13. Working with People with Physical Health Problems

Question 1

How does psychological difficulties link to physical health problems?

Answer 1

Psychological difficulties can

• contribute to physical health problems
• maintain physical health problems
• result from physical health problems

Question 2

What are some areas psychology can be helpful in the health sector?

Answer 2

• secondary mental health issues after being diagnosed
• help doctors and nurses think about how patients can improve adherence to treatment
• patient engagement with healthcare personnel

Question 3

Which treatment is related for people with physical health problems?

Answer 3

compassion-focused therapy

- deals with self-critical thoughts that clients have about their disability

Question 4

What are the 2 models typically used in formulations and interventions? Why are they chosen?

Answer 4

1) Health beliefs model (HBM)
2) Stress-coping model
Because they support CBT formulations and interventions learned

Question 5

In the health beliefs model, what are the 3 components?

Answer 5

1) modifying factors (age, gender, ethnicity, personality, ses, knowledge)
2) individual beliefs (perception of threat)
3) action (motivation to act, preferred course of action)

Question 6

What are the 4 types of individual health beliefs and perception?

Answer 6

1) perceived susceptibility to and severity of disease
2) perceived benefits
3) perceived barriers
4) perceived self-efficacy

Question 7

How does perceived susceptibility to and severity of disease contribute to an individual’s behavior?

Answer 7

Susceptibility: if perceive myself to be very susceptible, I will take steps to change my lifestyle
Severity: if I perceive the consequences of my behavior to be very severe, I will try to live more healthily.

Question 8

How does perceived benefits influence an individual’s behavior?

Answer 8

If I believe that the anticipated benefits outweigh the costs, I will actively change my life style to maximise my benefits.

Question 9

How does perceived self-efficacy influence an individual’s health related behavior?

Answer 9

If I believe that I can successfully execute the behavior required (eg. exercise every week, eat my meds regularly), I will be more likely to engage in those behaviors

Question 10

Stress can contribute to occurrence and progression of illness in 2 ways, describe them.

Answer 10

Directly - increase arousal of the HPA and fight or flight system
Indirectly - through poor health behaviors

Question 11

The impact of situational demands on the individual depends on: (2)

Answer 11

1) how much demands (primary appraisal - perceived susceptibility and severity of threat)
2) ability to cope (secondary appraisal - perceived benefit and self efficacy)
- perceived ability to change the situation
- emotional reaction to the situation

Question 12

What are the 4 types of coping strategies?

Answer 12

1) problem-focused
2) emotions-focused
3) meaning-focused
4) disengaging (emotion/meaning)

Question 13

What is problem focused coping?

Answer 13

Changing the situation using active strategies
eg. information seeking, problem solving, working harder.
overengagement

Question 14

What is emotion-focused coping?

Answer 14

Changing the way one thinks or feels.

eg. seeking social support, venting.

Question 15

What is meaning-focused coping?

Answer 15

Making sense of what has happened to you

eg. reinterpretation, acceptance, religion and spirituality

Question 16

Describe disengaging coping strategies.

Answer 16

• emotion focused or meaning focused
• Not facing demands, denying the demands are there, and avoiding it.
• Happens when stressor is highly threatening and uncontrollable.
• cognitive and behavioral avoidance, distractions, denial

Question 17

What is the key gist of compassion focused therapy?

Answer 17

Compassionate self-correction. Embracing our mistakes as best as we can and focusing on what we can work on. We want to be the best that we can be instead of punishing ourselves when things go wrong.

Question 18

Compassion Focused Therapy (CFT) was developed for what kind of clients?

Answer 18

Clients with strong emotions of shame and self-criticism. Self-acceptance is difficult for them because they are not used to it. These voices are inherited and they probably experienced a lot of criticism as a child, and these ways of viewing the self becomes internalized and repeated in their own lives now.

Question 19

What are the 3 functionally distinct emotion-regulation systems? DAT

Answer 19

1) Drive System: system to stimulate us to achieve (pursue goals, get work done)
2) Affiliative System: experience contentment and safety in relationships
3) Threat System: system to deal with threat (fight or flight)

Question 20

What motives might drive individuals to criticise themselves? (3)

Answer 20

1) competitive social ranking motive. Social comparison can make you feel inferior and lead to self-criticism
2) Caring or friendship motive. Have beliefs that they are not deserving of others’ love when they make mistakes
3) stop themselves from making mistakes

Question 21

What processes are associated with the drive system?

Answer 21

Excitement, behavioral activation, trying to do a lot of things, incentive focused

Question 22

What processes are associated with the threat system?

Answer 22

anger, anxiety, disgust, safety seeking

Question 23

What processes are associated with the affiliative system?

Answer 23

content, connection

Question 24

What is the main goal of the 3 emotional regulation systems?

Answer 24

Aim is to restore balance into the system. Threat focused, affiliation focused, incentive focused. No overemphasis on any one of these systems at any point in time.

Question 25

During formulation, what are some areas to look out for? (4)

Answer 25

1) relative dominance of each emotional system. possible historical influences on current configuration.
2) identify key fears
3) identify safety/coping behaviors
4) identify self-critical attitudes

Question 26

What does intervention in CFT constitute?

Answer 26

• experimental exercise in self-compassion
• method acting technique where clients are invited to role play a compassionate self to produce the emotion of compassion.

Question 27

How might the nature of the illness impact psychological functioning?

Answer 27

1) prognosis and treatment
- acute vs chronic
- born vs acquired
- stable vs periods of exacerbation and remission
2) cognitive problems
- increase vulnerability to anxiety and depression
3) transdiagnostic difficulties (secondary concerns)
- sleep problems, weight managent. fatigue. sexual concerns, pain

Question 28

How might personal factors impact the client’s psychological functioning in the context of physical illnesses? (6)

Answer 28

1) health/illness beliefs
2) coping style
3) adjustment
- managing symptoms, treatments, relationships, emotions, self-image, uncertain future
4) lifespan issues (some disabilities easier to adjust to later in life due to cultural expectations that it’s more ‘normal’)
5) existential issues - capacity to process and make sense of existential issues
6) societal factors - cultural beliefs, stigma, and social support

Question 29

What does the cognitive stress-coping model suggest about coping with physical illness?

Answer 29

Suggests that the way in which we appraise illness affects how effectively we cope with them.

Question 30

Describe CBT approaches in physical healthcare settings.

Answer 30

1) helpful in managing depression and anxiety in chronic health problems and trauma
2) enables people to maintain a positive but realistic attitude towards their illness
3) increases communication skills and relationships, and dealing with stigma

Question 31

How might systemic approaches be useful for the individual in physical healthcare settings?

Answer 31

• illness can negatively impact relationships due to burnout and fatigue. Hence family support and systemic intervention can be helpful.

Question 32

What are the different interventions that can be used with clients with physical health problems?

Answer 32

• psychoeducation
• CBT: cognitive reappraisal; behavioral experiments
• Acceptance and Commitment Therapy (ACT)
• systemic work

Question 33

Is compassion focused therapy always used in the context of physical health problems?

Answer 33

Nope. Only when there is obvious self-critical voice that contributes to distress or health related behaviors.

Question 34

Describe the flow of compassion formulation.

Answer 34

Historical influences -> Key fears -> Safety/Defensive behaviors (Internal/External) -> Vicious cycle (unintended consequences; confirms initial beliefs about yourself -> self-critical voices -> defensive behaviors)