HealthPsych Session 5 Flashcards
Why do more elderly relatives tend to die in hospital now than they did historically?
Relatives at home feel unable to provide home care due to lack of support and advice as well as having concerns about pain management
What is the result of medicalisation of death?
Death is more unfamiliar so people tend to find it harder to accept
How have life expectancy and healthy life expectancy changed?
Life expectancy has increased but healthy life expectancy has not to the same extent so a significant proportion of life is in ill health
Describe the 3 main patterns of dying.
Gradual death: slow decrease in ability and health
Catastrophic death: through sudden and unexpected events
Premature death: in children/young adults through accident or illness
What are the stages in the 5-stage grief model?
Denial Anger Bargaining Depression Acceptance
Should a period of denial be allowed for people experiencing grief?
Yes, can be a helpful coping mechanism
Should pts be hurried out of the depression stage of the 5-stage grief model?
No, offer support instead
What is grief?
Set of psychological and physical reactions to bereavement which is a normal reaction to overwhelming loss where normal functioning no longer holds
What is the process of grief?
Disbelief and shock –> developing awareness –> resolution
What other event does dealing with grief have common elements with?
Terminal diagnosis
Are psychological interventions helpful in grief?
Only in high risk people
What factors lead to complication of the grief process?
Expression of grief discouraged
Ending of grief discouraged
What can result from an interrupted grief process?
Anxiety
Depression
PTSD
What type of stress is bereavement?
Severe form
What are the physical symptoms of bereavement?
SoB Palpitations Fatigue GI symptoms Decreased immune function
What are the behavioural symptoms of bereavement?
Insomnia
Irritability
Crying
Social withdrawal
What are the emotional symptoms of bereavement?
Depression Anxiety Anger Guilt Loneliness
What are the cognitive symptoms of bereavement?
Reduced concentration Memory loss Preoccupation Hopelessness Disturbance of identity Visual and auditory hallucinations
What are the outcomes of bereavement within 2 years?
85% have adjusted and are experiencing minimal grief
15% experiencing chronic grief (anxiety, depression, PTSD)
What are the risk factors for not adjusting to bereavement?
Prior bereavements Mental health Type of loss (young, traumatic, if person was caring for deceased) Lack of social support Additional stressors
What is palliative care?
A shift of focus away from medical management towards improving QoL by managing emotional and physical symptoms and supporting pts to live productively so they are in control and retain dignity
What are we less exposed to death as a population?
Death has become medicalised as the majority of people now die in hospital despite wanting to die at home
Describe type A psychological therapies.
Treatment gives as an integral part of mental health care by GP/district nurse using psychotherapy techniques
Describe type B psychological therapies.
Eclectic psychological therapy and counselling taking ideas from different branches of formal therapies
Describe type C psychological therapies.
Formal psychotherapists e.g. regular CBT sessions
What types of psychological therapies does the NHS use?
CBT
Psychoanalytical/psychodynamic
Systemic
Family
What is CBT?
Pragmatic combination of concepts and techniques to relieve symptoms by changing maladaptive thoughts, beliefs and behaviour (not situations but view we take of them is causing upset)
What behavioural techniques are used in CBT?
Graded exposure to feared situations
Activity scheduling
Reinforcement
Why does avoidance of stimulus perpetuate fear?
Association develops between feeling bad in presence of stimulus and feeling better once it is removed (operant conditioning)
What cognitive techniques are used in CBT?
Education of cause of problem Monitoring of thoughts, feelings etc Examining/challenging -ve thoughts Behavioural experiments to test beliefs Cognitive rehearsal
What is CBT the first line treatment for?
Depression
Anxiety states: phobias, OCD, generalised anxiety disorder, panic, PTSD, health anxiety, body dystrophic disorder
Eating disorders
Sexual dysfunction
What is CBT used as an adjunctive Tx for?
Psychotic symptoms (+anti-psychotic medication)
How does CBT work as an adjunct to medication in psychotic symptoms?
Decreases impact of -ve symptoms
Distracts from symptoms
Decreases preoccupation with delusions and intensity of beliefs
Alters beliefs about abnormal perceptions
Who is CBT suitable for?
Pts who are keen to be active participants
Pts who engage collaboratively
Can accept model emphasising thoughts and feelings
Able to articulate problems
Practically seeking solutions to problems
Is CBT suitable for pts with a nebulous wish to be happy?
No
What are the limitations of CBT?
Findings of efficacy are usually from homogenous populations with limited comorbidities
Delivered by expert practioners (challenge for routine practice)
Circumscribed benefits in complex and diffuse problems
What do focal psychoanalytical/psychodynamic therapies identify?
Conflicts arising from an early experience which is re-enacted in adult life
What does focal psychoanalytical/psychodynamic therapy use to resolve conflicts?
Relationship with therapist and pt
What is the purpose of analytical psychoanalytical/psychodynamic therapy?
Long term approach to re-enact and interpret unconscious conflicts underlying symptoms using the relationship with the therapist
What is transferance?
Unconscious redirection of feelings towards one person to another e.g. smiling at a stranger that reminds you of a friend
What is counter-transferance?
Emotional reaction of analyst to subject contribution
Who is psychoanalytical/psychodynamic therapy suitable for?
Interpersonal difficulties and personality problems
Capacity to tolerate mental/emotional pain
Interest in self-exploration
What does classical psychoanalytical therapy need to be effective which means it is not used routinely in the NHS?
To be daily over a prolonged period of time
What is systemic and family therapy?
Approach focused on relational context to address patterns is interaction and meaning to facilitate resources in the system as a whole
Why is family therapy used to treat children?
Treatment in isolation –> return of original behaviours once back in family environment
What does humanistic/client-centred therapy rely on?
General counselling skills: warmth, empathy, unconditional +ve regard to enable reflection
What is humanistic/client-centred therapy effective in?
Scoping with immediate crises where there is already motivation and willingness to problem solve
Who is humanistic/client-centred therapy suitable for?
Mild to moderate difficulties related to life events
Subclinical depression
Mild anxiety/stress
Marital/relationship difficulties
All with recent onset of
What problem factors should be considered when choosing a psychological therapy?
Nature
Chronicity
Severity
Complexity
What patient factors should be considered when choosing a psychological therapy?
Psychological mindedness
Pain tolerance
Preference for short or long term focus
Exploratory work
What is the -ve cognitive triad?
- ve view of self
- ve view of surrounding world
- ve view of future
What leads to development of the -ve cognitive triad?
Early experience –> core beliefs (may be unbalanced) –> assumptions –> critical incident activates assumptions –> -ve automatic thoughts
What is the rationale behind CBT?
Event/situation –> thought –> emotion
Not situations but our view of them that cause upset
When do anxiety systems become problematic?
Perceived danger doesn’t exist
What causes anxiety in terms of brain function?
Unable to distinguish between physical and psychological threat so responds to false alarm
How does CBT treat anxiety?
Decreases avoidance
Ceases safety-seeking behaviour
Exposure –> habituation and testing with subsequent change of beliefs by real-life experiments
Give some examples of anxiety disorders.
Panic disorder +/- agoraphobia Social anxiety disorder Specific phobias Health anxiety OCD BDD PTSD GAD
What are the 10 common healing factors?
Emotionally charged, confiding relationship with helpful person
Healing setting
Rationale/myth that explains symptoms and suggests way forward
Ritual/procedure requiring active therapist and pt participation
Combatting pt’s sense of alienation
Inspiring pt’s expectation of help
Providing new learning experiences
Arousing emotions
Enhancing sense of self-efficacy
Providing opportunities for practice
How does a healing setting aid healing?
Ritualistic aspect focuses on activity
How does providing new learning experiences aid healing?
Essentially unlearn and replace with corrected experience
