Psychology of Chronic Illness Flashcards
Features of chronic illness
Long duration (>3m)
Slow progression, may include periods of remission/relapse
Medical interventions are to control (not cure- no return to “normal” life)
Impacts quality of life
Reaction to diagnosis of chronic disease
Shock (emotional distress, bewilderment, behaving in automatic fashion, detachment, disorganised thinking)
Emotion-focussed coping strategies
Fear, grief, helplessness, feeling overwhelmed, anxiety, depression, anger
Retreat and denial (to control emotional responses)
Most patients achieve psychological adjustment, 30% do not
Anxiety common in most chronic physical conditions
Waiting for test results, multiple hospital visits
Anxiety increases as number of chronic illnesses increases
Depression and chronic illness
2-3x more common in those with chronic physical health problems
20% of people with a chronic physical health problem have depression
Fatigue, lethargy and low mood are features of both depression and chronic illness
Depression more evident in those with multiple comorbidities than without
Impact of depression on chronic illness
Increased risk of death
Impact on clinical progression of disease
Reduced recovery on measures of daily living
Reduced for self-management (access healthcare, treatment adherence)
Reduced quality of life
Initial features of psychological adjustment
Uncertainty (of disease course, outcome, treatments etc.)
Changes plans
High vulnerability
These can change identity, self-esteem and self-efficacy
Outline the crisis theory
Diagnosis = life crisis
Leads to a loss of psychological equilibrium
Coping mechanisms to bring back state of equilibrium (adapting to chronic disease)
Centred around coping
Crisis theory: illness-related factors
Disability
Embarrassment (symptoms/self-care routines that patients feel self-conscious about)
Pain
Life-threatening
Lifestyle changes
Crisis theory: backgrounders/personal factors
Age
Gender
Socio-economic status
Cultural/religious beliefs
Personality: High neuroticism and low conscientiousness associated with developing chronic disease
Conscientiousness associated with medical adherence Resilient personalities cope better
Previous experience of illness
Post-traumatic growth: Growth occurs as a result of dealing with a traumatic life event
Associated with self-efficacy, self-esteem and optimism
Associated with better survival outcomes, better immune functioning, lower cortisol
Crisis theory: physical, social and environmental factors
Restrictive/dull hospital environment
Changes may need to be made to home environment due to chronic diseases
Good social support adapt better
Emotional (empathy, trust)
Practical
Informational
Coping process: cognitive appraisal
Start of the coping process
Patient examines the significance of their conditions in their life
Coping process: adaptive tasks
Illness/treatment
Cope with physical changes (symptoms etc.)
Adjust to hospital, procedures, self-care routines
Develop relationships with healthcare providers
Psychosocial functioning
Maintain emotional balance
Maintain sense of competency
Good relationships with social network
Prepare for uncertain future
Coping process: strategies
Denying/minimising
Seeking information
Learning to provide own medical care
Setting (limited) goals
Recruit emotional support from family
Consider future events
Gaining perspective
Define ‘adaptation’
Appropriate illness management that gives life continuity and meaning in spite of the changes
What comprises ‘quality of life’?
Fulfilment
Purpose
Personal control
Relationships
Activities
Personal and intellectual growth
Material possessions
What is the perceptual-practical model of adherence?
What is the necessity-concerns framework?
Operationalisation of factors involved in intentional non-adherence
Balance between:
- Necessity of taking treatment
- Concerns about taking treatment
Greater necessity associated with greater adherence
