1. © 2012 McGraw-Hill Companies, Inc. All rights reserved.McGraw-Hill/Irwin© 2012 McGraw-Hill Companies, Inc. All rights reserved. Health Psychology 8 th edition Shelley E. Taylor Chapter Eleven: Management of Chronic Illness

2. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-2 Quality of Life What is quality of life? - physical functioning - psychological status - social functioning - disease or treatment-related symptomatology - interference with activities of daily living

3. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-3 Quality of Life (cont.) Why study quality of life? - provides basis for interventions - can help pinpoint which problems are likely to emerge for patients with diseases - assesses the impact of treatments - is used to compare therapies - can inform decision-makers about care

4. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-4 Emotional Responses to Chronic Illness Denial: - a defense mechanism by which people avoid implications of as illness Anxiety: - patients become overwhelmed by potential changes in their lives and/or the prospect of death

5. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-5 Emotional Responses to Chronic Illness (cont.) Depression: - debilitating reaction to chronic illness - medical significance being recognized - sometimes a delayed reaction to chronic illness Significance of depression: - has an impact on the overall prospects for rehabilitation or recovery - has been linked to suicide among the chronically ill - can be a long-term reaction

6. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-6 Emotional Responses to Chronic Illness (cont.) Assessing depression: - can be problematic - depression may go untreated - can lead patients to make extreme decisions about their care Who gets depressed? - patients experiencing pain and disability - patients with physical limitations

7. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-7 Personal Issues in Chronic Disease The physical self: - body image plummets during illness - poor body image related to self-esteem and an increased likelihood of depression and anxiety - in most cases, body image can be restored except for those with facial disfigurements or extensive burns

8. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-8 Personal Issues in Chronic Disease (cont.) The achieving self: - achievement is important to self-esteem and self-concept The social self: - important aspect of readjustment after chronic illness The private self: - loss of independence and strain of imposing on others represent major threats to the self

9. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-9 Coping with Chronic Illness Coping strategies and chronic illness: - social support/direct problem-solving - distancing - positive focus - cognitive escape/avoidance - behavioral escape/avoidance Which coping strategies work? - active coping and coping with positive responses

10. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-10 Coping with Chronic Illness (cont.) Patients’ beliefs about chronic illness: - beliefs about the nature of the illness: - patients adopt an inappropriate model for their disorder - beliefs about the cause of the illness: - patients blame stress, physical injury, disease-causing bacteria and God’s will for their illness - self-blame can lead to guilt, self-recrimination or depression

11. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-11 Coping with Chronic Illness (cont.) Beliefs about the controllability of the illness: - belief in control and a sense of self-efficacy with respect to the disease and its treatment are generally adaptive - the experience of control or self-efficacy may prolong life

12. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-12 Comanagement of Chronic Illness Physical problems associated with chronic illness: - goals of physical rehabilitation: - learn how to use one’s body as much as possible - learn how to sense changes in the environment in order to make appropriate accommodations - learn new physical management skills - learn a necessary treatment regimen - learn how to control the expenditure of energy

13. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-13 Comanagement of Chronic Illness (cont.) Developing a comprehensive rehabilitation program: - patients need a pain management program - there is a need for assistive technologies - important to identify factors that contribute to the recurrence or that exacerbate the disease Impact on sexuality: - chronic illness leads to a decrease in sexual activity

14. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-14 Comanagement of Chronic Illness (cont.) Adherence: - adherence to long-term medical regimens and cognitive-behavioral interventions are essential - appropriate education ensures adherence - self-efficacy beliefs are important to adherence

15. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-15 Comanagement of Chronic Illness (cont.) Vocational issues in chronic illness: - discrimination against the chronically ill: - especially job discrimination - financial impact of chronic illness: - insufficient insurance can lead to enormous financial responsibilities

16. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-16 Comanagement of Chronic Illness (cont.) Social interaction problems in chronic illness: - negative responses from others: - acquaintances, friends and relatives may not adjust to the patient’s altered conditions - impact on family: - intimate others may be distressed by the loved one’s condition - new responsibilities may fall on other family members

17. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-17 Comanagement of Chronic Illness (cont.) Caregiving role: - care for the chronically ill often falls on a family member - caregiving may be intermittent or supplementary - caregiving family members are at risk for distress, depression and declining health - can strain the relationship between patient and caregiver - caregivers may need interventions also

18. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-18 Comanagement of Chronic Illness (cont.) Gender and the impact of chronic illness: - women have more deficits in social support than men - married women more likely to be institutionalized for their illness than husbands - women carry more of a burden of household responsibilities

19. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-19 Comanagement of Chronic Illness (cont.) Positive changes in response to chronic illness: - many people experience positive reactions and optimism because they narrowly escaped death - increased appreciation each day and the inspiration to take action now instead of postponing it - increases in joy, value in families, hobbies and health - more positive mood

20. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-20 Comanagement of Chronic Illness (cont.) When the chronically ill patient is a child: - children may be confused because they don’t understand the diagnosis and treatment - children cannot follow the treatment regimen without help from family - children are exposed to isolating and terrifying procedures Improving coping : - parents, self-care, school attendance and reasonable physical activity are beneficial

21. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-21 Psychological Interventions and Chronic Illness Pharmacological interventions: - antidepressants used to treat depression Individual therapy: - therapy likely to be episodic - collaboration with patient’s physician and family is critical - requires respect for patient’s defenses - therapist must have a comprehensive understanding of the patient’s illness and its modes of treatment

22. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-22 Psychological Interventions and Chronic Illness (cont.) Brief psychotherapeutic interventions: - telling patients and their families what to expect during treatment alleviates anxiety - group coping skills training can be successful - more novel techniques, such as music, art and dance therapies, have improved patients’ emotional and behavioral responses to pain

23. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-23 Psychological Interventions and Chronic Illness (cont.) Patient education: - Internet: - provides interventions in a cost-effective manner - many websites offer information to patients - expressive writing: - has benefits, especially for the terminally ill

24. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-24 Psychological Interventions and Chronic Illness (cont.) Relaxation, stress management and exercise: - relaxation training is widely used with the chronically ill - mindfulness-based stress reduction (MBSR) has been used to improve adjustment to medical illness - exercise can improve quality of life

25. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-25 Psychological Interventions and Chronic Illness (cont.) Social support interventions: - influence health outcomes favorably - can be threatened by chronic illness Family support: - enhances patient's physical/emotional functioning - promotes adherence to treatment

26. © 2012 McGraw-Hill Companies, Inc. All rights reserved.11-26 Psychological Interventions and Chronic Illness (cont.) Support groups: - valuable resource for the chronically ill - support groups discuss issues of mutual concern - low-cost, convenient treatment option