💙 PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE WITH CHRONIC CONDITIONS
🤔 Understanding Family Perceptions of Chronic Illness
Before people actually experience specific chronic illnesses in their families, they usually have some ideas about how serious the health problems are. How do they feel about an illness after someone in the family develops it? Is it worse than they expected, or not as bad, or about the same? 🤷♀️ The answers to these questions should have a bearing on how well the family adjusts to health problems. One study had parents whose children had either diabetes, asthma, epilepsy, or no chronic illness rate how serious each of the three health problems would be if their children were to develop it or had it now.
The ratings reveal two interesting findings: 📊 (1) the lowest ratings of seriousness the parents gave were for the health problems their own children had and (2) parents whose children did not have chronic illnesses rated each of the health problems as being very serious. These findings indicate that parents who live with chronic illnesses in their children tend to have less negative views of the health problems than parents whose children do not have those illnesses. 😨 People are frightened by the prospects of health problems, but most families adjust fairly well if a child develops a chronic illness. 💪
As we have seen, not all people adjust well to chronic health conditions. The types of adjustment problems that commonly develop with chronic conditions are outlined here.
⚠️ Types of Adjustment Problems in Chronic Illness
- Physical 🤕—being unable to cope with disability or pain.
- Vocational 💼—having difficulty revising educational and career plans or finding a new job.
- Self-concept 🪞—being unable to accept one's changed body image, self-esteem, and level of achievement or competence.
- Social 👥—having difficulty with losing enjoyable activities or finding new ones and coping with changed relationships as family, friends, and sexual partners.
- Emotional 😰—experiencing high levels of denial, anxiety, or depression.
- Compliance 📋—failing to adhere to the rehabilitation regimen.
The problems patients and their families experience depend on many factors, such as how visible, painful, disabling, or life threatening the illness is. 🔍
Another factor is the patient's age. 👶 In the early childhood years, victims of chronic illness may become excessively dependent if the parents are over-protective, such as by not allowing an epileptic child to play in a wading pool with careful supervision. 🏊♂️ In later childhood and adolescence, chronically ill individuals may experience school failure because of absences 📚 and peer criticism or rejection because of the illness. 😔 These events can impair the development of friendships, self-confidence, and self-esteem. Adults who develop a chronic condition may have difficulties if their illness leads them to stop working or change jobs, alter their parenting role, or change or stop their sexual relations. 💔
👨⚕️ Interdisciplinary Teams for Rehabilitation
Ideally, intervention programs to help individuals with chronic health problems involve interdisciplinary teams of professionals—physicians, nurses, psychologists, physical and occupational therapists, vocational counselors, social workers, and recreational therapists—working in an integrated manner toward the overall goals of rehabilitation. 🤝
Psychologists contribute to this process by helping each client cope with the psychosocial implications of his or her medical condition and by using behavioral and cognitive principles to enhance the person's participation in and adherence to the therapeutic regimen. 🧠 We'll consider many useful psychosocial approaches, most of which can be used either with individuals or in groups and for a variety of illnesses.
📚 Educational, Social Support and Behavioral Methods
The first thing chronically ill people and their families need to help them adapt to a health problem is correct information about the disease and its prognosis and treatment. ℹ️ The uncertainty and confusion about a chronic illness and its severity can be an additional problem adding to the stress that the chronic illness itself caused.
Effective systems of social support are also important for patients' and their families' adaptation to chronic health problems. 🤗 People with chronic medical conditions usually receive this support from family or friends, but it can also come from support groups that offer patients and family information and opportunities to meet with people who are in the same boat. 🚣♀️ For example, support groups for diabetics and/or their families help by providing information, giving sensitive emotional support, and sharing members' own experiences and ways of dealing with everyday problems and difficult decisions, such as whether to place the patient in a nursing home. 🏥
Information about the availability of support groups in specific geographical areas can be obtained through physicians, local community service agencies, or national organizations for any particular illness. 🌐 If such support groups do not exist, or do not match the patients' needs, they can always start new support groups with the help of local physicians. Health psychologists can play a very important role in this regard in our country, where the concept of community support groups is not so well-established yet. 🇵🇰 Even you, the student of VU can help in this process after you complete your education in health psychology. 🎓
Psychosocial factors are often involved in patients' failing to adhere to their medical regimens for managing chronic conditions. 💊 There are methods that can enhance adherence. Some methods involve improving the way practitioners present information about the procedures and the importance of following the treatment. 🗣️ Other approaches use behavioral methods, such as tailoring the regimen to make it as compatible as possible with the person's habits, using prompts and reminders, having patients keep records of their self-care activities, and providing a system of rewards through the method of behavioral contracting. 📝 Various behavioral approaches can help improve compliance with different aspects of diabetes regimens, for instance.
Reinforcement techniques are very effective in improving these patients' performance of therapeutically beneficial behaviors. ⭐ Reinforcement can be given, for instance, by praising the client for each measurable improvement, such as arm movement in a patient of arthritis, 💪 and periodically updating the person's graph that charts these improvements. 📈
🧘 Relaxation and Biofeedback
We have seen that stress and anxiety can aggravate some chronic conditions, such as by decreasing diabetics' ability to metabolize glucose 🩸 and by triggering or worsening asthma attacks. 😮💨 Psychologists use stress management techniques—especially progressive muscle relaxation and biofeedback—to help patients control these psychosocial factors and the underlying body processes.
These approaches are useful for several chronic conditions. For instance, relaxation training can help diabetic patients manage their stress and their blood glucose levels. 🧘♀️ People with epilepsy can benefit from both relaxation and biofeedback training. ⚡
In using relaxation, epileptics are taught to recognize sensations and events that are associated with attacks and to apply relaxation techniques when those situations occur. 🌊 In using biofeedback, epileptics receive training with feedback from an electroencephalograph (EEG) device, which measures electrical brain activity. 🧠📊 Although not all patients benefit from this approach, many do. ✅
🧠 Cognitive Methods
An 18-year-old diabetic girl entered psychotherapy because of difficulty coping with her condition. 😢 The therapy revealed that her difficulties were based on incorrect beliefs that she now could not attend college, would constantly look drunk and crazy, and would be a social outcast. Her therapy helped her disconfirm this belief and see that she could pursue her life goals much as she had planned before learning of her condition. 🎓✨
Cognitive methods can help people change their feelings and thought processes. 💭 One cognitive approach is cognitive restructuring, whereby individuals or groups discuss incorrect thoughts and beliefs and learn ways to cope better by thinking more constructively or realistically. 🔄
We have seen that many chronically ill people and their families experience strong feelings of helplessness, hopelessness and depression. 😞 In the case of diabetes for example, research has found that elderly caregivers are two to five times more likely to suffer severe levels of depression than younger caregivers. 👴👵 Their depression is related to the degree of stress or burden they perceive in their caregiving role, such as from the patient's memory and behavioral problems. Many people who are disabled or have chronic pain also become severely depressed, often because of their restricted daily activities. ⛓️ Cognitive approaches can help people identify distorted thoughts ("I never get to do anything fun anymore" 🙁), replace those thoughts with more accurate ones, and learn how to increase their ability to perform activities, such as by scheduling them in reasonable amounts. Cognitive methods are very effective in treating depression. ✅
💡 Insight and Family Therapy
Insight therapy is designed to help people gain an understanding of the roots of their feelings and problems. 🔍 This approach is especially useful in helping patients to deal with their anxieties and change self-concepts or relationships with family and friends. As an example, one hospitalized quadriplegic man who became difficult to deal with each night 🌙 revealed in group therapy that he felt very vulnerable and helpless at nighttime, which frightened him. 😨 By learning in the group that other patients had similar feelings, he began to feel better able to deal with this disability and the day-to-day problems it created. 💪
Insight therapy has also been used in helping chronically ill people deal with sexual difficulties 💑 and understand the thoughts, needs and problems their friends and family members face.
Family therapy typically has the family meet as a group and draws on cognitive, behavioral and insight-oriented methods to examine and change patterns of interaction among family members. 👨👩👧👦 A family with a chronically ill member might meet to review household and medical-regimen responsibilities, discuss grievances, and plan ways to alter daily routines. If the patient is a child, they may discuss, for instance:
- 😠 Jealousy that siblings may feel if the patient seems to be getting more or special attention.
- 🎯 Activities the chronically ill person can engage in successfully to build his or her feelings of competence and self-esteem.
- 💬 How to tell friends and relatives about the illness so they will understand what it is, the limitations it imposes on the patient and what to do if an episode occurs.
- 📋 How and when the ill person could take responsibility for or improve self-care.
Parents and their ill children often do not communicate about sharing responsibilities for the patient's care. 🤐 As a result, each person incorrectly assumes someone else is taking care of a task.
Sometimes a patient's recovery can present family problems. 🔄 For example, a husband whose wife's epilepsy was greatly improved with surgery felt secure when his wife with epilepsy was dependent on him but became uncomfortable when she could function on her own and take advantage of new opportunities. 😟 Family therapy can help to uncover and resolve anxieties that develop when the family dynamics and modes of interaction change in either a positive or negative direction. ⚖️
✅ Summary
In summary, psychosocial intervention can apply many approaches to address many different adjustment problems that chronically ill people and their families face. 🎯 In most cases, using more than one approach provides the optimal help these people need. 💙