Behavioral Mod, Compassion Stress, Psychoanalytic Psych, & EQ,

classical conditioning

Pavlov’s experiment

stimulus that invokes response

unconditional stimulus

eventually will evoke predictable response

conditional response

operant conditioning

BF Skinner

animal/individual free to act in ways that produce reward

reward determined by environment, not only the experiment

conditioned to repeat action

relate to trial-and-error learning

Health Belief Model

social psychologists - 1950

tried to explain why people do not participate in - preventive health, disease detection programs

combination of stimulus response and cognitive theory

model expanded to explain response to sxs, to dx and compliance w/ meds

components of health belief model

• individuals will act to ward off, to screen for, or control ill health condition if they

  • regard themselves as being susceptabble

  • percieve risks/serious complications of dz

  • perceive benefits if course of action reduces susceptibility

  • perceive anticipated barriers (costs) outweighed by benefits

shaping behavior

involves changing behavior in deliberate and predetermined way

reinforce those behaviors that are in a desired direction

closer the reinforcement to the operant behavior, the better the learning

transtheoretical model

uses stages of change to integrate processes and principles of change from across major theories of intervention

core components - stages of change, decisional balance, self efficacy, and processes of change

decisional balance pros/cons

pros - benefits of changing, modifying behaviors

cons - cost of changing, to modify or not

self efficacy

confidence that one can engage in the healthy behavior amid different & challenging situations

temptation to engage in unhealthy behavior amid different & challenging situations

behavioral modification goals

pt adherence/compliance

cruicial link b/w clinician’s txt recommendations AND pt’s health outcome

5 stages of change

precontemplation

contemplation

preparation

action

maintenance - relapse

pre-contemplation

pt not considering change

not interested or considering any kind of help

may be defensive when confronted about changing behavior

provider role in precontemplation

validate thier lack of readiness

clarify that the decision is theirs

encourage re-eval of current behavior

explain and personalize the risk

contemplation

spending time thinking about some change

ambivalrnt about change

more open to receiving info

not considering change of behavior within the next month

provider role in contemplation

validate their lack of readiness

clarify that decision is theirs

encourage eval of pros/cons of behavior change

identify and promote new, (+) outcome expectations

preparation

getting ready to change

some experience w/ change and are trying to change

realizing something must change

planning to change within the next month

provider role in preparation

identify and assist in problem solving

help pt identify social support network

verify that pt has underlying skills for the behavioral change

encourages small initial stages

action

belief in their ability to change

actively engaged in taking steps to change their bad behavior

shortest of all stages

practicing the new behavior for 3-6 mos

provider role in action

focus on restructuring cues and social support

encourage self-efficacy for dealing w/ obstacles

establish short term rewards to sustain motivation

combat feelings of loss and reiterate long-term benefits

maintenance

continued commitment to sustaining new behavior

successfully avoiding any temptations and/or return to bad behavior

goal = sustain status quo

post 6 mos - 5 yrs

provider role in maintenance

plan for f/u support

reinforce internal rewards

discuss coping w/ relapse

relapse

resumption of “old” behaviors

normal and natural to “regress” part of the process

normal process of changing a habit

provider role in relapse

eval triggers for relapse

reasses motivation and behaviors

plan stronger coping strategies

motivational interviewing

client-centered approach of promoting behavioral change in interpersonal context

explores and resolves ambivalence to decision

provider and pt work together to understand barriers, challenges, and obstacles

4 components of motivational interviewing

empathy

discrepancy - perceptions of pt behavior and whether it matches pt goals/values

reflection - reflect what was said back to pt

supporting self-efficacy - provider empowerment

compassion stress

emotional/behavioral effects felt by people who work w/ others under stress

progressive, signaled by subtle changes in mood

can l/t burnout

can present as poor job performance, impersonality, lack of motivation, and health issues (HTN, insomnia, depression, or addiction)

risk factors for compassion stress

don’t know how to say “no” to demands on their time and energy

assume added responsibility when they are already working at capacity

consistently sacrifice their personal lives for work

lack control in their positions

don’t discuss their problems or feelings

routinely criticize themselves, feel often guilty

haven’t learned how to manage stress effectively

views work as a “calling”

faulty perceptions about compassion stress

i will “fix” the problem

i can do it alone

if i’m strong enough, i can deal w/ the stress

compassion fatigue stages

passionate phase

overwhelmed

irritability phase

withdrawal phase

illness vs renewal/maturation

passionate phase

committed, involved, available

solving problems/making a difference

willingly go the “extra mile”

volunteers w/o being asked

high enthusiasm

overwhelmed phase

intrusive thoughts associated w/ the client’s problems and pain

obsessive or compulsive desire to help certain clients

client/work issues encroahcing on personal time

inability to “let go” of work-related matters

perception of clients as fragile and needing your assistance

irritable phase

begin to cut corners - impulsivity/reactivity

sense of dreading working w/ certain clients

begins to denigrate the people we serve

use of humor is inappropriate

oversights, mistakes, and lapses of concentration

start distancing ourselves from friends and coworkers

sense of inadequacy

increased perception of demand/threat

withdrawal phase

clients become irritants

tired all the time

neglect family, clients, coworkers, and ourselves

loss of humor, energy

isolation

sleep disturbance

change in weight/appetite

tardiness/absenteeism

intervals/prevention for compassion stress

recognize signs

role boundaries/expectations

learning to say “no”

taking control

social professional support

self-care strategies

work/life balance

emotional obstacles

emotional absorption = I feel your pain

boundaries = Should I be doing this?

enabling = Let me do it for you

setting limits and saying “no” = You’re not going to like me

mental illnesses

health conditions involving changes in thinking, emotion or behavior

associated w/ distress and/or probolems functioning in social, work, or family activities

mental illness epidemiology

1 in 5 adults experience

1 in 24 has mental illness

1 in 12 has SUD

mental health d/os and illnesses

addiction disorders

SUD

ADHD

anxiety D/os - generalized, panic, and social

ASD

personality D/os

bipolar

depression

eating D/os

OCD

PPD

PTSD

caring for pts w/ mental health issues

awareness of own biases

empathy, rapport, & trust

non-verbals & approach are critical

identifying info

HPI/CC

past psych, social, fam, med hx

psych ROS

somatics sxs common complaint

depression = most common mental illness

screening hx of mania, psychosis

SIGEMCAPS

sleep changes

interest

guilt

energy

mood

concentration

appetite change

psychomotor

suicidal ideation

mental status exam (MSE)

appearance & behavior

motor activity

speech

mood and affect

thought content

thought process

perceptual disturbances

cognition

insight

judgment

ideas of reference

belief of receiving special messages

illusions

misperception of actual stimuli

delusions

false beliefs

hallucinations

false sensory perception w/o stimulus

auditory most common

olfactory = seizure/temporal lobe epilepsy

depersonalization

feeling like one is standing outside one’s own body

derealization

feeling that one’s environment has changed (not feeling real or present)

defense mechanism

inherent protection to decrease anxiety - helps the individual maintain a sense of safety, equilibrium, and self-esteem

defense mechanisms are used to deal w/ fear and pain associated w/ their illness

defense mechanisms that prevent a pt from seeking appropriate care of compliance issues can ultimately be harmful

common defense mechanisms (psychological theories)

denial

projection

regression

displacement

altruism

humor

suppression

rationalization

denial

primitve defense

commonly noted in medical practice where logical implications of reality are refused, denied in favor of internally-generated thoughts

projection

shifting one’s unacceptable thoughts, feelings or actions onto someone else to avoid feelings of guilt, shame, or regret

dominant defense mechanism w/ paranoid pts or personality disorders

regression

“escape anxiety”

partial return to childish form of behavior

common response to severe or chronic illness (physical/psychiatric)

recognized when physical sxs and incapacities are disproportionate to actual disorder

displacement

redirecting emotions from original matter to more acceptable substitute

common emotion is anger

altruism

unselfishly assisting others to avoid (-) feelings

can be a good thing but can also become martyr characteristic

humor

using jokes, wit, or lighthearted attitude to protect oneself from painful of uncomfortable feelings

suppression

includes some aspects of consciousness, person deliberately putting down or holding back ideas, thoughts

pushes anxiety-provoking or personally unacceptable emotions out of consciousness awareness

rationalization

“making excuses”

controversial behaviors or feelings are justified and explained in a seemingly rational or logical manner to avoid the true explanation

individual unconsciously distorts his or her perception of an event so that its (-) outcome seems reasonable

personality d/os & coping styles

traits and coping styles are individuals’ unique ways or responding to the environment and interpersonal relationships

influenced by - genetic make-up and life experiences, becomes determinant of how people

understanding these can help better predict responses and improve compliance

personality disorders

chronic and lifelong, usually present by early adulthood

DSM-V - criteria based on certain shared characteristics and genetic associations

1-3% of pop

pts have no insight and lack awareness

rarely seek psych help

do not typically show disabling psych problems

pharm txt not shown usefulness

personality disorder Cluster A

paranoid, schizoid, schizotypal

respond to illness by becoming more withdrawn or suspicious

provider must take time to establish trust

personality disorder Cluster B

histrionic, narcissistic, antisocial, borderline

more likely to become emotional when stressed by illness

provider needs to set limits on inappropriate behavior and use closed ended Qs that limit pt’s responses

personality disorder Cluster C

avoidant, obsessive-compulsive, dependent

increased anxiety and may become more fearful than other pts about losing control and becoming dependent during illness

may respond to illness by becoming more controllong or angry or needy

provider not take manifestations of these emotions personally

(+) Psychology

autonomy

humor

moods

optimism

happiness

self-compassion

EQ

know yourself

your needs

self-esteem

5 core emotions

happy

sad

angry

afraid

ashamed

percentage of people who can properly identify their emotions

36

emotional intelligence (EQ)

• ability to understand, use, and manage your own emotions in (+) ways to

  • relieve stress

  • communicate effectively

  • empathize w/ others

  • overcome challanges

  • defuse conflict

• ability to perceive, understand, and regulate emotions in oneself and others

health benefits of EQ

less prone to stress, depression, and anxiety

heal more quickly from serious illness

greater influence on personal and professional success than IQ

EQ facts

more intense your emotions are, greater the likelihood that they will dictate your actions

events which provokes a prolonged emotional reaction in you = “trigger event”

no known connection IQ and EQ

accounts for 58% of performance in all types of jobs

strongest driver of leadership and personal excellence

5 domains of EQ

self awareness - ability to understand one’s strengths and weaknesses

self regulation - ability to monitor and control one’s emotional state

motivation - ability to provide self-motivation to accomplish goals

empathy - ability to understand another person’s feelings and/or emotional state

social skills - ability to successfully interact and have a good relationship w/ others

EQ in medicine

recent move toward more empathetic approach in practices

ability to connect w/ pts on emotional level, improves pt trust and outcomes and professional fulfillment

crucial role in shaping pt-provider relationship

ensuring pts understand info in emotionaly charged environments necessary for valid informed consent

basis of empathy

recognizing emotions in your pts and attempting to understand bow they are influencing their behaviors