3. Health Psychological Interventions & Stress:Coping.docx

CRITICAL READING: CORNELL NOTES Health Psychological Interventions & Stress/Coping Name: Date: 23 October 2023 Section: Lecture 3 Period: Questions/Main Ideas/Vocabulary Notes/Answers/Definitions/Examples/Sentences Why do we Use Substances? It’s very much a part of Australian cult...

CRITICAL READING: CORNELL NOTES Health Psychological Interventions & Stress/Coping Name: Date: 23 October 2023 Section: Lecture 3 Period: Questions/Main Ideas/Vocabulary Notes/Answers/Definitions/Examples/Sentences Why do we Use Substances? It’s very much a part of Australian culture – its accepted as the ‘norm’ and encouraged in many social situations. It’s also widely available: To relax. For enjoyment. To be a part of a group. To avoid physical and/or psychological pain. To experiment out of a sense of curiosity. Excitement. Rebellion. Cope with problems. Relieve stress. Overcome boredom. Cigarette Use Cigarette smoking is the single latest cause of preventable death in Australia. Smoking was the highest in 1945: 72% of men and 26% of women smoked. The ABS indicates that: Since 1995, the proportion of adults who are daily smokers has decreased from 23.8% to 13.8% in 2017 - 2018 to 10.7% of daily smokers in 2020 – 2021. The proportion of adults (18 + years) who have never smoked have increased from 49.4% in 2007 - 2008 to 55.7% in 2017 - 2018 to 61.2% in 2020 – 2021. Have never smoked (18 - 24 years): 2014 - 2015: 69.5%, 2017 - 2018: 75.3%, 83.3% in 2020 - 2021. Men continue to be more likely than women to smoke daily despite rates for both declining since 1995. Remained similar from 2014 - 2015 to 2017 - 2018 and slightly decreased in 2020 - 2021. Cigarette Use – How Much Are People Smoking? 2020 – 2021 data suggests that daily smokers smoke 10.7 cigarettes a day or just over half a pack (a pack is 20 cigarettes). People aged 65 – 74 years smoked more cigarettes per day (average of 13.6 per day) than any other age group. Cigarette Use – Disadvantaged Groups The likelihood of being a daily smoker is: 1.7 times as high for unemployed vs. employed people. Twice as high in remote areas vs. cities. 2.6 times as high for Aboriginal and/or Torres Strait Islander individuals. Three times as high in the lowest vs. highest socioeconomic areas. 5.7 times higher for prison entrance vs. general population. Alcohol Use Alcohol consumption is measured in standard drinks (1 SD = 10g of pure alcohol). We can’t use a 1:1 ratio as drinks come in various sizes and units of alcohol. Guidelines for alcohol consumption changed for latest ABS data: No more drinks in the last week and/or 5 drinks on any day at least monthly in the last 12 months. 1 in 4 people (25.8%) aged 18+ exceeded this guideline in 2020 – 21: Men were more likely to exceed than women (33.6% compared to 18.5%). People aged 18 – 24 were three time more likely to have consumed 5 or more standard drinks on any day in the last year at least monthly than those aged 75 and older (22% compared to 6.5%). Alcohol Use – NHMRC Guidelines To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol. To prevent harm from alcohol to their unborn child, those who are pregnant or are planning a pregnancy should not drink alcohol. For those who are breastfeeding, not drinking alcohol Safest for their babies. Alcohol Use in Pregnancy 70% of children with heavy prenatal alcohol exposure are neurobehaviourally affected. Heavy is defined as more than four alcoholic drinks at least one day per week or 14 drinks per week throughout pregnancy. National drug strategy household survey – latest data from 2019: About 1 in 2 (55%) consumed alcohol before they knew they were pregnant, and this declined to 14.5% once they knew they were pregnant (down from 25% and 2016). Foetal Alcohol Spectrum Disorder (FASD) A diagnostic term for severe neurodevelopmental impairments that result from brain damage caused by alcohol exposure before birth. Some (< 20%) have distinctive facial features: Small palpebral fissures (length of eye opening). Smooth philtrum (lack of ridges between nose and upper lip). Thin upper lip. People with FASD often present a range of diagnosis. FASD Characteristics The effects may not be seen at birth. All people with FASD will have damage to different parts of the brain which can cause structural (small head) and functional impairments which can be physical, cognitive and behavioural. Some people with FASD will have other birth defects such as heart and eye problems. Although the use of ‘fetal’ may imply that it only relates to babies, FASD has lifelong consequences and can be diagnosed in children, young people and adults. People with FASD will have strengths and difficulties. Some people with FASD will have distinctive facial features but most do not. FASD occurs in all parts of Australian society where alcohol is consumed. FASD is a social issue not just a medical condition. No level of maternal alcohol consumption at anytime during pregnancy can be guaranteed to be completely ‘safe’ or ‘no risk’ for the developing fetus. Some women are at higher risk of drinking and need support from partners, friends, family, health professionals and drug and alcohol workers to stop drinking alcohol when they are pregnant. Illicit Drug Use Illicit use of drugs covers a broad range of substances including: Illicit drugs: Drugs prohibited from manufacture, sale or possession in Australia. Pharmaceuticals: Drugs available from a pharmacy, over the counter or by prescription, which may be subject to non-medical use. Other psychoactive substances: Legal or illegal, used in a potentially harmful way. Opioids, mostly heroin, have the highest mortality risk of illegal drugs. Main cause of death is accidental overdose. Individuals, families and the broader Australian community are affected: Health impacts: Burden of disease, death, overdose and hospitalisation. Social impacts: Violence, crime and trauma. Economic impacts: Cost of healthcare and law enforcement. Results from the National Drug Strategy Household Survey (2019): More than 2 in 5 (43%) of Australians aged 14 years and older have used an illicit drug in their lifetime (including pharmaceuticals used for non-medical purposes) and 16.4% had used one in the last 12 months. In 2019, cannabis was the most commonly used illicit drug. Followed by cocaine, ecstasy and non-medical painkillers and opioids. A number of changes were reported in the recent use of illicit drugs between 2016 and 2019, including increases in the use of: Cannabis (from 10.4% to 11.6%). Cocaine (from 2.5% to 4.2%). Ecstasy (from 2.2% to 3%). Hallucinogens (from 1% to 1.6%). Inhalants (from 1% to 1.4%). Ketamine (from 0.4% to 0.9%). Psychological Interventions for Substance Use Problems Types of psychological interventions can include: Motivational interviewing. Multimodal interventions. Harm reduction approaches. Relapse prevention. Motivational Interviewing (MI) MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion. MI leads the person to their own conclusion by asking questions about the discrepancies between the current state of affairs and the individuals self-image, desired behaviours and desired outcomes. And this focus on discrepancies may help initiate change, which means we can then help the client to set goals and strategies for behavioural change, then support them in their efforts. Key Qualities of MI A guiding style of communication, that sits between the following (active listening) and directing (giving information and advice). Is designed to empower people to change by drawing out their own meaning, importance and capacity for change. Is based on a respectful and curious way of being with people that facilitates the natural process of change and honours client autonomy. MI requires the clinician to engage with the client as an equal partner and to refrain from unsolicited advice, confronting, instructing, directing or warning. It is not the way to get people to change or a set of techniques to impose on the conversation. MI is Particularly Useful to Help People Examine Their Situations & Options When Any of the Following Are Present Ambivalence is high and people are stuck in mixed feelings about change. Confidence is low in people doubt their abilities to change. Desire is low and people are uncertain about whether they want to make a change. Importance is low and the benefits of change and disadvantages of the current situation are unclear. Where is MI Used? A broad range of settings (health, corrections, human services, education). Populations (age, ethnicity, religion, sexuality and gender identities). Languages. Treatment formation (individual, group, telemedicine). Presenting concerns (health, fitness, nutrition, risky sex, treatment adherence, medication adherence, substance use, mental health, illegal behaviours, gambling, parenting). Multimodal Interventions Substance use behaviours can be difficult to change: Physical dependence. Psychological dependence. Conditioning (trigger behaviours – drinking coffee outside and wanting a cigarette). Social relationships (friends use the substance, social events encourage substance use). A range of effective interventions are combined in an effort to improve outcomes. Make use of biological interventions (nicotine replacement therapy). Multimodal Interventions – Psychological Interventions stress management, relaxation training, mindfulness skills. Self-monitoring (recognising triggers, knowing the consequences). Social skills and coping training (for high-risk situations). Positive reinforcement (to strengthen change). Long-term maintenance of change for substance use problems is low (30% for smoking, alcohol and illicit drug use) and clients may relapse before it's effective. Harm Reduction Interventions Harm reduction is a prevention strategy that is designed to reduce the harmful effects of a behaviour when it occurs. Harm reduction strategies for illicit drug use can include: Needle and syringe exchange programmes (to reduce the spread of HIV infections). Methadone programmes for people who have used heroin (to reduce the need to commit crime to fund use). Pill testing at music festivals where people use illicit drugs. Relapse Prevention Behaviour change programmes can have high drop-out rates and not everyone maintains their changes (maintain a healthy diet, exercise, ending problem substance use). Most programmes now include relapse prevention: To plan for high-risk situations (stressful events, social pressure, being with others who use the substance). To deal with lapses (as opposed to full relapses). The Transtheoretical Model of Change To understand behaviour change more broadly, the transtheoretical model of change is often used in theory and practice. Proposed by psychologists James Prochaska and Carlo DiClemente after they studied how people change (both with professional support and without). 6 major steps in the change process: How Does This Model Help Psychologists? Help psychologists understand how people change. Helps match intervention to a person's stage of change. Can guide interventions created to help move the person towards the next stage. MI is an approach that can help people move to the next stage. Experiences can also motivate change (being in a car accident while under the influence can move a person from contemplation to preparation and action). Stress Stress is a pattern of cognitive appraisals, physiological responses and behavioural tendencies that occurs in response to a perceived imbalance between situational demands and the resources needed to cope with them. Three ways to understand stress: Stress as a stimulus: I've got lots of stress in my life at the moment: work, exams, family issues. Stressors are demanding or threatening situations. Stress as a response: With cognitive, behavioural and physiological aspects. I am stressed, I've got too much to do, I feel shaky and keep yelling at my partner. Stress is a person-situation interaction: Combines the stimulus and response definitions. Stress as a Person-Situation Interaction Stressors & Kinds of Stressors Stressors vary in: Intensity/severity. Duration. Predictability. Controllability. Chronicity. And may be anticipated events. Kinds of stressors: Microstressors are daily minor annoyances (traffic, assignments). Major negative events (the death of family/friends, victim of crime). Catastrophic events (unexpected and can have a major effect on many people such as war, pandemics). Strategies to Cope with Stressors Problem-focused coping: Strategies attempt to confront and directly deal with the demands of the situation or to change the situation so that it is no longer stressful. Planning, problem solving, assertive confrontation. Emotion focused coping: Strategies attempt to manage the emotional responses that result from it. Positive reinterpretation, acceptance, denial, wishful thinking, avoidance. Seeking social support: Turning to others for assistance and emotional support. Seeking help and guidance, emotional support, tangible support. What Coping Strategies Are Most Effective? Problem-focused and seeking support strategies is related to better adjustment to the stressor. Emotion-focused strategies (avoidance, denial, wishful thinking) predict poorer adjustment. But some emotion-focused strategies can be adaptive – changing irrational negative appraisal, physical exercise, acknowledging and discussing feelings. There are times when problem-focused coping is not as effective. For example: cancer diagnosis, natural disaster, exam. Problem-focused coping works when we can control the stressor. No strategy is effective for all stressors. Effectiveness depends on: The stressor. The appropriateness of the strategy. How well we carry out the strategy. People cope well with stressors when they have a range of coping strategies to use and choose them at the right time and carry them out effectively.