Grief, Loss, Behavior change ID

Question 1

Pre-contemplation

Define

Answer 1

• No recognition of a problem. Lack of concern, ignorance, or denial.
• No intention to change in next 6 months.

Question 2

Pre-contemplation

Assessing

Answer 2

• Assess knowledge of the problem
• Pt may be surprised about the problem
• May be resistant to you

Question 3

Pre-contemplation

Intervention

Answer 3

• Tell me in your own words about your understanding and concerns about ______.
• Raising concern: Educate or address denial.
• Don’t push for action yet.

Question 4

Contemplation

Define

Answer 4

• Recognition of a problem.
• Ambivalence
• No plans to change in the near future.

Question 5

Contemplation

Assessing

Answer 5

“Yes I know I should, but—(excuses)“

Question 6

Contemplation

Intervention

Answer 6

• Move from ambivalence toward change.
• Focus on benefits and barriers
• Explore fears and concerns

Question 7

Preparation

Define

Answer 7

• Decision resolution.

* Making plans to change in the near future (6 months)

Question 8

Preparation

Assessment

Answer 8

The New Year’s Resolution phase.

“I can do it.”
“I must do it.”

Question 9

Preparation

Interventions

Answer 9

Transform into action:

• What concerns do you have? How ready are you to start?
• Encourage patient to set a date
• Be a resource for specific tips, techniques, groups/programs

Question 10

Action

Define

Answer 10

Taking steps to change

Question 11

Action

Assessment

Answer 11

Patient reports having made some changes already
“I started walking up the stairs”
“I stopped adding salt”

Question 12

Action

Intervention

Answer 12

• PRAISE patient for actions taken.
• Help organize activity and measure/provide results
• Encourage self-efficacy
• Role play difficult situations to prevent relaps

Question 13

Maintenance

Define

Answer 13

Sustaining change

Question 14

Maintenance

Assessing

Answer 14

Behaviors are a routine part of life now.

Question 15

Maintenance

Intervention

Answer 15

• Periodically check-in
• Identify barriers and create solutions
• Return to prior stages if there is a relapse
• Encourage them to model for others

Question 16

Relapse

Define

Answer 16

Demoralized, shame, decreased or loss of self-efficacy

Question 17

Relapse

Intervention

Answer 17

Re-energize behavior change. Educate that those who try more, even if they don’t succeed, are more successful in the end

Question 18

Complicated grief = now in DSM-5 as “Persistent Complex Bereavement Disorder”

Criteria

Answer 18

Individual has death of person close to him/her
1+ of the following, more days than not, min 12 months (6 months = children):
*Persistent yearning/longing for the deceased
*Intense sorrow and emotional pain in response to death
*Preoccupation with the deceased
*Preoccupation with circumstances of the death

Since the death, 6+ of the following, on more days than not, min 12 months (6 months = children):

• Difficulty accepting the death
• Disbelief or emotional numbness
• Difficulty with positive reminiscing of the deceased
• Bitterness or anger
• Maladaptive appraisals of oneself in relation to the death (self-blame)
• Excessive avoidance of reminders of the loss
• Desire to die in order to be with deceased
• Difficulty trusting others
• Feeling alone or detached
• Feeling that life is meaningless or empty, or that one is unable to function without the deceased
• Confusion about one’s role in life
• Difficulty to pursue interests or to plan for the future

Question 19

Stages of Grief

Denial

Answer 19

*a conscious or unconscious decision to refuse to admit that something is true

What can we do?

• Be as specific and explicit as possible with respect to the diagnosis and treatment recommendation
• Repeat and reinforce the diagnosis with second opinions, family meetings
• Have the patient repeat it back to you

Question 20

Stages of Grief

Anger

Answer 20

*An emotional or physical act in which the patient attempts to place blame

What can we do?

• Be open and honest about the expected medical course and potential long-term complications
• Make sure the patient feels and is as informed as possible
• Give extra time to identify root cause of the anger
• Try to channel the energy from anger into something productive

Question 21

Stages of Grief

Bargaining

Answer 21

*a negotiative process in which patients attempt to postpone or distance themselves from the reality of a situation

What can we do?

• Remain firm regarding treatment recommendations
• Do not participate in turning your recommendation into a negotiation

Question 22

Stages of Grief

Depression

Answer 22

*a feeling of loss of control or hopelessness with a situation

What can we do?

• Increase the control the patient feels in their life
• Actively screen/recognize depression and refer to mental health pr

Question 23

Stages of Grief

Acceptance

Answer 23

*a feeling of stability or resignation as the patient becomes an active participant in their life

What can we do?
*Suggest/arrange factors that support adjustment = Time, High levels of social support, Optimistic personality, Positive self-image, Coping strategies associated with self-worth