Chronic Illness: Psychological Impact & Adaptation

Chronic illness: Psychological impact and adaptation process

• The topics include the definition of chronic illness, emotional impact, coping styles, and adaptation processes.

Definition of chronic illness

• Chronic illness refers to a long-lasting disease or condition which is more than 6 months or seasonal/recurring and commonly found in older adults, increasing in prevalence with age.
• Symptoms can be controlled with treatment, although the pathology cannot be cured.
• Chronic illnesses limit normal functioning and impact quality of life.
• Common chronic illnesses include cancer, heart disease, stroke, diabetes, and arthritis.

Stress and Illness

• Stress and illness have a two-way relationship.
• Stress can directly cause physiological changes in the immune and endocrine systems, potentially leading to diseases, especially with prolonged stress.
• Indirectly, individuals may respond to stress by smoking, eating poorly, or consuming alcohol, increasing their susceptibility to illness.

Stress and cancer

• According to the National Cancer Institute (NCI), chronic stress is associated with digestive issues, heart conditions, high blood pressure, and a weakened immune system.
• The relationship between chronic stress and cancer is unclear, with studies showing inconsistent results.
• Some studies found associations between work-related stress and prostate cancer risk, while others did not.
• One study reported a higher incidence of lung cancer linked to stress.
• One study did not find any connections between work stress and lung, colorectal, breast, or prostate cancer.
• The link between stress and increased cancer risk might be indirect.

Illness as a Cause of Stress

• According to Rodríguez Marín, illness constitutes as stressful event that impacts quality of life.
• Illness disrupts behaviour and lifestyle, creating imbalance and stress, requiring adaptation.
• The stressfulness of an illness depends on factors like its duration, sudden or gradual onset, intensity, seriousness, and stage.

Emotional Impact

• Emotional impact refers to the negative emotions and thoughts experienced when living with a chronic illness, which can affect mental health.
• The greatest emotional intensity occurs during the worst times, like when limitations worsen, or during crises or flare-ups, averaging 7.4 on a subjective scale of 0 to 10.
• The severity of the impact associates with the disease's progression and reduced social connections.
• Being married, living with three or more household members, or having children can lessen the negative impact.
• Association with patient groups reduces emotional effects.
• Low socioeconomic status intensifies the impact, with impact lessening after age 50.
• The most emotionally impactful limitations relate to an inability to maintain one's pre-illness lifestyle.

Sentiments, Thoughts, and Situations

• Strong negative impact include reduced social activity and feelings of isolation.
• Other negative feelings are irritability with family and guilt about being a burden.
• Emotional problems caused by chronic illnesses include depressive symptoms like fatigue, sadness, sleep issues, apathy, stress, anxiety, fear, and anguish; depression occurs in 48% of cases.
• Emotions: sadness, apathy, stress, anxiety, depression, anguish, fear, guilt, and loss of control are experiences.
• 55% seek psychological or psychiatric care.
• Ailments result in a 38% worsening of the disease.
• Emotional problems can cause patients attend less to symptoms, lack the energy to cope with the illness, neglect diet, fail to follow prescriptions, skip medical appointments, and miss check-ups.

Coping

• Lazarus and Folkman define coping as cognitive and behavioral efforts to manage external and internal demands.

Coping resources

• Coping resources include internal and external elements/capacities available to manage stressful demands and situations.
• These include physical/biological resources (e.g., nutrition, energy), psychosocial resources (e.g., intelligence, self-esteem, problem-solving skills), and belief systems, social networks, and cultural factors.

Selection Determinants for Coping Responses

• The perceived severity of a situation correlates with more coping responses.
• Changeable situations promote problem-solving coping, while unchangeable situations promote cognitive reinterpretation.
• With remediable situations promote problem-focused coping or avoidance/passivity.

Coping Modes Based on Lazarus and Folkman

• Confrontation: Direct actions for changing situations.
• Self-control: Managing own feelings and actions.
• Seeking social support: Getting help from others.
• Escape-avoidance: Evading problems.
• Positive reevaluation: Creating positive meaning.

Coping Styles Based on Greer (1989)

• Fighting spirit:
  • The diagnosis is seen as a challenge with moderate perceived control.
  • Individuals maintain positive outlook with mild anxiety and seek treatment information while participating in recovery.
• Negation:
  • Denial of threat, positive outlook with low anxiety with no thinking of the illness and dismissing its importance.
• Hopelessness or helplessness:
  • Diagnosis evaluation is high amezaza with loss of control which can cause depression and limited coping abilities.
• Fatalism/passive resignation:
  • Diagnosis with little threat with low anxiety and acceptance along with passive coping.
• Anxious preoccupation:
  • Diagnosis appears highly threatening with great uncertainty, causing anxiety and worry.

Coping Styles and Proactivity (Miller)

• Avoidant Style:
  • This includes distraction and reduced focus on threatening information, along with a passive role and little treatment adherence.
• Approximative Style or Fighting Spirit:
  • Includes information seeking, decision activism, and good therapy adherence.

Coping Style Assessment: CAEPO

• The Questionnaire of Coping with Stress for Cancer Patients (CAEPO), created by María Teresa González Martínez in 2004, is a 40-item Likert-type questionnaire used to evaluate coping strategies in cancer patients.
• It measures 7 dimensions: Active Coping, Emotional Control, Social Support, Anxiety, Passive Resignation, Avoidance, and Denial.
• The results show a person's preferred coping method, positive, undefined, or negative.

Social support

• It helps individuals maintain their social identities, get emotional support, receive assistance, find information and services, and form new social ties.
• Social support builds consistent relationships, facilitating psychological and physical well-being over time (Jung, 1990).
• Functions: Sharing and preventing isolation. offer references, assist with crisis, provide intimacy.

Perception of Support

• The definition of a support system refers to how people react to the approach and it helps in how they appraise and cope with events.
• People that percieve that they have a high support system tend to be less stressed than others with a low support system.

Social Support Types

• Emotional support to feel safety and cared for; esteem support, such as, positive attention, to instill confidence.
• There is instrumental support like practical help that reduces stress, information such as feedback and experiences for communication
• Red support provides meaning to belonging and relationships.

Support and Disease: buffering hypothesis

• Buffer Hypothesis (Cohen & Wills, 1985): access to social support may reduce stress and coping mechanisms.
• Oldenburger study (Rodríguez-Marín, J. 2008) indicates: Adequate adjustment links to social support in chronic health problems, as seen with spouse support reducing post-illness depression, while excess care can be harmful.

Formal aid groups

• Katz and Bender groups small and volunteeristic groups by peers with the goal of supporting a single goal.
• The common goals allow for the support and exchange of resources between the users, allowing relations to form.
• This support facilitates social life.

The adaptation to sickness

• Flexibility depends on personal and enviormental factors.
• Personal variables includes personality, environmental (social support), illness variables (type,etc)
• Understand with quality information vs google, remove emotional barriers and have a relationship with physicians.
• Lifestyle adjustments helps adapt and maximize resources, for example review emotional responses and coping strategies.
• Search for interpersonal patterns and support.

Conclusions:

• No one adapts well as one will change with life experience.
• Important to learn from others and know you available resources.
• This causes emotional support, which is determined by support systems and previous experience.
• Be aware of high stress, which will cause a lower immune system.
• You must integrate personal and coping to have the capacity to adapt.