Psychology 4b - Death, Dying and Bereavement

Question 1

List the challenges of chronic illness

Answer 1

• Adjusting to symptoms and disability
• Maintaining a reasonable emotional balance
• Preserving a satisfactory self-image and sense of
  competence
• Learning about symptoms, treatment procedures and self-management
• Sustaining relationships with family and friends
• Forming and maintaining relationships with healthcare
  providers
• Preparing for an uncertain future

Question 2

Describe leventhal’s self regulatory model.

Answer 2

• Stage 1: interpretation (interpreting what the symptoms indicate you may have preexisting representations as to what the cause may be, and what consequences may be - may be psychological effects of fear, anxiety and depression)
• Stage 2: coping
• Stage 3: appraisal (symptoms begin to improve)

All affected by representation of health threat and emotional response to health threat (fear, anxiety, depression)

Question 3

What are psychological impacts of chronic conditions?

Answer 3

• People with one LTC are two to three times more likely to develop depression than the rest of the population.
• People with three or more conditions are seven times more likely to have depression
• Having a M/H problem increases the risk of physical ill health. Comorbid depression doubles the risk of coronary heart disease in
  adults and increases the risk of mortality by 50 per cent
• Adults with both physical and M/H problems are much less likely to be in employment
• People with mental health problems such as schizophrenia or bipolar disorder die, on average, 16–25 years younger than the general population.

Question 4

List stats of long term conditions in england

Answer 4

• 30% population have long term conditions
• 20% population have mental health problems
• 30% of people with long term condition have a mental health problem
• 46% of people with mental health problems have a long term condition

Question 5

Describe positive adaption of chronic illness

Answer 5

• Psychological distress is not inevitable – growth is possible too
• Considering psychological adaptation on a spectrum
• Some patients report positive changes and even growth
• Growth is associated with less distress in the short-term and
  better physical and mental health overall
• 60-90% of people with HIV or cancer report positive growth

Question 6

What are illness narratives?

Answer 6

• The events surrounding chronic illness, positive and negative changes, become part of people’s story. Can be shown in flim, TV, news.ect.
• Transform events and construct meaning from the illness
• Help people to reconstruct their Hx to incorporate the illness and reconstruct
  their identity to retain a sense of self-worth in the face of illness
• Help people explain and understand their illness
• Relate the illness to their values and life priorities
• Make illness a collective experience
• Can be used to improve patients clinical care (narrative-based medicine)

Question 7

What are the ethical issues of death in medicine?

Answer 7

• Medicine is rightly focused on how best to “treat disease” and “cheat death”
• Just because you “can” doesn’t always mean that you “should” and that’s where decisions sometimes get very complicated

Question 8

What is palliative care

Answer 8

• Founded on providing terminally ill people with
  compassionate care
• Addressing medical, psychological, social and spiritual
  aspects of dying
• Relieving/managing symptoms (e.g., pain,
  breathlessness) rather than curing disease
• Collaborative approach with honest communication
• Empowerment – control and choice is paramount
• But…tension regarding the ethical, moral and legal opposition and comparison’s made to “euthanasia”

Question 9

What did Hugginson et al find?

Answer 9

• Telephone survey (N = 9344): Respondents asked about their
  priorities “If faced with a serious illness, like cancer, with limited time to live”
• Multivariable logistic regressions to identify associated factors:
• Improve quality of life for the time they had left (57% - 81%)
• Only 2% said that extending life was most important

Question 10

What was Gomes et al. study?

Answer 10

• Effectiveness and cost‐effectiveness of home palliative care
• Examined difference these services make to people’s chances of dying at home, also issues for patients towards the end of life (e.g. pain) and
  family distress
• Doubles chances of dying at home, reduces symptom burden, does not increase grief, does not raise cost
• Recommended patients who wish to die at home should be offered home palliative care

Question 11

What are the 5 stages of reaction to a diagnosis of terminal illness by Kubler-Ross?

Answer 11

• Denial (lying about the situation, thinking it isnt really happening)
• Anger (why me, blaming god, angly at the world, feeling isolated with random outbursts of anger)
• Bargaining (if I do this, I can make it better - feeling grief and responsibility to fix problems, asking god)
• Depression (person is overwhelmed by feelings of sadness)
• Acceptance (loss is accepted, so work begins to cope with loss and minimise loss)

Question 12

What is the nature of 5 stages model in western culture?

Answer 12

• Linear progression – gives a sense of conceptual order to a complex process – proving a degree of
  predictability & control
• An overwhelming cultural desire to “make sense” of
  the uncertain
• Developed at a time when limited literature on death & dying existed
• Applied to a number of different situations
  (including bereavement)

Question 13

List weaknesses of stage theories

Answer 13

• Stages are prescriptive and place patients in a passive role
• Do not account for variability in response (e.g., “people deal with things differently”)
• Focus on emotional responses and neglect cognitions and behaviour
• Fail to consider social, environmental or cultural factors (e.g., a patient in a positive and supportive environment is likely to exhibit very different stages than those who are not)
• Pathologise people who do not pass through stages

Question 14

List the problems of pathologising in stage theories

Answer 14

• Distress or depression is not inevitable (many people report significant and valuable changes from the experience of the illness, some even report benefits)
• Acceptance might not be achieved (reaching a state of resolution may not be possible for some complex cognitive and emotional responses may continue to be
  present)
• “Good” patients vs “Bad” patients

Question 15

What is bereavement?

Answer 15

• The situation of a person who has recently experienced the loss of someone significant in their lives through
  that person’s death
• Grief is a normal BPS reaction to loss

Question 16

List stress theories of bereavement

Answer 16

• Emphasise stress and coping with bereavement as a dynamic process
• Involves changes in orientation toward loss or restoration
• Orientation toward loss: (preoccupation, think and yearn for the person lost, seeking out places as reminders or searching for the person)
• Orientation toward restoration: (adjustments to lifestyle, coping with day-to-day life, building a new identity, distracting away from painful thoughts)
• Duel process model - both loss orientated and restoration orientated oscillation

Question 17

What does response to bereavement depend on?

Answer 17

• How attached they were to the deceased person
• The circumstances of death and the situation of loss
• How much time they had to work through anticipatory
  mourning

Question 18

What is chronic grief?

When is it more likely to occur?

Answer 18

• Chronic grief: people are more severely affected
• Can be associated with worsening mental health (e.g.,
  depression, anxiety)
• More likely to occur if.. The death was sudden or unexpected, the deceased was a child, there was a high level of dependency in the relationship, the bereaved person has a history of psychological problems,
  poor support and additional stresses (e.g., financial)

Question 19

How can understanding of grief be advanced?

Answer 19

• Further development of cross-cultural theoretical
  approaches
• Sound empirical testing
• More focussed efforts to better understand those who suffer extremely
• Continued development of effective psychological
  interventions to help support those who experience
  chronic grief

Question 20

List the 5 dimensions of Leventhals SRM

Answer 20

• Identity
• Cause
• Consequence
• Time line
• Cure

Question 21

List the five myths of coping with loss (Wortman and Silver)

Answer 21

• The idea that healthy grieving includes a period of intense distress or depression shortly after the loss
• Failing to have these feelings bodes poorly for psychological adjustment
• The mourner should get over the loss after a finite period of grieving (acceptance is not always reached, and meaning is not always found)
• Every situation does not result in the same level of grief - loosing a child or spouse in an sudden incident increases depression and anxiety years after
• It is not inenvitable that severe distress or depression must follow a loss, and the absence of such a response is not necessarily pathological (grief can be borne lightly) - those upset immediately tend to be the most upset after a year or two