Psyc 412 1st Edition Lecture 14Outline of Last Lecture I. Clinical issues in Pain managementII. Pain Control TechniquesIII. Management of Chronic PainIV. Placebo as a HealerOutline of Current Lecture I. Quality of LifeII. Emotional Responses to Chronic IllnessIII. Personal Issues in Chronic DiseaseIV. Coping with Chronic IllnessCurrent Lecture- Quality of Lifeo What is quality of life? physical functioning psychological status social functioning disease or treatment-related symptomatology (symptoms) interference with activities of daily livingo 7 of every 10 Americans who die each year die of a chronic illnesso Chronic disease is a sign of the success of health care-we can now manage diseases that were once fatalo Iraq/Afghanistan wars traumatic brain injury/amputationo People are living longer with chronic conditions-are they actually living better? Quality oflife? treatments can be hard, exhausing, costly o Physical functioning: strength, endurance, can you pick up/play with kidso Psychological status: anger, sadnesso Why study quality of life? provides basis for interventions (identify individuals who need interventions) can help pinpoint which problems are likely to emerge for patients with diseases(breast cancer, hypertension) assesses the impact of treatments (how medically effective, impact on QOL) is used to compare therapies can inform decision-makers about careo Sometimes the most medically effective treatments are the worst for quality of life patients will choose less effective treatment in order to continue living life as normal as possible (especially in end-of-life situations)o The effects of treatment son quality of life influence patient behavior treatment non-adherence/refusal: can cause death; competent adults can choose no treatment that will cause death some medications will make people feel even worse than if they didn’t take them (hypertension-high rate of nonadherence)- Emotional Responses to Chronic Illnesso Denial: a defense mechanism by which people avoid implications of as illness (it was a mistake, not real) short term advantage (reduce anxiety) Long term disadvantage (not change bad behavior)o Anxiety: patients become overwhelmed by potential changes in their lives and/or the prospect of Death (some commit suicide)o Depression: debilitating reaction to chronic illness medical significance being recognized sometimes a delayed reaction to chronic illness Depression could worsen disease More likely to not adhere to treatment (I don’t care anymore), especially if treatment is difficult Depression can cause forgetfulness-make mistakes in treatment 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 Depression influences survival rates Depression may affect autonomic nervous system activity-heart functioning Carney et al (2009)- evaluated more than 1300 heart attack survivors, followed for 29 months- mortality:o first time depression: 18%o recurrent depression: 12%o no depression: 3%- patients with heart attacks should be screened and potentially treated for depression Assessing depression:- can be problematic- depression may go untreated- can lead patients to make extreme decisions about their care Problematic: some depression symptoms (somatic symptoms: changes in diet, sleep, concentration, libido) similar to those of chronic illness Who gets depressed?- patients experiencing pain and disability- patients with physical limitations Depression may go untreated- Can lead patients to make extreme decisions about their care (terminating treatment) 1 out of every 6 end-stage renal disease patients stops treatment, leading to death- competent adults have the right to refuse treatment, even if it leads to death- Personal Issues in Chronic Diseaseo The physical self: body image plummets during illness (breast cancer) seems to affect younger women more 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 burnso The achieving self: achievement is important to self-esteem and self-concept: job gives pride, self-esteem (cop, doctor) Affects men more than womeno The social self: important aspect of readjustment after chronic illnesso The private self: loss of independence and strain of imposing on others represent major threats to the self- Coping with Chronic Illnesso Coping strategies and chronic illness: social support/direct problem-solving distancing positive focus: Keeping a positive focus generally has better outcomes cognitive escape/avoidance behavioral escape/avoidance: drinking to deal with problemso Which coping strategies work? active coping and coping with positive responses-better psychological and medical outcomeso Patients’ beliefs about chronic illness: beliefs about the nature of the illness:- patients adopt an inappropriate model for their disorder (acute model-distressed when symptoms last) beliefs about the cause of the illness:- patients blame stress, physical injury, disease-causing bacteria and God’swill for their illness self-blame can lead to guilt, self-recrimination or depression- Self-blame can be beneficial to motivate patients to change behavior- Blaming others (spouse, God, doctors) is not beneficial 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 (people like control)- the experience of control or self-efficacy may prolong lifeo Positive effects when there is belief of control, even if control is not actually there; the belief