Health Psychology Flashcards
Compare the Biomedical and Biopsychosocial Models of Wellness
Biomedical: focus is on biological functioning
Biopsychosocial: better describes the reality of illness in the lives of individuals; considers biological, social, and psychological factors (We like this one obviously)
What are the 6 “essentials” of counselling
- Learning to be present and respond to your patients verbally, behaviorally, and emotionally
- Intentional interview skills– connection, empathy, rapport, body language, active listening, questioning styles, keeping an open mind
- Being aware of your biases / issues / judgements; being willing to address your own psychological vulnerabilities
- Communication skills— assertive speech, clarity, honesty, respect, integrity; causes of miscommunication
- Building the therapeutic relationship
- Theoretical foundations and specific counseling techniques
The ‘Therapeutic Relationship” meets what 6 needs?
- To be treated as an individual
- To express feelings
- To receive empathic communication
- To be recognized as a person of worth
- To not be judged
- To make one’s own choices and decisions
What are the 3 levels of ‘Therapeutic Relationships?
- Treatment only
- Treatment + relationship
- Treatment + relationship + the relationship as treatment
The ‘Therapeutic Relationship’ can be active on an unconscious level too! What factors increase the likelihood of unconscious activation?
- Length of relationship
- Level of intimacy and information shared
- Use of touch
- History of trauma, abuse, or unresolved intense emotions
- Vulnerable patient populations
* As ND’s we should us 1-3 in all visits.
What are the 6 core elements of Patient Centred Care; who is this concept derived from?
- Education and shared knowledge
- Involvement of family and friends
- Collaboration and team management
- Sensitivity to non‐medical and spiritual dimensions of care
- Respect for patient needs and preferences
- Free flow and accessibility of information
*Derived from Carl Rogers’ “client-centred theory,” which encourages practitioners to adopt a bio-psycho-social model of practice and place an emphasis on interpersonal relations.
What are the main points of Positive Psychology?
A focus on: Positive emotions, Engagement, Positive relationships, Meaning, Purpose + Accomplishment.
Taking the time to see + reflect on these things! Experience the positive and keep it with you to increase RESILIENCE + WELLBEING.
Who is the main figure behind Positive Psychology?
Martin E.P. Seligman, Ph.D.
What is Mindfulness?
A process of bringing attention to your moment-by-moment experience
A kind of nonelaborative, nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises in is acknowledged and accepted
What do A,B,C + S stand for when we are considering mindfulness?
Affect
Behaviour
Cognition
Sensation
What three things should we recognize when trying to better cope with stress?
- Recognize the behavior + choose to do something different
- Recognize the emotion and give it appropriate expression.
- Recognize the belief: what would I believe in that situation in order to act or feel stressed/upset etc.
What are three ways to keep defined boundaries between you and your patient?
- Keep your focus on the patient
- Be aware of personal needs
- Avoid dual relationships (ie. treating friends/family/business ppl)
Define Transference
Patient to Doctor
Transference is a phenomenon characterized by unconscious redirection of feelings from one person to another. Example: strong emotional responses as a result of unconscious associations and feelings from our past.
Define Countertransference
Doctor to Patient
Is defined as redirection of a therapist’s feelings toward a patient, or more generally, as a therapist’s emotional entanglement with a patient
What are the 5 types of communication styles?
Placating: Placaters agree with nearly everything, minimise problems, and tend to apologise for themselves on a regular basis.
Blaming: Blamers find fault in other people and shift the conversation away from themselves.
Computing:Computers hide their feelings from others.
Distracting:Distracters become overwhelmed in stressful situations and when conflicts arise. They shift between the three previous styles (Placater, Blamer, Computer)
Flowing:They’re generally honest and will communicate openly and directly.
List 3 different ways you could describe a communication style
Assertive
Aggressive
Passive
What are the 5 styles of managing stress?
Underfunctioners: become less competent under stress, thus inviting others to take over
Overfuctioners: move in quickly to advise, rescue, and take over when stress comes
Blamers: react to stress/anxiety with emotional intensity and fighting
Pursuers: react to stress/anxiety by seeking greater togetherness
Distancers: seek emotional distance or physical space when stress is high
Family Theory: define Function
: the suitability of behavior for achieving common goals
Family Theory: define Subsystem
a person or group of people who are themselves a system but who also play a specific role in the functioning of the family
Family Theory: define Boundaries
: invisible lines drawn within and among family members that form subsystems; boundaries protect the integrity of the subsystem while allowing interaction between subsystems, the family unit, and the outside world
Family Theory: define Rigid
: boundaries that are inflexible, may lead to closed system, disengagement
Family Theory: define Diffuse
boundaries that are highly permeable and that allow for too much flow of communication between subsystems
Family Theory: define Closed System
: a family system in which all members are expected to share similar views and self-expression is not valued
Family Theory: define Open System
a family system encouraging and supporting honest self-expression by family members
Family Theory: define Disengagement
extreme family type in which each family member is cut off emotionally from one another and functions without regard for the other
Family Theory: define Enmeshment
extreme family type in which family members are overly involved in one another’s lives and family relationships are undifferentiated, closed, and diffuse
Family Theory: define Differentiation of Self
extent to which one separates emotions and intellect and maintains a sense of self (ie, people whose intellectual functioning is dominated by feelings and who depend on others are poorly differentiated)
Family Theory: define Emotional Cut-off
a process whereby a person withdraws or denies the importance of their family (may be a geographic separation)
Family Theory: define Family emotional system
emotionally interdependent people who form a system organized by their individual and collective thoughts, feelings, and relationship history; typically are formed by people with similar levels of differentiation
Family Theory: define Family Projection
parents unconsciously project their difficulties onto the child with the lowest level of differentiation (ie the most vulnerable child)
Family Theory: define Multigenerational Transmission Process:
dysfunctional rules and dynamics transmitted over generations (learned behaviors, roles, emotional habits, communication styles, etc)
Family Theory: define Triangles
the smallest stable relationship; triangulation is a mechanism by which 2 people try to stabilize their tense, anxious relationship by involving a 3rd party
Family Theory: define Family Regression
chronic anxiety, external pressures, and stresses lower the family’s functional differentiation
What are the 3 mechanism of Rick Hanson’s Neuroplasticity/Mindfulness approach?
- Mindfulness training: activated areas of the brain will get more blood flow more oxygen, more glucose, more capillaries develop– literally thickening that part of the cortex
- Epigenetics: perceptual influence on cellular expression
- Experiential association: “Neurons that fire together wire together”
RAINBOW model - what does each letter stand for?
R = recognize A = accept I = investigate: be curious, analyze, question N = not-self it: see it in a larger, more objective, less personal way B = breathe; allow for release; activate parasympathetic systems O = open to new possibilities, actively establish new opportunities W = welcome in new possibilities with a positive felt-sense
Development of Self happens in stages. What are the main stages from 0-18mos?
“Here I am”: the sense of an emergent self
Birth – 2 mos
“Hey, Look at Me!”: the sense of a core self
2-7 mos
“Honey, I’m cold. Don’t you want a sweater?”:
the sense of a subjective self
About 1 yr, child begins to realize they have a inner, private world that is invisible to others.
“No, I don’t want a nap! I want to play!”: the sense of a verbal self
15-18 mos
Remember: The listened-to child is a confident child, and adults aren’t so different either*
Define Mirroring
consciously resonating with and replicating another’s state (matching tone, posture, movement, gestures, facial expression, etc)
Good mirror = Good listener = appreciates us as we are, accepts the feelings and ideas we express
What are the 5 E’s of the therapeutic conversation
Engage the patient Empathize with the patient Elicit the patient’s medical history and biopsychosocial information Educate the patient Enlist the patient in treatment
What are 5 important aspects of Engagement?
Blending: – assessing speech/body language Conveying empathy Creating a safe space Clinician genuineness Clinician expertise
Empathy Vs Sympathy (or Pity) according to James T Hardy, MD
- Sympathy implies a SHARED burden and may burn the practitioner out. This puts the practitioner in a position of being unable to help and heal.
- Empathy is when you BORROW feelings to observe and understand them without taking them onto yourself.
- Pity is a condescending sense an my lead to feelings of contempt and rejection.
What are the 3 dimensions of Empathy?
Cognitive component
Affective component
Communicative component
Define the terms Decode and Encode
Decode = ability to understand what patients are communicating with their nonverbal expressions Encode = doctors ability to control their own emotional expressions via nonverbal cues
What is Active Listening?
an active process of being attentive, taking in information and feelings accurately and completely, and rephrasing what you have heard to check its accuracy
What are the 4 keys to Active Listening?
Ask for clarification
Reflect content
Reflect feeling
Reflect meaning
What are 4 examples of different Dr-Pt relationships?
Active-passive model (patient abdication) Guidance-cooperation model (paternalistic style) Mutual participation model (collaboration, shared decision-making style) Consumerism model (patient autonomy)
“H.I.E.R” the message
Hear
Interpret
Evaluate
Respond
3 applications for active listening
Collect information
Give affirmation
Respond to “inflammation”
What are some common Empathy Blockers?
Personal needs
Assumptions: we make a conclusion with incomplete information and create a perceptual bias; “you only see what you believe”
Domination: threatening, ordering, being bossy, criticising, name-calling
Manipulation: withholding relevant information, interrogating, praising to manipulate
Disempowerment :diagnosing motives, untimely advice, changing the topic, persuading with logic, topping
Denial: refusing to address the issue, reassuring
LEARN to deal with disagreements - what does this acronym stand for?
L Listen E Explain A Acknowledge R Recommend N Negotiate
Define Perception
Through the filter of beliefs, emotions, meanings, images, habitually anticipated outcomes, etc. we all perceive an event differently — our early relationships shape our perceptual abilities/tendencies.
Perception is a function of:
Conscious and unconscious beliefs Conscious and unconscious interpretation Memory and past experience Expectations CNS activation Emotional state
Who espouses the a Psycho-Social theory of Development
Erik Ericson
psychological development is defined by a strong need to deal with 8 particular core issues that become active at different times in our lives
we constantly try to understand who we are, the greatest challenge is to develop a coherent sense of self - the way these 8 core principles develop is integral to our perception and reaction to the world.
What concept + age is the following related to: “Is my world caring and predictable?”
Trust vs mistrust Birth to 1year to get, to give in return hope, faith Ex/Def: sensory distortion/withdrawal.
What concept + age is the following related to: “Can I do things myself?”
Autonomy vs shame and doubt 1-3 years to hold on, to let go Will + Determination Ex/Def: impulsivity + compulsion
What concept + age is the following related to: “Am I responsible?”
Initiative vs guilt 3-6 years to go after, to play Purpose + Courage Ex/Def: Ruthless/inhibition
What concept + age is the following related to: “Am I proud of my accomplishments?”
Industry vs inferiority 7-11years to complete, to make things together Competence Ex/Def: narrow virtuosity/inertia
What concept + age is the following related to: “Who am I and where am I going?”
Identity vs role confusion Adolescence to be oneself, to share oneself Fidelity + Loyalty Ex/Def: Fanaticism/Repudiation
What concept + age is the following related to: “Can I commit to another person?”
Intimacy vs isolation young adulthood to lose and find oneself in a another Love Ex/Def: promiscuity/exclusivity
What concept + age is the following related to: “Can I contribute to society?”
Generativity vs stagnation Middle Adulthood to make be, to take care of Care Ex/Def: overextension/rejectivity
What concept + age is the following related to: “Am I satisfied with my life?”
Ego integrity vs despair Late Adulthood to be, through having been, to face not being Wisdom Ex/Def: presumption/despair
What is “Directed Reflection” ?
Physicians should take their opportunities to reinforce positive character traits that are already underlying in our patients character.
There are 36 character traits + authors of the article for week 5 argue that 3-5 directed reflections about the a quality the patient has will reinforce their own acceptance of that trait.
Define: Mentalizing
Mentalizing means having the ability to identify, be aware of, and pay attention to mental states in oneself and others
2 things promote a secure attachment and thus enable mentalizing – 1) attune to the mental state of oneself or one’s patient 2) consider its cause
Adaptive Mentalizing
Low level of psychological symptoms
Adequate social connections and healthy relationships
Affective expressiveness
Healthful neuroplastic and epigenetic effects (promotes Vis)
Non-Adaptive Mentalizing
Psychological symptoms
Difficulties with affect
Perceptual bias and cognitive distortions
Interpersonal difficulties
Intrusion of or avoidance of traumatic events
Health-obstructing neuroplastic and epigenetic effects (obstructs/stagnates Vis)
What is Epigenetics
Epi = “over, above, on top of, in addition to”
The term has evolved to include any process that alters gene activity without changing the DNA sequence, and leads to modifications that can be transmitted to daughter cells
Our lifestyles and environment change the way our genes are expressed
What are some of the roles “Junk” DNA play?
- turning genes on and off in a developing embryo
- separates coding and regulatory sequences
- can be spliced in and out during RNA processing to make variants of the same gene.
What are the 5 key points to understanding epigenetics.
- “DNA makes RNA makes protein”
But non-coding RNA are involved in many processes; important to regulate when and where a protein is made. - Non-coding DNA has risen from “junk” to a “driver of complexity” - how does deregulation cause disease?
- Life is protein
- The complexity is impressive: each protein usually interacts with only 5-15 other molecules.
- Small changes makes big differences: sequence or folding changes can cause severe disease.
The Biology of Belief (Dr. Bruce Lipton) - what are the main tenets?
the NERVOUS SYSTEM operates under the influence of the EMOTIONAL CENTERS of our brain
Our UNCONCSCIOUS beliefs:
Deeply ingrained physiologically
Deeply ingrained in our perception
Able to be re-conditioned: disharmonious psychophysiology is reversible
Genes are turned on or off by the environment
The cell’s fate is “controlled” by its interaction with the environment and not by a self-contained genetic program
Early experiences condition our cells on a molecular level. HOW?
When early environmental influences are chronically stressful, the developing nervous system and other organs of the PNI super-system repeatedly receive the electric, hormonal, and other chemical messages that the world is unsafe or even hostile. Those perceptions are programmed in our cells on the molecular level
If we have maladaptive unconscious beliefs as a results of early experience (0-6years) what consequences may manifest?
Impair the flow of Vis Induce stress Generate stagnation: “one step forward, two steps back” Cause frustration in life Induce dissatisfaction with Self Create biochemical change Perpetuate disease
What are the 5 content regions for the Naturopathic Interview?
Personal medical history Family medical history Biological determinants of health Psychological determinants of health Social determinants of health
Content VS Process
Content = the words, the message, the details; LODRFICARA
Process = the unspoken meanings, motivations, and intentions; the dynamics of relationships; the styles of communication; meta-communication
What are the 5 “phases” of the interview?
The introduction (1-3 minutes): what to expect today etc.
The opening or the “scouting” phase (7-9 minutes): “So what brings you here today?”
The body (approximately 30-35 minutes): To expand content regions discovered to be most relevant to the presenting problem or case analysis
The closing (5-10 minutes): summarize visit, talk about future visits + plans, ask the patient is they have questions/concerns.
The termination: a handshake, a smile, a touch on the arm, etc
We often used “gates” in the body of the interview to move between content regions. What are the 5 gate types?
“spontaneous gate:” patient leads, doctor follows
“natural gate:” patient gives cue statement, doctor uses to transition at that moment
“referred gate:” doctor uses cue statement previously offered by patient to transition
“phantom gate:” no cue statement or in-moment reference
“implied gate:” typical of everyday conversation
Examples of Variable Questions (between open and closed)
Swing questions
“can you describe your feelings about that?”
Qualitative questions:
“how has your mood been?”
Statements of inquiry:
“so you left the marriage after 3 years?”
Empathetic statements
“it sounds like a troubling time for you.”
Facilitatory statements
“Go on”
Define Confirmation Bias
a perceptual bias where you only notice and attend to that which confirms your beliefs.
Treating a maraton runner for IT band injury assuming they’re otherwise healthy
Define Premature Closure
a decision-making bias where a doctor decides on a diagnosis early and fits subsequent information to it, ignoring information that that does not fit
i.e. anxiety patient, you do a thorough psychosocial history and no physical examination
What is Process?
Process emphasizes AWARENESS: both the patient’s awareness and the awareness of the doctor
It is an in-the-moment awareness of INTERNAL mental and emotional experience as well as awareness of EXTERNAL dynamics between individuals
Consider Questions like: at what points does the interviewee show enthusiasm and emotion, and what kinds of emotion?
Recognize that you may not get through to the other person unless YOU adapt your style of communication
An example of misunderstanding in process….
Susan asks for details because she is interested; Drew feels interrogated
Paul wants Jane to get to the point; Jane feels that Paul isn’t interested in what she
has to say
When conversational styles differ, misunderstandings happen much more easily.
What are 3 topics of interest for us in terms of process?
Disclosure: when, if ever should we disclose our own experience. In general it should not be done.
Humour: laughter can be good!
Intimacy: is inherently linked to boundaries we need to learn to meet the patient where THEY are at.
if you’re patient is a distancer, the worst thing you can do is act as a pursuer!
Notice SELF INTIMACIES: patients may hold their own hands when speaking about certain topics etc.
What are the 4 levels of Psychophysiological Patterns?
- As individualized as a fingerprint
- A highly reliable source of information from the body
- Generate symptoms to signal imbalances and to process information that is held out of awareness
- Responsive to mind-body treatment
3 Keys of Emotional Health
Grounding:Practice being connected to and present in your body
Stabilization: Being present in this moment, with a manageable level of arousal
Mentalization:Create a valid story that allows you to make meaning from your experience and supports your sense of self
What is the Quick Coherence Technique?
Step 1: Heart Focus
Step 2: Heart Breathing
Step 3: Heart Feeling - this is the most important step. While maintaining the other 2 steps recall a positive experience and feeling and allow yourself to ‘re-experience’ it.
What is the difference between Reactive + Responsive?
we REACT without thinking, led by our emotions and our biochemistry, our cognitive scripts and schemas, our habits, our unconscious drives and motives, our conditioned responses, and our learned behaviors
To RESPOND is to be present, to be aware and mindful of your power to choose; to direct yourself purposefully towards a desired outcome; to maintain emotional integrity
What is the difference between deliberate coping responses and scripted coping responses?
deliberate coping responses: intentional responses chosen in the present moment
scripted coping responses: blueprints or “default” plans for thoughts, feelings, and behaviors that were developed in childhood and adolescence as part of one’s broader cognitive belief system
These may keep you bound to destructive/maladaptive patterns.
Working with ANGER - what are some key points to remember?
Anger often results from BLAMING others
Anger is often associated with:
Perfectionism
Denial
Feelings of loss of control
Anger is often a compensation for: Fear Self-doubt Feeling rejected or lonely Guilt Pain or anticipated pain
When anger is inappropriately expressed, it also has negative biochemical and interpersonal effects (especially effects cardiovascular health)
Working with GUILT - what are some key points to remember?
Guilt often unwarranted self-criticism and lingering rumination, regret, and self-punishment
The challenge with guilt is to turn the guilt into positive learning for the future
What constructive information can I learn from this?
Working with SHAME - what are some key points to remember?
Shame is different from guilt because it is about who you are (rather than something you have done)
Shame desire to hide, to avoid others, to mask self and give others what you think they want, to please others and validate your worth through their approval
When dealing with feelings of shame, it is essential to build self-awareness, self-esteem, and self-confidence
Working with WORRY + ANXIETY - what are some key points to remember?
Worry = apprehensive expectations; concern taken to over-concern; usually includes excessive rumination
May require multiphasic interventions on the behavioral, cognitive, and imagery levels
Essential: to teach and practice using tools for coping with distress
A good start is teaching relaxation techniques: deep breathing, progressive relaxation, guided imagery
Helpful to discuss “worst case scenarios”
Generalized Anxiety Disorder - symptoms
Motor Tension - trembling, fatigue, muscle soreness.
Autonomic Hyperactivity: palpitations, SOB, dizziness, sweating, diarrhea.
Vigilance and Scanning: startles easy, irritable, sleep problems.
Working with Depression - some things to remember
Depression has many etiologies:
A reaction to traumatic life events (the death of a loved one, loss of a job, divorce, etc)
A chemical disturbance: serotonin, NE, dopamine
The result of accumulated fatigue
A reaction to disharmony somewhere in your life (family, work, marriage, etc)
Quality of relationship between physician and patient is especially important
Need to consider whether depression is reactive or endogenous and to understand patient’s view on why they feel this way
Journaling may be helpful for patients who need to express their feelings
Cognitive therapy also very effective because it helps patients change distorted thinking
Lifestyle factors can be strong interventions: exercise has been shown to be very effective in reducing depression as a stand-alone treatment
Miriam Greenspan on “Dark Emotions”
Dark emotions can be profound spiritual teachers - if we can live mindfully with them.
Her approach as psychotherapist is to practice “emotional alchemy” in which she focuses on accepting dark emotions and turning them into their lighter counterparts (we talked about this with Dr. Godfrey - remember: every negative emotion the brain can produce has its antidote in the vis)
