Psychology in Physical Health PDF

Psychology in Physical Health care Dr Daniela Melamed Clinical Psychologist What do I do? Clinical Psychologist at Great Ormond Street Hospital NHS Foundation Trust Across Psychological and Mental Health Services Department in different medical teams Private practice T...

Psychology in Physical Health care Dr Daniela Melamed Clinical Psychologist What do I do? Clinical Psychologist at Great Ormond Street Hospital NHS Foundation Trust Across Psychological and Mental Health Services Department in different medical teams Private practice Today’s Session Aims: To think about the background and context for psychology in physical health care settings To discuss the role of psychology To discuss models and evidence base for psychology in physical health To think about the challenges Clinical case Definitions Acute illness/pain/injury Pain that lasts less than 6 months Warning sign to your body that something is unsafe, something is broken, etc Chronic pain/condition Pain that lasts more than 6 months Long term Health Conditions Chronic conditions where there is usually no cure and managed with medications and other interventions Context 16.5 million people with long term physical health conditions across the life span in England 4.5 million experience psychological distress 2-3x more likely to experience mental health difficulties compared to general population Increases to 7x with one or more conditions Context 10-30% of children are directly or indirectly affected by physical health difficulties 11% of children experience significant chronic illnesses that limit their daily life 10-37% experience a psychological difficulty Context This relationship between physical and psychological presentations result in £8-13 billion of the NHS budget in England spent on the population of physical health presentations Department of Health (2012) found that this amount accounts for 50% GP appointments, 70% bed days, 70% of acute and primary care budgets What contributes to these increased costs? When individuals do not receive the appropriate psychological support there is a 45-75% increase in service costs regardless of medical condition This number stays after accounting for demographic and clinician factors What contributes to these increased costs? Unnecessary medical investigations Frequent A&E visits and outpatient appointments Increase medication use and admissions Indirect costs such as not attending work and reduced work productivity Mindy and Body Dualism 17th Century Descartes with groundings in philosophy Mind and body as separate entities Underpins the medical model Biopsychosocial Model Biological Social Psychological Engel (1977) Biopsychosocial Model: Biological Biological Social Psychological Engel (1977) Biopsychosocial Model: Psychological Biological Social Psychological Engel (1977) Biopsychosocial Model: Social Biological Social Psychological Engel (1977) Role of Clinical Psychologists Clinical work Individual work Working with families and couples Group work Joint working with other professionals Inpatient and Outpatient work Role of Clinical Psychologists Working with multidisciplinary teams Consultation Teaching, Education and training Facilitating Reflective Practice for medical staff Supervision Research and Audit What models do we use in physical health? Cognitive Behavioural Therpay Third-wave Approaches Compassion Focused Therapy Acceptance and Commitment Therapy 5 P’s Solution-Focused Approaches Systemic approaches Clinical effectiveness of psychological interventions Evidence-based interventions e.g. CBT and third-wave therapies have been found to improve: treatment adherence adjustment to conditions quality of life and coping Some evidence that self-help interventions may improve mood in patients with physical health conditions (Matcham et., 2014) Clinical effectiveness of psychological interventions Richard et al. (2017)’s study found that psychological interventions improved psychological symptoms and reduced cardiac mortality for those with cardiac heart disorder Anderson and Ozakinic (2018) found that in individuals with LTCs short, medium, and long term psychological interventions improved quality of life In an 8-week RCT, ACT improved psychological stress and depression in patients with Irritable Bowel Disease (Wynne et al., 2019) Clinical effectiveness of psychological interventions A retrospective study found that psychological interventions offered in primary care predicted greater attendance at appointments and engagement with physical health care (Ricou et al., 2019) CBT for migraine has been found to reduce migraine frequency, intensity, (Bae et al, 2021) and has also been found to be effective in treating symptoms associated with chronic pain (Eccelston, 2001) Clinical effectiveness of psychological interventions Integrated MDT care for conditions such as Type 2 diabetes has found to improve quality of life and mood related outcomes (Diabetes UK, 2010) The National Institute for Health and Clinical Excellence (NICE) guidelines has recommended psychological approaches be a part of recommended interventions for certain physical health conditions Challenges Small Groups What might be the challenges in providing psychological interventions in physical health care settings? How might we overcome these challenges? Challenges Not recognizing the psychological factors that contribute to physical presentations Focusing on just the physiological impact of conditions risk ignoring important aspects of the individual (Naylor et al., 2016) Risk of pathologizing distress Risk of pathologizing normal coping response to stress Language How language is talked about in the medical model E.g. “bad hand” and instead of using factual language “corrective” surgery which suggests something is wrong ØUsing medical jargon ØAcceptance-Based approach rather than Fixing-Based approach ØThinking about modelling and messages we give to service users ØConsider cultural factors Assumptions Assumptions effect and influence us all They are subtle and often unconscious thought processes but they have a significant impact on our perceptions. Assumptions- Small groups What are some assumptions we hold about medical conditions and clinical health presentations? How does that influence our perceptions? What assumptions might medical professionals or psychologists hold? How might these assumptions impact a service-user? Case example 40 years old male with chronic headaches and chronic fatigue Started noticing symptoms 10 years ago Lost job around that time Went to GP who suggested ”it may be in your head” Following that experience did not seek further support for another 5 years until frequency of headaches increased Case example Family Married and has three children Brought up with belief that emotions are not talked about and would be punished for expressing emotions Triggers Feeling overwhelmed Light sensitivity Coping strategies Finds it hard to ask for help; does as much as possible when feeling well and rest and recover when fatigue and headaches start Case example What information would you want to know? What factors might you consider when assessing him? How might you make sense of this difficulty? What might be keeping the problem going? What is protective? What can we do to help? Further Suggested Reading References A-tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36. Anderson, N., & Ozakinci, G. (2018). Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials. BMC psychology, 6(1), 1-17. Bae, J. Y., Sung, H. K., Kwon, N. Y., Go, H. Y., Kim, T. J., Shin, S. M., & Lee, S. (2021). Cognitive behavioral therapy for migraine headache: a systematic review and meta-analysis. Medicina, 58(1), 44. Borrell-Carrió, F., Suchman, A. L., & Epstein, R. M. (2004). The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. The Annals of Family Medicine, 2(6), 576-582. References Eccleston, C. (2001). Role of psychology in pain management. British journal of anaesthesia, 87(1), 144-152. Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129- 136. Kahana, S., Drotar, D., & Frazier, T. (2008). Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions. Journal of pediatric psychology, 33(6), 590- 611. Kush, S. A., Campo, J. V., & Ammerman, R. T. (1998). Consultation and liaison in the pediatric setting. Handbook of pediatric psychology and psychiatry, 1, 23-40. Matcham, F., Rayner, L., Hutton, J., Monk, A., Steel, C., & Hotopf, M. (2014). Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: a systematic review and meta-analysis. Clinical Psychology Review, 34(2), 141-157. Maximising the Impact of Psychological Practice in Physical Healthcare: Discussion Paper Psychological Professions Network) Mehta, N. (2011). Mind-body dualism: A critique from a health perspective. Mens sana monographs, 9(1), 202. References Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet, 370(9590), 851-858. Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M., and Galea, A. (2012). Long- term conditions and mental health: The cost of co-morbidities. London: The King’s Fund and Centre for Mental Health. Richards, S. H., Anderson, L., Jenkinson, C. E., Whalley, B., Rees, K., Davies, P.,... & Taylor, R. S. (2018). Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis. European journal of preventive cardiology, 25(3), 247-259. Ricou, M., Marina, S., Vieira, P. M., Duarte, I., Sampaio, I., Regalado, J., & Canário, C. (2019). Psychological intervention at a primary health care center: predictors of success. BMC Family Practice, 20(1), 1-8. Sanjida, S., McPhail, S. M., Shaw, J., Couper, J., Kissane, D., Price, M. A., & Janda, M. (2018). Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta-analyses. Psycho-oncology, 27(9), 2063-2076. References Suhrcke, M., Fahey, D., & Mckee, M. (2008). Integration and chronic care: a review. Caring for People with Chronic Conditions: A Health System Perspective, Open University Press, London. Suls, J., & Rothman, A. (2004). Evolution of the biopsychosocial model: prospects and challenges for health psychology. Health psychology, 23(2), 119. Unützer, J., Schoenbaum, M., Katon, W. J., Fan, M. Y., Pincus, H. A., Hogan, D., & Taylor, J. (2009). Healthcare costs associated with depression in medically ill fee-for-service Medicare participants. Journal of the American Geriatrics Society, 57(3), 506-510. Wynne, B., McHugh, L., Gao, W., Keegan, D., Byrne, K., Rowan, C.,... & Mulcahy, H. E. (2019). Acceptance and commitment therapy reduces psychological stress in patients with inflammatory bowel diseases. Gastroenterology, 156(4), 935-945. Yeo, M., & Sawyer, S. (2005). Chronic illness and disability. Bmj, 330(7493), 721- 723.