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PSYC 3170
Jennifer Mills

HEALTH PSYCHOLOGY LECTURE: NOVEMBER 16TH, 2012 TOPIC: CHRONIC ILLNESS [email protected] (send notes) ➔ Terminal and Chronic Illness ◦ Example: Heart Disease ◦ Chronic diseases are not just for older people (yes their risks are higher but it affects everyone) ◦ Example: asthma is on the rise ➔ Reactions to Chronic Illness ◦ Alot of psychological factors play a role ◦ Shock -they cannot believe that they have this illness, feel confused, bewildered ◦ Encounter-a phase of the reaction where people have very negative emotions: feel overwhelmed, helpless, hopeless. Very similar to a grieving process. It can last from a few days to several months. It is all within the so called normal range of reactions. ▪ Example: cancer • People think of it as automatically terminal which is not necessarily true • Stigmatization and diagnosis of cancer leads to a negative reaction ◦ Stress ◦ Anxiety ◦ Insomnia • Challenges for health practitioners because it is not just biological aspects that they have to look at. ◦ Psychological symptoms ◦ Medications ◦ More doctors are becoming more sensitive to this so that they can try and work with symptoms from different angles ◦ Retreat -deny or avoid thinking about the diagnosis. ▪ Emotion-focused coping example • Deny or avoid is so that they do not obtain negative emotions and reactions ▪ Example: cancer • Maybe they will not follow through with treatment • They may skip appointments if in denial • Some people do not even tell loved ones they have been diagnosed • Whatever you push on them will be met with resistance ▪ Example: lung cancer • Is in denial and keeps smoking ▪ Example: asthma • Does not take steps to avoid allergens that cause an attack ➔ Crisis Theory: Illness-Related Factors ◦ Disfigurement ▪ Example: amputation, scarring, visible disfigurement ◦ Threat ▪ Objective Threat: how threatening the diagnosis is in reality and Perceived Threat: how threatening it is in your view. ▪ Your perceived threat determines your reaction ◦ Embarrassing problems ▪ Perceive a test for cancer as embarrassing ▪ Embarrassed talking about being diagnosed with cancer for example ▪ Men diagnosed with breast cancer (embarrassing because it is thought to be a female cancer) -difficult to cope, threat to gender role ◦ Visible conditions ▪ Changes they can see ◦ Pain ▪ Painful conditions ◦ Time commitment for treatment regimen ▪ Difficult to cope with large time commitments (such as going to the hospital all the time for treatment) ◦ Lifestyle changes ▪ Having to change your routine, health habits etc ➔ Personal Factors ◦ Hardy or resilient personality ▪ Resilience with crisis ▪ Example: lost of a loved one and such ▪ Good at coping ▪ Remain positive even when the situation is negative ▪ Strong level of appropriate social support • Social support that is not helpful could be damaging ◦ Example: introverted -people constantly calling a shy person may not be helpful because they like their personal alone time ▪ People high on this trait are good at obtaining the right level of social support ◦ Gender ▪ Men have a much harder time with the stress of a diagnosis • Concerned about finances • Have a harder time taking on the role of a patient → in conflict with the almost global, cross cultural representation of men being strong and responsible • Women cope better with this role • For kids it makes no difference until they reach adolescence because they really start to take on gender roles ◦ Timing during the lifespan ▪ Example: young moms being diagnosed with breast cancer for example (under age 45) • Have young families making it especially stressful • Treatments are severe, a lot of time commitment • Psychological: these women are in the prime of their life so they are forging a career and family when stopped in their tracks with cancer • Mother: nurturer role → cannot fulfill role when sick → threat because you feel like you are not a good mother (gender factor and timing) • Young people who just started high school or who are almost done University being thrown off by a chronic illness putting them behind because they had to take time off. • Lifestyle challenge ◦ Personal health beliefs ▪ How you perceive people in the sick role ▪ Feel you have control → cope better ▪ Leukemia Example • Two young people are candidates for a bone marrow transplant • One threw himself right into the preparation into the transplant ◦ Saw a personal trainer ◦ Learned how to cook ◦ Took time off to be the best possible patient he could be • The other person became very depressed and had insomnia ◦ No sleep → health deteriorates ◦ Saw psychologist for issues ◦ Got things back on track • Very different experiences and reactions to the same situation • In psychology we cannot predict how one will react • Doctors need to prepare for this ➔ Environmental Factors ◦ Depressive environments ▪ Alot of medical environments are like this ▪ Dirty floors, chipping paint, depressing ▪ Hospitals differ in different places (i.e.Australia, United States) ▪ Public versus Private System in terms of going to a hospital in another country (different payment amounts) ▪ Public System • Look like Canadian hospitals • Run down • Crowded • Good care • Medical school based ▪ Private System • Crystal chandelier • Bell Boys • Front desk resembles one from a hotel • Classical music playing • Fancy oriental rugs on the floor • Lower ratio of patients to nurses • Quality of doctors -doctors have to in their early stages have to split their time between both systems inAustralia. The care is the same. The environment is different → this makes a difference. ◦ Less anxiety ◦ More relaxed ◦ Lots of room for family to visit ◦ Environment may not foster self-sufficiency ▪ The patient's attitude that he or she could do things for themselves → self-sufficiency ▪ Low self-sufficiency → confined to bed and had to be waited on 100% ▪ Evidence: environments that foster self-sufficiency: patients do better, they have a better outcome and cope much better → better health ▪ Example: you could administer your own pain medication, go for a walk, get your own lunch → things you could do as a patient ▪ Hospitals are moving in this direction ◦ Social support ▪ Not just the level matters but the connection between what the person wants and what they are getting ▪ The better you perceive it the better you adjust ◦ Network members ▪ Doctors, nurses ▪ Other people you encounter when dealing with illness • Could be good or bad role models • Maybe they are positive, encouraging and validating → easier to adjust • Those with an illness often seek out someone with a similar illness • Human need to feel that others understand us ➔ Adaptive Tasks ◦ Cope with symptoms or disabilities ▪ Example: crutches ◦ Adjust to hospital or procedures ◦ Develop and maintain good relationships with practitioners ▪ People with an illness feel that the last thing they want to do is search for another doctor therefore they feel stuck. ▪ Some places do not have a lot of doctors to choose from ▪ Toronto has a lot → spoiled, lots of access ▪ May search because you do not like them or feel good about them ➔ Psychosocial Functioning Tasks ◦ Control negative feelings and remain positive ▪ Make sure negative emotions do not overwhelm the person ▪ Some people are more positive than others personality wise ▪ Need cognitive restructuring → less bias in terms of only thinking about negative things • Do not invalidate someone's experience (Oh it is a good thing you got cancer because it has taught you to be more positive → WRONG) • Instead → It sounds like you are very depressed but you will feel better (validating but not agreeing or making them feel more depressed). What would help you to feel more positive? ← these are questions one is to ask. • Validate bad feelings while enforcing positive ◦ Maintain satisfactory self-image ▪ Example: group therapy for women with breast cancer → breast removed –. self-image • Devastating to lose a part of the body associated with beauty, youth, sexuality ◦ Preserve good relationships ▪ Identify relationships in their life that are positive and helpful ◦ Prepare for uncertain future ▪ Help people feel okay about what comes next ▪ Example: family tensions, how much medical intervention is needed (chemotherapy – sometimes the patient stops treatment while the family disagrees and therefore the psychologist helps mediate). ▪ Assisted suicide • Psychologists can be helpful in situations where a patient is trying to navigate choices around treatment options. What happens if they refuse? REFER TO CHRONIC ILLNESSES IN TEXT SINCE WE CANNOT COVERALL OF THEM ➔ Asthma ◦ 10 most common reason to go to the doctor ◦ Prevalence increasing ◦ Impaired
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