Session 4 - Stress, coping, and pain

Question 1

What are the physiological responses triggered in stress?

Answer 1

Fight or flight response:

• Increased oxygen availability, breathing and increased haematocrit.
• Enhanced mental functioning
• Enhanced physical functioning
• Increased fuel availability.

Question 2

Why is stress positive?

Answer 2

Good for acute stressors, exercise, dangerous situations

Question 3

Why is stress negative

Answer 3

Frequent daily hassles results in chronic stress response,, which is damaging to the body

Question 4

Define a stressor

Answer 4

Anything that causes stress to an organism

Question 5

Give 2 tools to measure stress

Answer 5

1) The Holmes and Rahe stress scale
2) The Kanner Daily Hassles and Uplifts scale

Question 6

Explain the transactional model of stress

Answer 6

situation is appraised, if no threat percieved stress does not occur.

If threat percieved, and subject can cope with threat then positive stress, if inability to cope negative stress PIC

Question 7

Define a primary and secondary appraisal in the transactional model of stress

Answer 7

Primary appraisal – Is this event a treat? How bad could it be?

Secondary appraisal – Do I have the resources or skills to cope?

Question 8

Define the two factors that influence the impact of stress

Answer 8

1. Control of event – More control = less stress
2. Social support – more support = less stress

Question 9

How can stress negatively impact on health? Give 3 methods

Answer 9

• Negatively impacts cardiovascular system
• Chronic stress depresses immune function and inflammation (acute stress upregulates immune function)
• Stress can lead to unhealthy behaviours such as overeating or undereating, lack of exercise, smoking
• Leads to more rigid and extreme thinking, overgeneralisation, catastophising, and rumination
• Can teach a learned helplessness leading to anxiety and depression

Question 10

Give 5 strategies to deal with stress

Answer 10

Cognitive strategies – e.g. cognitive restructuring, hypothesis testing

Behavioural strategies – skills training e.g. assertiveness, time management

Emotional strategies – counselling, emotional disclosure, social support

Physical strategies – Relaxation training, biofeedback, exercise

Non-cognitive strategies – drugs

Question 11

How might a patient react to a chronic illness and its treatment?

Answer 11

• Diagnosis leads to fear, shock, anxiety, depression, denial etc.
• Physical impacts of illness e.g. pain, limited mobility
• Treatment may cause anxiety, discomfort, impact on body image etc.
• Hospitalisation causes loss of autonomy, privacy, possible removal from usual support network etc.
• Adjustments with illness
• Socioeconomic impact of illness

Question 12

Define emotion focused coping and give 2 exampleas

Answer 12

EFC = Change the emotion

Behavioural approaches - e.g. alcohol, distractions

Cognitive approaches - e.g. denial, focus on +ve aspects of problem

Question 13

Define problem focussed coping and give 2 examples

Answer 13

PFC = change the problem or your resources

1) Expend resources to deal with it
2) Reduce demands of stressful situation by learning how to cope

Question 14

Describe 4 ways to aid patient’s in coping with problems

Answer 14

1) Increase social support
2) Increase personal control e.g. patient choices, pain management
3) Prepare patients for stressful events through effective communication
4) Stress management

Question 15

Why are patients with chronic illnesses at increased risk of mental health problems?

Answer 15

Depression and anxiety due to threats to well being, feelings of helplessness, failure.

Question 16

Give 3 barriers which may prevent identification of depression in patients

Answer 16

1) Stigma associated with mental health
2) Patient doesnt want to be additional burden to doctors
3) Depression may set in after patient goes home

Question 17

Outline NICE guidelines in dealing with depression

Answer 17

• Recognition, assessment and management
• Mild to moderate depression – individual guided self help, structured group physical activity
• Moderate to severe depression – antidepressants and individual CBT (cognitive behavioural therapy)

Question 18

Outline NICE guidelines in dealing with anxiety

Answer 18

Generalised anxiety disorder – individual self help, medication

If more severe – individual CBT,

Question 19

What is the bio-medical model of pain? What is its limitation?

Answer 19

Physical damage = real pain

But some patients report pain when no damage present, phantom limb pain, and placebo effect

Question 20

Distinguish between acute and chronic pain

Answer 20

Acute - Short term, attracts our attention

Chronic - Pain for >12 weeks, does not indicate tissue damage, rest not helpful

Question 21

Outline the Gate theory of pain

Answer 21

Neural gates for pain messages are located in dorsal horn of spinal cord.

Extent to which the gate is open affects the number of pain messages that pass onto the brain

Question 22

Give 3 examples of what opens this gate and what closes it

Answer 22

Opens - injury, stress, Negative emotions

Closes - medication, exercise, relaxation

Question 23

What are the limitations of the gate theory?

Answer 23

• No physical structure identified
• Allows that physical and psychological processes interact but still sees them as separate

Question 24

What are the aims of a pain management programme?

Answer 24

• Improve fitness, mobility and posture
• Develop ways to cope with stress and depression
• Improve communication skills about condition

Question 25

What aspects make a Pain management programme effective?

Answer 25

• Being believed that the pain is real
• Being part of a group with shared experience of chronic pain
• Social comparison theory – people often judge others as worse off.