Health Psychology

1
Health Psychology

• Chronic Illness part 1
• PY 470 Hudiburg

2
What are chronic diseases?

• Multiple causes
• 85 of all cases of cancer are caused by
  behavioral choices and lifestyles
  
• Slow onset, and increased intensity over time
  example is AIDS
  
• Some chronic diseases can be cured and some can
  not be cured
  
• Estimated that 46 of all Americans have a
  chronic condition percentage increases with age
  group Figure 10.1, p. 367
  
• Note Box 10.1, p. 368 Chronic illness in Older
  adulthood increasing life expectancy and
  decreased physical and psychological functioning

3
What are the consequences of having chronic
illnesses?

• Potential threats Table 10.1, p. 369
• Physical problems
• There are a variety of physical debilitations
  paralysis, pain, neurological disorders, sensory
  deficits. Treatments of chronic illnesses can be
  have many adverse side effects, for example
  dialysis, chemotherapy, radiation treatment all
  have many side effects.
• Surgery can lead to disfigurement (amputation)
  and disability and other issues (colostomy).
  
• Sexual dysfunction may result from some
  treatments and conditions prostrate treatments
  and coronary heart disease (1 risk of heart
  attack during sex)

4
What are the consequences of having chronic
illnesses?

• Social problems
• There may be effects on interpersonal
  relationships.
  
• Some chronic conditions have high levels of
  stigma epilepsy and AIDS (low levels of
  disclosure even to sexual partners Kalichman
  Nachimson (1999)
• Sharing chronic illnesses may provided social
  support but strain friendships. There are
  problems with negative beliefs and biases about
  illnesses. Persons report being shunned by
  others.
• Difficult for family members to develop correct
  perceptions of a patients condition and
  capabilities. Developing and keep a patient
  demeanor with the chronically ill is difficult.
• Family members may have negative psychological
  reactions Box 10.2, p. 372 children with
  chronic disease impact on marital satisfaction.
  Providing care and support can emotionally
  draining for the caregiver.
• Family members can suffer their own losses when a
  love one is diagnosed with a chronic illness,
  possibly anxiety and depression and lost hope.
  
• The chronic illness may cause considerable
  financial problems for the family.

5
What are the consequences of having chronic
illnesses?

• Psychological problems
• Initial reaction of shock and disbelief how do
  children cope Box 10.4, p. 375
  
• Need to change just world view?
• Common reactions disbelief, denial, or anger
  Cartoon 10.1, p. 375. Many experience depression
  and sense of helplessness 35 suffer depression
  and compared to 12 in no affected population
  Mohr et al. (1999)
• Anxiety is a common reaction ever before there
  symptoms related to the chronic illness are
  experienced Epping-Jordan et al. (1999).
  
• Higher levels of stress experienced and negative
  emotions Cassileth et al. (1984).
  
• Facing lifestyle choices that might have caused
  the chronic illness, Table 10.3, p. 378. Blaming
  oneself for certain diseases in one study 41
  of breast cancer patients blame themselves
  Glinder Compas (1999).

6
What are the consequences of having chronic
illnesses?

• Sometimes there are positive effects Table 10.3,
  p. 379 In the study reported in Figure 10.2, p.
  379, 90 of the patients reported at least one
  positive change (Cordova et al., 2001). Some
  changes are increased coping, change in life
  priorities, and stronger focus on positive
  self-view.

7
How do illness factors influence how people
manage having a chronic illness?

• Illness intrusiveness
• For example for diabetes there is a limit on
  sugar intake.
  
• Patient with CHD need to change diets and alter
  certain physical activities.
  
• There might be a need to self-monitor the
  condition of the patient, like a diabetes patient
  testing blood glucose levels using a sticking
  device Photo 10.3, p. 381.
• Interaction with health care providers
• Many treatment involve much interaction with
  health care providers. Some procedures require
  several hours (4 6 hours per dialysis session
  three times a week).
• There are difficulties with communications with
  health care providers especially physicians
  (Lerman et al., 1993).

8
How do illness factors influence how people
manage having a chronic illness?

• Type of coping used
• Problem-focused
• Proactive, preventive coping
• Combative coping
• Emotion-focused
• Used to respond to stressful situations with
  little ability to change the situation or no
  control
  
• This approach manages the response to the stress
• Positive reappraisal is an emotion-focused coping
  strategy.
  
• Leake et al. (1999) found (Figure 10.3) that
  there were lower physical and psychological
  symptoms using a self-presentation coping
  strategy in 42 patient with kidney disease.
• Research shows that coping strategies that
  directly try to reduce a stressor are more
  effective. But some studies have shown
  emotion-focused to be as effective, like focusing
  on positive experiences Dunke-Schetter et al.
  (1992).
• Impact of denial, initially decreases the stress
  but in the long term is not effective (Buckelew
  et al., 1990).

9
How do illness factors influence how people
manage having a chronic illness?

• Level of social support
• This coping strategy is very effective in coping
  with chronic illnesses.
  
• These patients are better able to buffer the
  effects of stress produced by the chronic
  illness.
  
• Studies with CHD patients showed higher levels of
  social support was related with lower levels of
  anxiety, depression, anger and was related to
  faster recovery from surgery.
• Emotional social support is more beneficial than
  instrumental support , especially for people with
  good prognosis of recovery.

10
How can psychological interventions help people
cope with chronic illness?

• Education
• Providing knowledge in order to be more in
  control about the disease and treatments.
  
• Research suggests that education has positive
  influence on management of chronic diseases.
  Reduction of psychological and physical symptoms
  of cancer patients is suggested by research of
  Helgeson et al. (1999, 2001). Less disruption in
  daily lives with chemotherapy with patients who
  received relaxation training and brief
  information video (Burish et al., 1991).

11
How can psychological interventions help people
cope with chronic illness?

• Cognitive-behavioral therapy
• Challenging irrational beliefs
• Various techniques are used
• Goals of reducing anxiety and tension and manage
  of stress (Box 10.5, p. 387 Antoni et al.,
  2001)
  
• Systematic desensitization can reduce nausea and
  vomiting side effects of chemotherapy treatment
  (Morrow et al., 1992).
  
• Treatments can have long-term effects and
  increase immune system functioning.

12
How can psychological interventions help people
cope with chronic illness?

• Social support groups
• There are many types of social support groups.
• These groups may provide better social support
  than family and friends due to the specific
  nature of the chronic disease. A study by Spiegel
  et al. (1981) found that terminal women breast
  cancer patients who attended a weekly therapy
  session experience lower levels of depression and
  these women live longer on the average (36.6
  months v. 18.9 months).
• Participation in social support groups can
  improve immune system functioning and possible
  live longer (Fawzy et al., 1990)
  
• Social groups are useful for persons who dont
  have other social support. The important of
  emotional support received from the these groups.