Health and Forensic Psychology

Question 1

Health Psychology

What does it study and why is it important?

Answer 1

Impact of psychology, behaviour, and social factors on health and illness.

Illness perceptions – interpretation, coping, appraisal.

Can help us understand how people may respond to interventions.
Understanding clients’ perception of their illness and difficulties is important to create a therapeutic alliance.

Coping strategies will be helpful for clients and SLTs.

Question 2

How can an understanding of illness perceptions, coping, and stress support the management of clients with communication and swallowing disorders?

Answer 2

Illness perceptions can influence:

Therapeutic alliances.
Engagement in SLT.
Adherence to intervention.
Engagement of parents/carers.

Important to consider illness perceptions in assessment.

Question 3

How would this affect therapy?

What would you do differently?

Answer 3

Intervention can address changing illness perceptions.

Education of individuals about their health conditions is important in intervention.

Important to recognise when a client and/or carer may need additional support to cope.

Acknowledge the influence of stress.

Understanding that client’s perception of their illness can either help or hinder their progress.

Cultural differences in coping strategies – being aware of these.

Child may not fully understand what is happening to them – need to focus on the parents, they may engage more with the therapy. Make sure those around them are aware.

Positive psychology – help them to see the small positives and achievements every day rather than focusing on far away goals.

Supporting clients and families with groups to help them see they are not alone

Question 4

What role do SLTs have in the criminal justice system and why?

Answer 4

60% of young people in the justice system have SLC needs.

Providing SLT significantly improves:

Communication skills.

Reduces risk of reoffending.

Increases access to rehabilitation and treatment programmes.

Can improve an individual’s chance of gaining employment.

Around 80% of registered intermediaries are SLTs (mediating between parties – making sure communication is smooth and clear and neutral).

SLTs work in court settings:

Producing case notes.

Assessments/interventions as part of a case.

Question 5

What is an illness belief?

What are the five categories of illness perception?

Answer 5

An individual’s implicit, commonsense beliefs about their condition. There are five dimensions:

1. illness identity (how symptoms are experienced and attributed to the illness)
2. cause (beliefs about causes of the illness)
3. timeline (beliefs about the duration of the illness and whether it is cyclical, acute, or chronic)
4. consequences (beliefs about the impact of the illness)
5. control/cure (beliefs regarding the controllability/curability of the illness).

Question 6

What is Leventhal’s Common Sense Model (CSM)?

Answer 6

The Common-Sense Model of Self-Regulation is a widely used theoretical framework that expains the processes by which patients:

become aware of a health threat

navigate effective responses to the threat,

formulate perceptions of the threat and potential treatment actions

create action plans for addressing the threat
integrate continuous feedback on action

plan efficacy and threat-progression.

Question 7

What are the stages of Leventhal’s CSM?

Answer 7

1 identity,
which includes beliefs about how the condition is identified,
what experiences are expressions of the illness and what
experiences are not, as well as how those experiences are
labelled

2 timeline, which are beliefs related to the duration of the illness, when it began and when it will end

3 consequences, or beliefs people have about the impact that
the health condition has on their life

4 cause or underlying mechanism is a category of beliefs related to the perceived reasons for the development of the illness and the mechanism behind the manifestation of the symptoms

5 control, which includes the individual’s beliefs of how
much he or she has the ability to manage or control the illness and its symptoms as well as representations of how
control should be achieved (Hagger & Orbell, 2003;
Leventhal, Phillips, & Burns, 2016).

Question 8

The Crisis of Stroke Trajectory (Lutz et al., 2011)

Answer 8

1. The stroke crisis - patient admitted to care, experience feelings of confusion, loss and fear. Limited understanding of the challenges ahead.
2. Expectations for recovery - begin to recognise impairments but may also feel hopeful and optimistic. Many still believed that they would stay in rehab until they ‘got better’. Their definitions of improvement are different from that of the professionals working with them.
3. The crisis of discharge - caregivers realise what adjustments have to be made to accommodate the stroke survivor. Caregivers are worried about caring for the stroke survivor on a daily basis and in some cases taking over daily tasks.

Question 9

Why are illness perceptions relevant to SLT practice?

Answer 9

Illness perceptions of individuals influence their coping mechanisms (Leventhal et al., 1983), psychological wellbeing (Hagger and Orbell, 2003), medication adherence (Horne and Weinman, 2002) and quality of life (Foxwell et al., 2013)

For example, Buck et al., (2007) found that lay illness perceptions of dysphonia often differ from those of the clinician which can in turn influence treatment behaviour e.g., adherence to therapy. Therefore, they recommend explore treatment beliefs with the pt.

Question 9

Richardson et al., (2015) study on illness perceptions of people with head and neck cancer and their carers

Answer 9

Found that the illness perceptions of carers can contribute to the pts health-related quality of life. When carers had more negative illness perceptions, HRQOL of pts tended to be lower

Question 10

Changing illness perceptions in people with MI

Broadbent et al., (2009)

Answer 10

Reported on an intervention aimed at modifying the illness perceptions of MI patients.

This involved exploration of the pts ideas about the cause of MI and relating these to health behaviour and a recovery plan. Spouses were included where possible.

Participants who received the intervention reported a better understanding of the information that had been given to them in hospital, higher intention to attend rehab classes, less anxiety about returning to work, more increases in exercise and fewer calls to their GP.

Question 11

Stress

How might people deal with stress?

What can stress do to the body?

Answer 11

Stress causes illness (Ogden, 2012)
Individuals may use a combination of behavioural and psychological strategies to manage stress e.g., smoking or drinking alcohol.

Stress-related hormones can lead to physiological changes such as raised BP and decreased immune function (Ogden, 2012)

Question 12

Coping with stress

Cognitive Transactional Model (Lazarus and Folkman, 1984)

Answer 12

The CTM considers interactions between

Individual characteristics such as motivational and cognitive variables
An internal or external event (the stressor itself)
The internal and external resources available to the individual

Key role of appraisal

Primary appraisal occurs when the individual assesses the stressor in terms of damage already done or expectation of future harm

The secondary appraisal is the person’s evaluation of their internal and external coping resources i.e. their coping potential.

Stress occurs when there is a mismatch between perceived demands and resources

Question 13

Strategies for coping

Suggestions for therapy

Answer 13

Supporting individuals with chronic conditions to develop a strong repertoire of coping skills is an important but sometimes neglected element of intervention by health professionals

Attending groups may be helpful in supporting both problem focussed and emotion focussed coping; the client can get advice and ideas from others who have had similar experiences as well as having the opportunity to discuss feelings

Question 14

Coping after a stroke

What adaptive and maladaptive coping strategies were identified?

Price et al., (2012) (1)
Williams and Murray (2013) (2)

What recommendations does Kendall et al (2007) have? (3)

Answer 14

Social support, spirituality, internal locus of control, building on past successes, commitment to succeed, action-oriented approach and having personal goals (1)

Active coping mechanisms were emotional support, religion, acceptance, planning, instrumental support and humour (2)

Maladaptive coping mechanisms were self-distraction, self-blame, denial, venting, behavioural disengagment and substance use (2)

Emphasised the recursive nature of coping e.g., adequate coping resources lead to better outcomes which in turn increase coping resources (2)

Early intervention is important to prevent a regressive trajectory (3)

Question 15

Coping with aphasia

Answer 15

Aphasia following a stroke is associated with stress (Hilari et al., 2010)

People with aphasia had lower resources of stress monitoring, tension control, and acceptance

Although acceptance is usually considered a positive thing, ‘insistence on recovery’ i.e. not accepting their situation, is positively associated with functional recovery and negatively associated with depressive symptoms and apathy (DuBay et al., 2011)

Question 16

Coping with a child who has a disability

What strategies have been found to be helpful? Minnes et al., (2015)

Which variables have been found to be risk factors for stress?

Answer 16

Parents of children with developmental disabilities report greater levels of stress than the parents of TD children (Lopes et al., 2008)

Positive reframing and parent empowerment have been identified as coping strategies associated with the perception of positive gain (Minnes et al., 2015)

Neuroticism was a significant predictor of outcomes such as depression and subjective wellbeing for mothers whereas the type of coping strategy was likely to be more importanat for fathers.

Question 17

Stress in health professionals

McManus (2007)

Answer 17

McManus (2007) suggests it is the imbalance of effort and reward that is problematic and lead to stress

Stress is related to personality variables such as neuroticism
This may explain why not all health professionals report they are stressed when most tend to report ‘poor working conditions’ (McManus)

Eysenck and Eysenck (1985) suggest that one’s own feelings of fear and anxiety might be found in individuals high in neuroticism. They may therefore be more able to understand these feelings in others.
The very qualities that enabled the valued characteristic of being empathetic may also result in a vulnerability to stress

Question 18

Emotional labour

Answer 18

The energy that workers expend in changing or suppressing their emotions in order to comply with the expectations and rules of organisations (Hochschild, 1983)

Surface acting - faking the emotion the situation requires

Deep acting - genuine empathy, trying to put yourself in another’s shoes

Workers who use higher levels of surface acting tend to experience lower levels of job satisfaction and higher levels of burnout (Grandey, 2000)

Question 19

Emotional intelligence as a protective factor for stress

Answer 19

Emotional intelligence makes emotional labour easier to perform and moderates the negative effects of ‘surface acting’ such as stress, burnout and low job satisfaction (Botheridge and Grandey, 2002)

Higher levels of emotional intelligence were linked to higher life satisfaction and happiness. This link seemed to be mediated by lower levels of perceived stress (Ruiz-Aranda et al., 2014)

Question 20

What coping strategies are recommended for health professionals?

Answer 20

Relaxation 
Physical fitness 
Cognitive restructuring e.g., CBT 
Assertiveness training 
Stress inoculation (preparing in advance of stressful situations, Bellarosa and Chen, 1997)

Question 21

Positive Psychology

Answer 21

Seligman’s PERMA model (2012)

Positive emotions 
Engagement 
Relationships 
Meaning 
Accomplishment

Question 22

Broaden and build theory of positive emotions (Fredrickson, 2001)

Answer 22

Positive emotions increase creativity and problem-solving in contrast to negative emotions such as fight or flight which, whilst valuable for survival, ultimately narrow your repertoire of useful responses

The role of boosting positive emotions through a simple activity such as using humour or paying a compliment, should not be overlooked

Question 23

How to help patients feel more positive?

Sharp (2012)

The ‘tyranny of when’

Answer 23

Increasing the focus on patients wellbeing and helping them to feel more positive can enhance the effectiveness of treatment

Sharp suggests this can be implemented in 5 ways:

Helping a client focus on and savour positive life experiences
finding a common interest with clients to enhance the therapeutic relationship
being humorous and having fun during therapy
cultivating a sense of hope and optimist by reminding the client of achievements
using evidence-based mindfulness and meditation

The tyranny of when occurs when a client identifies a time or condition in the future when they believe they will be happy e.g., when I can talk how I used to I will be happy

Question 24

Hope

Kayes, McCan and McPherson (2013)

Answer 24

Hope can be viewed as

a general state of being positive in the future
goal-oriented hope relating to the achievement of particular goals
active process whereby an individual is engaged in acting on hope

Question 25

Role of hope in rehabilitation

Answer 25

Stroke survivors with low hope tended to experience more depressive symptoms (Gum et al., 2006)

Hopeful thinking was negatively associated with participation for participants who had poorer communication abilities.
One explanation for this is that these individuals could be focused on an unrealistic goal rather than functional strategies which would be more likely to improve participation

Providing information to reduce uncertainty and incorporating hope-supporting influences in intervention

Question 26

Teaching hope

Answer 26

Hope Theory (Synder, 2002)

Agency (goal-directed energy)
Pathways (planning to meet goals)

SLT should facilitate the selection of a goal that is clearly defined and of value to the client with an appropriate challenge level.

Agency can be supported through positive self talk, evaluating progress and increasing self-efficacy

Question 27

Optimism

Answer 27

Dispositional optimism has been seen as a personality variable that relates to global expectations about the future

Seligman believes in learned optimism (in contrast to learned helplessness)

Optimism can be cultivated using a version of Ellis’ A (adversity), B (belief), C (consequence) rational emotive behaviour therapy (REBT) model
Seligman has also added D (disputations) and E (energisation)

Optimism seems to be a predictor of successful completion of a variety of rehabilitation programmes for both children and adults (Michaels et al., 1997)

Optimism is important in initiating and maintaining goal-directed behaviour, and provide useful examples of intervention approaches that facilitate learned optimism

Question 28

Resilience

Answer 28

Refers to the ability to maintain relatively consistent psychological wellbeing even in the face of loss and trauma (Bonanno, 2008)

White et al., (2012) identified a resilience trajectory that was underpinned by adaptability, previous life experiences, optimism and altered life perspectives

Healthy people tend to underestimate the self reported wellbeing of people with a chronic disability

Cruice et al., (2009) spouses of people with aphasia tended to rate their quality of life lower than the people with aphasia themselves