Health Psychology

1. Health Psychology Chronic Illness � part 1 PY 470 Hudiburg

2. What are chronic diseases? Multiple causes 85% of all cases of cancer are caused by behavioral choices and lifestyles Slow onset, and increased intensity over time � example is AIDS Some chronic diseases can be cured and some can not be cured Estimated that 46% of all Americans have a chronic condition � percentage increases with age group � Figure 10.1, p. 367 Note Box 10.1, p. 368 � Chronic illness in Older adulthood � increasing life expectancy and decreased physical and psychological functioning

3. What are the consequences of having chronic illnesses? Potential threats � Table 10.1, p. 369 Physical problems There are a variety of physical debilitations: paralysis, pain, neurological disorders, sensory deficits. Treatments of chronic illnesses can be have many adverse side effects, for example: dialysis, chemotherapy, radiation treatment all have many side effects. Surgery can lead to disfigurement (amputation) and disability and other issues (colostomy). Sexual dysfunction may result from some treatments and conditions: prostrate treatments and coronary heart disease (1% risk of heart attack during sex)

4. What are the consequences of having chronic illnesses? Social problems There may be effects on interpersonal relationships. Some chronic conditions have high levels of stigma: epilepsy and AIDS (low levels of disclosure even to sexual partners � Kalichman & Nachimson (1999) Sharing chronic illnesses may provided social support but strain friendships. There are problems with negative beliefs and biases about illnesses. Persons report being shunned by others. Difficult for family members to develop correct perceptions of a patient�s condition and capabilities. Developing and keep a patient demeanor with the chronically ill is difficult. Family members may have negative psychological reactions � Box 10.2, p. 372 � children with chronic disease impact on marital satisfaction. Providing care and support can emotionally draining for the caregiver. Family members can suffer their own losses when a love one is diagnosed with a chronic illness, possibly anxiety and depression and lost hope. The chronic illness may cause considerable financial problems for the family.

5. What are the consequences of having chronic illnesses? Psychological problems Initial reaction of shock and disbelief � how do children cope � Box 10.4, p. 375 Need to change �just world view?� Common reactions: disbelief, denial, or anger � Cartoon 10.1, p. 375. Many experience depression and sense of helplessness � 35% suffer depression and compared to 12% in no affected population � Mohr et al. (1999) Anxiety is a common reaction ever before there symptoms related to the chronic illness are experienced � Epping-Jordan et al. (1999). Higher levels of stress experienced and negative emotions � Cassileth et al. (1984). Facing lifestyle choices that might have caused the chronic illness, Table 10.3, p. 378. Blaming oneself for certain diseases � in one study 41% of breast cancer patients blame themselves � Glinder & Compas (1999).

6. What are the consequences of having chronic illnesses? Sometimes there are positive effects Table 10.3, p. 379 �In the study reported in Figure 10.2, p. 379, 90% of the patients reported at least one positive change (Cordova et al., 2001). Some changes are increased coping, change in life priorities, and stronger focus on positive self-view.

7. How do illness factors influence how people manage having a chronic illness? Illness intrusiveness For example for diabetes there is a limit on sugar intake. Patient with CHD need to change diets and alter certain physical activities. There might be a need to self-monitor the condition of the patient, like a diabetes patient testing blood glucose levels using a �sticking� device � Photo 10.3, p. 381. Interaction with health care providers Many treatment involve much interaction with health care providers. Some procedures require several hours (4 � 6 hours per dialysis session three times a week). There are difficulties with communications with health care providers especially physicians (Lerman et al., 1993).

8. How do illness factors influence how people manage having a chronic illness? Type of coping used Problem-focused Proactive, preventive coping Combative coping Emotion-focused Used to respond to stressful situations with little ability to change the situation or no control This approach manages the response to the stress Positive reappraisal is an emotion-focused coping strategy. Leake et al. (1999) found (Figure 10.3) that there were lower physical and psychological symptoms using a self-presentation coping strategy in 42 patient with kidney disease. Research shows that coping strategies that directly try to reduce a stressor are more effective. But some studies have shown emotion-focused to be as effective, like focusing on positive experiences � Dunke-Schetter et al. (1992). Impact of denial, initially decreases the stress but in the long term is not effective (Buckelew et al., 1990).

9. How do illness factors influence how people manage having a chronic illness? Level of social support This coping strategy is very effective in coping with chronic illnesses. These patients are better able to buffer the effects of stress produced by the chronic illness. Studies with CHD patients showed higher levels of social support was related with lower levels of anxiety, depression, anger and was related to faster recovery from surgery. Emotional social support is more beneficial than instrumental support , especially for people with good prognosis of recovery.

10. How can psychological interventions help people cope with chronic illness? Education Providing knowledge in order to be more �in control� about the disease and treatments. Research suggests that education has positive influence on management of chronic diseases. Reduction of psychological and physical symptoms of cancer patients is suggested by research of Helgeson et al. (1999, 2001). Less disruption in daily lives with chemotherapy with patients who received relaxation training and brief information video (Burish et al., 1991).

11. How can psychological interventions help people cope with chronic illness? Cognitive-behavioral therapy Challenging irrational beliefs Various techniques are used Goals of reducing anxiety and tension and manage of stress (Box 10.5, p. 387 � Antoni et al., 2001) Systematic desensitization can reduce nausea and vomiting side effects of chemotherapy treatment (Morrow et al., 1992). Treatments can have long-term effects and increase immune system functioning.

12. How can psychological interventions help people cope with chronic illness? Social support groups There are many types of social support groups. These groups may provide better social support than family and friends due to the specific nature of the chronic disease. A study by Spiegel et al. (1981) found that terminal women breast cancer patients who attended a weekly therapy session experience lower levels of depression and these women live longer on the average (36.6 months v. 18.9 months). Participation in social support groups can improve immune system functioning and possible live longer (Fawzy et al., 1990) Social groups are useful for persons who don�t have other social support. The important of emotional support received from the these groups.