Lecture 14: mental and behavioral health Flashcards
(47 cards)
1
Q
Assess client’s knowledge
A
- to be able to facilitate a behavior change in client- toolbox of practical skills
- assess client’s knowledge about PA and past exercise experience (their expectations and perceptions); early cues to guide education, problem solving, and planning; interviews, questionnaires, or personal timeline methods, within formal or informal assessment
2
Q
Assess client’s decision making
A
- anticipate potential positive and negative consequences of adopting a new behavior
- may help to: establish reasons and motives for behavior change, set specific goals and avoid future pitfalls, understand environmental supports and challenges for PA, identify behaviors needed for adoption and maintenance of exercise
3
Q
Benefits of PA
A
- consider importance and personal relevance/ priority of each potential benefir for client- possible motivator for exercise
- reduces risk of chronic diseases including diabetes, hypertension, heart disease, and certain cancers
- assists in weight management
- promotes healthy bones, muscles, and joints
- improves congitive functioning and mental health and reduces symptoms of depression, stress, and anxiety
- improves body image, self-esteem, and self-concept
- increases fitness, improves physical functioning, and enhances ability to perform activities of daily living
- provides opportunities to develop social contacts and relationships with others
4
Q
Barriers to PA
A
- physical and mental health concerns
- accessibility, affordability, and convenience of safe facilities and equipment
- environmental and ecological factors (geographical, climate)
- lack of time
- lack of enjoyment and/or boredom
- insufficient encouragement and social support
5
Q
Problem Solving
A
- create a professional relationship to allow feelings of autonomy and control with respect to PA
- practical and systematic problem solving to overcome barriers
6
Q
Practical Problem Solving: IDEA Method
A
- I: identify and prioritize personal barriers-specific barrier
- D: develop of possible solutions
- E: evaluate each solution and select one
- A: act on plan and assess how well it worked/didnt
7
Q
Goal setting for PA
A
Goal setting is stepwise process that involves:
- assessing an individual’s current level of fitness or PA level
- evaluating individual’s expected outcome
- considering best professional practices for exercise prescription
8
Q
SMART principles
A
- S: specific- PA behavior to be clearly and precisely established
- M: measurable- easily assessed or monitored
- A: adjustable- adjustable and modifiable as needed (action-oriented and attainable)
- R: realistic- somewhat challenging, but within individual’s capabalities and readily acheivable
- T: time frame specific- accomplished within a specific period of time - appropriate rewards and measurement of progress
9
Q
behaviors/rewars/self-monitoring
A
- PA program should be gradually implemented ensuring success at each stage
- External rewards (client selected) may be needed for encouragement and motivation initially - program-based incentives as form extrinsic motivation; indentify intrinsically rewarding aspects of PA; intrinsic motivation may be learned when an individual finds personal, self-identified rewards for behavior independent of extrinsic factors
- helpful for self-management= identifying PA patterns and receiving feedback regarding progress- especially self-monitored feedback
- self-monitoring helps identify unhelpful patterns of sedentary behavior, set goals, monitor progress, identify barriers, and improve PA choices (journals, apple watch/monitors, step counters, apps)
individual involvement in process is important
10
Q
Self efficacy
A
- Self Efficacy: extent to which individuals feel capable
- enhanced by: setting realistic, personally tailored PA goals
- encouraging regular + feedback (receiving social support)
- tracking PA is way to measure progress and highlight success performing desired behaviors
- explore previous experiences along with unreasonable beliefs and misconceptions
11
Q
Support/Motivation
A
2 categories of support:
- Functional Support: refers to perception of support, includes instrumental support and emotional support
- Structural Support: refers to social networks, includes marital status, number of friends, participation in church or civic organizations
- praise and encouragement (immediate and specific)
- group participation in PA to enhance support
- appropriate and consistent role models
12
Q
Motivation: stimulus control
A
structuring one’s personal environment to remind or encourage behavior (visual, auditory reminders or prompts)
13
Q
Motivational Readiness: Transtheoretical Model (TTM) of behavior change
most important factors in maintaining PA is motivational readiness
A
TTM proposes that individuals move through 5 stages of readiness for changing health behaviors
1. Precomtemplation: not thinking about changing PA
2. Contemplation: thinking about changing PA
3. Preparation: making small changes in PA but not to a degree that meets the desired target
4. Action: meeting PA goals but for fewer than 6 months
5. Maintenance: being PA at desired level for at least 6 months
individuals move back and forth between stages
14
Q
Enhance Enjoyment
A
- customizing mode, intensity, duration, format (group or individual, instructor led or videotaped), and location (outside/inside, home or facility)
- develop individualized plans that match client preferences and expectations
15
Q
Minimize Boredom
A
- variety of PA and diversity of program options
16
Q
Preventing Relapse
A
- relapse: complete cessation of behavior change and a return to previous pattern of behavior
- lapse: break in activity that may lead to full-blown relapse and a return to previous sedentary lifestyle
17
Q
Strategies to prepare for lapses and to restart PA
A
- planning ahead for high-risk situations
- identifying alternate activities that can be done in place of usual activity
- planning to exercise as soon as possible after a break
- enhancing accountability and support systems
- modifying goals to avoid discouragement
18
Q
To sustain motivation…
A
- recognize relevant personal benefits of PA (physical, psychological, social)
- generalize training geared to future environments (expand to diff. settings to facilitate ongoing participation)
- regular reassessment of PA goals- opportunity to verify goals are relevant, realistic, and motivating
19
Q
Client-Centered Coaching Approach
A
- promotes collaborative relationship between client and professional
- acheives desired outcomes using skills and processes that are personally relevant and self-directed
- associated with: higher client satisfaction, increased medication compliance, reduction in client’s concerns, reduction in actual symptoms
20
Q
Client-Centered Coaching Approach: 5 A’s Model
A
- Assess: health and PA and client’s stage of change, benefits and barriers, self-efficacy, and social support system
- Advise: advising with recommendations tailored to client
- Agree: client and CEp agree on type and level of intervention and establish goals
- Assisst: CEP assissts in developing an action plan, strategies for behavior chance, and resources
- Arrange: CEP arranges next steps
collaborative, cooperative, establish rapport, communicate empathy, active listening, reflection, open-ended questions, attentive to nonverbal communication
21
Q
Socioecological factors that contribute to active living
A
- consider relationships among socioecological factors (intrapersonal, interpersonal, community, and organizational factors) and PA
- Walkability and connectivity
- Active travel alternatives
- quality public space, minimal incivilities
- social interaction and inclusion
- perceived and objectively safe environments
- domestic environments can be made to be more active
22
Q
Group Coaching
A
- group settings provide a natural support system as well as other advantages
- provide feedback to each other based on experiences
- develop self-efficacy from peer role models and emulate others’ successful techniques
- evaluate practicality of desired goals, objectives, and plans
- encourage commitment and accountability
- develop solutions for barriers
- need to positively manage group dynamics and group process
23
Q
Mental Health disorders
A
- characterized by disturbance in thoughts, emotions, or behaviors significant enough to affect individual’s functioning
- occur in half of all people in US at least once in lifetime- can be transient or chronic and range from mild to severe
- some are more prevalent in those with chronic disease- disruptions in mental health can affect glycemic control, immunity, and CV functioning; behaviorally mental health concerns can adversely affect medication adherence, treatment compliance, exercise, nutrition habits, sleep patterns, and substance abuse
- those with poor mental health are less likely to be physically active and have greater rates of early mortality
24
Q
Mental Health Disorders: exercise associated with:
A
- reduced symptoms of depresion and anxiety
- improved self-esteem
- better functioning and quality of life
- improved sleep quality and less fatigue
- reductions in pain and physical complaints
- improved cognitive function
- PA can have advantages over mental health treatments; convenient, accessible, few negatice side effects, and positive side effects of better fitness and improved health
25
Stress
- acute and chronic stressors
- symptoms of psychological stress overlap with depression and anxiety disorders
- acute stress = elevated HR and BP
- prolonged stress = susceptibilty to illness
- high levels of stress may be associated with higher pain ratings, feelings of anger and irritability, increased risk of injury
- stress may also negatively influence health behaviors, including smoking, sleep, diet, medication compliance, and PA
26
Stress interentions
- potential relief from stress by participating in PA
- enhancing social support networks
- self-help or support groups
- relaxation training including biofeedback, guided imagery, and progressive relaxation
- resilience training
- psychotherapy
27
Depression
- mood disorder characterized by discrete symptoms that are present most of the day, nearly ever day, for at least two weeks
- 1 in 5 US adults experience mood disorder sometime in life (depression = most common)
- **persistent depressive disorder:** more chronic depression characterized by less severe symptoms, with or without episodes of major depression, lasting at least two years
- **Bipolar disorder:** characterized by periods of both depression and mania- symptoms of mania = extreme elation/irritability, increased energy and decreased need for sleep, grandiose ideas, inflated self-esteem, distractibility, increased goal-directed activity, physical agitation, and poor judgement, or inappropriate behavior
- depression affects all gender, age, socioeconomic
- increased risk = younger americans (18-25), women, sedentary, triggered by stressful life events or physiological factors (genetics, biological, social, and cognitive factors)
28
Depression treatments
- antidepressant medications: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and older medications such as tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs)
- can take several weeks to decrease symptoms, and often adjustment of dosage for optional therapeutic effect (some side effects may be relevant to exercise participation- weight change, fatigue, insomnia)
- Psychotherapy: cognitive behavioral therapy (CBT) and interpersonal psychotherapy
- exercise can be helpful as an adjunctive treatment for individuals who have depressive disorders
- if mild depression, exercise may be good alternative antidepressant treatment with monitored systems
- exercise does similar to general recommendations
29
Risk of suicide
- immediate action is needed if client communicates planned harmful or suicidal inentions- mental health provider- referred to a local suicide or crisis center (988)- taken directly to hospital/ER; client should be accompanied to help and not left alone
30
Suicide prevention strategies
- addressing economic factors
- improving access to and delivery of mental health care
- creating protective environments
- promoting connectedness
- increasing coping and problem-solving skills
- identifying and supporting those at risk
31
Anxiety
- feature of most anxiety disorders= unwarranted sympathetic nervous system (SNS) activation in response to anticipated risk or danger - women 2x as likely to suffer from anxiety disorders
- **Panic disorder:** anxiety disorder involving experience of sudden, unexpected periods of intense fear; panic attack symptoms- accelerated HR, sweating, trembling, shortness of breath, sensation of choking, chest pain, nausea, dizziness, and tingling
- **Generalized anxiety disorder (GAD):** characterized by chronic, exaggerated worry that occurs more days than not for at least 6 months with at least 3 of the following symtoms: feeling restlessness or keyed up, having trouble concentrating, being irritable, feeling fatigued easily, muscle tension, sleep problems such as difficulty falling or staying asleep
32
Anxiety disorders
- **Obsessive-compulsive disorder (OCD):** involves experience of disturbing and irrational thoughts (obsessions) and need to engage in repeated behaviors or rituals (compulsions) to prevent/ relieve anxiety
- **Specific phobias:** specific and intense fears triggered by presence or anticipation of objects/ situations; symptoms= excessive sweating, heart pounding, shaking, shortness of breath, and/or nausea
- **Posttraumatic stress disorder (PTSD):** develops after experiencing or witnessing an intense, traumatic event; symptoms= repeated disturbing thoughts of trauma, nightmares, sleep disturbances, feeling like event is recurring, tend to be hypervigilant, sleep difficulties, irritability, startle easily
- **Social anxiety disorder (social phobia):** characterized by intense anxiety and self-consciousness during normal social situations in which there is a possibility of scrutiny by others
33
Anxiety treatments
- diagnosis of anxiety disorders can only be made by trained professionals using standard diagnostic criteria
- common meds = antidepressant meds, benzodiazeines and beta-blockers
- targeted psychotherapy indicated for anxiety disorders (ex: CBT, exposure therapy, relaxation therapy)
34
PA and anxiety
- reduces risk of developing an anxiety disorder
- exercise may be useful in reducing symptoms of stress and anxiety in healthy people, chronic illness people, and clinical anxiety disorder people
35
Eating Disorders
- disordered eating comprises a spectrum of behavioral, cognitive, and emotional symptoms involving disturbances in eating and body image
- **Anorexia nervosa:** person has insufficient calorie intake to sustain normal body weight for age and height- health complications: osteoporosis, muscle atrophy, electrolyte imbalances, cardiac arrhythmias, sometimes early death
- **Bulimia nervosa:** episodes of binge eating and compensatory purging via self-induced vomiting, misuse of laxatives, excessive exercise to prevent weight gain; health consequences: GI disturbances, electrolyte imbalances, esophageal ruptures, pancreatitis, and erosion of tooth enamel
- **Binge-eating disorder:** involves recurrent binge-eating episodes during which individual lacks control over how much he/she is eating and eats more than what most people would eat in similar time period
36
Eating disorders: professional assessment
- medical evaluation to assess body weight and health problems
- psychological evaluation to assess severity of eating disorder and presence of comorbid mental disorders
- nutritional consulation to evaluate current eating habits
37
Eating Disorders Treatment
- multifaceted process that involves team of health care professionals: mental health counselors, physicians, psychologists, and nutritionists (regulate energy balance)
- maybe inpatient setting
- psychotherapy is important
- ability to recognize and alert/refer for treatment if needed
38
Substance Abuse Disorders
- include disorders associated with use of alcohol, prescribed/ over-the-counter medications, and toxins such as inhalants
- features = social impairment, risky use, impaired control, and pharmacological criteria (tolerance and withdrawal)
- professional assessment critical to ensure safety of individual and to implement appropriate treatment
- most likely to recognize symptoms of substance use during acute intoxicationor report of questionable behavior (concerns w/ performance-enhancing drugs when working with athletes)
39
Substance abuse disorders and exercise
- therapeutic treatment for substance use, adjunctive therapy within integrative treatment program
- favorable neurobiological adaptations
- distraction and coping
- enhanced self-esteem and sens of control
- increased social support
- management of comorbid risk factors such as depression and anxiety
40
CVD and stress
- chronic life stress is associated with increased risk factors and development of CVD
- acute stress- trigger cardiac events
- acute negative emotional states
- anger, anxiety, and frustration are associated with myocardial ischemia
41
CVD and Depression (common link)
- ex: CHD- associated with worse prognosis
- mechanisms may involve SNS and PNS changes and increase activation of pituitary adrenal axis
- depressive clients may have poor adherence to medical treatments
42
Role of social support
- widely recognized as an independent predictor of health and well-being
- social isolation- associated with increase in all-cause CVD mortality and 1-year post MI
- low social support associated with poor clinical pronosis- those with HF and stable CVD
43
Stroke
- most common psychological reaction in people suffering a stroke= depression (rate of 30%)
- contributing factors: institutionalization, pre-stroke alcohol use, impairment of ACL, perception of social support
44
Heart Failure
- depression and anxiety in heart failure both appear to be associated with sympathetic activation and catecholamine release as well as abnormal platelet reactivity
- depression is associated with elevations of pro-inflammatory cytokines
45
Diabetes
- stress, depression, and anxiety are more prevalent among patients with DM than general population
- stress may suddenly cause onset of DM or compromise glucose control after disease is established
46
COPD
- common psychological reactions= anger, frustration, guilt, dependency, embarrassment - depression and anxiety
- depression agravated bc of: worsening dyspnea and fatigue, perceived poor health- may lead to decrease in functional capacity and exercise tolerance
- dyspnea is conjucntion with fear of suffocation and death is a source of significant anxiety
- pulmonary rehab improves COPD patient's quality fo life
- exercise therapy combined with psychological interventions improves mood, anxiety, neurocognitive funcitoning, relief of dyspnea, improved functioning and control of disease
- psychological interventions on their own- reduce breathlessness and general disability and improve QOL
47
Asthma
- association between emotional stress and various indices of impaired airway function
- anxiety common in asthma patients with panic disorder
- stress management, yoga, biofeedback, and symptom perception have been shown to reduce measures of asthma morbidity and improve patient quality of life
- asthma education and management= improve frequency of asthma attacks and symptoms, medication adherence, and self-management skills
