Lecture 31- Models of Health Psychology — Transcript

Full transcript

1. 0:17Namaskar friends. This is module 7 of
2. 0:20the stress management course and I am
3. 0:23your course instructor Dr. Shubraasha.
4. 0:28This module focuses on chronic health
5. 0:31issues as a source of a stress in our
6. 0:35life.
7. 0:36Friends, we have been exploring
8. 0:40different domains of our life which may
9. 0:43cause significant stress to us. And in
10. 0:47this series we have already talked about
11. 0:51academic stress, occupational stress,
12. 0:55then relationship and family as a source
13. 0:58of a stress. And today we will see how
14. 1:02chronic health problems cause stress in
15. 1:06our life. So let us begin with lecture
16. 1:09one of module 7. Here is an overview of
17. 1:14what we are going to learn today.
18. 1:17First of all we will talk about the
19. 1:20chronic health issues. Then some common
20. 1:24chronic health problems will be
21. 1:26discussed.
22. 1:28Then we will be talking about the impact
23. 1:30of these health issues on our mental
24. 1:33health. And after that I will introduce
25. 1:38a particular branch of psychology which
26. 1:41is known as health psychology.
27. 1:46Health psychology models will be dealt
28. 1:48with and how these models and principles
29. 1:53can be applied to real life situations
30. 1:57so that one can cope with the stress
31. 2:00generated from these chronic health
32. 2:03issues will be the content of
33. 2:06discussion.
34. 2:08Let us begin with this one by one.
35. 2:12First of all, there's a question that
36. 2:17which particular health problem can be
37. 2:20called a chronic health problem.
38. 2:24So to decide this there are three main
39. 2:27criteria.
40. 2:29The first criteria here is that the
41. 2:32disease must last for 3 months or more
42. 2:36than that. So you can have it here. The
43. 2:38very first criteria is the duration of
44. 2:42the health problem. So it should either
45. 2:45last three months or more than that.
46. 2:48Then it requires an ongoing medical care
47. 2:53during the period of suffering whether
48. 2:56it is 3 months or more than that or
49. 2:59sometimes maybe lifetime uh care may be
50. 3:02required. So for the whole period the
51. 3:06patient must be taking drugs either
52. 3:09orally or in injectable forms or some
53. 3:11kind of treatment must going on. Then
54. 3:15finally the disease or condition is such
55. 3:20that the person's ability to do daily
56. 3:23activities is greatly compromised.
57. 3:27Means this problem is somehow going to
58. 3:30interfere with the appropriate and
59. 3:33smooth conduction of our daily routine.
60. 3:36If these three things are there, we will
61. 3:40call it a chronic health problem. So the
62. 3:44duration should be long. Continuous
63. 3:47medical assistance and treatment is
64. 3:49required and then the impairment caused
65. 3:53by the particular health condition is
66. 3:56great so that it interferes with the
67. 3:59smooth conduction of routine activities
68. 4:02by the person. The disease can be
69. 4:05managed not only with the help of
70. 4:08treatment but an appropriate lifestyle
71. 4:11management is also required because the
72. 4:14condition is of long duration.
73. 4:20Now when we deal with such kind of
74. 4:22health issues which are of longer
75. 4:25durations, it can cause immense stress
76. 4:28for many people. There are some common
77. 4:32health issues that we find nowadays in
78. 4:36every household. For example, diabetes,
79. 4:40a condition which is characterized by a
80. 4:43higher than normal blood glucose levels.
81. 4:47It creates not only problem because of
82. 4:51this higher glucose levels in the blood
83. 4:54but it also makes the person vulnerable
84. 4:58for several other diseases. That is why
85. 5:01diabetes is of course a dreadful disease
86. 5:05for many many people. Similarly,
87. 5:09many of us suffer from arthritis with
88. 5:12increasing age
89. 5:14which involves chronic pain, joints,
90. 5:17joint pain, restricted mobility and then
91. 5:21there is a constant search for finding
92. 5:24right medication because many medicines
93. 5:28uh are not very effective in long-term
94. 5:31use and even the patient take the
95. 5:35medicine at the same time the pain also
96. 5:38continues.
97. 5:40Similarly, hypertension is there which
98. 5:42is marked by head uh headache,
99. 5:44dizziness, increased palpitation,
100. 5:47sweating and just like diabetes, it also
101. 5:50increases one's vulnerability towards
102. 5:53other kind of diseases like stroke, like
103. 5:57heart attacks and things like that.
104. 6:00Cardiovascular diseases are also
105. 6:03increasing day by day due to our
106. 6:05lifestyle which has been adopted by most
107. 6:08of us and uh all these things including
108. 6:12cancer which is nowadays growing and
109. 6:16multiple forms can be seen uh very
110. 6:19commonly. So the pre rate of prevalence
111. 6:21is increasing. All these diseases are
112. 6:24going to cause a lot of distress,
113. 6:29anxiety, depression and sometimes even
114. 6:33identity crisis when the person is not
115. 6:37able to perform one's activities
116. 6:40successfully.
117. 6:43Moreover,
118. 6:44whenever a person
119. 6:47acquires a long-term disease, whenever
120. 6:50he gets uh somehow these long-term
121. 6:54diseases or chronic health problems,
122. 6:57these chronic health problems are going
123. 6:59to initiate anxiety, depression, and
124. 7:04negative emotional feelings through
125. 7:06multiple roots. See what is happening
126. 7:10here. This is a chronic health problem.
127. 7:13And when it happens, what is going on?
128. 7:16What will happen? First of all, it is
129. 7:19going to create significant physical
130. 7:22discomfort in the person.
131. 7:25Along with that, because continuous
132. 7:28medical treatment is required, so a
133. 7:32financial burden will also be there. The
134. 7:35person has to spend money after
135. 7:37treatment.
136. 7:39Then what happens because of the
137. 7:41significant impairments in conducting
138. 7:44the daily life courses
139. 7:48the patient usually becomes dependent
140. 7:51upon others
141. 7:53usually the other family members. So it
142. 7:57somehow creates a burden on the
143. 8:00immediate caretakers of the patient. And
144. 8:04finally when all these things are
145. 8:07happening the patient as well as the
146. 8:09caregivers are in a constant state of
147. 8:12worry about the progression of disease.
148. 8:16The medication is going on the patient
149. 8:19has been taken care of and still the
150. 8:21things are not recovering the way they
151. 8:24should or there is a little recovery and
152. 8:27then it goes back to the original level
153. 8:30of suffering. So there are a lot of
154. 8:33worries about the progression of the
155. 8:35disease.
156. 8:37Each of these root whether it is the
157. 8:40physical discomfort or financial burden
158. 8:43or burden on the take care uh people who
159. 8:46take care of the patient or worries
160. 8:48about the progression of the disease.
161. 8:50All of them are in themselves capable of
162. 8:55increasing distress in the patient as
163. 8:58well as in the caregivers. So what
164. 9:01happens that the originally stress which
165. 9:05which was created by a health problem is
166. 9:09now increasing many folds and it is
167. 9:13returning back to the individual through
168. 9:15multiple roots. So sometimes the patient
169. 9:18would be worrying about the burden which
170. 9:21is uh there on the caretakers. they are
171. 9:26not able to focus on their own important
172. 9:29things their priorities. Sometimes we
173. 9:32find that uh young children or
174. 9:35adolescent children has has to
175. 9:37compromise their studies due to taking
176. 9:40care of their parents who are suffering
177. 9:42from some sort of illness and things
178. 9:44like that. Financial burden could be
179. 9:46another big source of worry about them.
180. 9:50So from all these sources the worries
181. 9:53are coming back the emotional distress
182. 9:55is being created.
183. 9:59When we think about what happens when a
184. 10:02person gets ill
185. 10:05and start analyzing his mindset, start
186. 10:09analyzing his behavior, we find many
187. 10:13interesting things about it. And this
188. 10:16was the origin of a particular branch of
189. 10:20psychology which is known as health
190. 10:23psychology. So what health psychology
191. 10:26is? It is a specialized area of study
192. 10:30that examines how psychological factors
193. 10:35are going to affect our health and
194. 10:38illness behavior.
195. 10:41So how psychological factors are going
196. 10:44to affect the health and illness
197. 10:46behavior?
198. 10:49There are many interesting observations
199. 10:52about it. First of all, when do I
200. 10:56realize that I am really ill and I need
201. 10:59medical assistance? Of course, for the
202. 11:02very first day, none of us realizes that
203. 11:05the problem is such a great one and we
204. 11:08must see the doctor immediately.
205. 11:10For a few days, when we start
206. 11:12experiencing symptoms, we uh either
207. 11:16don't do anything or we rely on home
208. 11:19medications.
209. 11:21Even if the symptoms persist, we start
210. 11:25thinking of meeting a doctor to discuss
211. 11:29the things with him.
212. 11:32Another important psychological factor
213. 11:35comes in what type of doctor we are
214. 11:38going to choose a practitioner of
215. 11:42alopathic medicine, homeopathic
216. 11:44medicine, ayurvedic medicine or a faith
217. 11:47healer.
218. 11:48Visiting to a faith healer is not
219. 11:51uncommon especially in the rural areas
220. 11:53of our country
221. 11:55and people have reported significant
222. 11:58improvements in their health status even
223. 12:01if they visit simply a faith healer
224. 12:04instead of going to a certified medical
225. 12:08practitioner. So many many things happen
226. 12:11at this level also.
227. 12:13Then when we visit a doctor and he or
228. 12:17she prescribes a medication for the
229. 12:20treatment of the disease,
230. 12:22how particular we are to adhere by the
231. 12:26instructions of the doctor.
232. 12:29Do I remember taking the medications for
233. 12:32the first few days unless the symptoms
234. 12:35were intense and they were causing
235. 12:37significant pain and agony and as soon
236. 12:40as the symptoms start uh mitigating I
237. 12:44start forgetting taking the medicine or
238. 12:47I think that now I'm okay no matter if
239. 12:50the doctor has said to uh prescribed
240. 12:53medicine for 10 days if I feel fine in 5
241. 12:57days why to take medicine for another 5
242. 12:59days. So we start putting our own logic
243. 13:03in this process. Some people do it more,
244. 13:06some people do it less. But we all do
245. 13:08that. There may be other people who find
246. 13:12it strange why to take medicine uh
247. 13:15everything will be all right by it uh by
248. 13:18itself. Body corrects itself. So there
249. 13:21is no need to take medications from
250. 13:24outside. So different different
251. 13:27arguments are there, different different
252. 13:30ways of conceptualizing the situations
253. 13:33there and these things make a big
254. 13:37difference in the way we respond to our
255. 13:41illness. Another important thing is what
256. 13:45do I think why I have become ill? What
257. 13:49do I think if I take medication whether
258. 13:52it is going to help me or not? All these
259. 13:55things are going to make a big
260. 13:57difference in the decisions that I'm
261. 13:59going to take regarding my illness and
262. 14:02the way I respond to it. So all these
263. 14:06little little cognitive decisions and
264. 14:08the way we process the information, the
265. 14:10way we make decisions, everything is
266. 14:13included in the area of health
267. 14:16psychology. It is a big area. Of course,
268. 14:19it is simply impossible to cover it up
269. 14:21within a single module. Still I would
270. 14:25like to highlight the important points
271. 14:27of it and make a connection between how
272. 14:31psychological factors can alter the
273. 14:34level of a stress which is being
274. 14:36experienced by the patient and his or
275. 14:40her caregivers.
276. 14:42Let us move on and see what it has
277. 14:46while explaining the health related
278. 14:48behavior of individuals.
279. 14:51Health psychology has proposed several
280. 14:55models to explain it. The first one is
281. 14:59the biocschosocial model. Now this model
282. 15:03emphasizes the interconnectedness
283. 15:06of biological
284. 15:08psychos psychological and social
285. 15:11elements in determining what in
286. 15:14determining the health and illness
287. 15:17outcomes. So what it model basically
288. 15:20says, it says that the biological part,
289. 15:25the psychological part and the social
290. 15:28part of an individual are connected very
291. 15:33closely. And all the three taken
292. 15:37together are going to influence
293. 15:40how I perceive the concept of health and
294. 15:44illness and what I do in response to
295. 15:48illness if created at all. So the
296. 15:52biological part is very clear. Our
297. 15:54physiology, our nervous system,
298. 15:56different kind of organ systems, then
299. 15:59whatever uh medical basis of that health
300. 16:02issue is that is included in the
301. 16:04biological part. Then comes the
302. 16:07psychological part. Psychological part
303. 16:11means
304. 16:12the things which I had been discussing
305. 16:15just before.
306. 16:17Whether I find myself ill or not, I'm
307. 16:20ready to accept that I'm ill or I simply
308. 16:23think that okay there are certain
309. 16:25symptoms they will be alleviated with
310. 16:27time with the help of medication but
311. 16:29otherwise I'm all right and I can
312. 16:31continue with my daily tasks. Okay. or I
313. 16:35find myself very very sick even if I
314. 16:39have got cold and cuff which is common
315. 16:41in changing weather some people uh
316. 16:44realizes or feel as if they were very
317. 16:46very sick so how do I look at my health
318. 16:50status or illness status similarly the
319. 16:54kind of decisions the trail of decisions
320. 16:56that I'm going to make about when should
321. 16:59I visit a doctor what kind of doctor
322. 17:01should be consulted what should be the
323. 17:03adherence level to the instruction of
324. 17:05the doctor whether the outcome of the
325. 17:09illness or treatment is in my hands or
326. 17:11not. So many decisions they are all
327. 17:14included in the psychological element.
328. 17:17And what is the social element? These
329. 17:19are the popular belief about health and
330. 17:22illnesses which run in our society.
331. 17:25These are the kind of medical treatment
332. 17:28popularly taken by other people in our
333. 17:32society. So whatever social practices
334. 17:35are there will be followed by us also.
335. 17:38For example, if I get cuff and cold, I
336. 17:41may go for uh a drink made up of
337. 17:45hot milk with some sort of turmeric
338. 17:49powder you know or some other spices
339. 17:52which are available in my kitchen
340. 17:54because these are the age-old solutions
341. 17:57which we depend upon for treating these
342. 18:00kind of problems. So the social
343. 18:03practices, the social beliefs about
344. 18:05health and illness are also integral
345. 18:10while responding to illness.
346. 18:14This particular model for was further
347. 18:17extended in the health belief model.
348. 18:20Basically this expands the psychological
349. 18:23part of the bio psychosocial model.
350. 18:27Okay. So when I talk about health
351. 18:29belief, it has to uh draw more from my
352. 18:33psychological part. So what it states?
353. 18:36It states that an individual's beliefs
354. 18:40about their own health greatly impact
355. 18:44their behavior. So it is
356. 18:48my belief, my own belief about my health
357. 18:52which is going to impact my behavior
358. 18:56while responding to the state of stress.
359. 19:00Then this belief also includes my
360. 19:06assessment of vulnerability towards
361. 19:09illness, my assessment of the
362. 19:11seriousness of the illness and my
363. 19:15assessment of the benefits of certain
364. 19:18actions.
365. 19:20Okay. So three things are there. The
366. 19:23first thing which I may which I assess
367. 19:26or which I judge is how vulnerable I am
368. 19:30for the development of such diseases.
369. 19:32This is called risk assessment. Many
370. 19:34times when we visit doctors they ask
371. 19:38about the family history of diabetes or
372. 19:41hypertension or cardiovascular diseases,
373. 19:44strokes or things like that.
374. 19:47Plus if I have so many patients of a
375. 19:50particular disease at home somehow I
376. 19:53also develop a feel that being the blood
377. 19:56relative I am also vulnerable to develop
378. 20:00such kind of diseases. So I will be more
379. 20:03conscious about the signs and symptoms
380. 20:05of that disease.
381. 20:08Another important decision which I make
382. 20:11is uh how serious my illness condition
383. 20:15is. If I have certain symptoms whether
384. 20:17the symptoms are of normal uh level and
385. 20:20I can continue or they are even milder
386. 20:23so I can very much continue with my
387. 20:25daily routine or I perceive the symptoms
388. 20:28to be very very serious. Uh that is why
389. 20:31you find such differences in people.
390. 20:34Some people are working even if they
391. 20:36have a fever of 1023°
392. 20:40Fahrenheit. Others may prefer to take
393. 20:44bed rest even if they got fever of
394. 20:47intensity 100° Fahrenheit. So it is
395. 20:50basically my perception of the
396. 20:52seriousness of my symptoms which is
397. 20:55going to decide how I'm going to respond
398. 20:58in a particular situation. And the third
399. 21:01important thing is my belief whether uh
400. 21:05my belief about which action will be
401. 21:07more fruitful. What should be done which
402. 21:10can brought me a quick relief? Whether
403. 21:13drinking kas made up of various spices
404. 21:17is going to help me more or taking a
405. 21:20tablet of paracetamol 650 mg is going to
406. 21:24help me more if I got fever due to any
407. 21:28reason.
408. 21:30It is my own assessment and judgment
409. 21:32about the effectiveness of my actions.
410. 21:35So all these things taken together are
411. 21:38going to decide what I am going to do if
412. 21:41I got certain diseases. The third model
413. 21:45is known as the transactional the trans
414. 21:48theoretical model and this particular
415. 21:52trans theoretical model talks a lot
416. 21:55about the behavior change during
417. 21:58diseases through its stages of
418. 22:01precontemplation
419. 22:02contemplation then preparation action
420. 22:06and maintenance. So what I do in order
421. 22:09to prevent the disease, what I do if I
422. 22:13develop the disease, how much prepared I
423. 22:16am to deal with it, what kind of actions
424. 22:19I'm going to take and how much adherance
425. 22:22I will show with the health promoting
426. 22:26behaviors in future.
427. 22:29Then comes the concept of self-efficacy.
428. 22:32Self-efficacy
429. 22:34is basically the individual's assessment
430. 22:37about one's ability to deal with the
431. 22:40situation effectively. Whether I find
432. 22:43myself uh able to deal with it or not.
433. 22:47If I find myself able to deal with the
434. 22:50illness or the problems which has come
435. 22:53to me, I will be better uh managed. I
436. 22:57will be more confident. I will be uh
437. 23:01actively looking for the solutions for
438. 23:04the medical treatments and I will uh try
439. 23:07to adhere to them because I think that
440. 23:10with the help of medications and
441. 23:14lifestyle management I will be able to
442. 23:18manage the disease condition
443. 23:20effectively. On the other hand, if I
444. 23:24don't find myself capable of managing
445. 23:27the disease properly, the stress can
446. 23:30increase manyfold. Okay. Similarly, the
447. 23:35stress and coping models are also
448. 23:38included here to explain the
449. 23:41relationship between the chronic health
450. 23:44problems and the level of distress
451. 23:46experienced by the patient. And
452. 23:49basically this talks about the
453. 23:51transaction between the diseased
454. 23:54condition and different kind of coping
455. 23:57mechanisms utilized by individuals. So
456. 24:01am I going to accept the symptom? Many
457. 24:04times it is very much required
458. 24:06especially if one suffers from a
459. 24:08metabolic problem like hypoglycemia,
460. 24:13diabetes or hypothyroidism.
461. 24:16All these are the metabolic states of
462. 24:19the body. Therefore, they cannot be
463. 24:22reversed to its original condition.
464. 24:25There are only managements which are
465. 24:27available for such kind of diseases. So,
466. 24:30if I get somehow such kind of a problem,
467. 24:35I have to accept it and I have to learn
468. 24:37to live with it. On the other hand, if I
469. 24:40suffer from some kind of infections and
470. 24:43I know that there are effective
471. 24:45medicines available for treating and
472. 24:48curing those infections, my behavior
473. 24:51would be different.
474. 24:53much less lifestyle management would be
475. 24:56required because I know the condition
476. 24:59which has been developed is temporary in
477. 25:02nature and it can be completely
478. 25:04corrected with the help of medications
479. 25:07which may not be true if I develop a
480. 25:10long-term disease which is basically the
481. 25:13endocrine state or metabolic state of
482. 25:16the body.
483. 25:19So health psychology
484. 25:22has several applications when it comes
485. 25:25to the level of stress management in
486. 25:29patients suffering from chronic
487. 25:31illnesses.
488. 25:33Health psychology models can be applied
489. 25:36to promote
490. 25:38health conditions like encouraging
491. 25:42physical activities, healthy eating
492. 25:44behavior and different kind of lifestyle
493. 25:48managements and it can also be used for
494. 25:52disease prevention means staying away
495. 25:54from the risk factors that can trigger
496. 25:58the development of a disease.
497. 26:04So one can take vaccine, one can stay
498. 26:07away from smoking or taking alcohol. If
499. 26:10I want to be healthy for a long time,
500. 26:15then management of chronic diseases
501. 26:19can also be greatly benefited from the
502. 26:22insights provided by health psychology
503. 26:25model
504. 26:27particularly in the area of
505. 26:29self-management and treatment adherence
506. 26:33and effective intervention programs can
507. 26:37be uh designed which are mainly based on
508. 26:41the principles of cognitive behavioral
509. 26:44therapy and motivational interviewing
510. 26:47can also be introduced where people can
511. 26:50be connected with others who have
512. 26:52suffered from those diseases and
513. 26:55conquered them successfully in order to
514. 26:58feel encouraged in order to feel elated
515. 27:01in order to feel confident to deal with
516. 27:04the diseased condition.
517. 27:08Several coping strategies are employed
518. 27:11here. For example, self-regulation
519. 27:15training which is like monitoring
520. 27:18symptoms and uh regulating the
521. 27:21medications
522. 27:23mainly under the supervision of the
523. 27:25doctor. For example, when a diabetic
524. 27:29patient is shifted to insulin, the
525. 27:32doctor
526. 27:34usually teaches the patient himself or
527. 27:37herself how to monitor the symptoms of
528. 27:40hyperglycemia and hypoglycemia
529. 27:44and how to take the corrective measure.
530. 27:47Suppose there is dizziness and sweating
531. 27:49and palpitations just after consuming
532. 27:52injecting the insulin. One, this can
533. 27:56indicate an hypoglycemic state of the
534. 27:59body and what should be done that is one
535. 28:01is supposed to take glucose immediately
536. 28:04and the patient may be advised to keep a
537. 28:08glucometer at home so that the blood
538. 28:11glucose levels can be monitored
539. 28:13accurately and timely. So such kind of
540. 28:17self-management strategies can be taught
541. 28:21to the patient himself so that the
542. 28:23person is better able to regulate the
543. 28:26disease condition. Then uh the patient
544. 28:30can be asked to form relationships
545. 28:33with family, friends or communities that
546. 28:37can offer emotional support. As well as
547. 28:41the patients are also asked to join
548. 28:44communities of the other people who are
549. 28:48suffering from the same kind of disease
550. 28:51so that they can be benefited from each
551. 28:54other's experiences.
552. 28:57Stress management techniques like
553. 28:59meditation and deep breathing are
554. 29:01effective methods in managing the stress
555. 29:05levels in patients. And then a health
556. 29:08care team can also get connected with
557. 29:11the patient to offer advice and
558. 29:14assistance in managing long-term health
559. 29:18conditions.
560. 29:20This was all for this lecture. Here is a
561. 29:25recap of what we have learned in lecture
562. 29:29one.
563. 29:31First of all, we talked about what are
564. 29:33chronic health issues and why it is
565. 29:36important to think about effective
566. 29:40stress management in the patients who
567. 29:43suffer from chronic health issues.
568. 29:47We saw how chronic health problems can
569. 29:50build up stress in patients through
570. 29:53multiple route because of different kind
571. 29:56of worries that envelop the patient like
572. 30:00financial burden like burden on the
573. 30:03caretakers like worries about the
574. 30:06progression of the disease and the
575. 30:08physical pain and agony which is
576. 30:11definitely being caused by the disease.
577. 30:14All these are distinct roots through
578. 30:17which stress can come back to the
579. 30:20patient. So the stress which has been
580. 30:23originally generated due to illness is
581. 30:26now in multiplying itself and coming
582. 30:30back to the person through different
583. 30:32roots.
584. 30:33Then we also saw different models
585. 30:36proposed by health psychology in order
586. 30:39to understand how a person's psychology
587. 30:42play a role in perceiving the health
588. 30:46condition and effectively managing the
589. 30:49same. And finally we talked about the
590. 30:53self-regulation training support
591. 30:55connections uh connections with health
592. 30:58care team to manage chronic health
593. 31:02problems in patients.
594. 31:05These are the references
595. 31:07and recommended readings for you.
596. 31:12A few more references to enhance your
597. 31:15knowledge about the subject. Thank you
598. 31:18very much for your kind attention. Thank
599. 31:21you.