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USA Term 2 > FMC Test 2 Unit 8-9 *Psychosocial Aspects of Care* > Flashcards

FMC Test 2 Unit 8-9 *Psychosocial Aspects of Care* Flashcards

1
Q

In terms of pain management, when a patient has psychosocial risk factors present before acute pain episode, what are they in risk of?

A

They have an increased risk of developing persistent pain

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2
Q

In terms of pain management, what do we know about individuals with persistent pain?

A

Complete resolution of pain is unlikely

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3
Q

In terms of pain management, what do we know about Physiologically Informed Physical Therapy?

A

Want to prevent onset of persistent pain due to psychosocial risk factors
- Primary Goal: Secondary prevention of disability

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4
Q

What is Psychologically informed practice? How is it a “Middle Ground”?

A

Psychologically Informed Practice (PIP) is a “Middle Ground” between traditional biophysical PT approaches and mental health disorder counseling and therapy.
- This adopts cognitive behavior approaches used in mental health practice
–This is a paradigm shift form pain relief to pain management

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5
Q

How do you Develop a treatment plan in psychologically informed targeted interventions? (4)

A

You must consider assessment findings
- Body Function and structure: joint integrity, muscle performance, cranial/peripheral nerve integrity…
- Activity limitations: gait, bed mobility, self-care
- Participation restrictions: Work leave/restrictions
- Contextual Factors facilitating yellow flag signs
–Financial Challenges, job satisfaction, social/family support

Address findings with education and activity-based approaches

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6
Q

In Psychologically Informed Targeted Interventions, what are the Educational-Based Approaches?
What are the 3 Educational-Based Strategies?

A
  • PTs use education to communicate exam findings, the PT diagnosis, prognosis and POC
    –Must acknowledge the therapeutic benefits education can have

Educational-Based Strategies:
- Avoiding nocebo language
- Cognitive behavioral therapy
- Motivational interviewing

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7
Q

When using “Educational-Based Strategies” in Psychologically Informed Targeted Interventions, what is Nocebo Language?
What are some words to avoid?

A

Its the power of words:
- Negative Verbalizations = Power to Harm
- Positive Verbalizations = Power to Heal

For Example:
Avoid using words like: -> Alternatives:

Degenerative changes -> Normal age changes
Disease -> Condition
Bone on Bone -> Narrowing & Condition
Chronic -> May persist, but you overcome it
Damage -> Reparable Harm
Paresthesia -> Altered sensation
Tear -> Pull
Instability -> Needs more strength and control

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8
Q

When using “Educational-Based Strategies” in Psychologically Informed Targeted Interventions, what is Cognitive Behavior Therapy?
What are the strategies for cognitive change? (3)
What are the strategies for behavior changes? (2)

A
  • Educational strategies designed to facilitate change in cognitive patterns and pain behaviors

Strategies for Cognitive Change
- Learning to recognize and re-evaluate unhelpful thoughts and beliefs about pain
- Develop problem-solving skills for coping with difficult situations
- Enhance self-efficacy beliefs

Strategies for Behavior Change
- Learning how to calm the mind and body
- Facing fears head-on

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9
Q

When using “Educational-Based Strategies” in Psychologically Informed Targeted Interventions, what is Cognitive Behavior Therapy for Pain? (3)

A
  • Provide: Treatment rationale for increased understanding of the impact of negative thoughts/beliefs regarding pain experiences, enhance self-efficacy
  • Teach: Coping skills like relaxation, mindfulness, emotional regulation, activity pacing
  • Support: Newly learned skills by applying to more situations and circumstances
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10
Q

When using “Educational-Based Strategies” in Psychologically Informed Targeted Interventions, what is Motivational Interviewing?

A
  • A cognitive intervention strategy used by PTs
    (Focus on changing unhelpful pain related behaviors)
  • A method of motivating change congruent with individual values, beliefs, and desires
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11
Q

When using “Educational-Based Strategies” in Psychologically Informed Targeted Interventions, what are the 4 Motivational Interviewing Principles?

A
  • Express Empathy: Make individuals feel heard and
    understood
  • Support Self-Efficacy: Highlight successes already
    achieved and individual strengths
  • Roll with Resistance: Individuals define the problem
    and propose solutions
    –Addresses discrepancies between provider
    and patient viewpoints
  • Develop Discrepancy: Individuals need to
    understand where they are and where they want to be
    –Individual acknowledgement of unhelpful beliefs and behaviors and how they impede reaching their goals
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12
Q

When using “Educational-Based Strategies” in Psychologically Informed Targeted Interventions, what is Motivational Interviewing OARS Approach?

A

Enhance Therapeutic Alliance and Elicit Discussion about Change

  • Open-ended Questions: Let the individual do the talking
  • Affirmations: Acknowledge and celebrate successes already made
  • Reflections: Mirror individual statements for them to hear their own words
  • Summaries: Conclude conversation topics by paraphrasing and highlighting key parts of the conversation
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13
Q

In Psychologically Informed Targeted Interventions, what are Activity-Based Approaches? (3)

A
  • Individuals in pain move less
  • Overwhelming evidence supports movement as a safe, non-pharmaceutical approach for influencing pain and function
  • Activities-based strategies
    –Graded Exercise/Activity
    –Graded Exposure
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14
Q

In Activity-Based Approaches, in Psychologically Informed Targeted Interventions, what are Graded Exercise/Activities? (3)

A
  • Individuals should be encouraged to remain active despite the pain
    –Exercise into some discomfort but dont push too
    far
    —Avoid pitfalls of “no pain, no gain” and “if it
    hurts dont do it”
  • Establish a physical activity quota
    –Baseline exercise or activity individual performs
    before it is limited due to pain
  • Focus on individual meeting their quota
    –Reinforce success and gradual progression of
    quota as indicated
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15
Q

In Activity-Based Approaches, in Psychologically Informed Targeted Interventions, what are Graded Exposure? (4)

A
  • Addresses fear and avoidance behaviors
  • Individual identifies specific movements/tasks they are afraid to perform
  • Dosage based on hierarchical exposure to the fearful activity
    1) Provide activity that promotes minimal fear
    2) Progress activity that promotes slight resistance in fear and repeat until fear decreases
    3) Repeat step 2 until individual can perform desired activity without fear
  • Exposure must also occur outside of clinical setting
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16
Q

What is Trauma and Traumatic stress?

A
  • Common health problem stremming from history of violence, abuse, neglect, war, natural disasters, loss of loved ones…
  • Can occur anytime throughout the life span
    –Children as a vulnerable population
    –Neonatal needle sticks- correlated with future
    persistent pain and opioid use
  • Adverse childhood experiences (ACEs) - potentially traumatic events in children (0-17)
    –ACEs linked with chronic health conditions, substance abuse, negative impact on education and job opportunities
17
Q

What are the 3 “E’s of Trauma”?

A
  • Event
  • Experience
  • Effects
18
Q

What are the components of the Event portion of the 3 “E’s of Trauma”?

A

Exposure to traumatic or stressful event; can be one-time occurrence or persistent exposure

  • Death of loved ones
  • Separation/Divorce
  • Serious illness
  • War mental/physical event
  • Sever accident/injury
19
Q

What are the components of the Experience portion of the 3 “E’s of Trauma”?

A

Individual perception of these events assists determining if event is traumatic

  • Biopsychosocial approach to screening and management
20
Q

What are the components of the Effects portion of the 3 “E’s of Trauma”?

A

Long-lasting adverse effects of the traumatic event

  • Immediate or delayed onset
    –Physical (scars, bruises)
    –Poor Cognitive, emotional, behavior regulation
    –Neurobiological (Plastic changes to CNS)
21
Q

What is Trauma Informed Care?

A

Addressing trauma/ACEs (Adverse childhood Experiences) as a contribution to persistent pain experiences
- Many PIPT (Psychologically Informed Physical Therapy) skills incorporated in trauma informed care
–Screen for trauma history
–Patient centered communication
–Shared decision making
–Providing safe, healing and welcoming
environments
–Implementing a biopsychosocial care approach

22
Q

What are the 4 “Rs” of Trauma Informed Care?

A
  • Realizes widespread impact of trauma
  • Recognize signs and symptoms of trauma
  • Respond by integrating trauma into policies,
    procedures, practices
  • Resists re-traumatization
23
Q

In the 4 “Rs” of Trauma Informed Care, what are the components of Realizes widespread impact of trauma?

A
  • Recognize trauma can impact physical, cognitive, emotional, and behavior domains
  • Organization members understand common coping strategies utilized by individuals exposed to trauma
24
Q

In the 4 “Rs” of Trauma Informed Care, what are the components of Recognize signs and symptoms of trauma?

A
  • Organization members are trained in recognizing signs of trauma
25
Q

In the 4 “Rs” of Trauma Informed Care, what are the components of Respond by integrating trauma into policies, procedures, practices?

A
  • Organization understands traumatic events impact all individuals involved (Directly or Indirectly)
  • All organization members use positive language and behaviors when addressing individuals impacted by trauma
26
Q

In the 4 “Rs” of Trauma Informed Care, what are the components of Resist re-traumatization?

A
  • Organization members trained at recognizing how organizational environment, policies, and practices may trigger painful memories and re-traumatize clients
27
Q

What are the 6 Principles for Organizations Providing Trauma Informed Care?

A

1) Safety: Safe environment, interactions should promote psychological safety

2) Trustworthiness: Establish early to build and maintain trust

3) Peer Support: Group Therapy sessions with supportive individuals

4) Collaboration: Understand all stakeholders have an important role to play

5) Empowerment of Voice and Choice: Individual strengths and experiences are encouraged

6) Culture, Historical, Gender Issues: Organizations and its members work to oppose cultural stereotypes and biases

USA Term 2 (46 decks)

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