffering/denial
- Toxic positivity -Burdensome – - Inspiration porn
Deep dive on
- Illness related beliefs
- Locus-of-control
- Self-concept
Useful for treating
- Psychiatric disorders
- Difficulties with adjustment
- Difficulties in adherence to treatment
- Problems with illness behaviors
Physical symptoms may remain but changing other elements encourages improvement in quality of life
Conceptualization is an intervention
Socratic questioning
Understand the problem
Look for exceptions
Reflect or summarize
Devise solutions
Cognitive restructuring
Schema -focused therapy/challenging core beliefs
Graded exposure
Behavioral experiments
Pacing
Self-efficacy
Toxic Positivity
- Experiencing guilt for being sad or angry
- dismissing others difficult feelings
- hiding painful emotions
- ignoring your problems
- reciting “positive” quotes about hard situations
Internalized Ableism
- when a person with a disability adopts or believes in negative attitudes, stereotypes, or prejudices about themselves or others with disabilities.
- when someone starts to believe that having a disability makes them less valuable or capable than people without disabilities. This can lead to feelings of shame, low self-esteem, and self-doubt.
- “I’m faking it”
- “I’m useless”
- “I’m a burden”
- “It’s my fault I’m feeling like this”
ACT
ACT focuses on improving functionality instead of reducing symptoms.
Stressful situations are looked at instead of looked from
Especially helpful when negative beliefs and fears are realistic
Tenants:
1) Acceptance
a. Experiential avoidance contributes to suffering
2) Defusion
a. Internal experiences are evolutionary function not binding fact
b. Never attempt to change cognitions, as it reinforces the wrestling
3) Being in the present moment
4) Self as Context
5) Values
6) Committed action
Can be administered through individual or group treatment.
Empirically based studies are still needed to understand ACT’s utility for medication adherence
Promising areas include
Psychological flexibility
Parents of children with chronic disease/long-term conditions
Seizure-control in epilepsy
Possible disease self-management (Graham et al., 2016)
Diabetes (Montgomery et al., 2011)
Cancer (Hulbert-Williams, et al. 2014)
