Health Psych Final

multimorbidity

two or more chronic conditions that require medical care or limit daily activitie

quality of life

The degree to which a person is able to maximize his or her physical, psychological, vocational, and social functioning; an important indicator of recovery from or adjustment to chronic illness

People with chronic health disorders are more likely to suffer from depression, anxiety, and generalized distress. T or F

True

self- concept

a stable set of beliefs about one’s personal qualities and attributes

Self-esteem

refers to the evaluation of the self-concept—namely, whether one feels good or bad about one’s personal qualities and attributes

Self-rated health predicts death over and above objective health indicator. T or F.

True

What predicts adherence to chronic disease regimens?

High expectations for controlling one’s health, self-efficacy, and knowledge of the treatment regimen

Mindfulness-based stress reduction

teaches people to be highly focused on the present moment, acknowledging and accepting thoughts and feelings without becoming distracted or distressed by them

With chronic condition where a “cure” isn’t on the table where does the focus shift to?

Quality of life

What is spoon theory?

“Lay theory” - an explanation where spoons are energy that can be used through out the day

Chronic illness threatens and diminish and disruption of life. So the goal is to:

Maximize quality of life

Denial

defense mechanism by which ppl avoid the implications of a disorder 

How does denial effect treatment of chronic illness?

Interferes w/ absorption of treatment info and compromises health 

Anxiety in relation to chronic illness

patients become overwhelmed by potential changes in their lives and the prospect of dying 

• Can interferes with treatment 

Depression in relation to chronic illness

complicates treatment adherence and medical decision making 

Who gets depressed with chronic illness

ppl who:

• Experience pain and disability 

• Experience negative life events 

• Lack social support 

How is body image influenced by chronic illness

changes to body and health 

How is achievement in the self-concept influenced by chronic illness

changes ability to do what you used to do or disrupts to future plans 

Over time, patients develop a model/understanding of their disease. May be accurate or inaccurate. T or F.

True

The models patients form about their disease lead them to do what

take certain actions (or not) 

Blaming one’s self about causing their disease can lead to what

Self-blame can lead to guilt, self-recrimination, or depression 

Patients who have a sense of control or self-efficacy w/ respect to the disorder are more ______ 

adaptive

Experience of control or self-efficacy may ____ life 

prolong

Coping Strategies

• Social support or direct problem solving 

• Distancing 

• Positive focus 

• Cognitive escape or avoidance 

• Behavioral escape or avoidance (substance use, going for walk) 

Best kind of coping strategy

active coping and coping by using positive responses 

Rehabilitation phase can be

vry helpful to restore/maintain function and painful 

Stages of chronic illness

Diagnosis, Rehabilitation, Maintenance

Does every people with a chronic illness have to do rehabilitation?

No, depends on situation

Physical rehab involves several goals including

• Learn how use one's body as much as safely possible 

• Learn new skills based off of your new body 

• To learn new physical management skills

• To learn a necessary treatment regimen

• To learn how to control energy expenditure

Increasing adherence to treatment is done by increase appropriate edu and ____

self-efficacy

Vocational issues in chronic health disorders 

• Career change may be necessary  

• Discrimination against the chronically ill 

• Financial problems arise when patients have to cut back on work 

Social interaction problems 

• Negative responses from others 

• Impact on the family 

• Caregiving role 

• Gender differences 

Positive changes in response to chronic health disorder 

• Experiencing positive reactions and optimism 

• Inspiration to act now instead of postponing 

• Acquiring more empathy and compassion 

• Feeling stronger and more self-assured 

Considerations for individual therapy

• Can be episodic 

• Collaboration w/ physician and family is critical 

• Understanding of the health disorders important 

Considerations for children with chronic illness 

• Children might have limited understanding 

• Fam must participate actively in the treatment process 

  • Child cannot follow the treatment regimen without help 

• May expose to isolating and terrifying regimen with/ help

• May exhibit a variety of behavioral problems or develop maladaptive coping styles.

How to Improve coping for families with children with chronic illness

• Parents can soothe children emotionally and provide an informed basis for care 

• Children should be encouraged to take care of themselves, including regular school attendance and reasonable physical activities 

• Fam therapy and training the family in the treatment regimen can help 

Cognitive behavioral therapy for Chronic illness

• Psychoedu 

• Coping skills training 

• Moderation in activities (like exercise) 

• Track and address negative thoughts 

• ACT

• MBSR

Importance of balancing validation, change, and acceptance  

CDC definition of chronic health condition

conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both

disability

any condition of the body or mind (impairment) that makes it more difficult for the person with the condition to do certain activities (activity limitation) and interact with the world around them (participation restrictions)

Components of Chronic Illness

• Physical functioning.

• Psychological status.

• Social functioning.

• Disease- or treatment-related symptoms

__ in 10 adults in the US have a chronic illness

6

__ in 10 adults in the US have a 2 or more chronic diseases

4

Acceptance and commitment therapy (ACT)

• promotes psychological flexibility and committed pursuit of core values and life goals rather than constant striving to eliminate or escape life’s troubles

• involves a mindful distancing from the pain experience

• helps patients to accept their health disorder experiences without avoidance or fruitless striving

2020 revised definition of Pain  

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage 

1979 Definition of Pain

An unpleasant sensory and emotional experience associated with actual, or potential tissue damage, or described in terms of such damage 

Clinical Health Psych

Applies scientific knowledge of the interrelationships among behavioral, emotional, cognitive, social and biological components in health and disease

Distinct focus of clinical health psych

physical health problems

Job of clinical health psych

• To the promotion and maintenance of health

• The prevention, treatment and rehabilitation of illness and disability

• The improvement of the health care system. 

What do clinical health psychologists do??

• Diagnosis of patients and assessment of patients’ level of functioning.

• Pre- and postsurgery preparation and pain control.

• Interventions to increase medication and treatment compliance.

• Teach appropriate self-care after discharge.

• Diagnose and treat psychological problems.

Steps (process) for using health services 

1. Have a need 

2. Recognize the need 

3. Seek health services 

4. Encounter health services 

5. Follow-up 

   (There are challenges at every step)

Individual diffs for who is more prone to recognizing a need

• Hypochondria: believe that normal bodily symptoms are indicators of illness 

• Neuroticism: either exaggerate their symptoms or are more attentive to real symptoms 

Attentional differences

• Internal vs. External focus 

• Level of distraction 

Situational factors such as boring situations make ppl more attentive to symptoms. T or F.

True

What is the medical students' disease (Situational factors)?

student believe they are ill with the same illness abt which they are studying 

Have a need/recognize a need (stress)

Stress-related physiological changes are interpreted as symptoms of illness 

Have a need/recognize a need (mood and emtions)

Affects perceptions of symptoms and perceived vulnerability to illness 

Interpretation of Symptoms (prior experience)

Common disorders less serious than rare disorders(flu) 

Interpretation of Symptoms (Expectations)

• Unexpected symptoms are ignored 

• Expected symptoms are amplified 

Interpretation of Symptoms (Seriousness of the symptoms)

Treatment is more sought when the symptom (1) affects a highly valued organ and/or (2) limited mobility 

Commonsense Model of Illness 

Ppl hold implicit commonsense beliefs abt health 

• Result in organized illness representations 

Illness representations

Includes basic info abt an illness 

• Identity: name of the illness 

• Causes: factors believed to have led to the illness 

• Consequences: symptoms, treatment, and their implications for quality of life.

Commonsense Model of Illness (timeline)

Length of time the illness is expected to last

Commonsense Model of Illness (control or cure)

belief that the illness can be managed or cured

Commonsense Model of Illness (Coherence)

How well these beliefs represent the disorder

Typical models of illness - acute illness

• Believed to be caused by viral or bacterial agents.

• Short in duration, with no long-term consequences.

Typical models of illness - chronic illness

• Believed to be caused by multiple factors.

• Long in duration, with severe consequences

Typical models of illness - Cyclic illness

Alternating periods of either no symptoms or many symptoms

Lay Referral Network 

Fam and friends who offer their own interpretations of symptoms before any treatment is sought 

Lay Referral Network - Advice is offered regarding: 

• What the symptoms means 

• Advisability of seeking medical treatment 

• Various home remedies 

Internet /AI is now a very common resources for interpretations of symptoms. True or False.

True

Who use health services? 

• Infants and the older adults use it most frequently

• Women more so than men.

• Higher SES groups

Why are women more likely than men to use health services?

• Pregnancy and childbirth

• Women’s medical care is more fragmented.

• Men culturally expected to ignore pain and not give in to illness.

Why are lower SES more likely than higher SES to use health services?

Lower SES has less use and less access

Delay Behavior

Putting off seeking treatment for one or more potentially serious symptoms

Appraisal delay

Time taken to decide that a symptom is serious.

Illness delay

Time between the recognition that a symptom implies an illness and the decision to seek treatment

Behavioral delay

Time between deciding to seek treatment and doing so

Medical delay

Time that elapses between the person’s calling for an appointment and his or her receiving appropriate medical care

Causes of Delay 

• Common among people:

  • With no regular contact with a physician

  • Who are anxious about medical services

Causes of Delay Pt. 2

• Symptoms that delay seeking treatment. 

  • Those similar to a previous one that turned out to be minor

  • Those that do not hurt or change quickly

  • Those that can be easily accommodated

Causes of Delay Pt. 3

Symptoms that are typical of a disorder are more likely to be treated

Causes of Delay Pt. 4

• Delay in taking recommended treatments.

  • Patients no longer feel any urgency about their condition.

  • Patients become alarmed by the symptoms and avoid thinking about them altogether.

  • Delay on the part of the health care practitioner.

What percentage of people in the U.S. have health insurance

• ~90%, but 10% do not

• Rates have been falling

Affordable Care Act

Passed 2010, enacted 2014

Affordable Care Act drove significant health insurance coverage gains. T or F.

T

ACA expanded health insurance access through:

• State marketplaces

• Expansion of Medicaid (41 states)

• Ppl w/ Pre-existing conditions couldn’t be denied coverage

ACA-related changes

• No denial of coverage for pre-existing conditions

• No lifetime maximum

• Woman can’t be charged more than men

  • Previously could be charged up to 1.5 times more

  • Pregnancy was a pre-existing condition

• Children can stay on parents insurance until 26

Attending to the psychological components of healthcare can improve the overall system

• recognizing that patients and providers are humans

• applying health psychology!

Patient-provider communication - Setting

• A medical office is an unlikely setting for effective communication.

• Role of provider: Extract significant information quickly from the patient.

• Patient and provider are not always on the same page.

Patient-provider communication - Provider mistakes

Jargon, talk down, stigma, too busy

Patient-provider communication - Patient

Low insight, limited knowledge, anxiety, cultural norms

Results of Poor Patient-Provider Communication

• No rapport or relationship

• Lack of opportunity for feedback to the provider

• Dissatisfied patients

Dissatisfied patients are:

• Less likely to comply with treatment recommendations.

• More likely to turn to alternative services that satisfy emotional rather than medical needs.

• Less likely to obtain medical checkups.

• More likely to change doctors and file formal complaints.

• Less likely to be adherent to treatment

Adherence to treatment

Degree to which patients adopt the behaviors and treatments their providers recommend.

Overall, about __% of patients fail to adhere completely to prescribed medications.

85%

Teaching Providers How to Communicate

• In simple behaviors that are seen as warm and supportive.

• Nonverbal communication.

Training patients

• Teaching skills to elicit information from physicians

• Listing one’s own questions ahead of time

Probing for barriers to adherence

• Barriers can be discovered by talking to the patient

• Breaking advice into manageable subgoals that can be monitored

• Rates of adherence increase if lifestyle changes are prescribed

Effective healthcare involves a team 

• Different roles, different perspectives

  • Physician, psychologist, psychiatrist, nutritionist, social worker, peer support specialist, physical therapist…