Psych of Injury: Assessment, pain, malingering- exam 2

Assessment

the gathering of info about patient/ client concerns prior to the selection of an intervention

measurement

the gathering of info about a client concerns “along the path” after an intervention has been introduced- reassess as we go

‘distress quotient’

how stressed is the athlete

Personal meaning of injury to athlete?

another challenge? punishment for past transgression? weakness? relieving? loss?

athletes advantage

pain tolerance, more resources, strong motivation, quicker recovery

non athletes advantage

time, no loss of athletic identity, not as an intense rehab to return to “normal”

somatization

experience emotions through physical pains

life stress and change

personal stress + injury= ++stress

sport stress and change

change in coach? change in team status? experiencing performance decline? how stable was the athletes life before injury?

approach of major competition

spent all season working towards this one game/ competition and now can’t play

marginal player status

not a starter, but working their way to be one, then gets injured and feel like they are back at square one.

overtraining

cortisol is constantly being released because of their constant stress- immune system shuts off- they get sick

sport- related health risk factors

substance abuse problems?

factors associated with injury

severity, emotional distress, injury site, pain, timelines, unexpectedness

severity

more severe = more distress (most of the time)

emotional distress

extreme fear, anxiety, irritability, depersonalization, incomplete memory, catastrophizing

injury site

different places on the body = more psych stress

face- everyone can see it, people constantly asking about it

hand- hard to hide, loss of everyday function

genitals- weird to be examined

pain

more pain = higher distress, pain out of proportion to the severity of injury could give us an idea of how the athlete will respond to the injury

timelines

Spontaneous time? middle of season"? end of season? what is the athletes’ level of attention?

unexpectedness

doing something stupid or not their main sport = higher psych distress, guilt

factors following injury

culpability, compliance with treatment, perception of treatment efficacy, treatment complications, pain, medication use, psych status, social support, personality conflicts, fans and media, litigation

culpability

whose fault was the injury, accident? self? on purpose?

compliance with treatment

are they going to treatment? low motivation?

perception of treatment efficacy

does the athlete believe treatment is helping and are they happy with their treatment care? ask them how treatment is going

treatment complications

setbacks = higher distress, may feel failure

pain

what does this pain mean to them? positive or negative perceptions? high pain tolerance?

medication use

using as a coping method?

psych status

more evident as you talk with them

social support

we need people

personality conflicts

now irritable? withdraw?

fans and media

are they covering the athlete in a positive or negative light due to their injury?

litigation

legal repercussions due to injury

methods of gathering info

interview, self- report, self- monitoring, direct observation

“triangulation” of assessment

need three pieces of data and they all have to confirm each other

assessment pinciples

info gathered is simply and sample of behavior, thoughts, or perceptions

assessments are often influenced by situation (fatigue, hunger, mood, health status)

want to spread out assessments over a few days

factors promotions effective assessment

personal characteristics of the counselor (listening, eye contact), professional behavior, establishing the counseling relationship before the assessment interview (10-10-40), privacy, counseling atmosphere, demonstrating respect

presenting concern

what is bothering them

onset

when did you first notice?

duration

how long has it been happening?

frequency

how often does it happen?

course

become better, worse, or same?

main purpose of an assessment interview

gain insight into the meaning of the injury to the athlete, emotional response, concerns which may warrant referral

ERAIQ- emotional responses to athletic injury questionare

nonclinical, interview style

SCIP- sport clinical intake protocol

clinical, interview

PInG- performance interview guide

non clinical, interview, more user friendly

LESCA- life experiences survey for college athletes

to assess life stress among college student athletes, could be used to prevent injury

POMS- profile of mood states

economical way of measuring mood “states”

6 main mood states

tension- anxiety

depression- dejection

anger- hostility

vigor- activity

fatigue- inertia

confusion- bewilderment

BAM- brief assessment of mood

shorter version of POMS

return to sports concerns assessments

SCAT- sport competition anxiety test

predictors of success

motivation to work on concerns, psychological mindedness, “relatively healthy” ego, capacity to cope with stress in therapy, capacity to trust

BASIC ID

B = behavior (attendance, tardiness)

A = affect (emotions)

S = sensations (pain, soreness)

I = imagery (dreams, visualization)

C = cognitions (self talk)

I - interpersonal (relationships, introvert)

D = drugs/ biology (personal health habits)

Pain

sensory and emotional experience characterized by actual injury and that indicate potential injury

Acute pain

relatively rapid resolution

Continued pain—> autonomic responses—> sensitization of pain receptors and greater pain

Chronic pain

long- term pain without sufficient relief

can cause anxiety, depression, anger, irritability, low motivation

types of pain

performance pain and injury pain

performance pain

associated with normal training/ competition

injury pain

associated with distrustful training and competition injury; shock, fear

function of pain

the body’s protective mechanism against further injury

increased awareness: heightened SNS activity in the area injury

perceptions of pain

different speeds (burn(slow) vs. pain prick)

pain mechanisms

nociception without pain (shocking pain- soldiers)

pain without nociception (“phantom limb”- limb amputated but feel pain in the limb they no longer have)

masochism

someone enjoys pain

experience of pain

emotional component, shock, numbness, anxiety, fear, anger over re-injury, irrational self- defeating self- talk

behavior that may come with pain

some athletes report excessive/ non- existent pain or suffering

purposeful to elicit attention, to gain sympathy

avoidance behavior (relief from practice, escaping responsibilities)

gender differences in pain

women may tolerate pain better than men- mensuration and birth

men often deny pain due to societal norms

sport culture

expected to play with discomfort, pain, injury

cultural differences

pain experienced and treated differently

women giving birth (US vs. Asia)

suffering

cannot be accurately measured

“disease model” of suffering

physical dysfunction exists

Pain- “symptom” of underlying physical dysfunction

tolerance

sensitivity/ tolerance to pain caries rhythmically throughout the day

latest, early mornings (2am) (lowest nervous arousal) (has nothing else to focus on)

most 8am to 6pm (more nervous arousal)

major tasks of sport psychologists

monitor reported pain and impact on clients

be available as a supportive resource

maintain connections

make appropriate referrals

assessment- give as a professional

pain drawings, coping strategies, psychological testing

pain management

reducing the chronicity facilitated by specifying time frame for recovery

operant conditioning (positive reinforcement)

clear understanding of what influences their perceptions about pain and how pain influences them

learn to distinguish between types of pain

pain control strategies

pain reduction and pain focus

pain reduction

guided imagery for pain, deep breathing, therapeutic massage

pain focus

mindfulness, soothing imagery, rhythmic cognitive activity, pain acknowledgment

Malingering

intentionally producing “false or groaaly exaggerated physical, psychological, or combined symptoms (faking an injury)

misconceptions of malingering

malingering is obvious, so it’s easy to detect

deceptive people are likely to be malingerers

inconsistancy in symptoms = malingering

sport malingering motivations

rationalize loss of starting status, less playing time, and poor performance

prevent loss of scholarship

offset personal realization of insufficient ability

offset expectations of coaches, teammates, parents

“saving face”

warning signs of malingering

deceitfulness

absence of guilt

dramatic

patient reports deviate from medical evals/ opinions

patient is repeatedly uncooperative, resistant

recovery time is not normal

all behavior is …..

purposeful

how to work with an individual who may be malingering

listen

confront honestly and directly

create clear goals

clarify consequences for noncompliance

encourage athlete to speak with others who have recovered successfully

reinforce appropriate behavior

refer if needed

avoid using term “malingering”

As a coach, what can you do to prevent malingering?

“if you don’t practice, you don’t play”

be encouraging after loss

it is important to find the _________ for a person malingering

motive

malingering in life

avoid working, $ compensation

prisons, miliitary, school, sport

“Approach- Avoidance” conflict

a predicament in which a person is faced with two equally bad choices

methods of disengaging from way of life that has proven undesirable and unavoidable

somatoform disorder

experiencing something psychological, bet feeling it physically (no injury)

not on purpose- patient is as confused as practitioner

when treating somatoform disorder, you would use…

psychological treatments

to be diagnosed with somatoform disorder, it must cause…

significant distress & disrupt school, work, &/ or relationships

Pts with somatoform disorder are often…

perscribed countless, useless medications and unnecessary operations

Types of somatoform disorders

somatization disorder

conversion disorder

hypochodriasis

body dysmorphic disorder

psychogenic pain disorder

undifferentiated SD- don’t worry about this one

Somatization disorder

experiencing something psychological, but feeling it physically

combo of pain, GI, sexual, false- neurological symptoms

Somatization disorder symptoms/ function

over exaggeration

a defense mechanism

onset/ course of somatization disorder

usually in adolescence, always before 30

symptoms change, often life long and made worse by life stress

conversion disorder

involuntary loss or change in physical function

may loose or experience change in one of the 5 senses

types of conversion disorder

anesthesia

hyperesthesia

analgesia

paresthesia

anesthesia

loss of sensitivity

hyperesthesia

excessive sensitivity

analgesia

loss of sensitivity of pain

paresthesia

unusual sensations (tingling)