HPsyHD S4 (Done) Flashcards
Describe the physiological response to stress
Fight of flight
Short term changes to mobilise for activity
Mainly triggered by catecholamines (Adrenaline + Noradrenaline)
Results in:
Inc. O2 availability
Enhanced cognitive functioning
Liberation of glucose, proteolysis, insulin resistance
Reduced blood flow to digestive/reproductive systems
Inc. Cardiac output, muscle response and sweating
What is the stress performance connection?
Performance is optimal at a medium/normal level of stress (eustress)
Performance can dip and you become disorganised under high stress
Performance can dip if not sufficinetly stressed
List some of the effects of long term stress
Long term stress can lead to:
Exhaustion
Cardiovascular problems (Hypertension, athersclerosis)
Diabetes
Negative health behaviour (Smoking, overeating, drinking)
Muscle pains
Increased susceptibilty to infections, E.g. Peptic ulcers, Colds (Downregulation of immune system)
Compare the hunter-gatherer model of society with modern life in terms of stress response
Hunter-gatherer:
Acute stressors give acute response
Provides survival advantage
Modern life:
Frequent daily hassles lead to chronic stress
Physiological response poorly suited to chronic stress
What is a stressor?
Give examples
An event which causes stress
E.g.
Death of a spouse
Christmas
Define stress
A condition or feeling experienced when a person perceives thats demands exceed the personal and social resources the individual is able to mobilize
What is the Holmes and Rahe stress scale?
Give examples of stressors on the scale
1-100 Scale quantifying the level of stress caused by life events
E.g.
Death of a spouse - 100
Christmas - 13
Marriage - 50
What is Kaneer et al’s ‘Daily hassles and uplifts’ study?
Why is it useful?
Participants ranked daily stressors and uplifting events on a scale of 1-3
1 = Somewhat severe
2 = Moderately severe
3 = Extremely severe
Over a course of 9 months, then assessed their physiological measurements of stress
Use:
Found that daily stressors rather than large event stressors where useful in predicting stress as small stressors on a daily basis can build up to form a bigger stressor
What is the major problem with creating a model of stress?
Accounting for Individual variation / Subjectivity of stress
What is the transactional model of stress?
Theorieses that stress is a result of how people appraise events and their ability to cope with them
Stressors and resources are appraised and a stress reponse is generated based on that appraisal
Stressors = Events, Hassles, Chronic stressors
Resources = Personality, Social support, Coping skills, Control
Describe the process of appraisal according to the transactional model of stress
3 Stages:
Primary appraisal:
Is this event a threat? How bad could it be?
We classify event as benign, challenging or threatening
Secondary appraisal:
We appraise our resourses and skills to cope and decide if we are able to deal with stressor
Reappraisal:
Reconsideration after attempting to cope (may decide it’s more or less stressful than initially thought)
How does control affect our reaction to stressors?
High control over stressor is more likely to produce a lower stress state than little/no control over stressor
Demonstrate how social support is important to our stress reaction
Death of a spouse
Common for living spouse to die shortly after
Response to stressor + Loss of resource (social support)?
How can long term stress affect the cardiovascular system?
What is the other major condition that stress can contribute to? By what mechanisms?
Cardiovascular:
Hypertension
Cholesterol increase (athersclerosis)
Smoking
Physical inactivity
Overeating
Other:
Diabetes due to increased insulin resistance and blood glucose
Demonstrate how short term intense stressors can affect the cardiovascular system
Increase in sudden cardiac death triggered by earthquakes
How are stress and the common cold linked?
Increased stress is associated with increased prediposition to colds
Describe the response of the immune system to short and longer term stress
Short/Medium term stress:
Immune system upregulated
Prepares to repair damage and resist infection (increased lymphocytes)
Prepares to fight off pathogens (Increase in antibodies, B-Cells)
Long term stress:
Depressed immune function (Cortisol)
Inflammation
How can stress distort our cognitive function?
Thinking tends to be more rigid and extreme under stress
Congnitive distortions:
Overgeneralisation
Catastrophising
Personalisation
Rumination
How is the concept of ‘learned helplessness’ demonstrated?
Electrical shocks administered to dogs in a situation they cannot escape
Then when put in a situation where they can escape persistent shocking, they do not even attempt to escape
Dogs that have not ‘learned helplessness’ escape as expected
How do we apply the idea of ‘learned helplessness’ to stress?
Chronic stressors may lead to a state where someone loses motivation to deal with stressors
Concequences include:
Anxiety
Depression
Downward spiral of illness
Describe a cognitive techniques used to reduce stress
Congnitive restructuring:
Identification of negative emotional
Idnetification of negative/irrational thoughts
Attempt to rationally analyze the situation
Monitor mood
Give an example of a behavioural strategy for stress management
Skills training in assertiveness/time management
Give examples of emotional strategies for stress management
Councelling
Emotional disclosure
Social support (Family, Friends, Groups)
What are 2 physical strategies for stress management?
Exercise
Relaxation training
Give a non-cognitive, clinical stress management technique
Drugs
What things might a patient have to cope with related to their diagnoses?
Emotion (Shock, anger, anxiety, depression, denial, fear)
What things might a patient have to cope with related to the physical impact of their disease?
Pain
Limited mobility
Oher symptoms
What things might a patient have to cope with related to their treatment?
Anxiety
Discomfort
Impact on body image
What things might a patient have to cope with related to hospitalisation?
Loss of autonomy, privacy, status
Removal from usual support network
What things might a patient have to cope with related to adjustment to a condition?
Biographical disruption
Change in identify (sick-role, stigma)
Chronicity (indefinite change)
Acknowledgement of mortality
What are the socioeconomic factors affecting patient response to disease?
Social:
Bereavement, divorce marriage etc
Improsonment
Personal achievement
Change of habits
Financial:
Dissmisal
Retirement
Job change
Change in financial status
Give some examples of emotional focussed coping styles/activities
Behavioural:
Talking to friends
Alcohol/drugs
Distraction
Cognitive:
Denail
Focus on positive (E.g. Quitting unliked job)
Give examples of problem focussed coping styles/activities
Reduce demands of stressful situations:
Coping mechanisms for disease stressors
Expand resources to deal with it:
Physiotherapy or motorised scooter to deal with immobility
What is the importance of coping mechanisms both to the patient and physician?
Patient:
Active coping associated with better adjustment
Passive coping also useful (particularly in chronically ill)
Physician:
Consideration must be given to patient’s coping mechanisms when giving information
What are the 4 ways to aid coping in a patient?
Increase social support
Increase personal control
Prepare for stressful events
Stress management techniques
In what ways can we increase a patient’s social support?
In what demographic is this particularly important?
Help patient recognise and mobilise support
Suggestions for sources of support (Socail services, community resources, hospital visitors/chaplain etc)
Particularly important in the elderly who frequently have impoverished social support networks
How can we increase pateint control with a view to aid coping?
Self managed pain medication
Self management of disease (Diabetes management regimes)
Give patients choices of treatments
Aid congnitive control (Emotional management)
How can preparing patients for stressful events aid coping?
Give two examples of how stress reduction techniques may aid coping
Reduces ambiguity and uncertainty
Effective communication:
- Reduces anxiety, pain, length of hospital stay
Peer contact:
- Pairing of pre-op and post-op patients to reduce pre-op anxiety and recovery time
What are the outcomes of successful coping?
Tolerating or adjusting to negative events/realities
Reducing threats and enhancing prospect of recovery
Maintaining positive self image
Maintaining emotional balance
Continue satisfying relationships with others
Give examples of the emotional effects of chronic and severe illness
Depression 2-3x more common in people with chronic disease
Anxiety more common in people with heart attach, stroke and cancer
Give a basic description of anxiety in patients
Response to threat (Surgery, test results, uncertain prognosis)
Unpleasant emotional state, may include feelings of panic of dread
Likely to occur at various stages of illness:
- Diagnoses*
- Awaiting test results*
- Discharge from hospital*
- Making lifestyle changes*
Outline how anxiety affects patients
Sustained anxiety associated with unhelpful thinking patterns:
- Increased threat vigilance
- Interpretting ambigous information as threatening
- Increased recall of threatening memories
Anxiety disorders (Phobia, Panic attacks etc)
Give a description of depression in patients
What is it a response to? (in patients)
Emotional state characterised by persistent low mood, sadness, loss of interst, despair, feeling worthless
Tends to be long term
Response to loss/failure/helplessness:
- Loss of health/physical capacity/identity
- Reaction to symptoms
- Medication side effects
What factors raise risk of depression in patients?
What can be the effect of depression on patients?
Severity of illness
Pain and disability
Negative life events
Lack of social support
Effects:
Exacerbate pain and distress
Adversely effect outcomes of illness
What are the direct and indirect pathways of psychological distress on health?
Direct:
See flashcards related to impact of stress on health (Cardiovascular, diabetes etc)
Indirect:
Negative health related behaviour (smoking, drinking, overeating)
Compromised quality of life
Negative impact on coping with treatment
Poorer self management of disease (reduced adherence)
What factors related to treatments and illnesses prevent recognition of psychological problems in patients?
Psychological response changes over time (Depression may set in after discharge)
Symptoms may be attributed to illness or treatment
What patient factors prevent recognition of psychological problems in patients?
Belief it can’t be alleviated
Wish to avoid complaining/being a burden
Avoidance of judgement/stigma
What factors relating to HCPs prevent recognition of psychological problems in patients?
Outside psychiatric setting HCPs may believe it’s not in their role or fear overwhelming distress of patient
Tendency to ignore
Reluctance to label patients as psychiatric
What is the importance of recognising psychiatric difficulty in pateints?
Clear links between mental and physical health
What are the 3 main types of psychiatric intervention for patients?
Aid in coping (prevention of psychiatric difficulty)
Counselling and psychological therapy
Medication (Antidepressants)
What are the NICE guidelines for treatment of depression (mild to moderate and moderate to severe)
Mild to moderate:
Individual guided self help
Structures group physical activity
Group based Cognitive behavioural training
+ Group peer support for chronic illness sufferers
Moderate to severe:
Combine above with anti-depressants
High intensity psychosocial intervention (Individual CBT, interpersonal therapy etc)
What are the NICE guidelines on mild to severe/persistent stress?
Mild:
Individual self help, psychoeducational group
Medication (SSRIs)
Severe/persistent:
+ High intensity psychosocial intervention (individual CBT, applied relaxation)
Describe the early bio-medical theory of pain
How does psychology relate to this model?
Tissue damage (E.g. Cut knee) = Pain receptors triggered and messages sent to the brain, resulting in the pain sensation
Physical damage is the sole cause of ‘real’ pain and explains all pains
Only role of psychology is in the aftermath of pain (E.g. fear, anxiety, depression)
What phenomena challenge the early biomedical theory of pain?
*Exhaustive list given, Probably not necessary to memorise them all*
Continued pain after damage heals
Experience of pain in absense of physical harm
Low pain experience upon severe injury
Phantom pain in amputees
Placebo effect
Variation of pain in people with similar injuries
What is the WHO definition of pain?
Unpleasant sensory and emotional experience which is associated with actual or potential tissue damage or is described in terms of such damage
What are the common features of acute pain
Short term
Attracts our attention
Pain lasts as long as there is healing
Action can be taken (Medication, Rest, Seeing Dr)
What are the common features of chronic pain?
Pain for >12 wks
Debilitating
Not useful (Doesn’t indicate ongoing tissue damage)
Prolonged rest, medication not useful
Arises from a variety of conditions/diseases or idiopathic
What are some ways we can assess pain
Why is assessment of pain difficult?
Assessment types:
Self-report
Assess behaviour
Psychophysiological measures
Measuring effect of pain on other areas of life
Difficulty:
Direct objective assessment is almost impossible to obtain, pain is extremely subjective
Describe the physiological theory behind ‘Gate Control Theory’
Pain is experienced in the brain through complex pathways in the body from damage/disease source
Important neural relays (gates) for messages to pass through are located in the dorsal horn of the spinal cord
Extent of pain messages recieved is determined by how open or closed the ‘gates’ are (open gate = more pain).
How does Gate Control Theory account for the subjectivity of pain?
Pain is a result of two way communication between brain and tissues/nerves
Psychological and physiological factors can open/close the gate
Give examples of factors which may open the ‘pain gate’
Biopsychosocial factors:
Injury
Sensitivity of the NS
Stress and tension
Focus on pain, Expectation of pain
Negative emotions and beliefs
Minimal involvement in life
Give examples of factors which may close the ‘pain gate’
Biopsychosocial factors:
Medication
Counter-stimulation
Exercise
Distraction
Positive emotions and beliefs
Active lifestyle
What are the psychological factors contributing to pain?
*List of buzzwords from earlier in course*
Operant and classical conditioning
Anxiety, fear
Secondary gains
Pain behaviour
Catastrophising
Attention
Self-efficacy
Meaning
What are the limitations of the Gate Control Theory?
No physical structure identified
Still assumption of biological basis of all pain
Assumes physiological and psychological processes interact but still sees them as separate (Duallistic thinking)
*Side note: Last one is probably the lamest excuse for a limitation I’ve ever seen, please don’t ever use it*
Give a brief description of the ‘Neuromatrix theory of pain’ and how it relates to pain
Avoid the urge to giggle at the ridiculously Sci-Fi name
Widespread distribution of neurons in our brain that imprint a ‘neurosignature’ upon patterns of impulse that pass through them
We have an overall neurosignature for our sense of self created by subsets of patterns that give us particular sensations (Warmth, pain etc)
Pain can be caused by multiple physiological and psychological process due to the fact that neurones of the pain neurosignature are also involved in other neurosignatures
What is the overall aim of ‘Pain Management Programmes’
How does it differ from bomedical management of pain?
Aims to improve the physical, psychological, emotional and social dimensions of quality of life in people ith persistent pain using a multidisciplinary team working according to behavioural and cognitive principles
Doesn’t focus on pain as a result of disease or damage or deficits in personality or mental health
What is the central message of PMPs?
Helping patients control pain, rather than pain be in control of them, not focusing on a cure, just management
What are the specific aims of a PMP related to change in behaviour/cognition?
Reinforce acceptance of chronic pain
Improve fitness, mobility, posture
Address fear of concequence of movement
Learn to cope with stress, anxiety, depression, anger
Learn to relax
Graded return to normal daily activity
Facilitate appropriate medication use
Improve communication skills
Reduce use of unhelpful aids and equipment
What are the 4 main ‘prongs/topics’ of PMP
Management of thoughts and feelings (CBT/Mindfulness)
Active, paced activity (Understanding posture and biomechanics, building achievements)
Goal setting
Relaxation
Give some examples of topics adressed by PMPs other than the 4 main prongs
Communication (Assertivness and anger managment)
Stress management
Maintaining change and planning for ‘bad days’
Relationships
How does CBT and the concept of Mindfulness factor into PMPs?
Learning to focus on present moment without negative rumination on past or worrying about future
Fighting negative thoughts/accepting them as ‘just thoughts’ and moving back to focusing on present moment
Taking a stance of self-compassion, act with kindness towards self
Can help in managment of stress, which in turn helps pain
Encourages learning to tolerate a focus on pain but to detach negative thoughts and emotions from the experience
What are some other imprtant aspects of PMPs other than active treatment/education?
Being believed that pain is real
Being part of a group (Shared experiences, social support)
Social comparision (Can see others as worse off, feel better as a result)
Why might we refer patients to PMPs?
When pain is causing:
Distress
Disability
Negative impact on QoL
What is a profile of someone typically referred to PMPs?
Average of 5yrs of pain
Exhausted medical methods of relief
Often angry, depressed, anxious, disabled, out of work, family difficulties, withdrawn socially
What patient factors might we need to consider when considering a referral to PMPs?
Communication
Mental health
Cognitive ability
Willing to work in a group
Level of physical function
Social/psychological factors that might need addressing first
What are the issues/limitations of PMPs?
Not all patients can work in groups
We know they are effective, but don’t know what key aspects in particular make it effective
Practicalities of follow up make it difficult to assess whether long term change is made
PMP ideally needs to begin at onset of pain
Staff needs specific training
