Living With Illness PDF

Living with Illness  Learning objectives 1. Understand the Psychological and Physiological Aspects of Pain: Explain the difference between acute and chronic pain and describe how pain can affect an individual’s psychological state and quality of life. 2. Recognize the Impact of Chronic Ill...

Living with Illness  Learning objectives 1. Understand the Psychological and Physiological Aspects of Pain: Explain the difference between acute and chronic pain and describe how pain can affect an individual’s psychological state and quality of life. 2. Recognize the Impact of Chronic Illness: Understand the various types of chronic illnesses and understand the psychological, social, and physical challenges facing individuals with chronic illnesses. 3. Evaluate Models of Illness and Adaptation: Compare and contrast different models of illness, including the Illness Constellation and Cognitive Adaptational models 4. Assess Treatment Response Factors: Identify the factors that influence an individual’s response to treatment and the importance of adherence to treatment plans 5. Role of Carers in Health Psychology: Understand the role of carers in the management of illness, recognise the impact of caregiving on mental health, and identify support systems available for carers. Introduction Importance Health Psychology aims to understand how people react to, cope with, and recover from illness Has a crucial role in the development of health care systems and policies Key Terms Pain: Unpleasant experience linked to harm. Chronic Illness: Long-term health condition affecting daily life. Treatment Response: Change in symptoms after medical intervention. Carers’ Role: Support providers influencing patient outcomes and their own stress levels. 1. Understanding Pain Pain is the ”most pervasive symptom in medical practice, the most frequently stated “cause” of disability, and the single most compelling force underlying an individual’s choice to seek or avoid medical care” (Karoly, 1985, p5) Pain as a Psychological and Physiological Experience Pain is really important in signalling people to do something. Complex Warning mechanism Psychological factors shape the perception of pain Attention, expectation, and past experiences The Role of Pain and its Impacts Part of a complex system Signalling is crucial for survival Impact on Quality of Life Profound impact Limits daily activities, social interactions and well-being Increased risk of depression, anxiety Effective pain management is essential The cost of pain Australia Singapore 3.24 million live with chronic pain Head and body pain costs $8.4 56% state that it restricts what billion each year they can do 3 days leave due to pain $73.2 billion Productivity down by 15% Expected to $215.6 billion by More than half remain silent 2050 (Choo, 2017) (Deloitte, 2019) 2. Chronic pain and illness Acute v Chronic pain Length of time is an important dimension in describing pain ACUTE: refers to the discomfort people experience with temporary painful conditions that last less than 6 months or so CHRONIC – a painful condition lasts for more than a few months, ongoing anxiety, feelings of helplessness and hopelessness – often linked to medical treatments not alleviating their pain Three types (Turi, Meichenbaum & Genest, 1983): 1. Chronic/recurrent pain – benign causes (e.g., tension headache) 2. Chronic/intractable/benign - is typically present all of the time (e.g. chronic lower back pain) 3. Chronic/progressive pain - continuous discomfort, linked to a malignant condition and gets worse as the underlying conditions gets worse (e.g. rheumatoid arthritis) Types of Pain Acute Pain Sudden May arise from specific injury or surgery Usually short-term Signals harm Chronic Pain Persists beyond healing of an injury May last for months or years Continue without a current injury or apparent damage Affects daily functioning and well-being Living with a Chronic Illness Rise in chronic illness poses many challenges 1.7 million have diabetes (economic impact = $14.6 billion) 342,800 living with dementia (one person every six minutes) Acute versus chronic Chronic: symptoms last > 6 months & no effective treatments Challenges, responses, outcomes etc. vary depending on the illness and the individual 11 Living with a Chronic Illness Cancer as an example Survival rate for many cancers is high (e.g., > 90%) if diagnosed early Unfortunately, cancer survivors are at an increased risk of: Cancer recurrence Impairments in functional capacity Sleep disturbances Depression Sexual dysfunction Pain Reduced quality of life Cancer survivors are 50% more likely to die of non-cancer causes 12 Living with a Chronic Illness A range of challenges Managing symptoms Uncertain futures Changes in self-images Loss of control/autonomy Changes in relationships with family and friends Stigma Loss of employment Loss of dignity Changed life roles 13 Illness Constellation Model (Morse & Johnson, 1991) Cognitive Adaptational Model (Taylor, 1983) 3. Models of Illness and Adaption Illness Constellation Model A generic model of the emotional and coping responses (Morse & Johnson, 1991) Uncertainty Understand meaning of symptoms Realisation of symptoms and severity Disruption Intense stress and high level of dependence on others Striving for Attempts to gain some control over illness via active recovery coping Restoration of Acceptance of the illness and consequences well-being 15 Illness Constellation Model Example Stage 1: Uncertainty 1. Experience: The patient notices symptoms like unexplained fatigue or lumps but is unsure of the cause. 2. Emotional Response: Anxiety and fear about the unknown. 3. Coping Resources: Seeking information, talking to family and friends for reassurance, and scheduling a medical appointment for evaluation. Stage 2: Disruption 1. Experience: The patient receives a cancer diagnosis. 2. Emotional Response: Shock, denial, and overwhelm. 3. Coping Resources: Emotional support from loved ones, counseling, and finding reliable information about the diagnosis and treatment options to regain a sense of control. Stage 3: Striving for Recovery Experience: The patient begins treatment, such as chemotherapy or surgery. Emotional Response: Hope mixed with fear of treatment side effects and uncertainty about outcomes. Coping Resources: Building a support network, participating in support groups, engaging in stress-reducing activities, and maintaining open communication with healthcare providers. Stage 4: Restoration of Wellness Experience: The patient completes treatment and moves into remission. Emotional Response: Relief, cautious optimism, and sometimes fear of recurrence. Coping Resources: Ongoing follow-up care, healthy lifestyle changes, realistic goals for the future, psychological support, and gradually resuming normal activities Cognitive Adaptational Model (Taylor, 1983) Cognitive Adaptational Model (Taylor, 1983) Search for Meaning Attempting to understand the reasons why Adopting an optimistic attitude Personal Control Making efforts to minimise or prevent further negative consequences May bring a sense of mastery or peace Restoration of Positive Self-Views/regain sense of mastery Negative life events often diminish our self-views Restoring this is important to improve wellbeing Coping with illness Three processes that result from the crisis of illness: i. Cognitive appraisal – appraising the implications of the illness of their lives ii. Adaptive tasks – the ill-ness specific tasks that are needed in order to deal with the illness; and general tasks such as preserving relationships iii. Coping skills – coping strategies i. Appraisal – focused (denial, positive appraisal) ii. Problem-focused (information and support seeking) iii. Emotion-focused (mood regulation, emotional discharge) Adaptive tasks can include: Dealing with symptoms of disease and pain Managing communication with health professionals Facing and preparing for an uncertain future.  Coping by denial or avoidance Initial denial is common, and in the short-term can be adaptive Cognitive avoidance includes passive acceptance and resignation Long-term denial and avoidance are problematic Ignore the problem Responding to symptoms Seeking help Patient delay – period between first awareness of a symptom of illness and the initial medical consultation… why? Downplay significance of symptoms Embarrassment/stigma Don’t want to bother their doctor Disruptive Denial 21 Problem-focused and acceptance (emotion-focused) coping Problem focused Making use of social support resources or planning how to deal with the problems faced Acceptance focused (emotion-focused) Accepting things as they are, reinterpreting in a positive light Responses are dynamic Reflecting Lazarus’ transactional model of stress 22 4. Response to Treatment Influencing factors Adherence to treatment plans Psychological approaches  Factors Influencing Treatment Responses Genetics Unique genetic profiles affect drug metabolism. Age and Body Size Influence treatment efficacy and side effects. Drug Interactions Concurrent medications can alter responses. Diet and Lifestyle Nutrition, smoking, and alcohol impact outcomes. Health Conditions Underlying diseases affect drug response. Psychosocial Factors Stress, social support, and psychological state influence outcomes. Importance of Adherence to Treatment Plans Treatment Adherence: Following the prescribed regimen maximizes success Chronic Condition Management: Proper adherence aids effective management Complication Prevention: Reduces disease progression risk Cost Savings: Adherence lowers healthcare costs by reducing visits and treatments Psychological Interventions to Improve Treatment Outcomes Enhancing Quality of Life: Cognitive-behavioural therapy aids in long-term condition coping. Boosting Patient Engagement: Tailored interventions increase patient involvement in treatment. Addressing Emotional Needs: Discussing emotions aids treatment adherence. Combatting Biases: Overcoming biases improves treatment perceptions. Responses to a Misdiagnosis: The HOUSE episode "Dr. Wilson and the Misdiagnosed Cancer Patient" 27 5. The Role of Carers Definition Impact of caregiving Support systems and resources Definition of a Carer and Their Role in Health Psychology “Carers are people who provide personal care, support and assistance to another individual in need of support due to disability, medical condition, including terminal or chronic illness, mental illness or is frail and aged” (The Australian Public Service) Crucial role Integral member of the healthcare team Carers - Australia 2.7 million unpaid carers. 520,000 aged > 65 years. 1.32 billion hours of unpaid Average: 40 hours per care week Mental illness – 104 hours $40.9 billion in value per week 30 Carers - Singapore Chan et al. (nd)The Survey on Informal Caregiving 31 The Impact of Caregiving on Mental Health and Well-being Emotional Strain: Caregiving induces stress, anxiety, depression, and burnout due to its demanding nature. Social Isolation: Carers may face social isolation and sacrifice personal time due to caregiving. Physical Health: Chronic caregiving stress elevates risks of conditions like hypertension and cardiovascular disease. The impact on family of illness Often experience the effects in a similar way to the ill person High levels of cohesion, adaptability and communication – better adaptability Parental coping strategies: Focus on family life and relationships Maintain well-being through social support Building relationships with health professionals and other parents Impact on families Positive aspects Strengthening relationships Improved communication Improved appreciation of positive things Personal growth and development Challenges Inflexible daily routines Lack of spontaneity Quick mood changes Difficulty coping in social situations 34 Impact on families Parents Psychological and emotional demands Unique parenting roles Coping with judgmental society Siblings Positive and challenging impacts Care-giving roles and responsibilities Varying levels of parental attention 35 Case study: Dementia Carers informal carers: unpaid people Dementia carers as an example 200,000 informal carers of dementia Physical and emotional well-being Weary/lacking energy – 34% Depression – 33% Sleep disturbance – 66% Relationships Employment Financial difficulties Anger, grief, burnout 36 A review by Golics, et al. (2013) Support Systems and Resources for Carers Professional Support: Healthcare professionals offer emotional guidance. Respite Care: Offers carers temporary relief for personal needs. Community Resources: Local groups provide information and peer support. Learning objectives 1. Understand the Psychological and Physiological Aspects of Pain: Explain the difference between acute and chronic pain and describe how pain can affect an individual’s psychological state and quality of life. 2. Recognize the Impact of Chronic Illness: Understand the various types of chronic illnesses and understand the psychological, social, and physical challenges facing individuals with chronic illnesses. 3. Evaluate Models of Illness and Adaptation: Compare and contrast different models of illness, including the Illness Constellation and Cognitive Adaptational models 4. Assess Treatment Response Factors: Identify the factors that influence an individual’s response to treatment and the importance of adherence to treatment plans 5. Role of Carers in Health Psychology: Understand the role of carers in the management of illness, recognize the impact of caregiving on mental health, and identify support systems available for carers. References Caltabiano, M. L., & Sarafino, E. P. (2002). Health psychology: biopsychosocial interactions. An Australian perspective. John Wiley & Sons. Carer Recognition Act 2010 Guidlelines. https://www.dss.gov.au/sites/default/files/documents/05_2016/carer_recognition_act_2010_guidelines_april_2016.pdf Czajkowska, Z. (2017). Theory of Cognitive Adaptation. Encyclopedia of Personality and Individual Differences, 1-3. Golics, C. J., Basra, M. K. A., Finlay, A. Y., & Salek, S. (2013). The impact of disease on family members: a critical aspect of medical care. Journal of the Royal Society of Medicine, 106(10), 399-407. Holland, J. C., & Gooen-Piels, J. (2000). Principles of psycho-oncology. Cancer medicine, 5. Morrison, V., Bennett, P., Butow, P., Mullan, B., & Sharpe, L. (2018). Introduction to Health Psychology in Australia EBook. P. Ed Australia. Morse, J., & Johnson, J. (1991). Toward a theory of illness: The Constellation Model. In J. Morse & J. Johnson (Eds.), The illness experience: DimensiIllnessons of suffering (pp. 315–342). Newbury Park, CA: Sage. Patterson, J. M. (1988). Families experiencing stress: I. The Family Adjustment and Adaptation Response Model: II. Applying the FAAR Model to health-related issues for intervention and research. Family systems medicine, 6(2), 202. Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American psychologist, 38(11), 1161. 40