Psychologist Interventions for patients diagnosed with chronic - - PowerPoint PPT Presentation

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,

• steoporosis, 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.”

Altering the Situation

 When dealing with stress, there are

• ften many ways in which a person

can change his/her approach or the situation to make it less stressful.

The greatest weapon against stress is our ability to choose one thought over another. William James

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 party Feedback Events close together Not a sign of weakness Sign of intelligence and strength

Words from the Wise

• Do not anticipate trouble or worry

about what may never happen.

Benjamin Franklin

• If your teeth are clenched and

your fists are clenched, your lifespan is probably clenched.

Adabella Radici

• There cannot be a stressful crisis

next week. My schedule is already full.

Henry Kissinger

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”

 Builds confidence (self-efficacy) to

perform 3 tasks:

 -disease management  -role management  -emotional management  Focuses on improved health status and

appropriate health care utilization.

Benefits of Self Management

Self Management Framework

 Patients accept responsibility to manage

• r 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

• wn problems with information, but not
• rders, from professionals.

Conclusion:

 The Self Management programs and counseling in

general have been effective in helping people diagnosed with chronic illness. Why?

 More people with chronic disease believe…  They have the right to take part.  They are capable of taking part, with the right

supports and information.

 Patient assertiveness is necessary …and needed  I thank you