health psych

Question 1

active listening

Answer 1

● The need to communicate and be understood.
● Is central to the helping relationship.
● Attend and encourage without intruding on the
patient’s telling of the story.
● Fight the impulse to run in and fix.
● Put your concerns, questions, theories on the back
burner and let the patient tell the tale.

Question 2

body language

Answer 2

Sends messages, regulates the interaction, enhances intimacy, is persuasive

○ Eye contact
○ Body position
○ Attentive Silence
○ Voice tone
○ Facial expressions and gestures
○ Physical distance
○ Touching and warmth

Question 3

how much of communication is nonverbal

Answer 3

80%

Question 4

how much emotion is converted by the voice, face and verbally

Answer 4

● 38% of emotions conveyed by the voice.
● 55% of emotions conveyed by the face.
● Only 7% of emotions conveyed verbally.

Question 5

eye contract

Answer 5

○ Confidence and involvement
○ Add potency to verbal communication
○ Cultural differences and mirroring the client

Question 6

body position

Answer 6

○ Relaxed alertness puts client at ease
○ Lean slightly forward (attentiveness)
○ Open posture (uncrossed arms, legs)

Question 7

attentive silence

Answer 7

○ Allow patient time for reflection
○ Provides the helper time to process
○ Encourages disclosure and opening up
○ Encourages “staying with” deep emotions

Question 8

voice tone

Answer 8

○ Emotional clues
○ Clients respond to voice tone
○ Helpers mirror patient and for emphasis

Question 9

facial expression and gestures

Answer 9

○ Primary emotions: the same expressions across cultures
○ Incongruence between expression and words
○ Nod, facial expressions of concern, encourage with hand movements

Question 10

physical distance

Answer 10

○ Cultural variations
○ Five feet (e.g., knee-to-knee sitting) is optimal

Question 11

touching and warmth

Answer 11

○ Communicate caring and concern
○ Positively impacts the relationship; increases
ability to influence
○ Ethical concerns: cultural taboos,
sexual/transference reactions
○ First, know the patient well

Guidelines:
○ Appropriate to the situation
○ Match intimacy level with what patient can handle
○ Do not use with negative messages

Question 12

door openers

Answer 12

○ Non-coercive invitation to talk
○ Signals availability
○ Encourages exploration and discussion
○ Positive nonjudgmental response
○ They encourage patient to expand, begin
conversations, time for helper to formulate response
○ E.g., Can you tell me more?” or “What’s on your
mind?”

Question 13

questioning

Answer 13

● Easily abused, distracting, can sidetrack the flow.
● May appear as interrogation or evaluation.
● Beginners tend to ask too many and the wrong kind.
● Used to ask about facts when an important part of story
is unclear and/or to encourage further discussion.
● Avoid “why” questions since patients often do not know
the answer, may lead to intellectualization or rationalization, and/or to defensiveness. Instead use attentive silence and encouragers.

Question 14

what to use instead of lots of why questions

Answer 14

attentive silence and encouragers

Question 15

what types of querstions to use and avoid

Answer 15

● Avoid leading questions since they are subtle ways of giving the patient advice, they push the helper’s agenda, and tend to stop communication.
● Types of questions - closed and open.

Question 16

chronic insomnia

Answer 16

upset mind: unpleasant or worrying experience

unwanted new lifestyle: treatment seeking behaviour, boring new daily routine, depressed mood

Question 17

non pharmacological treatments for insomnia

Answer 17

● The 3 P model of insomnia (i.e., predisposing, precipitating, and perpetuating factors) is perhaps the best way in which to understand how sleep problems become problematic, chronic, and in need of treatment.

Question 18

stimulus control in insomnia

Answer 18

Five basic instructions:
1. Don’t get into bed unless you are sleepy.
2. Don’t use the bed for anything except sleep and,
of course, sex.
3. If you are unable to fall asleep within 10–20 min of
either getting into bed or after waking up during
the night, get up and go to another room.
4. Get up at the same time each morning.
5. Don’t nap during the day.

Question 19

progressive muscle relaxation therapy fro insomnia

Answer 19

○ Starts with training during the day or evening.
○ Patient asked to sit comfortably in a chair during the
visit, and is instructed to purposely tense a muscle and then relax it and to focus on the changing experience of tension.
○ They are asked to tense for 10–15 seconds and relax for the same period of time.
○ Once the patient’s becomes fully comfortable and confident using this technique, they are asked to use it at bedtime to help promote sleep.

Question 20

sleep hygiene tips

Answer 20

1. Consistent sleep and wake times.
2. Limit time in bed.
3. Do not nap.
4. Remove the clock from the bedroom.
5. Avoid caffeine.
6. Avoid alcohol.

Question 21

reasons for reflecting the patient

Answer 21

● Verbally communicates empathy.
● Confirm or correct what client is saying.
● Stimulates further exploration of client’s experience.
● Captures relevant aspects of patient’s message that
may remain camouflaged.re

Question 22

three components of reflecting

Answer 22

cognitive
emotional
existential

Question 23

reflectings skills are

Answer 23

Specialized interventions to stimulate deeper exploration and understanding.

● Three components:
○ Cognitive: patient’s understanding of facts and
thoughts.
○ Emotional: patient’s understanding of feelings.
○ Existential: hidden meanings.

● People are usually most comfortable talking about content or facts; helpers take it deeper.

Question 24

per topic in the visist

Answer 24

1. door opener
2. minimal encourager
3. open question
4. minimal encourager
5. paraphrase
6. closed question
7. paraphrase

Question 25

how to paraphrase

Answer 25

● NOT word-for-word parroting.
● Neutral restatement of facts and thoughts.
● Highlight the patient’s perspective.
● To paraphrase:
○ Listen carefully to the patient’s story.
○ Provide non-judgmental and condensed version
of the facts and thoughts.

Question 26

common problems in paraphrasing

Answer 26

● Simply reciting the facts.
● Difficulty hearing story because of “noise.”
● Worrying about what to say next.
● Being judgmental and siding with the patient.
● Turning a paraphrase into a question.

Question 27

tips for paraphrasing

Answer 27

● Don’t paraphrase too early – get a clear picture.
● Use encouragers to invite the patient to share.
● Don’t repeat exact words.
● Paraphrase the patient’s thoughts and intentions and
basic facts.
● If you get lost, repeat the patient’s last statement or
try another paraphrase.
● Keep on track by responding to the last thing the
patient said.

Question 28

phenomenological finding in chronic headaches

Answer 28

● Building a foundation of safeness by averting the threat of having a migraine attack via trigger management; and striving for power to be in control.

● Amplifying the good in life via acting thoughtfully to increase one’s pleasure and joy; and being in a process of accepting migraine as a part of life.

Question 29

role of the helper in chronic headaches

Answer 29

● Treat both the disease and patient.
● Educate and manage cognitive influences (e.g.,
readiness to change, self-efficacy, locus of control) about headache pain and management, medication adherence, and managing triggers.
● Also, assess for and manage psychiatric comorbidity, significant problems with sleep or stress, medication overuse, and history of abuse.

Question 30

common triggers in headaches? strategies?

Answer 30

● Stress is a common trigger of migraines. So work on stress management.
● Passive or avoidant coping strategies. Encourage efforts to cope with the pain, and work to minimize attention to pain behaviors.
● Lessen influence of headache-related beliefs (i.e., via the use of headache diaries).

Question 31

maangement in chronic headaches

Answer 31

● Management of psychiatric comorbidities.
● Lifestyle factors (i.e., dietary habits and sleep
problems).
● Behavioral treatments (e.g., relaxation training,
biofeedback, CBT, mindfulness therapies, and/or CBT-I).

Question 32

skills of reflecting feelings

Answer 32

● Paraphrasing – involves content and thoughts.
● Reflecting feelings – communicates that you understand
the emotions (conscious or unconscious).
● Leads to deeper patient disclosure, greater awareness
of feelings, and helps patient report them.
● Normalizes emotions and brings relief from emotional
pressure.
● Deepens the relationship.

Question 33

express feelings

Answer 33

● Feelings are often implicit in patient’s statements.
● It’s ok to follow your hunches or make guesses and
reflect the feeling.
● Typically, the patient will correct you if you are wrong.

Question 34

challenges in expressing feelings

Answer 34

● Before approaching feelings, however, consider the attitude of the patient’s culture, family, upbringing and gender toward feelings.

Question 35

steps and formula to reflect feelings

Answer 35

1. Identify the feeling or feelings, then imagine how the patient is feeling. Nonverbals are major clues!
2. Put the emotion into words. Make a statement that mirrors emotions.
3. Reflect feelings using the formula, “You feel (or felt)__________,” or “You feel (or felt)__________ when________.”

Question 36

common problems in reflecting feelings

Answer 36

• Asking the patient to identify feelings, “How did that make you feel?”
• Waiting too long to reflect.
• Turning a reflection into a question.
• Combining reflections and open questions.
• Focusing on the wrong person or the wrong topic.
• Interrupting too soon.
• Letting the patient ramble.
• Use the word feel in place of think.
• Undershooting / Overshooting.
• Letting your reflecting statements go on and on.

Question 37

uncovering the next layer

Answer 37

● Why reflect meaning?
● To understand the patient at a deeper level.
● To lead to deeper self-understanding in the patient.
● To emphasize that the story is the client’s version
● To push the patient to go deeper.
● To move the conversation deeper.

Question 38

worldview is formed by

Answer 38

language, gender, race, ethnicity, age, SES, family, experience, spirituality/religion, etc.

Question 39

view of self and view of others

Answer 39

● View of Self:
○ “ I am essentially…(a good person) (smart/stupid).
(worthless/worthy) (damaged) (unlovable).”
○ “I am lucky.”
○ “I am a victim.”

● View of Others:
○ “People are… (good, untrustworthy, unreliable, kind).”
○ “Women are all alike.”
○ “Things always turn out for the best.”
○ “White people are all the same.”

Question 40

beliefs and values (worldview)

Answer 40

● Beliefs:
○ “ It’s a jungle out there.”
○ “Men are all alike.”

● Values:
○ “People should treat each other fairly.”
○ “Men should be the head of the family.”

Question 41

meanings are implicit

awareness of patents beliefs and values

Answer 41

● Meanings are implicit:
○ First, understand the content and feelings.
○ Fully comprehend the situation.
● Awareness of the patient’s beliefs & values:
○ Use intuitive thinking.

Question 42

reflect meaning

Answer 42

● Use invitational skills, paraphrasing, and reflecting feelings to help meaning emerge.
● Fully comprehend the situation and the patient’s beliefs and values.
● Use open questions to get at the meaning.
● Use educated guesses, intuition about why the story is
important.

Question 43

meaning formula

Answer 43

Reflect meaning by using the formula, “You feel (or felt)________ because _______ (meaning).”

Question 44

types of summaries

Answer 44

1. focusing
2. signal
3. thematic
4. planning

Question 45

types of summaries

Answer 45

● Focusing - major issues and themes.
● Signal - tells the patient that the helper has digested
what the patient has said.
● Thematic - helper makes connections among the
content, emotions, or meanings expressed by the
patient.
● Planning - review of progress, plans, and
agreements.

Question 46

nonjudgmental listening cycle

Answer 46

open question
minimal encourager
door opener
paraphrase
reflection of feeling
reflection of meaning
summary

Question 47

Nonjudgmental Listening Cycle

Answer 47

● Repeating pattern of basic helping skills used with the introduction of each new topic.
● Positive regard is essential within the NLC: An active demonstration of nonjudgment.
● Too many closed questions can stall this process.
● Respond to the last thing the patient said. This is
helpful in getting out of “the trap.”

Question 48

reflect mening

Answer 48

● Use Open questions, Minimal Encouragers, Reflection of Feeling, then Reflection of Meaning.
● Ask: What is the patient telling me?
● Be patent! Listen long enough to understand meaning.
● Think about and tie in the patient’s background.
● Respond to last thing the patient said.
● Attend to your intuition and follow your hunches.

Question 49

phenomenological findings in dementai

Answer 49

● From self-efficacy toward an external locus of control.
● Struggling to accept new identity and the need to use
adaptive strategies.
● Preservation of self amidst problems, such as
increasing memory lapses.
● Shifting identity for the patient and their family.
● Coping amidst the struggle to be part of things and to
remain connected to who the patient once was.

Question 50

phenomonelogcial findings in the family members of patient with dementia

Answer 50

● Partners (or family members)shift roles to that of caregiver and face their own emotional challenges that may further alienate the patient with dementia.
● Family members be exhibit Infantilizing behaviors even when the patient is present.
● Some family members may become more involved and less fearful of their loved one with dementia.

Question 51

counselling with dementia

Answer 51

● Expectations and outcomes of counselling: (1) Coping strategies and (2) facilitating acceptance.
● Emotional impact of life with dementia: (1) Being a burden to others; (2) burden of coping; and (3) burden of other life events.
● Appraisals of identity: (1) Self or caring identity; and (2) self-care of resilience.
● Importance of therapeutic relationship: (1) Comfortable to disclose information; (2) impartial listener; and (3) understanding of dementia.