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Understanding the Impact of PsA

Understanding the Impact of PsA. Dr Kelly Archer Clinical Psychologist Bath Centre for Pain Services, Royal National Hospital for Rheumatic Disease. Agenda. Why psychological perspective? Understanding impact Bio Psycho Social Reducing Impact Reducing exacerbating factors

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Understanding the Impact of PsA

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  1. Understanding the Impact of PsA Dr Kelly Archer Clinical Psychologist Bath Centre for Pain Services, Royal National Hospital for Rheumatic Disease

  2. Agenda • Why psychological perspective? • Understanding impact • Bio • Psycho • Social • Reducing Impact • Reducing exacerbating factors • Improve quality of life • Questions

  3. What is Impact? 85% said daily life affected, 15% said not (Chandler, 2005)

  4. What areas of life are affected? 108 (25%) reported Conceal diagnosis, 304 (75%) do not (Chandler, 2005)

  5. A Biopsychosocial Perspective

  6. Joint Pain/Inflammation Itching Nails, Skin Malformation / Disfigurement Flare Ups Side effects of medication Nausea, Mouth ulcers Changes in Appetite Ongoing Treatments /Monitoring (e.g. blood tests) Ongoing investigations Fatigue General and difficulties sleeping Inability to exercise leading to poor aerobic and physical fitness Difficulty concentrating from the side effects of medications leading to poor performance Increased irritability from lack of sleep or medication side effects Managing LT Condition

  7. Social Impact • Withdrawal from Social Activities • Disclosure vs Concealment • Relationship issues • Intimacy • Misconceptions of public, family, work

  8. Psychological Impact • Unpredictability of Flare-Ups • Frustration • Anxiety • Withdrawal from activities because of low energy • Low mood & decrease in motivation • Adjustment • Malformation of joints/fingers/nails • Bereavement – unwanted changes in appearance • Difficulties getting Initial Diagnosis • Stress • Frustration • Embarrassment and Shame

  9. Impact of PsA Unpredictability of Flare ups Bereavement Sadness Depression Loss of Confidence Helplessness Hopelessness Anxiety Stress Frustration Anger Shame Embarrassment Reduction in activity Ongoing Treatments PsA Loss of Job, Financial Stress Excess Suffering Withdrawal from Social Activities Relationships/Intimacy Reduced fitness

  10. Reducing Impact Unpredictability of Flare ups Reduction in activity Ongoing Treatments PsA Loss of Job, Financial Stress Reduce Distress Withdrawal from Social Activities Relationships/Intimacy Reduced fitness Address Factors that Exacerbate

  11. Reducing Impact

  12. Managing Flare-Ups • Planning • Communicating • Work • Family/Friends • Identifying influences/triggers • Environmental/Situational • Behavioural • Emotional • Unpredictability

  13. Valued Living • Identifying Valued Living • Long journey far away’, ‘Epitaph’ • ‘Making Adjustments in line with Valued Living • Relationships, Health & Wellbeing, Leisure, Education and Professional Development etc. • Direction rather than Destination Moving Away Moving Towards

  14. Making Room for Distress • Journey to Diagnosis • Adjustment • Work • Family life • Social relationships • Bereavement • Loss of function • Change in appearance

  15. Communication – Why? • Communicating information • Part of ongoing treatment • Limitations • Flare-up management – what to expect etc. • Support • Practical Support • Daily adjustments • Emotional Support • Addressing misconceptions

  16. Communication – Who? Who is in your network? ???? Groups (e.g. church, Clubs) Family Strangers You Friends Medical Professionals Work/ Colleagues

  17. Communication – How? • Verbal • Non-Verbal • Communication Styles • Passive • Passive Aggressive • Aggressive • Assertive

  18. Challenges with Communication • Embarrassment / Shame • Mind-reading • Misconceptions • How much information? • The ‘right’ time

  19. YOU ‘Others will be disgusted’ ‘they won’t understand’ ‘I need to hide this’ Anxiety Shame Embarrassment ‘OTHERS’ Avoid going to work Avoid Talking Conceal ‘I’m fine’ ‘snappy’ ‘Did I do something wrong?’ They are annoyed with me They don’t want to be bothered Confusion Irritable ‘Snap back’ Leave alone

  20. Things to Keep in Mind • What is the function? • What do I hope to communicate? • What difference will that make for me? • What are the ST consequences? • What are the LT consequences?

  21. Making a Decisione.g. Concealment vs Disclosure Pros and Cons of Each?

  22. Relationships • Intimate Relationships • Embarrassment / Shame • Continuum of Intimacy

  23. In Summary… Reducing Impact • Identifying Impact • Raising awareness to bio, psycho, social issues most interfering • Vs ‘autopilot’ • If could reduce the impact, what do you hope to be doing? • Values • Making adjustments in line with Values

  24. Reducing Impact • Do I need further support to move forward? • What type? • Communicating needs • Knowing what, who, how

  25. Useful Resources • Living Well with Pain and Illness – The mindful way to free yourself from suffering by Vidyamala Burch • www.breathworks-mindfulness.org.uk • www.getselfhelp.co.uk • Communication guides • Contact GP for local psychological services

  26. Thank you!

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