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Behavioral Medicine Flashcards

(75 cards)

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1
Q

Define disease

A

a disruption in normal biological functioning (objective) Focus = curing

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2
Q

Define illness

A

a sense of dise-ease (subjective sense of feeling sick), reflected in mood - Focus = healing

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3
Q

Define health

A

Health is not the absence of disease - process which you have a sense that life is meaningful, and you have the ability to function in the face of change

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4
Q

Behavioral medicine

A

applying knowledge in behaviorial, psychosocial, and biomedical science to prevention, diagnosis, treatment and rehab

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5
Q

Consensus trance

A

the states of trance induced by the environment to which we have become accustomed

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6
Q

Values useful for difficult conversation

A
  1. a demonstrated commitment to quality care
  2. trustworthy & time communication
  3. heart-centered listening and truth-telling
  4. a lack of denial
  5. proactive, ongoing decision-making
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7
Q

Transference

A

reactions the patient has to the clinician

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8
Q

Countertransference

A

reactions the clinician has to the patient

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9
Q

Empathy

A

the capacity to think and feel yourself into the inner life of another person (a recognition of self in the other)

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10
Q

5 factors that contribute to happiness and well-being

A
  1. work/leisure experiences leading to flow
  2. finding meaning/purpose in religion/spirituality
  3. having relationships that provide social support
  4. being physically healthy
  5. community service/helping others
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11
Q

Gratitude boosters

A

Gratitude journal, acts of kindness, learn to forgive, invest energy in friends and family, take care of your body, gratitude visit

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12
Q

Patients are more likely to cooperate when they:

A
  1. Perceive high severity of illness or consequence
  2. feel highly susceptible to the disease
  3. capable of performing a behavior to reduce risk
  4. confident treatment will reduce risk
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13
Q

What should we do with resistance from a patient?

A

“Court” it, go along with it, work with it rather than against it

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14
Q

Common responses to suggestions from others

A

acceptance, modification, rejection

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15
Q

View noncompliance as a _______ requiring exploration into cause

A

SYMPTOM, look for reasons behind this behavior

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16
Q

Goals for obtaining cooperation

A
  1. elicit feedback on patient’s perceived ability to reach goals (or to make a change)
  2. renegotiate goals based on patient feedback (accept this outcome)
  3. be positive about their ability to achieve that goal
  4. inquire about goal accomplishment during each visit
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17
Q

When prescribing medications

A

integrates daily routine, anticipate adverse effects, use written instructions

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18
Q

Patients are most receptive to info. and education about condition and treatment in ______ & _____

A

preparation and actions stages

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19
Q

Transtheoretical Model

A
  1. Change is a process - not an event
  2. people typically cycle through the stages of change
  3. decisional balance - pros and cons to make change
  4. Various stages of change
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20
Q

____ changes processes help people move through early stages of cahnge

A

Cognitive

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21
Q

____ change processes help people move through later stages of change

A

Behavioral

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22
Q

Various stages of change

A

Precontemplation, contemplation, preparation, action, maintenance, relapse

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23
Q

Precontemplation

A

Reasons to keep things the same, not really thinking about change

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24
Q

Contemplation

A

recognizes problems and considering change (some day)

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25
Preparation
pros > cons, ready to change but some ambivalence may remain
26
Action
Pros >>>> cons, real change begins here
27
Maintenance
gains are consolidated, long and ongoing
28
Termination
confidence in changes made, no fear of relapse
29
Lapse
a temporary setback, able to get back on track
30
Relapse
a return to old behavior
31
Disengagement
too much of a "getting right down to business" style
32
Common interview errors
inadvertantly shaming, embarrassing or humiliation patient, blaming patient, focus on assessment excluding relationship, drawing premature conclusions, assuming common understanding, spending too much time in social chit chat
33
Engagement
begins immediately, process by which doctor and patient initiate and maintain an effective working relationship, based on trust and respect (mutual)
34
Open ended questions
more than yes or no, invited story telling
35
close ended questions
yes or no answer, limits story telling
36
Evocative questions
typically open ended, helps clinician gather self motivational statements
37
Reflective listening
reflecting what you hear the patient saying, or what you believe the patient means
38
Types of reflection
repeating, rephrasing, empathic reflection, reframing, double-sided reflection
39
Affirmation
a way to build self efficacy, a compliment or nice statement about the patient
40
Intention and commitment
"How important is this to you?" "How much do you want to do this?"
41
Two critical steps must occur before educating a patient and problem solving
1. building patient's motivation for behavioral change | 2. building patient's motivation for treatment
42
Core interviewing skills - OARS
Open-ended questions, affirming by other & self, reframing, summarizing
43
Who should present arguments for change?
The patient not the doctor
44
Patient Interview Outline
1. Engage patient & build rapport 2. Inquire about the context of encounter 3. Ask about their concerns 4. Seek permission 5. Explore the hx of the problem/concern 6. Ask about the "trip point" that made them want to come in today 7. Explore attitudes, beliefs, resistances, and ambivalence 8. Explore patient's strengths & resources (areas of self efficacy) 9. Develop discrepancy & assess motivation to change 10. recognize and assess risk factors 11. Summarize - negotiate plan for change and/or follow up
45
Maturation vs. Development
development is maturation in addition to the psychological process by which someone gains independence
46
Freud's topographic model
conscious mind, preconscious mind, and unconscious mind
47
Psychic determinism
all psychological events are determined by some antecedent event
48
Freud's structural model (1923)
Superego (conscience) Ego (mediator) Id (instinctual drives) Outside world (reality)
49
Every symptom in Freud's structural model....
has a problem component AND reflects an adaptation a person has made
50
Freud's psychosexual stages of development
Within each stage there can be progression, regression, and fixation Stages: Anal stage (1-3 years), Phallic-Oedipal stage (3-5 yo), Latency (school age), Genital (early adolescence-adulthood)
51
Margaret Mahler
"The Psychological Birth of the Human Infant" (1975)
52
Normal symbiosis
1-5 months, mother and me (need satisfying object)
53
Separation-Individuation
5-24 months, three subphases: | Hatching, Practicing, Reapprochement
54
Object Constancy
24-36 months, the establishment of "whole" object relations
55
Erik Erikson's Psychosocial stages of development
Trust vs. mistrust (birth-1 year), Autonomy vs shame & doubt (age 1-3), Initiative vs guilt (age 3-5), Industry vs Inferiority (age 5-11), Identity vs role confusion (11-21), Intimacy vs Isolation (21-40), Generativity vs stagnation (40-60), Integrity vs despair (60-death)
56
Piaget's Theory of Cognitive Development
sensorimotor (birth-2), preoperational (2-6), concrete operational (6-12), formed operational (12-19)
57
Kohlberg's Theory of Moral Reasoning
Level 1: Preconventional (stage 1: heteronomous morality, stage 2: instrumental morality), Level II: Conventional (stage 3: good child morality, stage 4: law and order mentality), Level III: Postconventional, or Principled (stage 5: social-contract reasoning, stage 6: universal principles)
58
Carol Gilligan's critique of Kohlberg
Kohlberg used all boys as original participants. She found there were not strong differences in moral reasoning as Kohlberg seems to suggest.
59
Persons are primarily ____ seeking, rather than ____ seeking
object, pleasure
60
Our ability to form attachments enables us to:
1. feel connected with others 2. experience a sense of being loved and loving 3. feel part of a larger whole
61
Our ability to detach enables us to:
1. distance when we feel threatened or too close 2. reduce emotional intensity 3. experience a sense of ourselves as autonomous and free 4. may involve a sense of loss
62
Define attachment
a relatively enduring emotional bond with another person that forms in response to exposure, interaction, and familiarity
63
Behaviors of attachment that are not present in cases of children with abusive parents
Proximity-seeking, separation protest
64
Core functions of attachment
Protection/Survival (safe haven and secure base), regulation of physiological arousal and emotional distress, development of a sense of self, foundation for mentalizing
65
Abusive caregivers
heighten attachment needs, BUT provide minimal safe haven and secure base functions
66
Primary predictors of depression in adults
heredity, severe situational stress, early attachment trauma (from a loss, abuse, or neglect)
67
_______ makes up the core of the developing self
Pre-verbal experience
68
Attachments are hierarchical
Time spent, quality of care, emotional investment, emotional responsiveness, repeated presence
69
Bowlby's hypotheses
1. Behavioral patterns of seeking care and expressing emotions form as a function of the mother's response to the child. 2. The patterns that become preferred are those that provide some measure of felt security.
70
Three Patterns/Styles of Attachment originally identified by Mary Ainsworth
Secure, Insecure (anxious, avoidant) [Main and Solomon added four style - disorganized - in 1986]
71
Single most important factor in fostering mentalizing is a _____
secure attachment
72
Problems in ______ are prominent in personality disorders
mentalizing
73
Adult Attachment Interview (AAI)
a means of studying the inner world of adult caregivers (and their children) through narrative analysis
74
Main conclusions of AAI (Mary Main 1984)
1. adult security is reflected in the ability to talk about past attachment experiences in a coherent and collaborative way 2. mother's who are aware of their own attachment processes are more likely to be sensitive to child's attachment needs 3. attachment styles of parents tend to be passed on to their children
75
We ted to _____ seek out those who resonate with our early attachment figures and patterns (regardless of how bad they may have been)
unconsciously

Behavorial Medicine (2 decks)

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