AGENDA

1. Medical psychology: definition, subject and tasks. Psychosomatic and somato-psychological co-operations.Determination of psychical health :

2. AGENDA •  DEFINITIONS of medical psychology •  LEVELS of medical psychology: individual psychological issues of the patient, patient-physician relationship, cultural and social issues •  MODELS OF illness: biomedical model, biopsychosocial model

3. DEFINITIONS OF MEDICALPSYCHOLOGY • Medical psychology entails the atitude towards illness and the patient, atitude of the healthy and sick individuals towards healthcare systems, and also the atitude of the doctor towards the medical profession. •  This is the branch of psychology that integrates somatic and psychotherapeutic modalities into the management of mental illness and emotional, cognitive, behavioral and substance use disorders".

4. Medical psychologists apply psychological theories, scientific psychological findings, and techniques of psychotherapy, behavior modification, cognitive, interpersonal, family, and life-style therapy to improve the psychological and physical health of the patient

5. Clinical psychologists • are rained for • service in primary care centers, • hospitals, • residential care centers, • long-term care facilities • multidisciplinary collaboration and team treatment.

6. Clinical psychologists • They are trained and equipped to modify physical disease states and the actual cytoarchitecture and functioning of the central nervous and related systems using psychological and pharmacological techniques (when allowed by statute), and to provide prevention for the progression of disease having to do with poor personal and life-style choices and conceptualization, behavioral patterns, and chronic exposure to the effects of negative thinking, choosing, attitudes, and negative contexts.

7. Responsibilities of medical psychologists include: • Psychotherapy - helping patients manage the emotional aspects of chronic illnesses. • · Pain Management - finding ways to curb the physical symptoms of a disease and minimize the side effects of treatments. • · Pharmacology- prescribing psychotropic medications for patients with mental issues or disorders. • · Behavior Therapy - initiating and implementing behavioral interventions and stress reduction techniques that will positively affect patients' immune systems.

8. Most diseases common in modern society are opportunistic. When we experience a traumatic event or live in a state of chronic stress, the immune system is severely compromised. • As a result, the body becomes more hospitable to everything from allergies to cancer. • A medical psychologist helps clients properly process the stresses in their lives with the intention of bolstering the immune system. • They also help clients manage specific conditions. For example, a patient with cancer might be in a state of shock from the diagnosis, feel fear and confusion about the treatment options, or depression over a poor prognosis or the limitations the disease poses. They might also worry about the effect the illness will have on loved ones. The medical psychologist helps the person manage this emotional turmoil.

9. Medical psychologists are also trained in various interventions to help patients minimize physical symptoms. • Some of the techniques that are commonly used are behavioral interventions and relaxationtechniques, hypnosis, and guided imagery, which all tend to effect physical changes by enhancing the person’s immune system and decreasing tension. • Energy medicines such as acupressure, bodywork, and homeopathy are also frequently used. Different practitioners have different training and specialties

10. Pain management • Pain is a combination of many things – the actual physical site of the pain, exacerbated by tension, fear, and anxiety. When the patient can learn to relax his or her body, there is a natural reduction of pain. Most of my work in Medical Psychology is as a pain specialist (cancer, fibromyalgia,arthritis, etc.) and allergy elimination work (yes, in most cases, allergies can be permanently eliminated). • Others specialize in neuromuscular, genetic, or birth disorders, gynecological problems, or other specific ailments.

11. THE RELATIONSHIP BETWEENMEDICAL PSYCHOLOGY AND OTHERFIELDS MEDICAL psychology is intricated with other research fields: • psychopathology, • holistic psychology, • antropology, • psychoanalysis and dinamic psychology, • cronobiology, • etology, • sociology, • experimental psychology, • neurophysiology.

12. MEDICAL PSYCHOLOGY ANDPSYCHOLOGY MEDICAL psychology is connected with GENERAL psychology in the following areas: • Communication • Developmental psychology • Personality •  MEDICAL psychology is connected with SOCIAL psychology: Patient-physician relationship – the impact of the medical profession on related professions: pharmacists, biologists, nurses etc. • From the biopsychosocial model of illness to patterns and models in the pharmaceutic field • Modern means of assessment of the therapy and medical care – quality of life

13. MEDICAL PSYCHOLOGY ANDMEDICINE • The hisorical and methodological relationship between medical psychology and psychiatry is undoubtedly the deepest of all • •  Almost all founding parents of medical psychology were PSYCHIATRISTS • •  PSYCHIATRY is the main field where medical and clinical psychology draw information from, and also the field where medical and clinical psychology data and techniques are best put into practice • 

14. POSTULATES IN MEDICAL PSYCHOLOGY1. The individuality of the patient •  „There is no illness, there are only sick people” •  More clearly: there is no illness separated from the sick person with his/her individual characteristics and particularities •  Sometimes fighting the illness is essential for healing, some other times changing individual particularities of reaction is required •  From the viewpoint of medical psychology, these reactive particularities are physical and related to person and personality

15. •. POSTULATES IN MEDICAL PSYCHOLOGY2. Patient – physician relationships   Patient-physician relationships involve contrary directions, from idealization to cynical despair •  According to the manner in which each “actor” plays the role assigned due to various expectations, either satisfying, effective relationships or suspicious, frustrating, disappointing ones are underlined •  Patients are specifically tolerant to the therapeutic limitations of medicine in a context of respect and genuine communication and empathy from doctors/medical staff. •  Doctors/medical staff deal with sick people, not clinical syndromes, and sick people bring a complex influence in the patient-physician relationship – a merge between biological factors, psychological dynamics and social context

17. Indicators of communicational difficulties • Predominance of clinician’s speaking time • Unbalanced focus on medical themes • Abrupt transitions and deadlocks (premature consolations, denial of preoccupations, closed questions) • Introduction of a third person • Distance, agressivity, indifference

18. CST-Example: Introduction of a « Third » C … well, that’s about what I can tell you about the situation, did you talk to your family ? P (sights) I have small children … C we have also social workers or psycho- oncologists in this clinic, they can be of great help !

19. Communicational Difficulties are related to • a lack of technique, but also… • levels of anxiety and defensive styles of clinicians when facing external and internal pressure

20. 1. Lack of Technique: Examples • Structuring the interview • Negociating the agendas • Closing topics, transitions • Transmission of information • Preparation, setting

21. CST- Example: structure / transitions N: … before you receive chemotherapy, we will administer a medication against nausea P: .. Mhm, mhm N: chemotherapy is not always associated with nausea, but we like to prevent nausea, that’s why we prescribe it anyway, eh: what do you work ? P: I am accountant of a small factory… N: the chemotherapy should be well tolerated …

22. 2. External Pressure: Examples • Complex informations • Disclosure of diagnosis • Relaps, progression • Patient’s emotions • Irritated patient

23. CST-Example: Relapse C: … to summarize, the results show that the cancer has come back again P: but I thought I was cured ! C: but I have told you that the chance for cure is not 100% ! P: well …

24. 3. Internal Pressure: Examples • Professional identity • Ego and Ego-Ideal • Narcicistic vulnerability • Ambivalence of the patient • Identification, projection

25. Real Life-Example: Professional identity / ovarian cancer P: Is there no possibility to clean up this situation with more surgery ? C: What do you think ! C: Or to utilize again a strong medication ? P: In your situation, a chemotherapy ? I could rather kill you right away ...

26. Models of illness •   Under the influence of the discoveries made by Virchow (the cells) and Pasteur (microbes), medicine in the end of the 19th century and early 20th century was dominated by the strictly biological causality. • •  Engel develops the biopsychosocial model of illness, underlining the overlap of specific (biological) and non- specific (psychological and social) factors • •  This model is regarded as more accurate and is derived from the general theory of systems. •

27. –  Biological System emphasizes the anatomical, structural, mollecular underpinning of the illness and its impact on the biological functioning of the patient. • –  Psychological System emphasizes the impact of motivation and personality in experiencing illness and reacting to illness • –  Social System emphasizes the influence of cultural, environmental and family factors in expressing and experiencing the illness

28. Models of illness •  Engel G stated that each of the aforementioned systems can influence and be influenced by the others •  The novel patterns of illness of the 20th – 21st centuries demand a complex explanation, approach and management, directed mostly in prevention through detection and change of risk factors •  The current stage of knowledge reveals that the traditional, biomedical model of explanation and management of chronic illnesses is restrictive and unilateral, because it does not take into account nonbiological variables . •  The biopsychosocial paradigm incorporates the state-of-the-art biological medicine and also psychological, behavioral, social, cultural, ecological variables, as factors related to the cause and evolution of illnesses (Matarazzo, 1980).

29. Biomedical Model •  It is restraining, constrictive (takes into account only biological factors) •  It is a liniar pattern of causality (from germ to illness) •  It incorporated Descartes’s duality (separates body from psyche) •  It emphasizes illness as a state of being •  It disregards prevention of illness •  Focus on the sick organ, disregarding the sick person •  Responsibility for treating the illness is placed solely on the doctor

30. Biopsychosocial Model •  It developed as a reaction to the biomedical one •  The causes of the illness are seen as multifactorial •  Psyche cannot be separated from body •  Focus on both health and illness •  Focus on both treatment and prevention •  Organ damage generates the person’s distress •  Medical staff, society and the sick person are regarded as responsible for prevention, treatment and recovery

31. Patient-physician relationship fromthe biopsychosocial viewpoint Patient-physician relationship is a key element of the biopsychosocial model. •  Any doctor should have both practical medical knowledge/skills, and knowledge about/insight into the specific psychological state of the patient. • 

32. LEVELS OF PATIENT-PHYSICIANRELATIONSHIP (apudTatossian A.)

33. Psychological response to illness

35. Stress associated with illness • Major health problems are stressful • Stressfulness dependent upon an individual’s perception of illness • No clear separation between “normal” and “abnormal” psychological reaction to illness

36. Crisis • According to the contemporary approach, illness can be considered a crisis. Especially this concerns serous, prolonged, disabling illnesses. An individual reacts to the stress of a disease by activating his/her capacity to adjustment. If the defence mechanisms fail, the balance is disturbed, and pathological reaction of the personality appear.

37. Danger • In the case of a serious disease, danger threatens the happy family life, the satisfaction of a favorite work and other sides of usual everyday life, and the patient experiences painful anxiety and fear ("What will happen to me?").

38. Eliciting beliefs • Do you have any worries or concerns about your illness? • Is there anything you’re not sure of? • Is there anything that you’re really worried about?

39. Coping strategies • Seeking information • Seeking practical and social support • Learning new skills • Developing new interests • Helping others

40. Emotion focused coping • Sharing feelings and concerns about illness • Expressing anger or other distressing feelings in an appropriate way • Managing loss • Gaining emotional support • Giving up idealised hopes of recovery

41. Less helpful coping strategies • Hoping the condition will just disappear • Denial • Obsessively focusing on minute details of the disorder • Seeking others to blame

42. Individual Factors • Personality traits (e.g. tendency to worry about illness) • Prior experience of illness within a family • An individual’s psychological state at the time of the illness • Previous experience of trauma, or a neglected or abusive childhood

43. Identifying personal factors • What was this person like before the illness? • Is there a history of serious illness in the family? • Was this person suffering from psychiatric illness when the physical condition began? • Is there any evidence of a difficult or abusive childhood? • Any other major problems?

44. Life history crisis activates available pathological somatic mechanisms (e.g. hypertensive) which have been conditioned early in life and possibly maintained by the organism's coping mechanisms at a subliminal level. Life situations are experienced as stressful because of unresolved emotional conflicts. Each personality type will have his specific conflict which in a crisis situation will activate his specific physiological mechanism.

45. Past experience • The reaction to illness depends not only on the personality features of the patient, but also on his/her past experience. The horror of the disease can increase, if someone else in the family, or a friend has had a similar illness or operation with a sad outcome. The patient's apprehension and fear is grounded on what he/she sees, hears, imagines, has once read or learned about the illness.

46. Lifeeventsandstresscanbringonfeelingsofsadnessordepressionormake a disorderhardertomanage.

47. Nonverbal Cues of Self-Healing or Disease Prone Personality • Self Healing • Calm-even speech • Even hand gestures away from body • Open, relaxed body • Mutual gaze • Smooth movements • Charismatic & optimistic

48. Nonverbal Cues of Self-Healing or Disease Prone Personality • Disease Prone • Uneven speech • Loud, explosive voice • Sighs, stutters, ums • Clenched fist, teeth • Closed body posture • Fidgets shifts tapping • Shifty-eyed,downcast • Facial grimace • Vocal gesture impatience • Over controlled calm unexpressiveness

49. Factors related to illness • Acute • Chronic • Life threatening • Terminal

50. Psychological Adjustment to Physical Illness Emotional distress 6 months Time