Psychologist Interventions for patients diagnosed with chronic diseases By: Eunice Gonzo Clinical Psychologist
Introduction: The World Health Organization (WHO) defines health “as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. From this definition we learn one important aspect: Mental health and physical health have a bi- direction relationship. Meaning there is no health without mental health.
Introduction continue… It is because of the latter said, that this presentation will be focused on explaining this relationship. It will help participants better understand the link between mind, behavior and body. Understanding this link will help health professionals be more of help to their patients who are (diagnosed) living with chronic physical conditions and who might also be suffering from mental health conditions – i.e. depression and anxiety.
Impacts of Chronic Disease Chronic disease will increase 300% by 2049 Chronic diseases results in pain, debilitation, disability, dependence, lost physical function and less mobility Chronic diseases include: heart diseases, cancer, stroke, arthritis, asthma, hypertension, osteoporosis, multiple sclerosis, Parkinson disease … Sources: NGA study, Stanford University Patient Education Center. http://www.stanford.edu/group/perc/
Rising Costs of Health Care Chronic disease costs: 75% - 95% of health care expenditures! By 2030: Anticipated increase in health care costs tied to chronic disease is estimated to be between 25% to 54%. Sources: Partnership for Solutions: Better Lives for people with chronic conditions, WA State; Health Affairs, 2005: 24 (1) 80-92, Center for Healthy Aging (NCOA)
Association between Mental Health and Physical Health 1. Poor mental health is a risk factor for chronic physical conditions 2. People with serious mental health conditions are at high risk of experiencing chronic physical conditions 3. People with chronic physical conditions are at risk of developing poor mental health
People with Chronic Disease Report: Significantly reduced productivity Living with less income Accomplishing less Spending more time in bed sick Having poor mental health
Chronic Medical Conditions & Associated Mental Health Conditions DIABETES ARTHRITIS Major Depressive Mood Disorder 2X greater Disorders Panic Disorder, Anxiety Generalized Anxiety, Disorders PTSD
Chronic Medical Conditions & Associated Mental Health Conditions HEART DISEASE CANCER Anxiety and Bipolar Disorder Depression Schizophrenia Phobic ASTHMA Anxiety Depression Panic Anxiety Disorder
Stress About Medical Symptoms Every change lead to psychological distress. I mean every change – good or bad, real or imagined. Being diagnosed with a medical condition is change and needless to say will lead to a psychological distress. Medical condition can lead to pressures and changes of lifestyle that the patient finds unpleasant
Stress About Medical Symptoms Unplanned and unwanted lifestyle changes can lead to stress Patients feel worse than anticipated resulting in acute stress that interferes with physical recovery. Thus being diagnosed with a chronic illness come with a range of negative emotions which threatens to overwhelm the person’s coping strategies and if not handled well can lead to psychological distress/trauma.
Stress about medical conditions Grief is another common reaction to chronic illness. The person may experience various stages of grief including denial, bargaining, anger and sadness. In therapy one is presented with a patient who accept one day, is angry the next day and pretend never to have received such a diagnosis the other day.
What is stress? When stress is encountered i.e. being diagnosed with a chronic illness, a chain reaction occurs in the body that releases a surge of hormones, including adrenaline and cortisol – the fight or flight (freeze) response. Adrenaline increases heart rate, elevates blood pressure and boost energy. Cortisol increases sugars in the blood stream,
Stress continues… Enhances your brain’s use of sugar and increases the availability of tissue repairing substances, while also curbing nonessential functions. It suppresses the digestive and reproductive systems, alters the immune system and slows growth processes. In an ideal world, after stress has passed, hormone levels drop to normal and body functions return to baseline levels.
Stress and Chronic illness Diagnosis In this case, a diagnose of chronic illness come with chronic stress for most if not all patients. When stress become chronic, the fight-or- flight process remains activated. The effects of long-term activation of the stress-response system can be crippling to not just the body but to the mind too. So when you are in a constant state of chronic stress, your body never gets that signal to relax.
HIV/AIDS as a Chronic condition As with all other chronic conditions being diagnosed with HIV also have devastating impact on the human psyche. In fact because of the perceived negative psychological implications more people are reluctant to go for testing. Why? This because of the myths, misconceptions and associations connected to the transmission of the virus. Its seen as a disease of shame and disgrace as it connotes to low moral standards and sexual promiscuity.
HIV/AIDS as a chronic condition… As a results about plus/minus 95% of the million HIV infected people worldwide do not know they are infected. Only a few people (about 5 – 10%) in many countries have been tested. And where HIV testing is more widely available, very little counseling is offered when testing.
Counseling as a key intervention to decrease stress Counseling is important because having a chronic condition is a life long phenomenon and during the course of the illness, a broad range of physical, social and psychological needs and problems are likely to be experienced. The changing nature of the illness (esp. HIV/AIDS) imposes a variety of psychological and emotional strains in individuals and their loved ones.
Counseling… Counseling is a dialogue between a client and psychologist aimed at enabling the client to cope with stress, verbalize fears And develop or strengthen new support structures The process also is used to give needed information and dispel myths and misperceptions
Psychosocial stress of HIV Responses experienced by clients which are attended to in therapy: Shock Grief Denial Guilt Anger Depression Fear Anxiety Isolation Loss of Self-esteem Loss Spiritual concern
HIV Counseling: Pre-test counseling (review diff. between HIV and Aids, modes of transmission and method of prevention, test to be done, correct misconceptions and very readiness for test) Risk reduction counseling (Asses risk, develop risk reduction strategies)
HIV Counseling… Partner counseling and testing Post-test counseling (asses readiness for results, explain results, describe additional test if required, assess client understanding and provide further information) Risk reduction counseling Treatment counseling
Unchanged diagnosis When we change our perception, we gain control. Greg Anderson Benjamin Franklin once said, “In this world nothing can be said to be certain, except death and taxes.”
The greatest weapon Altering the Situation against stress is our ability to choose one thought over another. When dealing with stress, there are William often many ways in which a person James can change his/her approach or the situation to make it less stressful.
Establishing a Support System Network of family and friends Even in good times Take advantage of support Great investment
Knowing When to Seek Help Objective third Feedback party Events close Not a sign of together weakness Sign of intelligence and strength
Words from the Wise Benjamin • Do not anticipate trouble or worry Franklin about what may never happen. Adabella • If your teeth are clenched and your fists are clenched, your Radici lifespan is probably clenched. Henry • There cannot be a stressful crisis next week. My schedule is already Kissinger full.
Self Management as a Therapeutic Technique “Involves [the person with chronic disease] engaging in activities that promote health, monitoring and managing symptoms and sign of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes”
Benefits of Self Management Builds confidence (self-efficacy) to perform 3 tasks: -disease management -role management -emotional management Focuses on improved health status and appropriate health care utilization.
Self Management Framework Patients accept responsibility to manage or co-manage their own disease conditions. Patients become active participants in a system of coordinated health care, intervention and communication Patients are encouraged to solve their own problems with information, but not orders, from professionals.
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