S1L1.2_Psychological Responses to Injury & Illness

Psychological Responses to Injury & Illness

• Adjustment issues

• Depression &/or anxiety

• Diminished self-efficacy

Models of Responses to Injury & Illness

• The Biopsychosocial Approach

• Crisis of Physical Illness Mode

• Cognitive-Behavioral Model

The Biopsychosocial Approach: Bio + Psych =

IQ temperament

The Biopsychosocial Approach: Psych + Social =

Family rs & life events

The Biopsychosocial Approach: Bio + Social =

Substance abuse

Crisis of Physical Illness Model

Diff contexts, interventions, coping proc.s, & outcomes

Recognizing that there’s a prob

Coping Skills: differs d/t diff kinds of appraisals

Cognitive-Behavioral Model

Reaction, Response, & Adjustment to Injury & Illness

• Psychological Reactions

• Psychological Response

Psychological Reactions

May either be:

• Immed, reactive, reflexive,

• Somewhat uncontrollable, or

• Shorter duration

Tells us to respond as well

Psychological Response

• Secondary, evaluasive → invokes respo choices

• Longer duration but more dynamic

• May be efficient or inefficient, and:

Psychological Response: Abnormal or pathological responses

• anxiety, depression, etc.

• Leads to pathological / maladjustment

Psychological Response: Abnormal or pathological responses:

• Cognitive

• Emotional

• Behavioral

• Cognitive: ongoing, irrational thoughts

• Emotional: intense, unresolved grief

• Behavioral: chronic non-compliance

Psychological Response: Normal or expected responses

• Sad, fear, anger, optimism, motivation

• Leads to normal adjustment

Psychological Response: Normal or expected responses:

• Cognitive

• Emotional

• Behavioral

• Cognitive: optimism

• Emotional: hopefulness

• Behavioral: compliance

Cognitive Appraisal & Responses

Identity

Coping

Optimism/Pessimism

Control

Self-perceptions

Illness Cognition/ Attributions

Faith & Religious beliefs

Cognitive Appraisal & Responses: Identity

Identities relative to their roles

Cognitive Appraisal & Responses: Coping

Managing the perceived discrepancy bw demands of a situation & available personal & social resources

Cognitive Appraisal & Responses: Optimism / Pessimism

Holding (+) or (-) expectancies

Cognitive Appraisal & Responses: Control

• Internal health locus of control → c strong sense of control over health events

• Internal locus: self-motivation, what we can do

• External locus: what we can still work on it (??)

Cognitive Appraisal & Responses: Self-Perceptions

• Client’s confidence & self-efficacy

  • Pt’s confidence on ppl helping them

Cognitive Appraisal & Responses: Illness Cognition / Attributions

• Cognitive assessments abt the causes, meaning, & salience of medical events → affect their ff responses & choices

• Imp to clearly explain to Pt → layman’s terms 

Cognitive Appraisal & Responses: Faith & Religious Beliefs

• Religious involvement → may (+) affect health

  • Enhances social support, alleviate stress, & promote healthy practices

Emotional Responses

Mood States

Fear & Anxiety

Emotional Distress & Somatic Complaints

Kinesophobia

Emotion Regulation Strategies

Grief

Emotional Responses: Mood States

• Stem directly fr cognitions

• Change dynamically throughout injury/illness & recovery process

Emotional Responses: Fear & Anxiety

Fear = inhibits pain       

Anxiety = enhances pain

Emotional Responses: Emotional Distress & Somatic Complaints

Neurotic Triad
Hypochondriasis	Depression	Hysteria

Emotional Responses: Kinesophobia

• Fear of physical activity

• Fr belief that it will lead to pain, injury, or reinjury

Emotional Responses: Emotion Regulation Strategies

• Emotional approach coping

• Once felt → body may also be affected

• E.g. stressed = headache, stomach ache, etc.

Emotional Responses: Grief

• A cycle of cognitions (sense of loss), emotions (grief), & behaviors (mourning)

Behavioral Responses

Social-Support-Seeking Behavior

Emotional Disclosure

Adherence Behavior

Malingering Behavior

Behavioral Responses: Social-Support-Seeking Behavior

• Perceived help & caring that indiv receives fr others

Behavioral Responses: Emotional Disclosure

• Engaging in disclosing & expressing one’s emotions → helpful in altering (-) emotions

Behavioral Responses: Adherence Behavior

• Sticking c tx & rehab protocol & plan

Behavioral Responses: Malingering Behavior

• A psychological adjustment to (-) circum.s

• Some incentive to remain in medical setting

Coping Strategies/Skills

• Problem-focused Coping

• Emotion-focused Coping

Coping Strategies/Skills: Problem-focused Coping

• Do smth constructive abt stressful conditions harming, threatening, or challenging an indiv

Coping Strategies/Skills: Emotion-focused Coping

• Regulate emotions experienced d/t stressful event

• E.g. bath, exercise = happy hormones → maintain homeostasis by negating stress hormones; if injured = rest

Coping Styles

Approach

Avoidant

Coping Styles: Approach

• Confrontative, vigilant

• Wanting to address the prob, get it out in the open & deal c it

Coping Styles: Avoidant

• Minimizing

• The reverse of approaching → removing the stressor & avoiding it in the future is preferred

Link Between Psychological Response & Psychological Intervention

• May be: heightened but not patho, typical & expected, or abnormal/pathological respo

• Psychological rehab by PT aside fr 3 responses

Psychological Aspects of Rehabilitation

• Adherence to rehab

• Link bw rehab adherence & outcome, and methods of enhancing adherence

Following Medical Advice

Compliance

Adherence

Concordance

Compliance

• Term traditionally used

• Acting in accordance c MD’s instructions

• Implies that “doctor knows best”

• Replaced by Adherence

Adherence

• Implies that the MD & Pt reached an agreement abt an appropriate course of tx

Concordance

• Encouraged w/i healthcare

• Reflect need for shared understanding bw healthcare professional & pt abt nature of illness, its tx, & mx

Stages of Change

• Eventually understand that proc is occuring

• Transtheoretical model (TTM)

Transtheoretical Model (TTM) Stages

• Precontemplation → contemplation → prep → action → maintenance → relapse → termination

• Must NOT end c maintenance → there is a chance of relapse = back to start bc napabayaan

Self-Regulation Theory

• Implies that ppl have/can dev, autonomy, self-control, self-direction, & self-discipline

• Assumption tha ppl’s behaviors are motivated by their desire to achieve goals that are personally important

Self-regulation theory: Banduras level of readiness

Cognitive Evaluation Theory

• Humans are motivated intrinsically & extrinsically → to satisfy needs

Cognitive Evaluation Theory: Extrinsic Motivation

• Results fr external rewards

• Engaging in certain activities/behaviors that either dec biological needs/help us obtain incentives/external rewards

Cognitive Evaluation Theory: Intrinsic Motivation

• Comes fr w/i the person

• Engaging in certain activities/behaviors bc the behaviors themselves are personally rewarding or  fulfills our beliefs/expectations

WHO Quality of Life Measure (WHOQOL)

• QoL: implies more than just happiness

• Inc professional’s understanding of pt’s needs

• Provides valuable info abt aspects of indiv’s life that is most affected

• Informs appropriate responses

• Info abt: physical, psychological, lvls of independence, social rs, environmental, spiritual, & overall

WHO Quality of Life Measure (WHOQOL) TABLE