HealthPsych Session 4 Flashcards
What are associated with an increased risk of anxiety and stress in the future following diagnosis of a chronic illness?
Unresolved questions
What emotional responses may be seen following a diagnosis of a chronic illness?
Shock Anxiety Depression Denial Anger Fear
What are potential stressors due to the physical impacts of chronic disease?
Pain, limited mobility etc
What are potential stressors due to the treatment of a chronic disease?
Anxiety about procedure Discomfort during procedure Impact on body image Burden of health management Long term lifestyle changes
What potential stressors are a result of hospitalisation in chronic disease?
Loss of autonomy
Loss of privacy
Loss of status
Potential removal from usual support network
What is biographical disruption in chronic disease?
Projected life trajectory is thrown off course
What can biographical disruption lead to when adjusting to a chronic disease diagnosis?
Change in identity
Can’t make long term plans
Acknowledgment of own mortality
What is the socioeconomic impact of a chronic disease diagnosis?
Financial problems: may have to give up work
Social problems: housing, childcare etc
Relationship problems: strain on family, friends, colleagues etc
How can coping be defined by the transactional model of stress?
During appraisal person decides they have the skills/resources to not allow a stressor to lead to a stress response
What do all patients with a chronic disease require regardless of their appraisals during the transitional model?
Adjustment
Which two approaches can be used in emotion focused coping?
Behavioural
Cognitive
What are behavioural approaches in emotion focused coping?
Doing something to change the emotion e.g. talking to friends, alcohol, finding a distraction
What are cognitive approaches to emotion focused coping?
Changing how you think e.g. denial, focusing on +ve aspect of problem, seeing problems as challenges to showcase abilities
What two approaches can be used in problem focused coping?
Reduce demands of stressful situation
Expand sources to deal with stressful situation
How can the demands of a stressful situation be reduced in problem focused coping?
Learn how to manage condition
Learn how to manage feelings around Tx
How can a person expand their resources to deal with a stressful situation in problem focused coping?
Attend structured teaching on managing condition
Focus on physiotherapy
Buy useful equipment
Which type of coping is associated with better adjustment?
Active
What type of coping is usually used in chronic illness?
Passive
What should be considered when giving a patient with chronic illness information?
Their coping style
What are the 3 ways that can aid coping with chronic illness?
Increase and mobilise social support
Increase personal control
Prepare pts for stressful events by decreasing ambiguity and uncertainty
What suggestions can be made to help a pt mobilise social support?
Social services
Chaplain
Pt support groups
How can personal control be increased to help pts cope with chronic illness?
Pain management CBT Self-management programmes Involve pt in care planning Facilitating cognitive control
How can pts be prepared for stressful event in their chronic illness?
Effective communication
Peer contact w/others who have had same Tx
Exposure to environment before procedure (children)
What are the outcomes of successful coping?
Tolerate/adjust to -ve events or realities
Continue satisfying relationships with others
Decrease threats and enhance prospects of recover
Preparation for the future
Maintain emotional equilibrium
Maintain a +ve self image mastery
What might cause anxiety in a pt with chronic illness?
Threats to identity
Threats to well being
Threatening events: surgery, test results
Uncertainty of prognosis
What may be experienced by a pt with chronic illness at various stages indicating they are suffering from anxiety?
Unpleasant emotional state which may include feelings of panic or dread
What does sustained anxiety in chronic illness lead to?
Unhelpful thinking patterns:
Increased vigilance of threats
Interpret ambiguous information as threatening
Increased recall of threatening memories
Physiological effects
Anxiety disorders (phobia, panic attacks, PTSD)
What may cause depression in a pt with chronic illness?
Loss of health/physical capacity Loss of identity/social status Reaction to symptoms Physiological changes Medication
What is depression?
Emotional state characterised by persistent low mood, sadness, loss of interest, despair, feelings of worthlessness
Which chronic disease pts are more at risk of developing depression?
Those with more severe/painful/disability illness in the context of other -ve life events or when lacking resources to cope
How can co-morbid depression adversely affect illness outcomes?
Directly or indirectly by choosing ineffective coping mechanisms
What are barriers to recognising psychological problems in chronic illness pts?
Symptoms attributed to illness
Symptoms experienced outwith consultation
Pt perception of inevitability, stigma, judgement, being burden, failing to cope
HCP don’t ask - outwith role/capacity, time constraints, don’t want to stigmatise pt
What is the biomedical a theory of pain?
Physical damage explains full extent of pain experience
When is psychology considered in the biomedical pain model?
In the aftermath if long term or associated with anxiety, fear or depression
What is WHO definition of pain?
An unpleasant sensory and emotional experience which is associated with actual or potential tissue damage or is described in terms of such damage
What challenges are there to the biomedical theory of pain?
Pain after tissue damage heals Pain but no identifiable physical damage Lower pain reports in severe injuries Phantom limb pain Placebo effect Variations in pain b/w similar injuries and different people
What is acute pain?
Short term pain that attracts our attention to tissue damage so that we can take action
How long does acute pain last?
As long as there is healing taking place but there is a visible end point
What is chronic pain?
Lasts >12wks and is debilitating but not useful as it does not indicate ongoing tissue damage
Prolonged rest and medication are ineffective
What can cause chronic pain?
Variety of conditions/diseases or may have no known cause
Is chronic pain experienced at a constant level?
No, it fluctuates causing ‘good’ days and ‘bad’ days
What can be used to assess individual progressions of pain?
Self report
Assessing behaviour
Psychophysiological measures
Effects on life
What does using self report to assess pain take into account?
Objective measures
Can individual pain assessments be compared between pts?
No, only previous assessments from same individual
How does the gate control theory describe pain?
2-way process of communication between brain and tissue damage/nerve messages which pass through important ‘gates’ in the dorsal horn of the spinal cord that determine how much pain is experienced by how open they are
What psychological factors are included in the gate control theory of pain?
Thoughts Beliefs Interpretations Expectations Fear Anxiety
What physiological events are included in the gate control theory of pain?
Physical stimuli
Tissue damage
Nerve messages
Medication
What can close the ‘gate’ in the gate control theory of pain to decrease the number of pain messages received?
Medication Counter stimulation Exercise Relaxation Distraction \+ve emotions \+ve beliefs Active life
What can open the ‘gate’ in the gate control theory of pain to increase the number of pain messages received?
Injury Being over/under active Sensitivity of nervous system Stress and tension Focusing on pain Expectation of pain -ve emotions and beliefs Minimal involvement in life
What are the limitations of the gate control theory of pain?
No physical structure identified
Assumption of organic basis of pain
Dualistic thinking: physical and psychological processes interact but are separate
What is the approach used by pain management programmes?
Pt controls pain not vice versa
Not about cure
What method is used in pain management programmes?
MDT manage: Thoughts and feelings-CBT Activity Goal setting Relaxation
What is the guided practice in a pain management programme?
Reinforce acceptance of reality of chronic pain
Address fear of consequences of movement
Graded return to daily living activities
Facilitate appropriate medication use
Improve communication skills so they can explain pain to non-sufferers
Decreases use of unhelpful aids
Plan for bad and good days
Who should pain management programmes not be recommended for?
Pts with deficit in personality
Mental health pts
Those who have not accepted that there is no medical cure
Pts with ineffective communication
Pts not willing to be in a group environment
Pts who need social/psychological obstacles addressing first (e.g. damages claims)
Describe how mindfulness can be used in pain management.
Focus on present moment –> acknowledge -ve thought as ‘just a thought’ –> return attention to present moment –> take stance of self-compassion and act with kindness
What does mindfulness in pain management programmes facilitate?
Avoidance of unproductive ruminating/worrying about future
Management of stress, in turn managing pain
How does mindfulness contrast to CBT?
Mindfulness: tolerate focusing on pain sensations, detach -ve thoughts and related unpleasant emotions from the experience
CBT: taking mind off pain
What are the benefits of pain management programmes?
Being believed pain is real
Being part of diverse group with different causes but shared experiences of effects
Social comparison theory (see people who are ‘worse off’)
What are the problems with pain management programmes?
Don’t know key aspects which make them effective
Ideally should be started at the beginning of an episode of pain
Practicalities of follow-up and maintaining changes people make
Specific training needed for PMP team to ensure consistency
