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cognitive behavioral interventions > Lecture 2 - Medically unexplained physical symptoms > Flashcards

Lecture 2 - Medically unexplained physical symptoms Flashcards

1
Q

Predisposing factors:

A
  • Personality factors (neuroticism)
  • early experiences of adversity
  • schemas
  • lifestyle
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2
Q

Predisposing factors - personality

A

-Neuroticism/negative affectivity = stable lifelong tendency to experience negative affect rendering people more vulnerable to experiencing emotional / physical complaints –> predisposition to somatopsychic (physical and psychological) distress

Alexithymia:
1) not being able to distinguish between physical sensation and emotion
2) having difficulty to recognize and
3) label emotion
Example: sweaty palm, something in belly => ANGER

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3
Q

predisposing factors - Early experiences of adversity:

A

-childhood experiences of parental illness/ vicariously learned illness behavior > children copy the reaction of parents to symptoms and stress

-physical or sexual abuse in childhood (trauma) > fibromyalgia

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4
Q

predisposing factors -schemas:

A

Core beliefs/ schemas: ‘always perform perfectly’ > perfectionism, ‘never show weakness’

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5
Q

Precipitating (triggering) factors:

A

STRESS (Physical, events, chronic stress, etc.)
Physical:
o Infections
o Accidents
o Surgery

Life events:
o illness
o death of a partner/good friend
o moving houses
o violence

Chronic stress:
o home, work, study, relationship

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6
Q

what interaction leads to symptoms?

A

Interaction between predisposing and precipitating factors -> symptoms

  • precipitating factors trigger the development of symptoms/complaints in people who are more predisposed (vulnerable) to developing such symptoms
  • e.g. Person high on neuroticism that is confronted with a life-threatening disease of a good friend
  • e.g. Person who as a child was confronted with a sick father and is involved in a car accident
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7
Q

what factors are the focus of psychotherapy?

A

Perpetuating factors

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8
Q

perpetuating factors

A

= factors that maintain or aggravate symptoms
* physiological factors
* cognitive factors (beliefs about the stability of symptoms, “I’m very sick”)
* emotional/affective factors (e.g., anxiety about not recovering, patients with low activity > mainly high levels of distress, patients with high frustration > mostly active)
* behavioral factors (e.g., overexertion)
* social factors (e.g., support)

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9
Q

perpetuating factors - cognitive processes (3)

A
  • biased attention
  • attribution
  • beliefs/thoughts about symptoms (now/future)
  • beliefs on relation about activity & symptoms (“it’s dangerous to exercise”)
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10
Q

perpetuating factors. Cognitive processes - attention

A

-Selective attention to bodily processes (attention intensifies physical symptoms; distraction ameliorates physical symptoms);

-Somatosensory amplification => tendency to focus on bodily sensations & experience these sensations as serious and threatening

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11
Q

perpetuation factors. cognitive processes -attribution

A

-somatic illness attributions (e.g. I must have a problem with my bloodflow, that’s why I have a headache; even if there is another explanation) predict increased symptom experience and illness behaviours (e.g. consulting MD);

-Psychological / mixed somatic and psychological attributions predict better symptom outcomes (e.g. ‘I’ve had a stressful week and didn’t sleep much, that’s why I have a headache)
» psychological / mixed attributions are better than just somatic illness attribution > no sign difference between the two

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12
Q

perpetuation factors. cognitive processes - beliefs/thoughts

A

-Catastrophizing (e.g., I have a tumor) > related to increased symptom experience

-Beliefs about the relationship between symptoms and activity (walking will increase the pain I feel -> make it worse because you avoid activities)

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13
Q

perpetuating factors - behaviors

A
  • Avoidance of activity
  • Overriding the signs of your body / overexertion => neglecting that your body says no
  • Dysfunctional coping behaviors (medication use, alcohol abuse)
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14
Q

perpetuating factors - social support

A
  • Not only how many people support you, but also the quality of support
  • What is supported? The complaining about symptoms? The avoidance behavior? > not so good, can reinforce the symptoms
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15
Q

CBT for MUPS

A
  • Treatment focuses on perpetuating factors , but some predisposing factors may also function as perpetuating factors (e.g. personality / core beliefs)
  • Thoughts about bodily sensations influence mood, emotions, bodily processes (tension / arousal) and behaviour (avoidance of physical and social activities)➔reinforcement bodily sensations➔ vicious circle in which thoughts play a crucial role.
  • Cogn. restructuring for beliefs and ATs, activity scheduling for behavioral avoidance/ overexertion
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16
Q

Effectiveness of CBT in MUPS

A
  • CBT reduces somatic symptoms, but not so much the psychological distress
  • Moderate beneficial effects of CBT for MUPS, not really helpful for CFS

Research: Interventions differ in terms of content (e.g. focus on cognitions or more on behavior), method of delivery, and patient group

17
Q

Chronic fatigue syndrome (CFS) - general info

A
  • Subjective feeling of aversion toward activity & a perceived inability to perform
  • Tiredness/ weariness/ exhaustion
  • Physical vs. mental fatigue > CFS patients often suffer also from mental fatigue
  • Primary care: 5-10% have this as the main complaint
  • Persistent over 6 months
  • Substantial reduction of previous activity
  • Diagnosis criteria depend on a diagnostic tool (oxford criteria vs. CDC criteria)
  • Fatigue can be a symptom of physical disease
  • Can be also a symptom of psychiatric disorders
  • Medically unexplained fatigue = idiopathic fatigue > fatigue cannot be explained by a known medical or psychiatric condition
18
Q

diagnosing chronic fatigue syndrome

A

Depending on which diagnostic criteria you use (Oxford or CDC), you will find different results for effectiveness, because CDC patient are more severely impaired

19
Q

CFS - Risk factors for poor prognosis:

A

 Older age
 Longer illness duration
 Fatigue severity
 Comorbid psychiatric illness
 Somatic illness attributions!!

20
Q

Vicious circle of thoughts and behavior

A
  • thoughts ( I should rest to get well) > behavior (avoid activity) > symptom reduction goes down, expectancies go up
  • thoughts (I should try harder) > behavior (outburst of activity) > achievement goes up, but symptoms go up as well > start at the beginning again
21
Q

Focus on illness perpetuating factors in CBT

A

cognitive restructuring
o thoughts about CFS > difficult to target
o thoughts about a relationship between activity and symptoms > it’s easier to target in therapy (e.g., I am making myself worse by exercising/going out with friends)

Behavior -> activity scheduling (not same as behavioral activation! from last lecture)
o We want to decrease avoidance of acitvity or outbursts of activity

22
Q

Activity scheduling vs behavioral activation:

A

Activity scheduling:
o Focus on physical and social activities
o Increasing activity itself

Behavioral activation:
o Treatment for depression
o About having more positive reinforcement, experience more positive things

23
Q

Activity scheduling: what do you do at baseline level of activity?

A

Self-monitoring:
-Patient notes everything he/she does the whole day
-Be specific
> What means resting? Sitting on the couch, Netflix, Book?? Is that really resting? > get an idea about the amount of energy to do this activity > helps judging if this is really resting for that person
-Keep track of fatigue level from 0 to 8 (worst possible fatigue)

24
Q

activity scheduling - planning activity and rest

A

Setting goals:
-Long term (end of therapy) and short term (weekly) goals
-Must be realistic
-Goals must be defined operationally (getting better is not a good goal > what does better mean? > for example being able to resume part-time work
-Gradually increasing activity
-Gradually decreasing rest

  • Balance between activity and rest > plan both activities!!
25
Q

Relatively active vs. passive CFS patients

A

-Different treatment needed homework for first week > daily activity diary
-How to tell them apart: let them write a week-diary
-Relatively active: often regular outbursts of activity that lead to exhaustion > focus immediately on BALANCE
-Passive: stay in bed most of the time &raquo_space;> patients focus mostly on thoughts that lead to avoidance behvaior&raquo_space; INCREASE level of activity and decrease rest bit by bit

26
Q

Effectiveness of CBT for CFS

A
  • Not clear if cognitions act as a mechanism of change
  • Graded exercise treatmemt (GET) &raquo_space; patient continues to work on acitvitiy level (same as in CBT)
  • Adaptive pacing is different&raquo_space; encourage patients to be morw acitvie, but if patient is not feeling well > they are allowed to rest
  • Most effective: CBT AND GET; CBT better for patient who have anxiety or depression comorbidity (to fatigue)
27
Q

cognitions as a mechanism of change?

A

cognitions act as a mediator between behavior and fatigue

28
Q

another word for the 3 P’s

A

classical CBT model of emotional distress proposed by Beck

29
Q

idopathic fatigue

A

medically or psychiatric unexplained fatigue

30
Q

model of perpetuating factors introduced by Vercoulen

A
  • sense of control&raquo_space; fatigue
    -causal attribution&raquo_space; physical activity > fatigue
    -focusing on symptoms&raquo_space; impairment & focusing
31
Q

importance of the Complex CBT model for CFS

A

1) core beliefs (e.g. perfectionism)
2) model is based on two interacting cognitive- behavioural cycles:
- One cycle is based on a catastrophic (mis)interpretation of symptoms leading to distress and to avoidance of activity;
- The other cycle is based on ‘should’ statements that lead to frustration and to brief but unsustainable bursts of activity.
-> switch between these cycles leads to perpetuating fatigue

32
Q

planning of activity for CFS patients

A
  • Setting goals (St & LT)
    -goals must be realistic
  • Goals must be defined operationally (e.g. getting better→being able to resume part-time work)
  • Planning both activity and rest
33
Q

Activity scheduling

A

❖ Baseline level of activity * → self-monitoring
❖ Planning activity and rest
* →gradually increasing activity
* →gradually decreasing rest ❖ Balance between activity & rest

cognitive behavioral interventions (10 decks)

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