💙 PSYCHOSOCIAL INTERVENTIONS FOR TERMINALLY ILL PATIENTS
🧠 Interventions for Stroke
Survivors of stroke often suffer substantial physical and cognitive impairments. 😔 Some evidence suggests that younger stroke patients may show somewhat better recovery than older ones. 👴👶 Similarly, hemorrhages often impair functioning partly by creating pressure on neurons. 💥 If that pressure is relieved by the blood being reabsorbed by the body, the person may gradually recover some of the lost functioning. ✅
Because of the paralysis, 🦽 these patients often cannot walk, dress themselves, or perform many usual self-help activities. Medical treatment along with physical, 💪 occupational, and speech therapy 🗣️ can help these people regain many of their lost abilities. 🌟
❤️ Psychosocial Interventions for Heart Disease
Interventions to enhance people's recovery from and long-term adaptation to having heart disease have used several different approaches. 📋 One approach used technological devices: researchers equipped cardiac patients with electrocardiogram ECG monitors 📱 to transmit analyses of their heart function to a hospital nurse by telephone on a periodic schedule and whenever they felt certain symptoms. If an analysis indicated medical action was needed, the nurse dispatched a rescue squad 🚑 and instructed the patient to take a drug. 💊 Compared with people who received the standard cardiac care, those with the ECG system were far less depressed during the next several months. 😊📈
Other approaches have used programs in which patients received health and regimen education, 📚 psychosocial counseling, or both to improve their compliance with the cardiac regimen, enhance their adjustment to the illness, and reduce their risk of future cardiac problems. 🎯 Two meta-analyses have been conducted with data from many interventions using these approaches. In most interventions, nurses 👩⚕️ or physicians 👨⚕️ provided the education and counseling.
📊 Key Findings from Interventions
Analyses comparing patients who received usual medical care with those who had the interventions revealed four important findings:
- First ✅—the interventions produced substantial reductions in mortality and recurrence of heart problems in the subsequent year or two. 📉
- Second 💪—the programs successfully reduced several risk factors, improving blood pressure, 🩺 cholesterol levels, 🩸 body weight, ⚖️ eating habits, 🥗 exercise, 🏃 and smoking. 🚭
- Third 😟—the interventions did not improve patients' anxiety or depression.
- Fourth 🎯—compared with programs that were not successful in reducing risk factors, those that were successful were more effective in reducing mortality and heart problems.
Why weren't programs with psychosocial counseling successful in reducing patients' anxiety and depression? ❓ The answer may be that counseling in most programs was given by medical personnel, not professionals trained in psychological methods. 🧠 Therapy with psychologists using behavioral and cognitive methods is highly effective in reducing people's depression and anxiety. ✅
💡 Examples of Psychological Counseling Success
Two examples can be given in which psychological counseling improved emotional adjustment in cardiac victims:
Example 1: 🏥 One intervention provided patients with information about their conditions and treatment, training in relaxation to reduce stress, 🧘 and counseling for their fears and anxieties while they were still in the hospital. Individuals who received this program showed far better psychosocial adjustment during the next year than those who received standard care. 📈✨
Example 2: 💙 In another intervention, hospitalized patients who received counseling showed reduced anxiety and depression. 😊
Interventions by psychologists to help cardiac patients cope with stress can have additional benefits. 💪 One study found that stress management reduced the daily number of angina pectoris attacks 💢 by nearly 40% compared against attacks of clients who received standard medical care. Other research has shown that stress management can reduce patients' Type A behavior 😤➡️😊 and lower blood pressure. 🩺 These approaches can effectively reduce coronary risk. All these benefits suggest that training to help patients anticipate and manage stressful situations can be a useful component in cardiac rehabilitation programs. ✅
🌟 The Ornish Program: A Comprehensive Approach
In a now-famous intervention, Dean Ornish and his colleagues (1990) developed and tested a multi-component program of dietary, exercise, and stress management approaches for cardiac rehabilitation. 🎯 The patients who volunteered to participate were randomly assigned to receive either the program or standard medical care. The program had the people:
- 🥗 Eat a mainly vegetarian diet
- ☕❌ Eliminate caffeine and restrict alcohol consumption
- 🚭 Stop smoking
- 🏃♂️ Get moderate exercise regularly
- 🤝 Meet regularly as support groups
- 🧘 Use stress management techniques, including relaxation and meditation
Medical assessments were made at the start of the study and at the end of a year. 📅 Comparisons of the two groups showed that the atherosclerosis 🩸 and reports of chest pain 💢 worsened for the subjects who received standard medical care but improved for those in the intervention program. ✨ Although the results don't indicate which features of the program worked, they show that changes in lifestyle can unclog arteries. 🎯 Other studies have not only confirmed these findings but found that intensive reduction of lifestyle risk factors reduces subsequent cardiac problems and hospitalizations. 🏥📉
📝 Summary for Heart Disease
To summarize, recovery after a heart attack presents difficult physical and psychosocial challenges for patients and their families. 👨👩👧👦 Cardiac rehabilitation programs require individuals to adhere to regimens of exercise, 🏃 diet, 🥗 medication, 💊 and stress management. 🧘 These programs can reverse the disease process. ↩️ The long-term impact of heart disease often involves emotional, 😔 vocational, 💼 and marital problems 💑 that may require therapeutic interventions to enhance adaptation. 💙
🦠 Psychosocial Interventions for AIDS
Psychosocial efforts for AIDS need to begin when patients are tested for HIV. 🧪 These individuals usually decide to get tested because they believe they could have the virus. They need carefully presented information to help reduce anxiety during the time before getting the results. 😰⏳ Those who test HIV-positive will need counseling regarding the illness, treatment, and the many organizations and support groups available today to help AIDS patients and their families cope. 🤝💙
Interventions for individuals with and without access to effective antiretroviral treatment need to focus on different issues. 💊 Because antiretroviral regimens are complex and must be strictly followed, interventions for people taking the drugs must monitor and promote adherence. ✅
Many people with HIV and AIDS need psychosocial interventions for other problems, including emotional distress, 😔 pain management, 💢 and sleep disorders. 😴 So far, most interventions have focused on using stress management training, 🧘 exercise, 🏃 and cognitive therapy 🧠 to promote adaptation and reduce anxiety and depression among patients who did not have effective antiretroviral drugs. These interventions can help HIV-positive patients when begun in the early stages of HIV infection or long after. ⏰
🔬 Research by Antoni and Colleagues
Research by Michael Antoni and his colleagues (1990, 1991) recruited gay men who did not know their HIV status and randomly assigned them to intervention and control groups. 👥 Intervention began weeks before HIV testing and consisted of:
- 🏃♂️ Aerobic exercise
- 🧘 Relaxation training
- 💬 Group meetings that included cognitive restructuring methods to modify self-defeating beliefs
Psychological and immunological assessments were made at various points in the weeks before and after notification of the HIV test results. 📊 For individuals who tested positive, those who had received the intervention subsequently showed substantially less anxiety and depression 😊📈 and much stronger immune function, 🛡️ and these benefits increased with the amount of relaxation practice they did. ⏰✅ Other studies have found that similar interventions also enhance immune function and reduce anxiety and depression for people with advanced levels of HIV or AIDS. 💪
🎗️ Psychosocial Interventions for Cancer
Psychosocial approaches for helping individuals cope with their cancers can begin in the diagnostic interview with the physician. 👨⚕️ The physician can promote positive adaptation to the illness by discussing the diagnosis while the patient is alert with a spouse or other significant person present, 👥 expressing concern and giving the people some time to react emotionally and compose themselves, 😢⏰ and then presenting information about the prognosis and treatment options. 📋
Medical personnel and health psychologists can also help by providing information on ways to manage the disease and difficult aspects of treatment and advice on improving the patient's diet 🥗 and physical activity. 🏃
💊 Managing Chemotherapy Nausea
Several types of psychosocial interventions have been applied successfully to improve cancer patients' adjustment to their illnesses and quality of life. 💙 Some programs have been applied to reduce patients' nausea from chemotherapy. 🤢 Two approaches with particularly strong support are:
- Relaxation training 🧘—For example, one study found that training patients to use progressive muscle relaxation and imagery before and during chemotherapy sessions sharply reduced the development of nausea after the first session. ✅
- Systematic desensitization 🔄—Another study showed that systematic desensitization can help people who have already developed anticipatory nausea. Patients used relaxation techniques while they imagined increasingly difficult scenes relating to chemotherapy, such as driving to the clinic 🚗 or entering the waiting room. 🏥 These individuals reported much less nausea and vomiting in subsequent chemotherapy sessions. 📉
Not all patients benefit from these techniques, partly because they don't believe psychosocial approaches will help. 🤷♀️
🌟 Broader Interventions: Survival Benefits
Other interventions have had broader focuses and shown that psychosocial methods not only enhance patients' adjustment to cancer, but may improve their survival, too. ✨ One study assessed the survival of cancer patients after a year-long intervention in which they attended weekly group meetings 🗓️ that were led by therapists who had cancers that were in remission. The meetings enabled the patients to:
- 💬 Discuss their feelings and coping strategies
- 🧘 Learn self-hypnosis to manage pain 💢
Compared with a control group, the patients who received the psychosocial intervention lived nearly 15 months longer during a 10-year follow-up period. ⏰✨ If psychosocial methods can, in fact, enhance survival, they may do so by improving immune function 🛡️ and reducing physiological stress reactions. 📉
👨👩👧👦 Support Groups and Family Therapy
Because of the social problems cancer patients face, they and their families may benefit from family therapy and attending support groups that include education and group discussion. 🤝 In one study, cancer patients in a support group received:
- 💬 Counseling sessions
- 🧘 Training in relaxation
- 📚 Information about diet, exercise, and their illnesses
Subsequent comparisons with control subjects revealed that those in the support group were less depressed and anxious, 😊 had fewer sexual problems, 💑 and participated more in leisure activities. 🎾
So far, we have examined what it is like to live with and adapt to four very different high-mortality health problems. 💔 Each of these diseases can disable its victims and progress to the point that the patients and their loved ones are aware that the disease is terminal and death is imminent. ⚰️
⚰️ ADAPTING TO A TERMINAL ILLNESS
💭 The Reality of Dying
When people talk about the hypothetical prospects of dying, you will often hear them say, "I hope I go quickly and without pain." 🙏 Some people might argue that there are no good ways to die, but almost everyone would agree that a slow and painful death is the worst way. 😔 By definition, a terminal illness entails a slow death. ⏳ The patient typically suffers a progressive deterioration in the feeling of well-being and ability to function and may also experience chronic pain. 💢 Although dying from a terminal illness generally takes several weeks, it sometimes takes as little as a few days or as long as several months. 📅
😔 Psychosocial Adjustments to Terminal Illness
As we have seen, most people with life-threatening chronic illnesses manage to adapt reasonably well to their conditions over time after the initial crises, 💪 and so do the closest people in their lives. But when their conditions worsen and progress to a terminal phase, new crises emerge that require intense coping efforts. 😰
🛡️ How People Cope with Terminal Illness
How do terminally ill people and their families cope, and what types of stress do they experience? 🤔 The principal coping mechanism people use during the phase of terminal illness is denial. 🙈 As we saw in earlier in our course, emotion-focused coping is especially useful when the individuals cannot do anything to change their situations. Unfortunately, when people mutually avoid facing the imminent death, they may not discuss with each other how they feel or have any way to 'say their good-byes.' 💔
😰 Three Types of Stress Terminal Patients Experience
Psychiatrist John Hinton (1984) has described three types of stress terminal patients experience:
- Physical effects 🤕—First, they must cope with the physical effects of their worsening conditions, such as pain, 💢 difficulty breathing, 😮💨 sleeplessness, 😴 or loss of bowel control. 🚽
- Lifestyle restrictions 🛏️—Second, their conditions severely alter their styles of living, restricting their activity and making them highly dependent on others. Perhaps two-thirds of dying people are restricted in their activities during the last 3 months of their lives, and one-fifth of these patients are confined to bed. 😔
- Awareness of death ⚰️—Third, they typically realize that the end of their lives is near, even when they are not told so. If they are in a hospital, 🏥 they may think about never going home again 🏡 or no longer being able to experience the intimacy they used to have with those they love. 💔
🕊️ Achieving Peace
Thinking about someone who is dying typically arouses feelings of sadness in people. 😢 With good care, many people do achieve a positive acceptance of dying and have a peaceful death. 🕊️
Often, patients adapt better than their loved ones. 💪 For instance, spouses of dying people often experience increased health problems, 🤒 depression, 😞 and memory difficulties. 🧠 Individuals who are most likely to adapt to dying with the least amount of anger or depression are those who:
- 💊 Are in little pain
- 🤗 Receive sensitive and caring social support
- 😊 Feel satisfied with their lives
- 💪 Have a history of coping well with life's problems and crises
Support groups and family therapy can be of great help to dying individuals and their families. 👨👩👧👦💙