Health Psychology 3 unipd Flashcards
1
Q
Hippocrates
A
considered the mind and body as one unit, and thus it was thought that the level of specific bodily humours related to particular person- alities: excessive yellow bile was linked to a choleric or angry temperament; black bile was attached to sadness; excessive blood was associated with an optimistic or sanguine personality; and excessive phlegm with a calm or phlegmatic temperament.
2
Q
Galen
A
Galen considered there to be a physical or pathological basis for all ill health (physical or mental) and believed not only that the four bodily humours underpinned the four dominant temperaments (the sanguine, the choleric, the phlegmatic and the melancholic) but also that these temperaments could contribute to the experience of spe- cific illnesses.
3
Q
What happened in the eighteenth century (organic medicine)
A
This view (galen humors) dominated thinking for many centuries to come but lost predominance in the eighteenth century when organic medicine, and in particular cellular pathology, devel- oped and failed to support the humoral underpinnings.
However descriptions of personality types were still in use in the latter half of the twentieth century
4
Q
Middle Ages
A
Middle Ages however (fifth–sixth century), Galen’s theories had lost dominance when health became increasingly tied to faith and spirituality. Most of the knowledge was very narrowed and concentrated in few people normally Mons And the mind shape
During Middle Ages the idea that health and disease were related to faith and spirituality
Malicious masificados- book of what is a with- now days more seen as a description of mental disorder
Obsession- resist to the devil’s possession- if not you become psychotic/ possessed.
Santa Giovanna di arco: talking with god seen as a Saint instead of a witch (in France, but wich in England)
Santa Clara- anorexic…
5
Q
Treatment in Middle Ages
A
treatment along the lines of self-punishment, abstinence from sin, prayer or hard work
6
Q
Renaissance
A
During the Renaissance, individ- ual thinking became increasingly dominant and the religious perspective became only one among many. The scientific revolution of the early 1600s led to huge growth in scholarly and scientific study and developments in physical medicine.
7
Q
What did Rene Descartes said and the interaction between the entries is I limited or limited?
A
During the early seventeenth century, the French philosopher René Descartes (1596–1650), like the ancient Greeks, proposed that the mind and body were separate entities. However, Descartes also proposed that interaction between the two ‘domains’ was possible, although initially the understanding of how mind–body interactions could happen was limited
8
Q
Other data from Descartes… and how he aportes to the medical understanding
A
pineal gland in the midbrain (see Chapter 8 ☛), but the process of this interaction was unclear. Because Descartes believed that the soul left humans at the time of death, dissection and autopsy study now became acceptable to the Church, and so the eighteenth and nineteenth centuries witnessed a huge growth in medical understanding.
9
Q
What is the biomedical model
A
In this model, health is defined as the absence of disease, and any symptom of illness is thought to have an under- lying pathology that will hopefully, but not inevitably, be cured through medical intervention.
10
Q
Some problems with the biomedical model
A
Problems: the medical explained symptoms (we see the effect but we can’t find the cause)we haven’t understood pathology enough? Matter of understanding where it comes from and how ti treat
Comparison between individuals
When we discuss with the physicians are symptoms, signs (objective- even though understanding is a little more complicated)
Just remove pathology through medical intervention but there is no place of subjectivity even if all the parameters are taken (reductionism)
How we can deal with unexplained symptoms?
11
Q
Introduce subjectivity as a solution for the biomedical model but how?
A
Including your psychological symptoms
Bunt- introspection to understand subjectivity
What is what it makes an individual different from another
Individual difference is not subjectivity, our experiences, subjectivity is related but it’s not it
Consciousness… move the problem
Or this questions have to take into account for including subjectivity, where they come,
Why our subjectivity brings out medically unexplained symptoms
Maladaptive way that we perceive normal sensations.
12
Q
Beyond dualism how the monastic structure can be perceive?
A
this monadic structure can be perceived in two different ways:
objectively and subjectively.
13
Q
How does subjectivity plays a role in the illness?
A
subjectivity in terms of beliefs, expectations and emotions interact with bodily reactions to play an important role in the illness or stress experience (e.g. phantom limbs, placebo/nocebo response)
14
Q
Sigmund fried after the biomedical model
A
A key role was played by Sigmund Freud in the 1920s and 1930s when he rede- fined the mind–body problem as one of ‘consciousness’ and postulated the existence of an ‘unconscious mind’ seen in a condition he named ‘conversion hysteria’. Following examination of patients with physical symp-tomatology but no identifiable cause, and by using hypnosis and free association techniques, he identified unconscious conflicts which had been repressed. These conflicts were considered to ‘cause’ the physical disturbances including paralysis and loss of sensation in patients where no underlying physical explanation catarsis
• Freud stimulated much work into unconscious conflict, personality and illness, which ultimately led to the development of the field of psychosomatic medicine.
Hysteria…. Uterus
15
Q
Bio psychosocial model
A
model signals a broadening of a disease or biomedical model of health to one encom- passing and emphasising the interaction between body and mind, between biological processes and psychologi- cal and social influences
16
Q
categories of health by Bauman 1961
A
a general sense of well being - feeling.
The absence of symptoms of disease- symptoms orientation.
The things that a person who is physically fit is able to do- performance.
17
Q
The difference conventions of health are influenced by
A
State of health or illness
Age
Younger- performance centered
Middle-symptoms(matter of well being)
older people with more health problems define it more in the being of clusters
Gender
Young males measure it as performance
The perception we have of health can be different if it’s perceive from difference in this parameters.
18
Q
The categories of health identified from THE HEALTH AND LIFESTYLE SURVEY findings were:
A
Health as not ill: i.e. no symptoms, no visits to doctor, therefore I am healthy.
● Health as reserve: i.e. come from strong family; recovered quickly from operation.
● Health as behaviour: i.e. usually applied to others rather than self; e.g. they are healthy because they look after themselves, exercise, etc.
● Health as physical fitness and vitality: used more often by younger respondents and often in reference to a male – male health concept more commonly tied to ‘feeling fit’, whereas females had a concept of ‘feeling full of energy’ and rooted health more in the social world in terms of being lively and having good relationships with others. Health as psychosocial well-being: health defined in terms of a person’s mental state; e.g. being in harmony, feeling proud, or, more specifically, enjoying others.
● Health as function: the idea of health as the ability to perform one’s duties; i.e. being able to do what you want when you want without being handicapped in any way by ill health or physical limitation (relates to the World Health Organization’s concept of handi- cap, now described as participation/participatory restriction, see ‘In the spotlight’: i.e. an inability to fulfil one’s ‘normal’ social roles).
19
Q
Cross cultural perspective of health
Are diseases and health considered in the same ways in different countries and cultures?
–Pregnancy
A
Western Try not tell them as a patient or clients even if they need medical attention but is it the same worldwide
In some countries the matter depends on you marital status. If you are not married you are treated less humanized, as someone with a mental disorder,
20
Q
Cross cultural perspective of health
Are diseases and health considered in the same ways in different countries and cultures?
Mental disorder
A
In some countries mental disorders do not exist for them.
Not acceptance to go to the psychiatrist
Seem as a taboo in the past
21
Q
•Are the strategies to maintain health, to prevent illness and to cure it the same in different countries and cultures? How to work with health and make it better
A
E.g. collectivism-
vs. individualism-
What are possible examples of individualism and collectivism that have influenced health?
Evidence based methods (individualistic)vs. alternative/ritualistic/religious methods (collectivistic)
Passive smoking in a collectivist if society doesn’t harm people around me but individualists can prioritize themselves.
Pollution- the heritage of the world… think of the future generations or not
Reduction in vaccination-
22
Q
•Are the strategies to maintain health, to prevent illness and to cure it the same in different countries and cultures? How to work with health and make it better
Evidence based methods vs. alternative/ritualistic/religious methods
A
Red towels in the windows for measles.. cultural heritage is there.
But they can have bad outcomes by taking the energy for curing ritualistic and religious issues
23
Q
Childhood under 7 how they classify illness
A
magic explanation (if any) are typical:
- Incomprehension: child gives irrelevant answers or evades question: e.g. sun causes heart attacks.
- Phenomenonism: illness is a sign that the child has associated with the illness, but with little grasp of
cause and effect: e.g. a cold is when you sniff a lot.
-Contagion: illness is usually from a person or object that is close by, but not necessarily touching the child; or it be attributed to an activity that occurred before
asked how?
Illness: e.g: ‘You get measles from people’. If
Just by walking near them’
24
Q
Child between 8-11, how they explain health
A
Contamination: i.e. children understand that illness can have multiple symptoms, and they recognise that germs, or even their own behaviour, can cause illness: e.g. ‘You get a cold if you get sneezed on, and it gets into your body’.
Internalisation: i.e. illness is within the body, and the process by which symptoms occur can be partially understood. The cause of a cold may come from outside germs that are inhaled or swallowed and then enter the bloodstream. Can differentiate between body organs and function and can understand specific, simple information about their illness. They can also see the role of treatment and/or personal action as returning them to health.
In this concrete operational stage, medical staff are still seen as having absolute authority, but their actions might be criticised/avoided: e.g. reluctance to give blood, accusations of hurting unnecessarily, etc. may appear as children can now begin to weigh up the pros and cons of actions.
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Adults in health
Adults are less likely than adolescents to adopt new health-risk behavior and are generally more likely to engage in protective behavior: e.g. screening, exercise, etc. for health reasons
Middle age has been identified as a period of doubts and anxiety, reappraisal and change, some of it triggered by uncertainty of roles when children become adults and leave home, i.e. ‘the empty nest’ syndrome, some of it triggered by awareness of physical changes – graying hair, weight gain, stiff joints, etc. Positive health behaviour changes may follow
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Symptoms
subjective perception of something that it’s not seem to be not okay. Related to diseases, symptoms can be related to disease…
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Illness and disease
•Disease, then, is considered as being something of the organ, cell or tissue that suggests a physical disorder or underlying pathology, whereas illness is what the person experiences
People can feel ill without having a disease. Or the other way around! Ex: well control diabetes
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Are you sick? Which is the process for define ourselves as ill…
perceiving symptoms;
interpreting symptoms as illness;
planning and taking action. (Getting the label of disease or healthy)
Ex PTSD- it was first described on the 80’s and described in the DMS….independency word of the USA, then with the two wars,
It was also seem in the golf war
It was important for the veterans of the Vietnam wars (anxiety, depression, conversion disorder) for the label for the insurance, for treatment. If there was no diagnosis the insurance didn’t pay. They had the subjective perception of being ill, so no disease? No insurance. Having definitions and how is not enough to perceive the subjectivity for the person
29
How does selective attention and external information influence on the somatic information contributing to our physical symptoms
There is no subjective symptoms without cognitive interpretation of it. There is no attribution of being I’ll without the cognitive evaluation of the situation, with the process of attention and the knowledge of previous deseases.
Signs can be detected and identified, for example, blood pressure, whereas symptoms have been defined as what is experienced and, as such, they are more subjective
•There are signs and symptoms that tend to be considered as pathological
Yo can explain this graph with the two examples, panic attack
The fact that you are bringing your attention to a bodily sensation to your body can create or worsen the symptoms as a reversion conditioning.
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there are signs and symptoms that tend to be considered as pathological
Painful or disruptive: if a bodily sign has consequences for the person
Three types of symptoms:
• Novel: subjective estimates of prevalence significantly influence (1) the perceived severity of a symptom and (2)whether the person will seek medical attention.
Experiencing a 'novel' symptom (new to one- self or believed not to have been experienced by others) is likely to be considered indicative of something rare and serious, whereas experiencing a symptom thought to be common leads to assumptions of lower severity and a reduced likelihood to seek out health information or care.
Persistent: a bodily sign is more likely to be perceived as a symptom if it persists for longer than is considered usual, or if it persists in spite of self-medication.
• Pre-existing chronic disease: past or current illness experience has a strong influence upon somatisation (i.e. attention to bodily states) and increases the number of other symptoms perceived and reported
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Attentional states and symptom
perception
•Individual differences exist in the amount of attention people give to their internal state and external states
•A high degree of attention increases a person’s sensitivity to new, or different, bodily signs (e.g. psychogenic illness due to well-publicised outbreaks of illnesses or the ‘medical student’s disease’)
•Previous experience with an illness can increase a person’s attentional bias toward symptoms of that illness
32
Social influences
on symptom perception
•People hold stereotypical notions about ‘who gets’ certain diseases and that this can inter- fere with perception and response to initial symptoms.
• Our motivation to attend to and detect signs or symptoms of illness will depend on the context at the time the symptom presents itself. As referred to above, people tend not to notice internal sensations when their environment is exciting or absorbing, but a lack of alternative distraction may increase perception of symptoms.
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(influences)Symptoms interpretation in general
Once a symptom has been perceived, people do not generally consider it in isolation but relate it to other aspects of their experience and to their wider concepts of illness.
•Several influences were studied:
- Cultural influences
Child dies the degree you perceive depends on the culture and the normality of it. Other example is the deseases during the child since there can be a lot in the past and now there are more vaccinations.
- Gender
Females are more careful in monitoring and giving interpretations of symptoms and that man can be more bluster of them.
- Life stage (age):
• children have similar multidimensional illness representations to adults, including perceived illness consequences and issues of control
- Personality
• Self identity: a person's sense of who they are at a group
.Illness experience
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Illness desease prototypes
This can affect by:
HIV as an example is not as the prototype says it can be misperceived the type of persons who can acquire as just drug users and unprotected sexual Inter curse. However it can be any person who does unprotected intercourse.
Prototypes similar to heuretics!
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common-sense model of illness
•In this model, illness cognitions are defined as ‘a patient’s own implicit common-sense beliefs about their illness’
• This ‘common-sense model’ states that mental representations provide a framework for understanding and coping with illness, and help a person to recognise what to look out for
36
S in spikes
SETTING UP the interview
•This involves mentally rehearsing the likely plan of how the interview will proceed and setting up the physical setting in an appropriate way.
–Arrange for privacy
–Involve significant others (is a patient’s choice)
–Make connection with the patient.
–Manage time constraints and interruptions.
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PIK in SPIKES
Step 2: P – Assessing the patient's PERCEPTION (What do you know about your clinical situation so far?)
•Step 3: I – Obtaining the patient's INVITATION (understanding how much the patients want to know about his/her situation)
•Step 4: K – Giving KNOWLEDGE and information to the patient (when the bad news is given)
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E in SPIKES
Step 5: E – Addressing the patient’s EMOTIONS with empathic responses
1.Observe for any emotion on the part of the patient.
2.Try to follow and identify the emotions experi- enced by the patient. If they appear sad but silent, the clinician should use open questions to find what they are thinking or feeling.
3.The reason for the emotion should be identified. It is easy to assume this is due to the bad news, but it may not be clear which issue is of concern After the patient has been given a brief period of time to express his or her feelings, the clinician should respond to their distress through empathetic feedbacks
Any further medical dialogue needs to be suspended until the patient is able to renegade it. This may take some time during which the clinician may provide more empathetic responses
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last S in SPIKES
Step 6: S – STRATEGY and SUMMARY
•Having, and knowing, a clear treatment plan will reduce anxiety and uncertainty but should be discussed only after patients are ready to address these issues.
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The impact and outcomes of illness : patients perspective
The process
1. Uncertainty: in this period the individual tries to understand the meaning and severity of the first symptoms.
2. Disruption: this occurs when it becomes evident to the individual that they have a significant illness. They experience a crisis characterised by intense stress and a high level of dependence on health professionals and other people emotionally close to them.
3. Striving for recovery: this period is typified by the individual attempting to gain some form of control over their illness by means of active coping.
4. Restoration of well-being: in this phase, the individual achieves a new emotional equilibrium based on an acceptance of the illness and its consequences
1.Disbelief, denial and shock
2.Dysphoria
3.Acceptance, optimism and long term copying strategies
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All individuals will move through stages in the same order, it’s continuous
True or fals
Fakse
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Three physical outcomes of illness
Death (not so relevant for health psychology)
• Fatigue (which is related with anxiety, depression and negative emotions)
• Immune changes
43
Which are the reactions to a diagnosis (which can include negative emotions)
Reactions to diagnosis (typically negative and sometimes catastrophic emotions)
• Emotional reaction to illness
- Depression and anxiety:
• Cancer
• Heart disease
• HIV and other pathologies with associated stigma (considered as a punishment)
- Loss of 'self'
44
Two process not to loss yourself after a disease diagnoses:
'hold on' to earlier ideas of 'self' (identity and worth, different roles) and learning to control the illness as something separate to these
- letting go' where patients accept that they cannot control everything and that they have boundaries.
45
With what is associated the positive responses to illness?
positive or optimistic outlook has been consistently associated either directly or indirectly (via effects on coping responses) with positive outcomes and reduced pain perception
46
Positive emotions in somatic diseases
Cardiac wellbeing in patients with CHD
- CD-4 T in HIV patients(CD4+ cell counts are usually measured when you are diagnosed with HIV (at baseline), every 3 to 6 months during first 2 years or until your CD4 count increases above 300 cells/mm3.)
- Pain reduction in patients with rheumatoid arthritis
47
Are Positive emotions are isomorphic to the negative ones?
No, They suggest that benefit-finding may have reflected early unrealistic hope which, when unmatched by outcomes, became a cause of distress.
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Positive emotions vs negative emotions
•Positive emotions are not isomorphic to the negative ones
• Negative emotions reduce behavioral choices
• Positive emotions increase behavioral choices
•Positive emotions increase the number of behaviors
• Positive emotions may "undo" negative emotions
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Meaning of post traumatic growth
In psychology, posttraumatic growth (PTG) is positive psychological change experienced as a result of struggling with highly challenging, highly stressful life circumstances.[1] These circumstances represent significant challenges to the adaptive resources of the individual, and pose significant challenges to the individual's way of understanding the world and their place in it.
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Benefits of post traumatic growth
1. enhanced personal relationships;
2. greater appreciation for life;
3. a sense of increased personal strength;
4. greater spirituality;
5. a valued change in life priorities and goals.
51
How to measure post traumatic growth
(a) evaluate her/his current standing on the dimension described in the item, e.g., a sense of closeness to others;
• (b) recall her/his previous standing on the same dimension;
• (c) compare the current and previous standings; (d) assess the degree of change;
• (e) determine how much of that change can be attributed to the stressful encounter
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Post traumatic growth can be bias by:
Post traumatic growth
• Memory bias
• Subjective Bias (the change is attributed to the diesase)
• Magnitude of change Bias ("[e]xaggerating the difficulty of past experiences is another way people enhance [their current status] -
Schacter 2001)
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Coping with illness
• According to Moos and Schaefer (1984)
illness can be described as a 'crisis' (crisis theory) the patient has to cope
• They identified three processes that resulted from the crisis of illness:
- 1. Cognitive appraisal: the individual appraises the implications of the illness for their lives. (Cognitive coping includes strategies such as seeking information about the illness, trying to understand its causes and consequences, and finding meaning in the experience. )
- 2. Adaptive tasks: the individual is required to perform illness-specific tasks such as dealing with symptoms, and general tasks such as preserving emotional balance, or relationships with others
- 3. Coping skills: the individual engages in coping strategies defined as either appraisal-focused (e.g. denial or minimising, positive reappraisal, mental preparation/ planning); problem-focused and emotion- focused.
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Problem-focused and acceptance
coping
Problem-focused and acceptance coping:
- Typically associated with better outcomes
* Religious and spiritual coping:
- Religious beliefs have been associated with higher perceived challenge appraisals, greater optimism, hope, meaning-making and better emotional and physical adjustment in older adults' response to general stress.
- Such beliefs are reflected also in coping behaviours. adopted across a range of ill-nesses
- However, the benefits are not consistently reported maybe because of different definitions and measurments
| PROLEM FOCUSED- antagonises the problem and has to be solved, make a plan
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Acceptance of illnes and when it can be challenged
Part of the process of adjusting to illness is the individual process of evaluating its impact on their lives and a central part of this is related to the person 'accepts' their illness.
This is not to suggest passivity, but rather, considered as beneficial to both patient mood and coping and to a range of key health
outcome
• Generally, acceptance is considered to be necessary if a patient is to 'move on' with their treatment or with their life more broadi. and is thought to benefit wider adjustment and quality of life.
•Acceptance may be challenged where there is a high degree of visibility: for example, in burns or injury victims. The reactions of others to one's appearance is an added challenge, with often negative consequences for self-confidence and self-esteem, social interaction and emotional well-being of the person affected
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What is quality of life and health related quality of life
What is quality of life
• Quality of life (QoL): individual's evaluation of overall life experience (situation, experiences, states and perceptions) at a given time (global quality of life)
• 'Health-related OoL' (HRQoL) evaluations of this life experience and how it is affected by symptoms, disease, accidents or treatments, and.
also by health policy
• "health-related quality of life is the gap between our expectations of health and our experience of it' (Carr et al., 2001)
57
Ool domains according to
WHO (WHOQOL-100)
1. physical health: pain and discomfort; energy and fatigue; sleep and rest;
2. psychological: positive feelings; self-esteem; thinking, memory, learning and concentration; bodily image and appearance;
negative feelings;
3. level of independence: activities of daily living (e.g. self-care); mobility; medication and treatment dependence; work capacity; social relationships: personal relationships; practical social support; sexual activity;
5. relation to environment: physical safety and security; financial resources; home environment; availability and quality of health/social care; learning opportunities; leisure participation and opportunities; transport; physical environment;
6. spirituality, religion and personal beliefs
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What influences quality of life?
'health-related quality of life is the gap between our expectations of health and our experience of it'
• Different expectation of health means different experiences of QoL and HRQoL
• Among others expectation (and thus QoL and HRQoL) may influenced by:
- demographics
- health condition: e.g. symptoms, presence or absence of pain, functional disability
- treatment: e.g. its availability, nature, extent, toxicity, side effects, etc.)
- psychosocial factors: e.g. emotions (anxiety, depression), coping, social context, goals and support.
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QoL in children is very different as compared to ageing population
In children is more related to be healthy and don't have any impairment
• In ageing is more related to successful ageing
• Expectancies are very important moderators
- E.g. knowing to have to cope with a permanent and irreversible condition may result in an improvement of OoL as compared to similar conditions which are not completely clear cut yet.
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Psychological variables affect 00L.
Particularly the presence of anxiety and mood symptoms are powerful modifiers
• Some researches suggest that several OoL measures are highly (negatively) correlated to depressive mood
• Coping strategies are important determinant of Ool.
- In some researches different coping strategies may increase OoL in different situations
- Even avoidant coping may be useful in situations where control is not possible
- However, other studies suggest that acceptance and positive re-interpretations are always better to increase goL
• Social support and QoL: a better Social support increase Qol
• Goal disturbance: when illness alter the individuals' goal this affect negatively the OoL.
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measuring QoL why?
• to inform: increased understanding about the multidimensional impact of illness and factors that moderate impact to:
- evaluate interventions and best practice
- inform patients about treatment outcomes or possible side effects in order that they are 'prepared' for them, or so that supportive resources can be put in place.
• to evaluate alternatives: QoL measures may be used as a form of clinical 'audit' to identify which interventions have the 'best' outcomes - for the patient, but also often in relation to costs (QALYs - number of years achieved with a good QoL).
• to promote communication: enable health professionals to address areas (otherwise not considered) like treatment satisfaction, treatment or illness impact on family interactions, social or sexual functioning
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Tools for measuring qol
Generic vs specific and standardized vs individualised
Generic vs. Specific QoL? (based on peoples illness)
- Generic measures allow for comparison between different illness groups, but may fail to address some unique QoL issues for that illness
- Disease-specific measures therefore have 'added value', but they do not allow for the same amount of between-illness comparability
• Standardized scales vs. individualised Qol
- Individualised methods (Q-SORT.SEIQoL, PGI)
(based on the domains)
highlights the subjective value of different domains to different people.
- Such methods are time- consuming and relatively complex processes, some of them showed only moderate reproducabilty, responsiveness to change and correlation with other OoL measures
- A possible solution is the use of standardized scales using only part of the items selected from a pool, dependent upon participants' prior responses to global questions.
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Assessing illness experience and outcome in children
adapting an adult questionnaire into a child version needs to consider cognitive limitations that make it difficult for young children to understand abstract questions such as those concerning life satisfaction or global well-being
• Although some measures have been developed specifically to assess Qol in child populations, few have been fully validated
• many studies using parents to complete questionnaires on behalf of their children (proxy measurement)
• parental 'proxy' reports in effect go against the principle of QoL being a personal subjective belief, as a parent may not share the same views
• By assessing 'visible' emotional distress, perhaps the reliability of parent proxy is increase
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Assessing ‘visible’ emotional distress
physical restriction (my child has been able to perform as usuall
•emotional distress: (my child has anger outbursts)
• discomfort from medical treatment: (my child complained of pain after a medical procedure)
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Mental representation of illness
Mental representations of illness (illness representations – IRs) emerge as soon as a person experiences a symptom or receives a diagnostic label. At this point they start a memory search to try to make sense of the current situation by retrieving pre-existing illness schemata with which they can compare
•IRs are acquired through the media, through personal experience and from family and friends and, as prototypes, they can be vague, inaccurate, extensive or detailed.
The new symptoms may be matched to a preexisting model or prototype of illness that the person goods
Erroneously matching IRs may be dangerous.
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Areas that define our representation of illness
Common sense model of illness
1. Identity: (face value what we can recollect among the illness) variables that identify the presence or absence of the illness. Illnesses are identified by label, concrete signs and concrete symptoms. For example, ‘I feel shivery and my joints ache, I think I have flu’.
•2. Consequences: the perceived effect of illness on life: physical, emotional, social, economic impact or a combination of factors. May be short-term or long- term. For example ‘Because of my illness I will have to take early retirement’.
•3. Cause: the perceived cause(s) of illness. May be biological (e.g. germs), emotional (e.g. stress, depression), genetic or environmental (e.g. pollution), or as a result of an individual’s own behavior. What are the problems/ probability to be cured!
It can be a problem because of the comparison of behavior and then don’t take responsibility of their actions- unreliable optimists. How we frame medical conditions.
•4. Timeline: the perceived time-frame for the development and duration of the illness. Can be acute (or short-term, with no long-term consequences), chronic (or long term) or episodic (or cyclical). For example, ‘I think my flu will last only three or four days’ or ‘My pain comes and goes’.
•5. Curability or controllability: the extent to which individuals perceive they, or others, can control, treat or limit progression of their illness. For example, ‘If I take this medicine it will help to reduce my symptoms’ This dimension may be particularly relevant for those facing chronic disease. Ex: diabetes.
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With the use of the illness perception questionnaire (IPQ) it was possible to better characterize the domains and their relationships:
•Domains are not independent:
–strongly believing that an illness can be controlled or cured is likely to be associated with fewer perceived serious consequences of the illness and a short expected duration.
•Domains are influenced by other variables:
–emotional representations are highly correlated with perceived consequences (high perceived negative
Consequences associated with high anxiety representation) -the way you tend to live emotions….
-also age
Domains are robust in terms of how they relate to each other, but illnesses differ in the specific strengths of each component. Ex: the way in different domains can relate with each other can be very different with respect to an illness to another.
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Illness representations may also affect the outcomes trough several pathways:
seeking and using/adhering to medical treatment
•engagement in self-care behaviour or behaviour change
•attitudes towards the use of brand-specific vs. generic medicines, and treatment choices
•illness-related disability and return to work
•caregiver anxiety and depression
•quality of life
In turn outcome and treatments may change the illness representation.
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Causal attribution of illness
(Attributional models)
•Attributional models consider ‘where’ a person locates the ‘cause’ of an event or symptoms and/or illness. (Locus of control) attribution model of illness
•We make attributions in order to attempt to make unexpected events more understandable or to try and gain some sense of control
•If we know ‘why’ something has happened, we can elicit coping efforts. Of course, attributions can be wrong and thus coping efforts misguided, as we will discuss later.
The majority of attributional research in health psychology has addressed “ill populations”
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Phases for clinical consultation
1. The doctor establishes a relationship with the patient.
2. The doctor attempts to discover the reason for the patient’s attendance.
3. The doctor conducts a verbal or physical examination or both.
4. The doctor, or the doctor and the patient, or the patient (in that order of probability) considers the condition.
5. The doctor, and occasionally the patient, considers further treatment or further investigation.
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factors for a good clinical consultation
1. having a good knowledge of research or medical information and being able to communicate this to the patient;
*2. achieving a good relationship with the patient;Therapeutic alliance, it influences the adherence to treatment
*3. establishing the nature of the patient’s medical problem;. Gathering information
*4. gaining an understanding of the patient’s understanding of their problem and its ramifications;Find the common ground to make them understand
Ex: their own understanding of an allergic reaction.
5. Engaging the patient in any decision making process- treatment choices
6. Managing time so that the consultations does not appear rushed
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Thre is two types of models of consultation which are:
The professional centered approach
The patient centered approach
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The professional-centered approach include:
*The health professional keeps control over the interview.
*They ask questions in order to gain information. These are direct, closed (allow yes/no answers), and refer to medical or other relevant facts.
*The health professional makes the decision.
*The patient passively accepts this decision.
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Patient-centered approach include:
*The professional identifies and works with the patient’s agenda as well as their own.
*The health professional actively listens to the patient and responds appropriately.
*Communication is characterised by the professional encouraging engagement and seeking the patient’s ideas about what is wrong with them and how their condition may be treated.
Negative: the patient can believe they have the same or more knowledge than the physician making it complicated for both to give a treatment or to be treated. The physician is confronted or doubtful
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The decision making process
* Choice refers to the step of making sure that patients know that reasonable treatment options are available. The health professional 'conveys awareness' that a choice exists.
* Option refers to providing more detailed information about options. Patients are informed about treatment options in more detail.
* Decision refers to supporting the work of considering preferences and deciding what is best. The patient is encouraged to determine their initial choice, based on their existing knowledge and then shift this to informed preferences based on 'what matters most to patients' based on an understanding of the most relevant benefits and harms. => where equipoise does not exist the health professional may educate the patients to help them understand or accept the health professionals choice of treatment.
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breaking bad news first part:
After the patient has been given a brief period of time to express his or her feelings, the clinician should respond to their distress through empathetic feedbacks
Any further medical dialogue needs to be suspended until the patient is able to renegade it. This may take some time during which the clinician may provide more empathetic responses
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compliance in health psychology
Compliance of the patients to the physician’s order is the obedience, the outcome of the consultation broad forward from the professional centered approach. The patient should not make any questions because it is not logical for it to obey (extreme case).
Example:you can calculate the compliance by counting the compliance to the treatment by counting the pills that were supposed to be ingested.
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adherence in health psychology:
Adherence is a joint agreement to the physician's order. How much the patients respect the joint agreement of the physician.
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concordance
Concordance is the shared decision that the treatment is a good one for the patients and should be followed as agreed by physician and patient
It does not explicitly describe adherence behavior, but more the conditions in which to encourage it
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What will affect to compliance adherence and concordance ?
* social factors: including low levels of education, unemployment, concomitant drug use, low levels of social support;
*psychological factors: including high levels of anxiety and depression, use of emotion focused coping strategies such as denial, a belief that continued use of a drug will reduce its effectiveness, taking drug holidays to prevent "harm' as a consequence of long- term drug use; (e.i. lithium)
* treatment factors: including misunderstandings regarding treatment, complexity of the treatment regimen, high numbers or fear of side effects, little obvious benefit from taking medication, poor relationship between patient and health-care provider, poor health professional-patient communication.
-a problem with adherence might arrive because of not clear outcomes from the treatment.
-
* Illness representation and health beliefs (especially in case of asymptomatic conditions)
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To maximize medication use it is important to:
–Achieve concordance (and not just compliance )
–Maximizing understanding (use of prepared-prompts prepared by the patients with all the questions to ask physicians)
–Maximizing memory:
*Relevant information should be given at the beginning or at the end, with the necessary emphasis
*Providing specific statements instead of general one
*Ask patients to repeat the statements
*Provide permanent record of information (written or audiotape)
Behavioral tips/ memory cues
To keep patients take medications is useful to:
–Reduce the memory load (one pill a day, associate treatment with routine activities as eat or go to sleep, use pills dispensers)
–Use reminders (text, app, telephone calls, emails)
–Use self-monitoring (diary)
Changing behaviors is more complicated than taking medication both to measure and to be implemented by patients because patients can choose not as animals.
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reason for not adherence
*Discomfort (e.g. pain, heat or cold to do exercises)
*Social constraints (e.g. difficult to change diet as compared to the rest of the family) maybe if work or to not eat what others have
*Lack of motivation (illness representation, health belief models) comparing with others and saying that you are not bad
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how to improve adherence
Self monitoring
*Graded exercise (small but continuous achievements of objectives)
Self-control strategies: participants are more likely to adhere to a programme if they attribute any successful behavioural change to their own efforts rather than those of health professionals. This can be enhanced by teaching self-management skills such as self-monitoring, goal setting, planning
*Relapse prevention: this involves identifying high-risk situations that may result in ‘relapse’ back to previous behaviours, and planning how to avoid or cope with them. It may also involve planning how to re-engage with any behavioral change following a ‘relapse’.
*Motivational strategies: these may include a stepwise progression in the degree of behaviour change made setting achievable personal goals and measuring successes in reaching them, rewarding oneself for success – with concrete rewards
*Make change habitual: change should be continuous and sustained, not intermittent. Rewarding appropriate dietary choice with, for example, an occasional high- calorie ‘take way’ meal prevents the establishment of long-term habits, which are the key to long-term change.
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the two types of caregivers and their characteristicas
Formal caregiver is a professional carer
Informal caregiver tends to be untrained family members or friends of the person with the illness or disability, who have no contractual ‘hours’ per se, no clearly defined limits to their role and variable financial recompense
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Self evaluation of the role of caregiver
| four
* Those who ‘embraced’ the carer identity as congruent with their other identities (regardless of whether support provided was more emotional or practical in nature);
* Those who enforced the identity but in discord with their other identities (e.g. partner, sibling, child) with an acknowledged loss of self and of the spousal role;
* Those who absorbed a partial carer identity but with ambivalence, pragmatism and flexibility depending on the needs of the day (‘I’m just my dad’s son looking after him. But if I’m speaking to somebody I’ll say I’m his carer because that’s what I’m doing);
* Those who rejected the carer identity in favour of holding on to their relationship identity: i.e. whilst acknowledging they may be described as a carer by others, they did not internalise this identity
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The amount of burden and the expectancies of care depends upon:
1. 1. Gender (females are prototypically considered as carer/nurturer)- it can be a bias.. as some biological reasons as leave longer and healthier.
2. Cultural factors
3. Motivation: intrinsic motivations to care (e.g. principles, caring nature, pre-existing relationship) vs. extrinsic motivations (e.g. out of guilt or expectation)
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family dynamic after a memeber recibing a diagnosis
| family system
1. Stage of resistance: family members try to deny or avoid the reality of what has happened.
2. Stage of restructuring: family members begin to acknowledge reality and start to reorganise their lives around the notion of a changed family.
3. Stage of consolidation: newly adopted roles may have to become permanent, for example if recovery is not forthcoming; and where new ways of thinking (about life/health/behaviour) may emerge.
resistence, restructuring, consolidation
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Spouse as caregivers
By nature of co-habiting, spouses will provide more hours of support, spanning the range of needs over a day and night.
In couples, support, whether practical, emotional or financial, tends to come from each other in the first instance and thus the supportive relationship is generally reciprocal, although most research has to date addressed the giving of support to patients by their carer spouses, and not the carer’s own receipt of support
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Supportive relationships: Benefits of social support are to both, the care recipient and the caregiver and include, for example:
Benefits of social support are to both the care recipient and the caregiver and include, for example:
increased care recipient adherence to treatment and self-care
better caregiver emotional adjustment, including following spousal heart attack, or bereavement
improved marital relationships
reduced caregiver burden and isolation
reduced mortality or increased survival
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helpful and unhelpful caring
There are common caring actions that are perceived as helpful and relative consistency in terms of actions considered to be unhelpful
Patients who perceived their caregivers’ actions as unhelpful have been found to have more negative perceptions of themselves and their spouses, and greater depression.
Helpful actions have generally been shown to occur more frequently than unhelpful actions
Unhelpful actions appear to have a more strongly negative effect on well-being than helpful actions have a positive effect
Over caring or being overly helpful and solicitous (e.g. taking over a person’s chores, encourag- ing them to rest) can act as a form of operant conditioning in which patients are rewarded for exhibiting ‘sick role’ behaviour
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examples of helpful and unhelpful caring
Examples of social interactions that are unsupportive and detrimental to the care receiver’s well-being:
insensitivity;
disconnecting or disengaging behaviour;
blaming or fault-finding;
forced optimism.
| predict depression
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Consequences of caring for the caregiver
Providing care for, or helping others in an altruistic manner, for example through voluntary work, has generally been associated with social, emotional and possibly physical well-being of the helper
Providing regular care in the context of illness in a loved one has been seen more often as a threat to well-being
‘Caregiver burden’, is defined as the objective and subjective ‘costs’ of caring to the caregiver
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causes of caregiver distress
• The financial drain of caring caused by caring interference with employment
• The emotional demands of providing long-term care for a relative who often provides little in return
• The physically tiring nature of some caring roles
• The inability to replenish personal resources due to social isolation or poor utilisation of support resources and leisure time
Or more deep-seated, even unacknowledged sources of stress:
• Feelings of anger (e.g. with the person for becoming ill, for them being born handicapped
• Feelings of guilt (e.g. that they may have directly/indirectly contributed to the situation)
• Feelings of grief (e.g. that they have 'lost who they used to have)
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Emotional impact of caring
Caregivers’ physical health and life satisfaction are generally found to be lower than in non-caregivers.
Studies suggest that emotional distress is most marked among women caregivers
Some of the reported gender differences may be confounded by the fact that up to three-quarters of caregivers are women
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Physical effects of caring
Inconsistent evidence:
sleep and weight disturbance
physical health complaints
back or joint pain
Apparently more in women caregivers
Other studies do not find differences between caregivers and non-caregivers in ageing populations
Immune function seems to be affected as well especially in ageing caregiver population
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Positive aspects of caregiving
There are many reports of subjective feelings of satisfaction and rewards arising from the care role.
sense of fulfilment
feeling useful
increased feelings of closeness
greater empathy and compassion
significant survival advantage
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Moderators of burden
Type of disease (including the perception of chronicity)
Ethnicity
Personality
Appraisal and efficacy
Use of social support (NOT ONLY presence of social support)
Protecting Buffering
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Appraisal and efficacy (Domains of perceived efficacy in the caregivers:
)
managing medical information
caring for the care recipient
caring for oneself
managing difficult interactions and emotions
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Relationship between caregiver and patients
* A better couple life reduces distress
* Small gestures even in the situation of caring (Express or thank for caring) ameliorate the relationship
* depressed caregivers reported close, communal and intimate relationships with the patient, and this closeness created the restrictions on their own activities
* resentful caregivers reported less close relationships and reported their activity restriction to be predicted by severity of patient symptoms
* resentful caregivers tend to provide overly controlling and overprotective care, and they suggest that such caring styles may undermine patient autonomy and progress
second part:
* Patients and caregiver may not share the same opinion on:
* Illness (Illness Beliefs, illness representation …)
* Need to care (or to be cared)
* Amount of help/care given(or received)
* Patients with low personal control beliefs may benefit from caregivers with high personal control beliefs. While when both have high levels there is typical a higher level of distress
* However, shared perceptions and dyadic coping are more adaptive than discrepant and individual responses
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ways of copying chronic illness (prevent the development of the disease)
providing relevant information;
stress management training;
the use of social support;
self-management training;
the use of written emotional expression.
enhancing social support
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ways of coping with chronic illness
1) Provide relevant information
the nature of a disease and/or its treatment;
how to cope with disease and/or its treatment;
how to change behavior in order to reduce the risk of disease or disease progression.
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2) stress management training and stress-provoking thoughtd which may initiate
problem-solving: to prevent or minimize external
problems that contribute to stress;
cognitive restructuring: to identify and challenge
*stress-provoking thoughts which may initiate or
exacerbate the stress response;
relaxation: to reduce the physiological arousal that
forms part of the stress response.
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3) self/stress management training
The approach has proven effective at various stages in the process of care, including:
waiting for a diagnosis;
during treatment
coping with the emotional stress of living with a long-term illness.
Relevant benefit:
a greater enthusiasm to live life to the full;
making positive life choices as a result of illness;
a greater appreciation of being alive;
improved relationships with partner
Mindfulness
MBSR protocols=midfulness based stress reduction
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4) Enhancing social support
building strong, supportive bonds;
expressing emotions;
dealing directly with fears of dying;
improving relationships within the family;
active involvement in decisions concerning treatment
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ways of copying chronic illness (minimise its negative impact on the affected individual)
a)providing relevant information;
b) self-management training;
stress management training;
c)the use of social support;
enhancing social support
d) the use of written emotional expression.
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a)providing relevant information;
patient education programs can enhance knowledge about a condition or its management, at least in the short term
However, even where increases in knowledge are achieved, they may not always impact on behavior or symptom control.
The internet now provides a key source of information for many patients.
This provides both formal ‘official’ sites and ‘unofficial’ sites, many of which advocate the use of a variety of treatment approaches or condemn them as dangerous and unacceptable.
Given the plethora of, often contradictory, information on the internet, access to this information can both benefit patients and carry the potential for confusion and even harm.
It also presents significant challenges for doctors when giving information about a particular condition.
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b) self-management training;
stress management training;
Self-management training:
The approach involves teaching affected individuals how to manage their illness in a way that maximises control over their symptoms and quality of life
example with arthritis:
exercising with arthritis;
● managing pain;
● eating healthily;
● preventing fatigue;
● protecting joints;
● taking arthritis medication;
● dealing with stress and depression;
● working with the doctor and healthcare team;
● evaluating alternative treatments;
● outsmarting arthritis: problem solving.
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b.2)stress management training;
rheumatoid arthritis
atopic dermatitis
irritable bowel syndrome (IBS)
angina
diabetes
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c) enhancing social and family support
Acknowledged the impact that family and friends of people with chronic illnesses may have on their behaviour and emotional well-being
Relatively few interventions have targeted such individuals.
Generally positive results with some cautionary findings
Results on CHD, diabetes, lung cancer
Target: best friends, partner or the entire family
Some ‘unclear’ results for instance after the ‘training’ phase the behavioral change not only disappear but there is rebound effect on number of requests for visits – in a study on CHD patients in a internet social support group
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d) emotional expression (managing illness) (minimise its negative impact on the affected individual)
Find a secluded place where you can write comfortably, either by hand or on a computer. Alternatively, you can use a tape recorder if writing isn't your preference.
Allocate a minimum of three days for your writing process, dedicating at least 15 minutes each day. The key rule is to write continuously. If you reach a point where you have nothing more to say, feel free to repeat what you've already written.
Let go of any inhibitions and delve into your deepest thoughts and feelings about X. Explore how X relates to different aspects of your life, such as your childhood, relationships with family and friends, current life circumstances, and potential future implications. Reflect on the reasons behind your emotions and consider any other related issues that arise.
You can choose to focus on the same topic throughout or explore different subjects each day. Spelling and grammar shouldn't concern you as this writing is solely for your personal use. Some people discard their writing once they're done, while others keep and even revise their work.
Embrace an experimental mindset and try various writing approaches. If you find yourself becoming too distressed during the process, take a step back and change your direction. Remember, the goal is to gain a better understanding of your thoughts and feelings regarding X. Determine which writing approach suits you best through experimentation.
*the interventions that have been conducted appear to show benefits:
Rheumatoid arthritis
Asthma – some negative results as well
Brest cancer
patients reported fewer somatic symptoms and fewer visits to the doctor with worries about cancer or related medical conditions
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PRECEDE–PROCEED MODEL:
Before any intervention is developed, determine which behaviours to address and how best to address them is necessary
PRECEDE: identifies a range of psychosocial variables that could be the target of any intervention
PRECEDE: takes into account any political, social and environmental influences that may facilitate behaviour change, including changes in health, education, or social policy
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precede factors of precede and procede model
Predisposing factors: knowledge, attitudes, beliefs, personal preferences, existing skills and self-efficacy in relation to desired behaviour change.
Enabling factors: characteristics of the environment that may facilitate behavioural change and the skills or resources required to achieve change. These include environmental factors such as the availability and accessibility of resources or services
Reinforcing factors: factors that reward or reinforce desired behaviour change, including social support, economic rewards and social norms
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PRECEDE phases
Phase 1: social diagnosis
Planners gain an understanding of the health problems that affect the quality of life of a community and its members, their strengths, weaknesses, resources and readiness to change.
This may stem from community forums, focus groups, surveys and/or interviews.
Phase 2: epidemiological, behaviour and environmental diagnosis
Epidemiological assessment involves identification and assessment of health issue(s) specific to the community, and their related behavioural and environmental influences. For example poor nutrition may be related to poor cooking skills, low nutritional knowledge, social norms that support the use of snacks and ready meals
Interventions here may require policy changes.
Phase 3: educational and ecological diagnosis
This phase involves prioritising and determining how to change any behaviours identified in phase 2, and identifying predisposing factors, enabling factors and reinforcing factors of relevance. Consideration is also given to the likely impact of any behavioural change
Phase 4: administrative and policy diagnosis
Designed to ensure that the programme is consistent with the policies of the organisation in which it is situated and which it wishes to address.
AKA PROCEED=Phase 5: programme implementation
The PROCEED phase is the implementation of the planned intervention with three elements of evaluation:
Process: did the programme do what was intended?
Impact: what impact did the intervention have on the target behaviours/outcomes?
Outcome: what long-term effects on health were achieved
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Strategies for changing risk behavior
1. pre-contemplation: not considering change;
2. contemplation: considering change but without thought about its exact nature or how it can be achieved;
3. preparation: planning how to achieve change;
4. change: actively engaged in change;
5. maintenance or relapse: maintaining change (for longer than six months) or relapsing
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Motivating change Information Provision
clear information may be of benefit when it is:
completely novel
does not contradict previous understandings of issues
is highly relevant to the individual
is relatively easy to act on
health-related information rarely meets all these criteria.
when it does, it may well not impact on behaviour
The NICE guidelines on behavioral change:
Key messages for motivate changing (in smoke cessation) should influence:
outcome expectancies: Smoking causes people to die on average eight years earlier than the average
personal relevance: If you were to stop smoking, you could add eight years to your life, and be fitter over that time.
positive attitude: Life is good and worth living. Better to be fit as you get older than unable to engage in things you would like to do.
self-efficacy: You have managed to quit before. With some support there is no reason why you cannot sustain change now.
descriptive norms: Around 30 per cent of people of your age have successfully given up smoking.
subjective norms: Your wife and kids will appreciate it if you were to give up smoking.
personal and moral norms: Smoking is anti-social and you do not want your kids to start smoking
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The elaboration likelihood approach
The model suggests that attempts to motivate people who are not interested in a particular issue using rational argument will not work
Only those individuals with a pre- existing interest in the issue are likely to attend to such information and, perhaps, act on it
individuals are more ‘motivated to receive an argument’ when:
it is congruent with their pre-existing beliefs;
it has personal relevance to them;
recipients have the intellectual capacity to understand the message.
According to this approach , influence in not motivated subjects is less reliable but still possible.
The model suggests that this can be achieved through what it terms ‘peripheral processing’
Peripheral processing involves maximising the credibility and attractiveness of the source of the message using indirect cues and information.
The long term effects of the approach of the use of the peripheral route are uncertain
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Change behavior Fear as a tool
Another approach to increasing the influence of both mass media and interpersonal communication is through the use of fear messages.
Many health professionals consider this a key strategy to motivate change, and the approach has also proven popular among health promoters, politicians, and those involved in the mass media, including its recipients.
Some studies found the general public considered fear- engendering advertisements to be more effective than humour.
Most of the literature however suggest that high levels of threat are relatively ineffective in engendering behavioural change.Two different copying strategies can be adopted to face fearful messages:
Danger control: reducing the threat, by actively focusing on solutions.
Fear control: reducing the perception of the risk, by avoiding thinking about the threat.
For danger control to be selected, a person needs to consider that an effective response is available (response efficacy) and that they are capable of engaging in this response (self-efficacy).
If danger control is not selected, then fear control becomes the dominant coping strategy.
Fear control, involves withdrawal from the message as it is too overwhelming
According to the available models the most persuasive messages are those that:
arouse some degree of fear
increase a sense of severity if no change is made
emphasise self efficacy
There are good theoretical and empirical reasons to suggest that interventions based entirely on fear arousal are likely to be of little benefit
Subsequent fear-based messages have also failed to promote appropriate behavioural change, and may even increase feelings of shame and scepticism relating to the issues being addressed
If fear messages are used, they need to be accompanied with simple, easily accessible strategies of reducing the fear.
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information framing in changing behavior
Health messages can be framed in either positive (stressing positive outcomes associated with action) or negative terms (emphasising negative outcomes associated with failure to act).
Negative framing is quite close to the fear arousal
Framing may represent a less threatening approach to the development of health messages
Both negative and positive framing are considered effective
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motivational interviewing changing behavior
It is a very effective form of persuasion in one-to-one interventions
It is aimed to increase an individual’s motivation to consider change, not to show them how to change.
It is designed to help people explore and resolve any ambivalence they may have about changing their behaviour.
The goal of the interview is to elicit the ambivalence of beliefs and attitudes and to bring it into sharp focus to place the individual in a state of cognitive dissonance which is resolved by rejecting one set of beliefs in favour of the other
If an individual decides to change their behaviour, the intervention then focuses on consideration of how to achieve change
It is deliberately non- confrontational. It is supporting individual change but is not attempting to persuade an individual to go against their own wishes.
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motivational interview-key structure
Opening questions:
What are some of the good things about your present behaviour?
What are the not so good things about your present behaviour?
Consideration of the disadvantages of the status quo:
What worries you about your current situation?
What makes you think that you need to do something about your blood pressure?
What do you think will happen if you don’t change anything?
Consideration of the advantages of change:
What would be the good things about losing weight?
What would you like your life to be like five years from now?
If you could make this change immediately, by magic, how might things be better?
Evoking the intention to change:
I can see that you’re feeling stuck at the moment. What’s going to have to change?
How important is this to you? How much do you want to do this?
Of the options I’ve mentioned, which one sounds like it fits you best?
Never mind the ‘how’ for right now – what do you want to have happen?
So what do you intend to do?
Evoking optimism about change:
What do you think would work for you, if you decided to change?
When else in your life have you made a significant change like this? How did you do it?
How confident are you that you can make this change?
What personal strengths do you have that will help you succeed?
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Changing Behaviour and problem solving
Problem-focused interventions involve considering how, rather than whether, to change and are best suited to individuals who want to change their behaviour but need help working out how to do this.
problem-focused counselling approach
It is focused specifically on the issues at hand and in the ‘here and now’, and has three distinct phases:
1. problem exploration and clarification: a detailed and thorough exploration of the problems an individual is facing: breaking ‘global insolvable problems’ into carefully defined soluble elements;
2. goal setting: identifying how the individual would like things to be different; setting clear, behaviourally defined and achievable goals (or sub-goals);
3. facilitating action: developing plans and strategies through which these goals can be achieved.
Some people may not need to work through each stage of the counselling process but the stages should addressed sequentially
Others may be able to work through all the phases in one session.
Others may require several counselling sessions.
Once you enter one stage is important to deal with it thoroughly.
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implementing plans and intentions changing behavior
We often fail to translate goal intentions into goal attainment. This may occur for a number of reasons:
Failing to start: the individuals do not remember to start, they do not seize the opportunity to act, or they have second thoughts at the critical moment.
Becoming ‘derailed’ from goal striving: the individual is derailed by enticing stimuli, individual finds it difficult to suppress habitual behavioural responses, or may be affected by negative mood states.
To overcome these obstacles, a relatively simple procedure known as implementation intentions may be utilised involving the ‘if–then’ approach
(modelling practice)
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modelling and practice changing behavior
Problem-focused and implementation-intention based interventions can help individuals develop strategies of change
However, achieving change can still be difficult, where an individual lacks the skills or confidence in their ability to make them
One way to remedy these deficits is by learning skills from observation (vicarious learning or observational learning)
Bandura identifies three basic models of observational learning:
A live model, which involves an actual individual demonstrating or acting out a behaviour
A verbal instructional model, which involves descriptions and explanations of a behaviour
A symbolic model, which involves real or fictional characters displaying behaviours in books, films, tel- evision programmes, or online media
Modelling and practice are also related to the necessity to practice the new behaviours and obtain reinforces (modelling) when the new behaviours are chosen instead of the old ones
Also reinforces can be conveyed in an observational vicarious way (e.g. the individual learns how a change in behaviour positively affect another individual)
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cognitive interventions for changing behavior
Cognitive strategies attempt to change directly cognitions that
drive an individual to engage in behaviours that may be harmful
prevent them making appropriate behavioural changes.
Various categories of relevant cognitions have been identified:
attitudes towards the behaviour and relevant social norms
beliefs about the costs and benefits of disease prevention and behavioural change
self- efficacy expectations
beliefs about an illness or condition and the ability to manage it
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examples of distorted beliefs
I cannot cope with going to a party without a hit / But I did cope without drinking in the past
Drinking makes me a more sociable person / But I may result sociable anyway
It will be fun to get high / I used to have fun even without getting high
I need a drink to get me through the day / I used to get trough the day without a drink so I think I can do it now as well
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BECK AND ELLIS
ABC
Dysfunctional/irrational Beliefs
Depressive triad
The down arrow technique
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The down arrow technique
Descent technique allows the therapist to access the beliefs underlying current thoughts or concerns. The veracity and helpfulness of these underlying or core beliefs can then be explored and addressed.
Down arrow:
Identifies core beliefs
Challenge core beliefs and their irrationality
Set possible homework:
Realistic
Measurable
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Adolescencence in health conception in the lifespan
Adolescence:
illness concepts at this stage as being at an abstract level, based on interactions between the person and their environment:
- Physiological: adolescents now reach a stage of physiological understanding where most can define illness in terms of specific bodily organs or functions (e.g. germs cause white blood cells to get active to try and fight them), and begin to appreciate multiple physical causes, e.g. genes plus pollution plus behaviour.
- Psychophysiological: in later adolescence (from around 14 years) and in adulthood, many people grasp the idea that mind and body interact, and under- stand or accept the role of stress, worry, etc. in the exacerbation and even the cause of illness.
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Challeging some views about aging The 3rd age
of those aged 65+ as a period of fulfillment as not all of course become ill or infirm at this point! (Laslett (1996))
The English Longitudinal Study of Ageing, highlights that increased risk of dying prematurely is associated with poorer enjoyment of life, thus highlighting the role of subjective well-being, what- ever the age.
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Challeging some views about ageing the 4th age
The ‘4th age’, however, is more strongly associated with disability and dependence, relating to the ‘oldest old’ those aged over 80 where health does decline more rapidly.
“Will you still feed me will you still need me when I’m 64?”
(Sir Paul McCartney, When I’m 64, Sgt. Pepper Lonely Heart Club Band – 1967)
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Aging is related to (if we stick to average)
Decrease of movement and, in general healthy behaviors
Loss of strength, stamina, and physical condition
Loss of independence
Loss of role (retirement)
Loss of significant others
Chronic conditions (e.g. Hypertension, Diabetes etc.)
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Healthy aging Bowling and Iliffe (2006) describe 5 progressively more inclusive ‘models’ of successful aging:
Biomedical: physical and psychiatric functioning – diagnoses and functional ability
Broader biomedical: as above but plus social engagement and activity.
Social functioning: nature and frequency of social functioning and networks, social support accessed.
Psychological resources : personal characteristics of optimism and self-efficacy and on sense of purpose, coping and problem solving, self- confidence and self-worth.
Lay : above variables plus socio- economic variables of income and ‘perceived social capital’, which included access to resources and facilities, environmental quality and problems (e.g. crime, pollution, places to walk).
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Individual Differences affecting symptom perception
Gender:
pain threshold, gender specific symptoms, differences in developed illness cognitions
Life stage (age):
increasing age tends to be associated with increased symptom self-report
Emotions and personality traits:
Negative mood, fear, nevroticism, negative affectivity
Cognitions and coping styles:
Type A personality
Repression and comparative optimism
Monitors vs. Blunters
