Psychology 6b - Coping With Illness Flashcards
Define health
Health is a state of complete physical,
mental and social well-being and not
merely the absence of disease or
infirmity
Describe WHO model of consequences of disease
- Impairment refers to a problem with a structure or organ of
the body - Disability is a functional limitation with regard to a particular activity
- Handicap refers to a disadvantage in filling a role in life
relative to a peer group, as a result of impairment and
disability - Disability correlates with handicap
- Low correlation between impairment and disability
Describe the crisis theory of coping with illness
- Similar to homeostasis, we have a need for social and psychological equilibrium.
- Serious illness presents ‘a crisis’ and our usual, habitual ways of coping are
inadequate. - A state of disorganisation, feelings of fear, guilt, sadness etc .
- A crisis by definition is self-limited because we cannot remain in an extreme state of disequilibrium.
- Adaptive responses lead to personal growth and adjustment to the illness.
- Maladaptive responses lead to poor adjustment (psychological problems, low
functioning etc). - Illness-related , background and personal factors as well as physical and social environmental factors affect the coping process
- Coping process consists of coping appraisal, adaptive tasks and coping skills
List illness related factors affecting coping
- Unexpected
- Cause and outcome/prognosis (self blame)
- Disability
- Stigma
- Disfigurement
- Prior experience
List background/ personal factors affecting coping
- Age of onset (teenagers affected more than children)
- Gender (women more affected than men)
- Socioeconomic status and occupation
- Pre-existing illness beliefs
- Pre-existing personality
How do big five personality traits affect illness
- Openness – no clear link to health
- Conscientiousness - +2 years life expectancy
- Extraversion – lower rates of CHD, protective
respiratory disease - Agreeableness – Hostility associated w/ CHD
- Neuroticism – higher use of alcohol and
smoking; higher symptom reporting
How does agreeableness affect adaption to illness
- Increased adaptability
- May be due to improved social support, better quality of friendships
- More likely to follow self-care instructions and have positive, active coping strategies
How do physical and social environment affect coping with illness?
- Hospitalisation
- Accommodation and physical aids/ adaptations
- Societal attitudes
- Social support and social role
Describe influence of social relationships on mortality risk
- Less than 3 people in social network increases mortality of CHD significantly
- 50% increase in likelihood of survival for participants with stronger social relationships
What is coping appraisal?
- Adaptive responses and one’s ability to cope with and avert the threat.
- Assessment of the situation
- The coping appraisal is the sum of the appraisals of the responses efficacy and self-efficacy, minus any physical or psychological “costs” of adopting the recommended preventive response
Define illness representations
A patients own implicit, common sense beliefs
about their illness
Describe the different aspects of illness representations
1) Identity (label of the illness and symptoms)
2) Cause (what may have caused the problem)
3) Consequences (expected effects from the illness and views about the outcome)
4) Time line (how long the problem will last, whether it is acute, chronic or episodic)
5) Curability/ controllability (expectations about recovery or control of illness)
Give an example of maladaptive coping appraisals and responses
- Stress caused my heart attack, smoking helps me
reduce my stress levels, so I’m going to continue
smoking - Now I’ve had a heart attack, my life is as good as
over, I’ll never be able to enjoy myself again
=> low mood => reduce activity levels, avoid seeing
friends => depression
What are the two types of adaptive tasks?
Describe them.
Tasks related to illness or treatment
- Coping with symptoms or disability
- Adjusting to hospital environment/medical procedures
- Developing and maintaining good relationships with healthcare
professionals
Tasks related to general psychosocial functioning
- Controlling negative feelings and retaining a positive outlook
- Maintaining a satisfactory self image and sense of competence
- Preserving good relationships with family and friends
- Preparing for an uncertain future
Define coping
Cognitive and behavioural efforts to master, reduce or tolerate external and internal demands and
conflicts
What is problem focussed coping?
- Efforts directed at changing the environment in some way or changing one’s own actions or attitudes.
- Seeking relevant information, learning strategies and changing behaviour
What is emotion focussed coping?
- Efforts designed to manage the stress-related emotional responses in order to maintain one’s own morale and allow one to function.
- Seeking reassurance and emotional support, learning relaxation strategies and meditation
Is emotion focused or problem focused coping better?
- Many studies have found that use of emotion focussed coping strategies associated with poorer adjustment and greater levels of depression.
- However, circular reasoning (i.e. those who are more
distressed may need to engage in more emotion focussed coping). - Optimal coping depends on the individual and the
situation- flexibility is the most beneficial.
What is the transactional definition of stress?
- Stress is a condition that results when the person / environment transactions lead the individual to perceive a discrepancy between the demands of the situation and the coping resources available.
- Often high perception of threat and low perception of resources
Why is patient distress bad?
- Moral/ethical responsibility to minimize suffering if
possible. - Distress during treatment related to longer term
psychological morbidity. - Distress during treatment related to wide variety of
treatment outcomes, eg, patients not complying
How can patient stress be reduced?
- Prepared patients experience less pain, used less analgesic and stayed in hospital for less time
- Sensory information is particularly important in painful procedures to reduce stress (though combination is best)
- Ask patients how much information they like to know, repeat things, avoid medical jargon and provide written information as well as verbal
- Increase patient control
What are the two types of information that can be given to patients?
- Procedural information – information about the procedures to be undertaken
- Sensory information – Information about the sensations that may be experienced.
What is the duel hypothesis of stress management in patients?
- Proposes that procedural and sensory information are both helpful because they work in different ways.
- Procedural information works by allowing patients to
match ongoing events with their expectations in a non-emotional manner. - Sensory information works by “mapping” a nonthreatening interpretation on to these expectations.
Describe Auerbach study (how much information is enough)
- Gave patients either general or detailed information
- Assessed distress during procedure and desire for information and involvement
- High information preference meant patients were more distressed when given general information
- Low information preference meant patients were more stressed when given specific informaiton
- Therefore, gage patient preference for level of information and involvement
Describe the nursing home study (Langer and Rodin)
- First floor people given free choice
- Second floor people given a timetable, and told staff would ensure rooms were pleasant
- Patients on floor 1 showed greated engagement in activities
- Floor 1 patients had general better well being
- 18 months later 15% floor 1 patients died while 30% of floor 2 patients died
How can patient control be increased in medical situations?
- A device for patient to signal their
pain/discomfort during dental treatment can
reduce distress - Patient can squeeze a buzzer during an MRI to halt the procedure
- Control over treatment options for fertility procedures related to greater well-being
How can children be prepared for treatment
- Preparatory information should be specific and include
procedural & sensory information. - Older children (> 7yrs) benefit most from information
presented about a week before a procedure, younger
children closer to the procedure. - Modelling and coping skills interventions can be helpful
- eg. Film ‘Ethan has an operation’ depicting a child in hospital using positive coping strategies reduced anxiety in children undergoing operations
How do children cope?
- Children use the same types of coping as adults, but
preference for problem-solving increases with age, whilst avoidant coping declines. - Distraction is the most effective coping strategy for
younger children. - For older children (>9yrs) matching coping strategy to
child’s preferred coping strategy is more effective.
What is the combined show-tell-do approach?
- Tell: Using simple language and a matter-of-fact style,
the child is told what is going to happen before each
procedure (comparisons the child understands are
used and negative, emotive words avoided). - Show: The procedure is demonstrated using an inanimate object (eg a doll), a member of staff or the
clinician. - Do: The procedure does not begin until the child understands what will be done.
How does parents behaviour impact childrens distress?
- Children’s distress during a routine immunization was
correlated with the amount of distress shown by parents but not to subjective anxiety - Pain promoting behaviours (being overly reassuring) increases pain, while pain reducing behaviours (distraction and humour) decreased pain in girls, with boys no impact
