Psyc 412 1st Edition Lecture 15Outline of Last Lecture I. Quality of LifeII. Emotional Responses to Chronic IllnessIII. Personal Issues in Chronic DiseaseIV. Coping with Chronic IllnessOutline of Current Lecture I. Co-Management of Chronic IllnessII. Psychological Interventions and Chronic IllnessCurrent Lecture- Co-Management of Chronic Illnesso 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 Adherence to long-term medical regimens and cognitive-behavioral interventions are essential Appropriate education promotes adherence Self-efficacy (belief in ability to do something) beliefs are important to adherenceo 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 diseaseo Impact on sexuality: chronic illness leads to a decrease in sexual activityo Adherence: adherence to long-term medical regimens and cognitive-behavioral interventions are essential appropriate education ensures adherence self-efficacy beliefs are important to adherenceo 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 responsibilitieso 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 memberso Caregiving role: care for the chronically ill often falls on a family member care-giving may be intermittent or supplementary care-giving family members are at risk for distress, depression and declining health can strain the relationship between patient and caregiver caregivers may need interventions alsoo 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 responsibilitieso Positive changes in response to chronic illness: many people experience positive reactions and optimism because they narrowlyescaped 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 moodo 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 procedureso Improving coping : parents, self-care, school attendance and reasonable physical activity are beneficial- Psychological Interventions and Chronic Illnesso Pharmacological interventions: antidepressants used to treat depressiono 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 treatmento 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 paino Patient education: Internet: - provides interventions in a cost-effective manner- many websites offer information to patients expressive writing: has benefits, especially for the terminally illo 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 lifeo Social support interventions: influence health outcomes favorably  can be threatened by chronic illnesso Family support: enhances patient's physical/emotional functioning promotes adherence to treatmento Support groups: valuable resource for the chronically ill support groups discuss issues of mutual concern low-cost, convenient treatment