Healthcare and Lifestyle Coaching Flashcards
What referrals are recommended for mild-to-moderate depression?
Low-intensity psycosocial intervention by IAPT.
Group-based CBT.
Which patients should you consider referral GP for anti-depressants for?
A history of moderate or severe depression.
Subthreshold depressive symptoms which have persisted for at least 2 years.
Subthreshold symptoms or mild depression that persists after other interventions.
Mild depression is complicating the care of a chronic physical health problem.
What is the 5-stage scale of depression?
- Sub-threshold - fewer than 5 but at least 1 key symptoms.
- Mild - >5 symptoms required to make diagnosis but just. Symptoms result in minor functional impairment.
- Moderate - symptoms or functional impairment between mild and severe.
- Severe - most symptoms present and are interfering with functioning.
- Complex - inadequate response to multiple treatment and is complicated by psychotic symptoms.
What are the key symptoms of depression?
9
Depressed mood most of the day, nearly every day.
Diminished interest/pleasure in almost all activities for most of the day, nearly every day,
Significant (>5%) weight loss when not dieting, weight gain, or decrease in appetite.
Insomnia or hypersomnia.
Fatigue or loss of energy.
Feelings of worthlessness or guilt.
Diminished concentration.
Indecisiveness.
Recurrent thoughts of death, suicidal ideation.
What is an easy way to remember a balanced diet?
Each meal should have:
Proteins - 1 palm
Vegetables - 1 fist
Carbs - 1 cupped hand
Fats - 1 thumb
What is the GROW model for feedback?
- Goal setting - define a clear goal and evoke an emotional response.
- Reality - what are the current challenges at the moment?
- Options - use OARS. Keep things simple and in line with their lifestyle/culture/values.
- What - what is the plan? What changes will be made, and how will we deal with obstacles? Use success boards, diaries etc.
What is OARS model?
Open questions - what do you think you can change? What would you prefer to do?
Affirmation - that’s a great idea, that would be even better if…
Reflective listening
Summary reflection - summarise options to help choose.
What technique can be used to help patients avoid triggers?
Shield -remove triggers from their life.
Survive - if a trigger can’t be removed, alter it so its less likely to be triggering.
Step away - if a trigger cannot be removed or altered, remove yourself from the situation.
Normal HbA1c range
<6% or 42mmol/L
Normal cholesterol
Total: <5mmol/L
HDL: >1mmol/L
Non-HDL: <4mmol/L
Normal BP
<120/80mmHg
Normal BMI
18.5-24.89
>25 = overweight
>30 = obese
What are some good initial open-ended questions?
What would you like to get out of this session?
What would you like to be different when we finish this session?
What are you ultimately seeking to achieve?
What is your first step to achieving this?
What are presuppositions and mind-reads?
Pre-suppositions - general statements we accept from someones language.
Mind-reads - addition of our own assumptions, emotions.
For example: “I stopped eating meat”.
Presupposition: They used to eat meat.
Mind-read: They dislike cruelty to animals.
What are the different types of questions?
Closed - no opportunity for development, there is a selected number of answers.
Open - patient has freedom of answer.
Leading - insinuates a certain answer should be given.
Probing - usually used when requiring more information about a previous answer.
When are closed questions best used?
To assist people with linguistic difficulties.
To give pharmacists control of the interaction.
To gather specific information.
To help embarrassed patients who may not open up otherwise.
What is an example of a negative closed question and why should they never be used?
Positive: “Are you using your inhaler as prescribed?”
Negative: “Am I right in thinking you’re not using your inhaler as prescribed?”
Decreases trust, rapport, and empathy.
What is the concept of clean language?
Designed to reduce any influence from the coach’s belief and assumptions by directing the patient’s attention to some aspecys of their experiences.
What are some questions which can be used for clean language?
And is there anything else about…?
And what kind of …….. is that?
And where is……..?
And what happens next?
And then what happens?
And what happens just before …..?
And where could …………come from? -And that ………….. is like what?
What questions could be used in the Goal setting section of GROW?
What would you like to work on?
What would you like to have after answering this set of questions (eg, a first step/strategy/solution)?
What is your goal related to this issue?
When are you going to achieve it?
What are the benefits for you in achieving this goal?
Who else will benefit and in what way?
What will it be like if you achieve your goal?
What will you see/hear/feel?
What questions could be used in the Realty checking section of GROW?
What action have you taken so far?
What is moving you toward your goal?
What is getting in the way?
What questions could be used in the options section of GROW?
What different kind of options do you have to achieve your goal?
What else could you do?
What are the principal advantages and disadvantages of each option?
What questions could be used in the What section of GROW?
Which options will you choose to act on?
When are you going to start each action?
How committed are you, on a scale of 1–10, to taking each of these actions?
If it is not a 10, what would make it a 10? What will you commit to doing?
What is a safe weight loss rate?
0.5-1kg per week.
5% in 6-12 months.
