Psychology - Chronic Diseases Flashcards
Different ways we think of health
Not having symptoms Having physical or social reserves Having healthy lifestyles Being physically fit Psychological well-being Being able to function
Health behaviours
Behaviours that affect our health positively or negatively (behavioural pathogens vs. behavioural immunogens)
Diff approaches to med
Biomedical
Biopsychosocial
Biomedical approach
Assumes all disease can be explained using physiological processes and treatment is for the disease, not the person.
Separates body and mind and makes doctors fully responsible for health
Limitations of biomedical approach
Reductionist to reduce disease down to biomedical science
If physiological factors have no influence, how can we explain the placebo effect?
Ignores influence of social factors
Biopsychosocial approach
More holistic and makes the link between psychological, social factors and health more explicit
Illness is a result of several factors
Responsibility is on individual and society
Health behaviours vs illness behaviours
Health behaviours are usually preventative/proactive and aim to maintain health and illness behaviours are usually reactive and are in response to an illness
Theory of planned Behaviour
Describes the key factors that explain behaviour and predict behaviour change
Pt’s attitude, norms, perceived control or intention
Health belief Model
Behaviour is a result of a set of core beliefs: Susceptibility Severity Cost Benefits Cues to action Health motivation Perceived control
Transthereotical/ stages of change model
Focuses on the process of behaviour change (rather than factors predicting it)
Steps don’t have to happen in order as behaviour is dynamic
Steps in transtheoretical model
Pre-contemplation Contemplation Prepration Action Maintenance
Pre-contemplation - stages of change model
Does not perceive they have a problem, has no intention of changing
Contemplation - stages of change model
Aware they have a problem, know they should make a change, not fully committed to idea (sitting on the fence).
Preparation - stages of change model
Intending to take action, may have begun to act
Action - stages of change model
Change has happened (over months) change occurs in behaviour, environment or experience
Maintenance - stages of change model
Working to prevent relapse, in maintenance stage if they remain free of problem for 6mths +
What else needs to be considered in addition to the stages of change model
Decisional balance
Self-efficacy
Processes of change
COM-B model
Any given health behaviour occurs as an interaction between 3 components
Can be used to understand why a person is carrying out a health risk behaviour but also to consider how we might intervene/ design interventions if we’re encouraging a health protective behaviour
COM - B model - capability
Psychological or physical ability to carry out the behaviour
COM - B model - motivation
Reflective or automatic mechanisms that activate or inhibit behaviour
COM - B model - opportunity
Physical or social environment that enables behaviour
How do we use psychological models in clinical practice
Explain and predict health related behaviours, and influence behaviour change
How do we apply psychological models
By asking questions in a consultation in order to try to identify elements from the specific models we have looked at
Classification of pain
Nociceptive
Neuropathic
Nociceptive pain
Pain arising from activation of nociceptors following tissue injury – A-delta and C-fibre terminals
Characteristics of nociceptive pain
Proportionate to injury
Enables healing w/ resolution of pain Physiological
Neuropathic pain
Pain arising from disease or damage to nervous system
Innate immune cells secrete chemical mediators that reduce the inhibitory effect of GABA. Causes pain signals to fire without a stimulus
Characteristics of neuropathic pain
Frequently lost lasting
Not proportional to tissue injury
Pathological
Why are cognitions important
Decided about how we think of our pain
Types of cognitions
Unhelpful
Catastrophizing
Rumination
Expectations
Unhelpful cognition
Anxiety provoking
Over generalization, using words like ‘always’ or ‘never’
Jumping to conclusions (usually -ve)
‘Should’ thinking – ‘I should be able to do x and I can’t’
Catatrophizing cognitions
Extreme assumptions/ amplifying the -ve aspects
Magnification
Helplessness
Association with pain that is perceived as an externally located, difficult to control and fixed
Passive coping strategies and predicts psychological distress
Pt’s w/ strong efficacy beliefs beliefs about pain
Pain is malleable
Associated with active coping mechanisms and lower levels of pain and distress
Associations w/ individuals who catastrophises pain
Increased pain and psychological dysfunction
What happens if a patient believes chronic pain is due to harm and damage
Avoid things that are painful –> reduction in physical mobility –> secondary problems incl postural changes, stiffness in joints.
These patients are usually less compliant –> anxiety and -ve behavioural changes
Non-pharmalogical intervention of pain
Hypnosis Biofeedback PT Exercise Accupuncture
Pain Management Programmes (PMP)
Use combination of CBT, ACT and duration along with exercise to enable people to cope or manage pain better
Aims of PMP
Education about pain
Techniques to address anxiety and depression to promote coping
Effective medication use
Types of placebo
Pure placebo
Impure placebo
Placebo procedure
Pure placebo
Thought to contain no active ingredient, for example, a sugar pill
Impure placebo
Contains an active ingredient, but one that is not known to have any effect on the condition being treated, e.g. a vitamin C tablet being given for headache
Placebo procedure
A procedure, for instance, taking blood pressure, which is not known to produce any clinical change
What do placebos work through
Sociomatics
Contributory mechanisms of sociomatics
Social influence
Role expectation
Classical and operant conditioning
Cognitive influence
When do we experience stress
When the demands of a situation exceed our resources to cope with it
The greater the discrepancy between demands and resources, the greater the experience of stress
Ways in which stress can manifest
Anxiety Sleeplessness Crying Appetite problems Lower libido Isolation Decreased confidence
Stressors can be
Internal External Acute Chronic Major life events
Internal stressors
How we appraise (make sense of) a situation
External stressors
Events out of our control
Acute stressors
Sudden illness, exams, work demands
Chronic stressors
Long illness, relationships, work
Physiological responses in chronic stress
Responses remain active for longer and lead to the wear and tear of our body
Can affect physical and mental health, contribute to the onset of illness, or delay recovery and response to treatment
Health problems linked w/ stress
High bp/ coronary heart disease
Headaches/ migraines
Muscular pain/ myopathy (adrenaline increases skeletal muscle tension)
Digestion: ulcers, IBS (acids remain in GI system)
Diabetes (production of increased glucose levels)
Suppression of the immune system; infections
Anxiety, depression (as a result of stress)
Diathesis-stress model
Views illness as the result of an interaction between pre-existing vulnerability (diathesis), and the external stress caused by life
What can the diathesis-stress model explain
Why some people are very resilient and are able to adapt while others develop illness or delayed recovery times.
Psychological approaches to stress management
Cognitive behavioural approaches
Mindfulness-based approaches
Allostatic load
Effects of long-term activation of the physiological stress response
ACTH
Adrenaline
Norepinephrine and cortisol
ACTH in allostatic load
Pushes the brain to function mainly in the limbic region (cerebral cortex loses 2/3 of its functioning)
Tunnel vision, reduction in rational thinking, forced down a fight or flight mindset
What does adrenaline cause in allostatic load
Increased skeletal muscle tension –> msk pain, stiffness, discomfort due to build up on lactic acid and ammonia
Immunosuppressive action during periods of heightened psychophysiological arousal —> repeated illness (cortisol and corticosterone)
Norepinephrine and cortisol in allostatic load
Slows and suppresses the digestive process, resulting in acids not being removed from the GI system
Increases alertness, puts you on edge, can cause a state which presents like anxiety
Peripheral sensitisation
Prolonged exposure to the stimuli enhances the responsiveness of the nociceptors
The activation threshold of nociceptors decreases, so pain signals are sent from less stimulation than is normally required
Central sensitisation
The increased signals coming from the nociceptors cause the dorsal horn neurons to increase in excitability
What does prolonged exposure to noxious agents cause
Somatosensory nervous system to become hypersensitive
Features of hypersensitivity
Increased pain signals, from stimuli that is not normally processed as being painful
Exaggerated response to painful stimuli
Risk factors for chronic pain
Ageing Suffering from an injury Having surgery Being female Being overweight/obese
Social factors affecting health seeking behaviour
Income - prescription costs Education Access - geography Support from family Cultural Employment status
Psychological factors influencing health seeking behaviour
Fear of outcome
Fear of inaction
Memory
Past experiences of medical intervention
Rights of the sick role
Not responsible for being ‘in the sick role’
Exempt from carrying out some/ all of normal functions
Responsibilities of the sick role
Must try to get well and make the side role temporary
Mist achieve this by following medical treatment
