NMT250 - health psych

REPLAN

• REPLAN is a goal oriented model with six therapeutic factors.
• Patients having the same diagnosis might require different treatment approaches.
• The REPLAN model focuses on a few number of goals and uses a brief treatment model.
• Regular evaluation and replanning is required.
• This model does not conflict with other models.
• The six REPLAN therapeutic factors are Maintaining Relationship; Enhancing Efficacy and self-Esteem; Practicing New Behaviors; Lowering and/or Raising Emotional Arousal; Activating Patient Expectations, Hope and Motivation; Providing New Learning experiences.
• REPLAN involves formulating mutually agreed upon goals from an assessment and prioritizing them, using the therapeutic factors to generate treatment strategies, and replanning every 6 weeks.
• REPLAN stands for:
  • R (Strong Relationship)
  • E (Enhancing Efficacy and Self-esteem)
  • P (Practice New Behaviors)
  • L (Lowering/Raising Emotional Arousal)
  • A (Activating Hope and Motivations)
  • N (Providing New Learning Experiences)

Self-Efficacy & Self-Esteem

• Raising self-esteem is a fundamental aspect of helping.
• Self-esteem contributes to, or results from problems such as anxiety, depression, stress, borderline personality disorder and substance abuse.
• Efficacy (competence) and self-worth are the two components of self-esteem.
• Focus on strengths, competencies, and enhances possibility for success to improve self-esteem.
• Self-Worth relates to the right to exist, where one is good and worthy to live (self-approval); attitude about the self.
• Efficacy is the attitude of being competent in some specific arena.

Sources of Low Self-Esteem

• Irrational beliefs and/or poor body image are factors that lead to low self-esteem.
• Irrational beliefs include needing to be loved by everyone, the need for competency and achieving, the idea that people are bad and should be punished, catastrophizing, no control over what happens "out there", avoiding vs. facing responsibility and difficulties, and the past determining the present.

Practicing New Behaviors

• Psychoeducation assist patient in development and practicing new behaviors.
• Numerous problems are due to skill deficits.
• Establishing new patterns of behavior through practice - "living life differently" leads to lasting change.
• Rationale for new skill is required.
• Demonstration of skill by model aids treatment.
• Learner (patient) demonstrates by practicing and completing homework.
• Social skills training and avoidance situations are good choices for role-playing.
• Helper may play auxiliary or observer role.
• Generalization involves creating a learning in as natural a setting as possible.
• Role-Playing techniques include:
  • Warmup
  • Scene setting
  • Selecting roles & role reversal
  • Enactment
  • Sharing and feedback
  • Reenactment
  • Homework and follow up
  • Potential problems: Resistance and being unprepared for strength of emotion
• Homework:
  • Practice is a Critical tool
  • Increase patient awareness
  • Unload feelings
  • Independent practice; shift control to the patient
  • Aids: Journaling and record-keeping Problems and Precautions:
  • Only assignments with high probability of success
  • Individually tailored
  • Regular practice
  • Simple and easy fit into patient's lifestyle
  • Increase difficulty/discomfort levels as patient progresses

Lowering and/or Raising Emotional Arousal

• Reducing anxiety and stress via Relaxation Training lowers and/or raises emotional arousal.
• Preparation, tighten and relax, relaxing fully and breathing, body scan and assign practice all encompass deep muscle relaxation techniques.
• Patients are troubled by unwanted thoughts and images that lead to anxiety, depression, and damaged self-esteem
• Thought Stopping is a helpful technique used to treat all kinds of recurring thoughts, and OCD
• Technique is really about lowering emotional arousal.
• It helps to halt the flow of negative messages.
• Taught in the clinic room and practiced by the patient whenever a severely disturbing thought arises.
• Three steps involved: Stating the thought, creating a startling interruption, and substituting a new thought.
• Once the troubling thought has been identified, the patient is asked to label and state it either mentally or aloud
• Patient creates some type of startling response that is strong enough to interrupt the negative thinking patterns such as yelling "Stop!" on in one's head.
• Patient inserts a positive and rational thought replacing irrational thought.
• Meditation can used to decrease anxiety, panic and persistent anger plus improve concentration
• Meditation increases positive emotional states, optimism, joy & feelings of well-being
• It assists with substance use, improves memory & encourages self actualization (superior perceptions of reality; acceptance of self and others)

Creating Positive Emotions

• Positive Psychology: Techniques such as gratitude, forgiveness, utilizing personal strengths, optimism, humility, and authenticity
• Gratitude Techniques include focusing on 5 things per day that the client is grateful, gratitude visit, daily reminders
• Emmons and Stern (2013) have documented several techniques, such as a gratitude journal, writing and delivering a letter (in person) of thankfulness to someone of significance, and imagining receiving forgiveness by someone that was wronged by the client to assist clients with the concept of gratitude

Patients' experiences of asthma exacerbation and management

• Distress, panic, and fear of dying during acute exacerbation is typical.
  • Factors in Distress include breathlessness and cough.
  • Sufferers feel lonely during acute exacerbations (Song et al, 2020).
• Theme: Feeling helpless with failed efforts to prevent exacerbation.
  • "Felt helpless" failing to prevent exacerbation despite substantial efforts
  • Common cold is seen as the biggest and most threatening trigger
  • Asthma attacks triggered by fatigue, lack of sleep, emotional stress, or changes in the seasons or climate (Song et al, 2020).
• Theme: Living a restricted life for fear of asthma re-worsening and psychosocial difficulties.
  • Discouraged, frustrated & depressed despite substantial efforts
  • Ashamed when symptoms go out of "un-control” such as severe cough
  • Challenges meeting the responsibility of their life, family members did not understand (Song et al, 2020).
• Theme: Reliance on OCSs with mixed feelings such as their knowledge that it was a "quick fix," and negative views of OCSs, specifically having a fear of adverse reactions.
  • Most were poorly informed about long-term adverse effects (Song et al, 2020).
• Theme: OCS side effects.
  • All participants experienced at least one adverse effect.
• Theme: Gaps in disease perception among asthma patients where few recognize they have severe asthma, despite meeting the criteria.
• Theme: Gaps between patients and health professionals that may result from patients not being properly aware about their diagnosis and long-term health consequences (Song et al, 2020).

Phenomenology of the Patient with COPD

• Breathing becomes the central activity in everyday life (van der Meilde et al, 2019).
• Breathlessness can be exacerbated by environmental triggers and is overwhelmingly compelling, resulting in bodily limitations.
• Requires prereflection, the process of reflecting on one's own experiences and attitudes before engaging.
• Constant hypervigalence of monitoring breath demands scanning for possible dangers
• There is a feed forward issue to avoid acute breathlessness, deconditioning and further breathlessness (van der Meilde et al, 2019).
• Relapse or hospitalization can cause them to lose any gains fast.
• "COPD is stronger than the body" (p.123)
• Some participants became housebound and felt self-conscious and awkward (van der Meilde et al, 2019).

Counselling the Patient with Bronchial Asthma

• CBT approaches may assist asthma patients with how they manage illness, and help to lower the levels of asthma specific panic (Prapa et al, 2017).
• Self-management leads to confidence and remission of asthma symptoms.
• Progressive muscle relaxation has been shown to help with "blood pressure, heart rate, lung function, as well as reducing anger level in pregnant women with bronchial asthma" (p.238).
• Psychological interventions may reduce the length of hospitals stays and admissions, reduce symptoms, and measures in lung function improve as does medication use (Prapa et al, 2017).
• There are less absences from work and improved quality of life among asthma patients with and without panic disorder (Prapa et al, 2017).
• Psychological interventions such as identifying emotions, thought records, coping, problem-solving skills, and relaxation strategies that reduce panic (but not necessarily anxiety) and have no change in symptoms of depression can yield better coping skills (Prapa et al, 2017).

Explore effective challenging skills in counselling, including giving feedback and confrontation techniques. Learn when and how to challenge clients appropriately, addressing misinformation and inconsistencies. Understand the balance between confrontation and support for optimal patient outcomes.