Adjustment to Chronic Illness

1
Adjustment to Chronic Illness

• Some notes to accompany chapter 11

2
Scope of the problem

• 50 have chronic problem
• 50 deaths cardiovascular and malignant
  neoplasms

3
research

• Identifying psychosocial and behavioral factors
  in chronic disease
• Study of psychological adjustment to chronic
  conditions

4
Positive adjustment

• Successful performance of adaptive tasks
• Absence of psychological disorder
• Low experience of negative affect
• Experience of positive affect
• Behavioral/functional status
• Sense of satisfaction or well being in various
  life domains

5
Tasks

• Reasonable emotional balance
• Good self image
• Good supportive relationships
• Preparing for uncertain future (sometimes)
• Search for meaning
• Mastery of life
• Self esteem

6
research

• Looks for absence of psychopathology
• Adjustment disorder
• Anxiety
• Depression
• Fatigue both a symptom of depression and illness

7
Functional status

• Return to work
• Mobility
• Completion of rehabilitation
• Adherence to treatment

8
Life satisfaction

• Complicated issue

9
adjustment

• Multidimensional
• Both intra and interpersonal factors
• Importance of self appraisal

10
Self appraisal Quality of Life (QOL)

• Potential for changing ratings based on
  comparison groups
• Premorbid or others with same condition

11
Self appraisal

• Chronic disease might not compromise mental
  health
• Feelings of loss and anxiety do not necessarily
  compromise mental health
• Such feelings can help a person move on, cope,
  find meaning.

12
Denial

• Defense mechanism when one feels overwhelmed
• Disorientation or may appear focused on the
  wrong problems

13
Anxiety

• Reasons for it
• Illness events such as awaiting test results
• Being dependent on health professionals

14
Depression

• High rates of depression in stroke and heart
  attack patients and many others
• May be delayed reaction.
• Suicide among elderly and chronically ill
• Difficult to measure

15
Stages of adjustment

• More complexity than stage theories allow for

16
Lazarus

• Personal resources
• Attributes of the situation
• Cognitive appraisals
• Coping strategies

17
Adjustment..

• Life goals is what is central threatened?
• What does person want to accomplish?
• Approach-oriented coping if can still pursue
  goals
• Disengagement may happen if person feels they
  cannot attain goals

18
adjustment

• Controllability
• Predictability
• Severity (lethality, life disruption)
• Disease course (progressive, unremitting)
• Prognosis
• Required lifestyle changes
• Toxicity of treatment
• pain

19
Illness and disease a useful distinction

• Kleinman (1988) and Keith (2003)
• Disease
• Disruption of biological structure or function
• Can be objectively defined and treated
• Does not involve whole person

20
Illness

• The contextual dimension
• Cultural, interpersonal manifestations of disease
• Much more ambiguous
• Illness shared by all involved (patient,doctor,
  family,etc)
• Elicits apprehensions in all involved
• Illness without disease
• Providing a name (diagnosis) may reduce anxiety
• Treatment may reduce symptoms

21
Illness

• Is depression a disease or illness??
• The medicalization of unhappiness

22
Social interaction

• Verbal and nonverbal discrepancies
• Avoidance
• Denial
• Anger
• Social support
• Impact on family
• Caregiver roles
• Role reversal
• Sexuality
• Gender issues

23
adjustment

• Most with chronic conditions not worse than
  general population
• Most show positive adaptations
• Most rely on internal and external resources
• Individuals shift their comparison groups
• Maybe islands of life disruption instead of
  global functioning changes