Session 1

Question 1

Give the main difference between the biomedical and biopsychosocial models of medicine.

Answer 1

Biomedical model does not involve psychological or social factors. It explains illnesses through biological and physiological means. Treatments involve physical interventions.

Biopsychosocial models includes psychological and social factors which can cause health & illness as well as the biological causes.

Question 2

Give 6 physiological responses involved in stress

Answer 2

1. Increased oxygen availability (increased breathing + increased haematocrit)
2. Enhanced mental functioning
3. Increased fuel availability (increased glucose liberation, proteolysis, insulin resistance)
4. Preparation for tissue damage/fatigue
5. Conservation of energy resources
6. Enhanced physical functioning (increased CO, BP, sweating, muscle responsiveness)

It is the fight or flight response.

Question 3

Discuss the transactional model

Answer 3

This is a model where stressors + resources lead to appraisal. Appraisal can then lead to a stress response.

Question 4

Discuss primary and secondary appraisal as well as reappraisal.

Answer 4

Primary appraisal = Looking at an event and considering whether it is a threat.

Secondary appraisal = Consider if you have the resources to cope with the stressor.

Reappraisal = After attempting to cope with event, reconsider it to see if it is more or less stressful.

Question 5

Give 2 important factors which can influence the effect of stress.

Answer 5

• Control

- Social support

Question 6

Discuss the 4 different ways stress can have negative effects on health.

Answer 6

1. Physical damage (in particular to the CVS)
2. Immune related conditions (in the short term, stress can increase the immune response (to respond to the stressor) however in the long term, stress can lead to a depressed immune system and cortisol can lead to inflammation).
3. Unhealthy behaviours (in response to stress, we can perform maladaptive behaviours - such as drink alcohol, eat chocolate)
4. Mental Health conditions - Stress can lead to these.

Question 7

Give 4 mental health effects that stress can cause.

Answer 7

1. More rigid and extreme thinking
2. Rumination (repetitively thinking about the causes, situational factors, and consequences of negative emotional experience)
3. Feeling of lack of control + helplessness.
4. More prone to cognitive disorders (eg. Overgeneralisation, personalisation, and catastrophising).

Question 8

Give the 4 categories of symptoms for stress warning.

Answer 8

1. Emotional
2. Cognitive
3. Physical
4. Behavioural

Question 9

Discuss strategies for managing stress. There are 5 types.

Answer 9

1. Cognitive strategies (cognitive restructuring + hypothesis testing)
2. Emotional strategies (counselling, social support, emotional disclosure)
3. Behavioural strategies (teach new skills like assertiveness + time-management)
4. Physical strategies (exercise, relaxation training, biofeedback)
5. Non-cognitive strategies (drugs)

Question 10

Give 6 stages of a chronic illness which patients must cope with.

Answer 10

1. Diagnosis (eg. Shock)
2. Treatment (eg. Anxiety, discomfort, impact on body image)
3. Hospitalisation (eg. Lost autonomy, privacy, status, possible removal from usual support networks)
4. Physical impact of condition (eg. Pain, limited mobility, other symptoms)
5. Adjustment (biographical disruption, change in identity, chronic nature of illness, terminal illness acknowledgement)
6. Socioeconomic impact (financial problems, social problems, relationship problems)

Question 11

Give the 2 types of coping.

Answer 11

1. Emotion focussed coping

2. Problem focussed coping

Question 12

Discuss emotion focussed coping

Answer 12

1. Cognitive changes (change how you think of the situation - eg. Denial or focus on positives)
2. Behavioural changes (do something - talk to friends, alcohol, find a distraction).

Question 13

Discuss problem focussed coping

Answer 13

1. Reduce the demands of the stressful situation (eg. Find solution to claustrophobia & mask needed in radiotherapy)
2. Increase resources to cope with situation (eg. Get mobility scooter or physiotherapy for mobility problem).

Question 14

Are all coping styles effective?

Answer 14

All may work in the short term, however some may not be good in the long term. For example, emotion focussed coping via the cognitive change (eg. Denial) may not work in the long term.

Active coping is associated with better adjustment, but chronically ill patients tend to report more passive coping. We should consider the persons coping style when giving information.

Question 15

Give 3 ways that we can help patients to cope.

Answer 15

1. Increased/mobilise social support
2. Increase personal control (pain management, CBT, self-management programmes such as DAFNE for T1 DM), involvement of patient in care planning, facilitate cognitive control)
3. Prepare patients for stressful events (in order to reduce ambiguity + uncertainty - via effective communication + peer contact + being responsive to patients preferences + consider special cases such as children).

Question 16

Give 5 outcomes of successful coping.

Answer 16

1. Can tolerate or adjust to negative events/realities
   2 Reduce threats and enhance prospects of recovery - preparing for the future.
2. Maintain positive self-image/mastery
3. Maintain emotional equilibrium
4. Continue to satisfy relationships with others.

Question 17

What is anxiety?

Answer 17

Anxiety is a response to a threat. It is an unpleasant emotional state with feelings of dread or panic.

This response to a threat becomes a problem when the threat is non-existent or exaggerated.

Question 18

If anxiety is sustained, it can be associated with unhelpful thinking patterns and physiological effects. Give 3 unhelpful thinking patterns.

Answer 18

1. Increased vigilance for threats (eg. Symptoms)
2. Interpret ambiguous information as threatening
3. Increased recall of threatening memories

Question 19

Give 3 examples of anxiety disorders.

Answer 19

• Specific phobias
• PTSD
• Panic attacks

Question 20

What is depression?

Answer 20

Depression is a response to loss, failure, or helplessness. It is an emotional state characterised by persistent low mood, sadness, loss of interest, despair, feelings of worthlessness. Tends to be long term.

Question 21

Who are at the greatest risk of depression?

Answer 21

Those with severe/painful/disabling conditions are at a higher risk of depression. Especially when alongside negative life events or when an individual lacks resources to cope.

Question 22

How can co-morbid depression affect physical health problems?

Answer 22

Co-morbid depression can exacerbate the pain and distress associated with physical health conditions. They can either be direct (eg. Immune-related condition) or indirectly (eg. Unhealthy behaviours).

Question 23

Give 3 barriers to identifying psychological difficulties in patients.

Answer 23

1. Symptoms are inadvertently missed (eg. Attributed to illness or treatment. May be experienced outside of consultation).
2. Patient may not disclose symptoms (eg. Doesn’t want to feel like a burden, doesn’t want to be seen as failing, doesn’t want to be judged or avoid stigma. Some patients may also see these difficulties as inevitable).
3. Practitioner may avoid asking (eg. Doesn’t want to label people, perception it is outside of their skill set, time + capacity constraints)

Question 24

What does the definitional framework for psychological therapies show?

Answer 24

Shows there are 3 types of psychological therapies.

1. Type A (Psychological therapies as an integral part of mental health care - eg. By GPs during consultation)
2. Type B (Eclectic psychological therapy and counselling - eg. By psychologists).
3. Type C (Formal psychotherapies - eg. By trained psychotherapists)

Question 25

Discuss CBT. What is it? What techniques are involved? What can it be applied to? What type of people are suitable for it? Limitations of CBT?

Answer 25

Cognitive-behavioural therapy is a pragmatic combination of cognitive + behavioural therapies. Symptoms are relived by changing maladaptive thoughts, beliefs, and behaviour.

Behavioural techniques (RAG):

• Reinforcement
• Activity scheduling
• Graded exposure

Cognitive techniques (EMBER):

• Education
• Monitoring of thoughts, behaviour, feelings
• Behavioural experiments
• Examining/challenging negative thoughts
• Cognitive rehearsal of coping with difficult situations.

CBT can be applied to depression, anxiety, eating disorders, sexual dysfunctions.

CBT is suitable for:

• Active participants
• Those who engage collaboratively
• Those willing to accept a model based on feelings + thoughts
• Those who can articulate their problems and are practically seeking solutions.

CBT is limited because:

• Findings of efficacy are usually based on homologous populations with limited co-morbidity.
• Requires to be delivered by expert practitioners
• Circumscribed benefits where problems are complex and diffuse.

Question 26

What is the cognitive therapy rationale?

Answer 26

The rationale is that it is not situations that upset us, but the view we take of them. Changes to mood state are directly related to the way we make sense of events.

Question 27

Discuss the cognitive model.

Answer 27

This is a model where thoughts, emotions, behaviour, and physiology are in a circle with each other. Environment then inputs into this circle.

Question 28

What is the negative cognitive triad?

Answer 28

1. Negative view of self.
2. Negative view of the world around
3. Negative view of the future.

If an individual has this, suicide is a feasible thought (as they have lost all desire to survive).

Question 29

Discuss psychodynamic therapies. Who are they suitable for?

Answer 29

These techniques aim to resolve unconcious conflicts that underlie symptoms. It explores feelings, using experience of the therapist and the relationship between the patient and therapist. It aims to enhance insight into difficulties and help incorporate painful previous experiences.

Suitable for:

• Those with interpersonal difficulties and personality problems
• Requires an individual who has the capacity for emotional/mental pain. Patient must also have desire for self-exploration.

Question 30

Discuss systemic/family therapy.

Answer 30

This is therapy which involves a system (individual, family, couple). This can be useful as we address issues on a group, rather than helping an individual and returning them to a group which causes them to revert.

In this therapy, there is a focus on relational context, address patterns of interaction and meaning. Aim is to facilitate resources to the system as a whole.

Question 31

Discuss humanistic/client-centred therapy. When does it tend to get used?

Answer 31

There is no universal definition for this therapy. It relies on general counselling skills (eg. Warmth, empathy, unconditional positive regard). Tends to do well with coping of immediate crises where motivation and willingness to solve is present.

Tends to be useful for acute (less than a year) situations. Most suitable for mild/moderate difficulties which can relate to life events, subclinical depression, mild anxiety, marital/relationship difficulties.

Question 32

When considering a therapy type, what must we consider?

Answer 32

1. The problem (severity, time of onset, nature, complexity)
2. The patient (capacity to tolerate emotional/mental pain, psychological mindedness, preference to short or long term treatment, preference for focussed/exploratory work).

Question 33

Give 4 ways that CBT helps with anxiety

Answer 33

1. Reduces avoidance (makes you challenge fears)
2. Ceases safety-seeking behaviours
3. Exposure (leads to habituation)
4. Test beliefs (real life experiments)

Question 34

Define: Psychotherapy

Answer 34

A systematic use of a relationship between a therapist and patient (rather than physical and social methods) in order to achieve changes in feelings, thoughts, and behaviours.