Slides Week 1-6 Flashcards
MI in healthcare (Rollni)
Chapters 1 and 2 of “Motivational Interviewing in Healthcare” by Rollnick et al. (2022) introduce the concept of motivational interviewing (MI) as a patient-centered approach to foster change. It emphasizes the importance of forming a collaborative partnership, expressing empathy, supporting patient autonomy, and focusing on the patient’s own motivations for change. The text outlines practical strategies for engaging patients, focusing the conversation, evoking patient motivations, and planning for change. It also discusses the balance of change talk and sustain talk, highlighting how practitioners can guide patients towards articulating their own reasons for change.
MI in healthcare (Rollnic) Obliging people to change
When you stop trying to oblige people to change they become more open to changing.
What Do Patients Want? MI in healthcare (Rollnic)
freedom of choice, They also want to trust, to be heard—and understood—
MI guidelines
- You view them as people first, patients second.* You place high value on connecting well.* You work with their strengths, not only their problems or deficits.* You champion choice and believe your patients are capable of making wise decisions about their lives.* You offer advice rather than impose it.
What is health?
Health psychology is interdisciplinary, integrating knowledge from psychology, medicine, nursing, sociology, and public health to understand and improve health outcomes. It plays a crucial role in the healthcare system by addressing the psychological and behavioral aspects of health and illness, aiming to enhance the quality of life for individuals and communities.
How is Clinical Health Psychology Distinct from other terms?
- Names matter. Think about importance of the term “Clinical Psychology”* CHP vs other terms* Behavioral Medicine* Medical Psychology* Clinical Health Psychology (Belar & Deardorf, 2009)* Clinical – applied practice not just research* Health – breadth of the field (e.g., all health-related issues)* Psychology – subspecialty within the field of clinicalpsychology
What do health psychologists do?
Behavior and Health: Investigates the impact of lifestyle choices, such as diet, exercise, and substance use, on overall health. Health psychologists develop interventions to encourage healthy behaviors and reduce harmful ones.Etiology, health illness and dysfunctionHealth Promotion and Disease Prevention: Focuses on strategies to promote healthy living and prevent diseases through public health campaigns and education programs.
Why is biomedical model ill-suited to understanding illness
The biomedical model is ill-suited to understanding illness because it focuses solely on biological factors and neglects the psychological, social, and environmental influences on health. This narrow perspective overlooks the complex interplay of behaviors, emotions, and societal factors that significantly impact health outcomes.
Division of Health Psychology
The Division of Health Psychology focuses on applying psychological principles to understand and improve health behaviors, prevent illness, and enhance patient care by considering the interplay of biological, psychological, and social factors.
The need for health psychology
Changing patterns of illness, expand healthcare services, increased medical acceptance rise of integrated care
changing patterns of illness
leading causes of death changed to heart disease, cancer unintentional injuries compared to influenza tuberculosis
Expanded healthcare services
- The medical community has grown to value the role of psychology, whether it be to help with behavior management of health habits, managing pain, coping with comorbid anxiety and depression that often accompanies health disorders.* Psychologists are often integrated into care teams andmedical settings
What is integrated care?
Integrated care refers to a coordinated approach that combines medical and mental health services to address the whole person’s health needs. This model emphasizes seamless collaboration among healthcare providers across different specialties to improve patient outcomes, enhance patient experience, and reduce healthcare costs.
Stigma definition
Stigma is the disapproval of, or discrimination against, individuals based on perceivable social characteristics that serve to distinguish them from other members of a society. Stigma often arises from misconceptions, prejudices, and ignorance, leading to exclusion, devaluation, and marginalization of individuals with certain health conditions, identities, or behaviors.
5 overlapping components
Labeling, stereotyping, separating, Status loss and discrimination, loss and power
Types of stigma
public stigma, self stigma, label avoidance, structural stigmas, courtesy stigma, stigma power, automatic stigma, multiple stigma
Types of stigma in healthcare
mental health conditions, infectious diseases, substance use disorders, weight, menstruation, STI, Skin disorder
Effects of stigma
reduced life opportunities, lower quality social relationships efforts to conceal, chronic stress, maladaptive emotional regulation, substance use
Self-stigma interventions
ACT, CBT, CT, narrative enhancement
Nutrient Functions
- Our body requires a balance of nutrients to function optimally.* Macronutrients:* Carbohydrates are our primary energy source, fueling everything from brain function tomuscular activity.* Proteins, composed of amino acids, are essential for tissue repair, immune function, andenzyme and hormone production.* Fats, often misunderstood, are crucial for cell membrane integrity, energy storage, andabsorption of fat-soluble vitamins.* Micronutrients, although required in smaller amounts, are vital for disease prevention and themaintenance of bodily functions.* Vitamins and minerals, which play roles in bone health, blood clotting, and maintaining thehealth of our nervous and immune systems
Nutrition & Physical Health
Proper nutrition is the cornerstone of physical health. It supports various bodily systems,notably cardiovascular health and immune function.* A diet rich in fruits, vegetables, whole grains, and lean proteins can reduce the risk ofchronic diseases such as heart disease, stroke, and diabetes.* (e.g., Omega-3 fatty acids found in fish can reduce inflammation and lower the risk ofheart disease.)* Malnutrition leads to a range of health problems.* Undernutrition can weaken the immune system, making the body more susceptible toinfections.* Overnutrition, often resulting in obesity, increases the risk of chronic illnesses.
Psychoneuroimmunology
This field examines the interaction between psychological processes, the nervous system,and the immune system
Environmental factors influencingeating
Food deserts Nutritional deficiencies, Chronic Health Conditions, Mental Health: Child Development and Education:
Psychological Factors influencingeating
Cognitive influences: Our beliefs, knowledge, and attitudes towards food significantlyimpact our dietary choices. Cognitive bias can lead to unbalanced eating habits. Knowledgeand education about nutrition also play a crucial role, as informed individuals are morelikely to make healthier food choices,Manyindividuals turn to food for comfort during stress or emotional turmoil, often choosinghigh-calorie, sugary, or fatty foods.
Sociocultural factors influencingeating
Cultural norms, Economic factors, Family habits and traditions
Recommended Exercise
2 ½ to 5 hours a weekof moderate intensity, or 1 ¼ to 2 ½ hours a week of vigorous aerobicphysical exercise, or a mixture of both
Theories of Motivation to Exercise;
Self-Determination Theory (SDT):* Emphasizes the role of autonomy, competence, and relatedness in fostering intrinsic motivation towardsexercise, Transtheoretical Model, Goal Setting Theory (SMART goals).
Barriers to exercise
Barriers: Lack of time, energy, resources, low self-efficacy stemming from previous failures, lack of access to safe exerciselocationsWhat therapeutic modalities might be helpful in increasing motivation?
Mental Health Benefits of Exercise
- Stress reduction: It lowers cortisol levels, the body’s stress hormone, and enhancesour stress resilience.* Improves mood: Triggers endorphin,’* Positively impacts cognitive function
Exercise Prescription in ClinicalPractice
Role of Health Psychologists:* Advocating for and incorporating exercise into treatment plans* Addressing behavioral and psychological factors to facilitate physical activity
Strategies for Incorporating Exercise Recommendations:
Collaborating with patients to set realistic exercise goals by tailoring exerciserecommendations to individual needs and capabilities* Engaging in Cognitive-behavioral or MI strategies to enhance motivation and adherence
Obesity
35% of men and 40% of of women in the US are obese, risk for coronary heart disease, type 2 diabetes, various types of cancer, gallstones,and disability, increased risk for death
Obesity Conceptualized as a Disease
Complex Etiology: Obesity is caused by a complex interplay of genetic, environmental, and behavioralfactors, reduces stigma
Need for Medical Intervention for obesity
including lifestyle modification, medication, andsometimes surgery, similar to other chronic medical conditions
Why is Insomnia Important to KnowAbout?
Negatively affects physical and mental co-morbidities (e.g., CV Dz,DM2, depression, anxiety, suicide) and health related Q of L
What is sleep
- Light Sleep* Stage 1 (2-5%)* 5 mins; transitional phase* Low arousal threshold* Stage 2 (40-55%)* Deep (15-20%)* Stage 3 (in 2008 Stages 3 & 4 combined)* “Delta” “slow-wave sleep”* REM (20-25 %, formerly stage 5)* Paradoxical sleep; body is paralyzed; vivid dreams
The Nature of Insomnia
Three common types of insomnia:* Sleep-onset* Problems with falling asleep at bedtime (common in anxiety)* Sleep-maintenance* Awaken in night and trouble returning to sleep* Terminal* Awakening too early in AM (common in depression)
DSM-5-TR insomnia criteria
Dissatisfaction with sleep quantity or quality* Difficulties initiating and/or maintaining sleep* Be aware normal SOL is less than 30 minutes and SE greater than 85%
Epidemiology
Most common of all sleep disorders and perhaps the mostfrequent health complaint after pain
Predisposing /Risk Factors
Psychiatric Condition, esp. Depression/Anxiety* Increased Muscle Tension/Chronic Worry* Family Members Modeled Poor Sleep Habits* Ongoing Stressful Situations in Your Life
Precipitating Factors
New Stressful Situations, Changes in Schedules, Hospitalization, Produce hyper-arousal or change in sleep cycles/disturbed sleep
Perpetuating Factors(i.e., Maintaining Factors)
- Misinformation About Sleep/Effects of Insomnia* Regular Use of Sleeping Pills* Medications for Other Health Problems* Irregular Sleep Schedule* Daytime Napping* Anxious Thinking* Excessive Time Spent in Bed Awake* Leads To . . .* Hyperarousal about sleep problems* Conditioned arousal* Disturbed sleep cycles* Need meds to sleepPerpetuating Factors(i.e., Maintaining Factors)
Assessment of Insomnia
- Sleep Diary (Gold Standard for routine sleep assessment andoutcome evaluation)* Screening for Other Sleep Disorders (see manual for these)
Sleep History
- Onset, duration, frequency, progression* Sleep related behaviors* Circadian tendencies* Sleep environment* Times - bed time, awaken, variations* SOL, WASO, RTS, EMA (Common Abbreviations to Know)* Sleep Onset Latency (SOL), Wake After Sleep Onset (WASO), Return to Sleep(RTS), Early Morning Awakening (EMA)* Sleep quality* Daytime impacts* Past attempts to treat (meds (Rx & OTC), sleep studies, etc.)
Sleep Sleep Diaries
Sleep Diaries Have Reasonably Reliability and Validity* Morning estimates of SOL, WASO, RTS are fairly accurate* Insomniac sleep tends to be poorer than controls on both sleep diary andpolysomnography.
General Empirical Evidence
Cognitive-Behavioral Treatment for Insomnia (CBT-I)* General term capturing a variety of techniques* Produces clinically significant and enduring change* Effective with insomnia assoc w/ co-morbid medical and psychiatricconditionsMulti-component and Stimulus Control/Sleep Restriction superiorto Relaxation Alone* Average Sleep Improvement – 40-60% to 70-80%* Differences between subjective and objective improvement
Clinical Practice
Most Common Cognitive Behavioral Treatments:* Sleep Education & Sleep Hygiene* Stimulus Control* Sleep Restriction* Relaxation Therapy* Cognitive Therapy* Most Use a Multi-modal Approach
CBTi Therapeutic regimen
Norm* 4-8 weeks* Face-to-face individual or group* Usually education, sleep hygiene, stimulus control and sleep restriction* Adjunctive therapies - relaxation, cognitive, and planning for maintenanceof gains
Educational Component
The educational components involves teaching basic sleep hygieneprinciples.* Adherence to good sleep hygiene practices is generally poor amongpeople with insomnia* But, outcome studies show that sleep hygiene education alone isunlikely to be sufficient
Sleep Restriction Therapy
- Three basic steps:1. Establish a fixed wake time2. Decrease time in bed to average total sleep time3. Increase time in bed when sleep efficiency >85-90%* May be contraindicated in patients with bipolar or seizure disorder* Sleep deprivation can trigger seizures and mania
Stimulus Control
- Purpose:(1) Strengthen the association between sleep behaviors and stimuli likea. The bedb. Bedtimec. Bedroom environment(2) Consolidate sleep over shorterperiods of time spent in bed
Combined Stimulus Control and SleepRestriction Procedures
- Set a reasonable bedtime and arising time and stick to them.* Go to bed only when you are sleepy.* Get out of bed if you can’t fall asleep or go back to sleep within 20minutes; return to bed only when you are sleepy. Repeat asnecessary.* Use the bedroom for sleep and sex only.
Treatment Adherence
- The single most important complicating factor in StimulusControl/Sleep Restriction is poor treatment adherence* Minimum of 5 hour sleep window
Tips to Enhance General AdherenceProblems
- Find things to do when you are out of bed during the night.* Know signs that show you are sleepy.* Use an alarm clock to wake and get up the same time every day.* Avoid clock watching
Common Cognitive Errors in Insomnia
Faulty Appraisal* View transient sleep difficulties is a common triggering point of chronicinsomnia (e.g., loss of control vs. extenuating circumstances).* Misattributions* Daytime impairments to poor sleep can feed into a self-fulfilling prophecy.* Unrealistic Expectations* Wrong beliefs regarding sleep requirements are common
Additional Strategies Used in InsomniaProgram
Stress Management Training* Neuromuscular Relaxation Training* Worry Control/Problem Solving Training* Mindfulness/Meditation* Acceptance and Commitment Treatments/Techniques* Generalized Anxiety Management* Pain Management* Smoking Cessation
