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THE COPING PROCESS IN PATIENTS OF CHRONIC ILLNESS:Asthma

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Health Psychology­ PSY408
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Lesson 28
THE COPING PROCESS IN PATIENTS OF CHRONIC ILLNESS
Crisis theory proposes that coping begins with the patient's cognitive appraisal of the meaning or
significance of the health problem to his or her life. The outcome of this appraisal leads the individual to
formulate an array of adaptive tasks and to apply various coping skills to deal with these tasks. Let's see
what these tasks and skills are.
The Tasks and Skills of Coping
According to Moos (1982), people who are ill need to address two types of adaptive tasks in the coping
process:
· Tasks related to the illness or treatment, which involve learning to (1) Cope with the symptoms or
disability the health problem causes. (2) Adjust to the hospital environment and medical procedures needed
to treat the problem and (3) Develop and maintain good relationships with their practitioners.
· Tasks related to general psychosocial functioning, which involve striving to (1) Control negative feelings
and retain a positive outlook for the future, (2) Maintain a satisfactory self-image and sense of competence,
(3) Preserve good relationships with family and friends, and (4) Prepare for an uncertain future.
These tasks can be very difficult for patients, particularly when their health problems may lead to disability,
disfigurement, or death. Still, many people with poor prognoses [or their health manage to adapt
successfully and make the most of their new life circumstances.
Crisis theory proposes that patients encounter these adaptive tasks in any health problem they experience.
But the relative importance or salience of each task for each illness or injury depends on the nature of the
condition and the patient's personality and environmental circumstances. A person who becomes blind may
have little physical discomfort, but may experience difficulty maintaining a job or social relations. A woman
who has a mastectomy may need to focus on adapting to her new self-image. A professional athlete,
construction worker, or other physically active individual is likely to experience more difficulty adapting to a
wheelchair than a more sedentary person.
Family members must make similar adjustments, and these individuals are critically important in helping
patients achieve each goal. Patients are likely to adapt well to a chronic condition if their family members
participate actively in their treatment regimens, encourage them to be self sufficient, and respond to their
needs in a caring and sensitive manner.
What coping skills do patients and their families employ to deal with these adaptive tasks? The next section
describes several useful strategies that they commonly use.
Coping Strategies for Chronic Health Problems
· Denying or minimizing the seriousness at the situation. As we have seen, this approach can be beneficial
in the early phases of adjusting to a health problem. Patients may benefit from this approach by using it
selectively to put aside their emotions temporarily, thereby saving them from feeling overwhelmed and
giving them time to organize other personal coping resources.
· Seeking information about the health problem and treatment procedures.
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· Learning to provide one's own medical care such as self-administering insulin shots. With this
approach, patients gain a sensed control and personal effectiveness with respect to their conditions.
· Setting concrete, limited goals such as in exercising or in going to shows or social gatherings, and
maintaining regular routines as well as possible. By doing this, patients and their families have things to look
forward to and opportunities to achieve goals they consider meaningful.
· Recruiting instrumental and emotional support from family, friends, and practitioners by expressing
needs and feelings.
· Considering possible future events and stressful circumstances in order to know what lies ahead and to
be prepared for unexpected difficulties.
· Gaining a manageable perspective on the health problem and its treatment by finding a long-term
"purpose" or "meaning" for the experience. Patients often do this by applying religious beliefs or by
recognizing how they have been changed in positive ways by the experience.
As we can see, each of these skills can help in achieving the goals of adaptive tasks and in leading to a
positive outcome of the crisis. Is one approach best? Generally speaking, although moderate or temporary
use of any specific skill can be beneficial, using any single skill exclusively may undermine the coping
process. Some coping skills may be more appropriate for dealing with some tasks than with others. As a
result; people generally use these skills selectively, often in combination.
For instance, seeking information may help patients deal with the symptoms, and setting reasonable goals
may help them do exercises and reduce their incapacitation. Individuals who have adjusted successfully to
each phase of the crises are ready to deal effectively with subsequent phases in their adjustment to their
health problems.
Long-Term Adaptation to Chronic Health Problems
Chronic disorders last for a very long time--and patients and their families need to adapt to the illnesses
whether they worsen, stay the same, or improve over time. The term adaptation refers to "the process of
making changes in order to adjust constructively to life's circumstances". For chronically ill individuals and
their families, the adaptive changes they make can enhance their quality of life by promoting their effective
physical, psychological, and social functioning.
What does "quality of life" mean?
Quality of life refers to the degree of excellence people appraise their lives to contain. People around the
world appraise excellence with similar criteria, such as performing daily activities, energy or discomfort,
positive and negative feelings, personal control, interpersonal relations, pleasant activities, personal and
intellectual growth, and material possessions.
When chronically ill people can expect to live for many years, they need to make many decisions, such as
career selections, that involve examining their options based on realistic assessments of their conditions.
People who continue to rely heavily on avoidance coping strategies, such as denial, are less likely to adapt
effectively than those who use strategies that allow them to consider their situations more carefully and
objectively.
Impacts of Different Chronic Conditions
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What is it like to live with a chronic health problem? To some extent, the answer depends on the illness.
Beginning with this section, we will consider the impact of specific chronic medical conditions and
treatments on patients and their families. The particular health problems we will examine were selected to
illustrate disorders of different body systems and widely different adjustment difficulties. Some of the health
problems tend to develop at much earlier ages than others; some require much more complex treatment
regimens than others; and some produce more pain and disability than others.
People who are disabled by illness are more likely than others to adjust poorly to their condition and
become clinically depressed. After we discuss these disorders, we will consider psychosocial approaches to
help chronically ill people adapt to their condition.
Although the medical problems we will discuss here include some that can be life-threatening, none of these
chronic conditions is among the most deadly illnesses people around the world develop-- particularly heart
disease, cancer, stroke, and AIDS.
We will use a life-span perspective to organize the health problems: illnesses that generally begin in
childhood will be presented first, and illnesses that usually begin in old age will be considered last. As we
have seen, the impact of a health problem and the way people cope with it depend partly on the patient's
age. We will start by considering the impact of asthma, a chronic respiratory disorder that generally begins
in the early childhood years.
Asthma
We all experience respiratory disorders at one time or another. If we are fortunate, these disorders are
limited to occasional bouts with colds and the flu. But millions of people are not so fortunate-- they surfer
from chronic respiratory problems. In some cases, these problems involve constant breathing impairments
that vary in intensity from one day to the next. In other cases, the victims breathe normally most of the time
but suffer recurrent episodes of impaired breathing. Some chronic respiratory disorders become severe
enough to disable their victims and may even claim their lives. This can happen with asthma.
What Is Asthma?
Imagine being at home reading one evening and noticing that a slight whistling, wheezing sound starts to
accompany each breath you take. Soon the sound becomes louder and your breathing becomes labored.
You try opening your mouth to breathe, but very little air goes in or out. When your chest begins to
contract from the effort and your heart pounds rapidly you are quite frightened and worry. "Will my next
gasp for air be my last?" This is what a major asthma attack is like. Victims of extreme attacks may begin to
turn blue and look as if they are about to die, and some do die.
Asthma is a respiratory disorder involving recurrent episodes of impaired breathing when the airways
become obstructed. This disease in very prevalent around the world; in the United States alone, about 17
million people (6% of the population) suffer from asthma. Prevalence rates are much higher for children
than adults. Although the disorder may emerge at any age, it is most likely to develop by age 5 in children
and between the ages of 30 and 40 among adults.
Fortunately, most childhood cases of asthma become less severe over time, and 25 to 50% of the children
who develop asthma no longer have symptoms by the time they reach adulthood. Each year, over 5,400
asthmatics in the United States die from asthma attacks; the death rates from attacks have increased since
1980 and are higher among African Americans than white individuals.
Because African Americans have lower incomes than whites and are less likely to have regular physicians,
they tend to use hospital emergency rooms as their main source of treatment for asthma and seek help
mainly when attacks are severe.
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Asthma is clearly a major health problem. Let's see what causes asthma attacks.
The Physiology, Causes and Effects of Asthma
Asthma episodes typically begin when the immune system is activated to react in an allergic manner,
producing antibodies that cause the bronchial tubes and other affected body tissues to release a chemical
called histamine. This chemical causes irritation to those tissues. In an asthma attack, these events cause the
bronchial tubes to become obstructed as their smooth muscles become inflamed, develop spasms, and
produce mucus. These events last, perhaps, an hour or two and can lead to tissue damage, thereby
increasing the likelihood of more frequent and severe future attacks. For some asthmatics airway
inflammation becomes constant.
What Causes Asthma Attacks to Happen?
We do not have a full answer to this question, but we do know that attacks usually occur in the presence of
certain conditions, called triggers. Asthma triggers can include personal factors, such as having a respiratory
infection or feelings of anger or anxiety; environmental conditions, such as air pollution, pollen, or cold
temperature; and physical activities, such as strenuous exercise. The triggers that lead to attacks are different
for different asthmatics, and some individuals have attacks only when two or more triggers occur at the
same time. The main triggers for many asthmatics are allergens-- substances, such as pollens or molds, that
are known to cause allergic reactions. But other asthmatics do not have any known allergies, and other
factors, such as physical exercise or cold air, are the main triggers for them. Tests for allergic reactions
usually involve injecting a small amount of the allergen under the skin and checking to see if the skin in that
area becomes inflamed.
Medical Regimens for Asthma
Medical approaches provide the cornerstone of treatment for asthma. Asthma regimens consist of three
components, the first being to avoid known triggers of attacks. The second component involves
medication. To treat an acute attack, patients mainly use bronchodilators, which open up constricted
airways. To prevent attacks patients can use anti-inflammatories, such as inhaled or oral corticosteroids and
cromolyn, which reduce bronchial inflammation or block the release of histamine and other chemicals that
cause inflammation.
The third component of asthma regimens involves exercise. In the past, physicians advised many
asthmatics to avoid exercise because it could induce an attack. But it now appears that the less these people
exercise, the worse their conditions get. Many physicians today recommend treatment regimens that
carefully combine fitness training and the use of medication.
Asthma's potential for producing disability and, sometimes, death makes it important that patients adhere to
their regimens. Although adhering to asthma regimens reduces attacks and incidents of wheezing, many
asthmatics fail to take medication to prevent attacks and use medication during an attack incorrectly.
Psychosocial Factors in Asthma
Many people with asthma report that the triggers of their attacks often involve their emotional states, such
as being worried, angry, or excited. Experimental research has shown that emotional arousal; such as when
watching an exciting movie, can trigger attacks in some children. Studies have also found that suggestion
can induce symptoms in some asthmatics.
In one study, researchers had asthmatics inhale several doses or a placebo solution, with each succeeding
dose labeled as containing an increasingly strong level of an allergen. Nearly half of the subjects developed
symptoms, either as full asthmatic attacks or as spasms of the bronchial muscles. Another study confirmed
the effect of suggestion, but also showed that the asthmatic reaction could be negated if the subjects were
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first given another placebo that was described as a new asthma drug. In other words, the first suggestion
blocked the second one.
For example, studies have shown that false feedback indicating that the airways are becoming obstructed
increases breathlessness in people with asthma.
Although there is little question that psychosocial factors can influence asthma attacks, we do not know
how these factors work and which asthmatics are more affected by them. It is possible that psychosocial
factors make asthmatics more sensitive to allergens or other conditions that trigger their attacks.
Asthma attacks are frightening for the patient and family alike; and frequent episodes are costly to the
family and disrupt these people's lives and functioning. Living with this disorder adds to the stress that
asthmatics and their families' experience, and studies have found that asthma is sometimes related to
maladjustment in patients and their families.
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Table of Contents:
  1. INTRODUCTION TO HEALTH PSYCHOLOGY:Health and Wellness Defined
  2. INTRODUCTION TO HEALTH PSYCHOLOGY:Early Cultures, The Middle Ages
  3. INTRODUCTION TO HEALTH PSYCHOLOGY:Psychosomatic Medicine
  4. INTRODUCTION TO HEALTH PSYCHOLOGY:The Background to Biomedical Model
  5. INTRODUCTION TO HEALTH PSYCHOLOGY:THE LIFE-SPAN PERSPECTIVE
  6. HEALTH RELATED CAREERS:Nurses and Physician Assistants, Physical Therapists
  7. THE FUNCTION OF NERVOUS SYSTEM:Prologue, The Central Nervous System
  8. THE FUNCTION OF NERVOUS SYSTEM AND ENDOCRINE GLANDS:Other Glands
  9. DIGESTIVE AND RENAL SYSTEMS:THE DIGESTIVE SYSTEM, Digesting Food
  10. THE RESPIRATORY SYSTEM:The Heart and Blood Vessels, Blood Pressure
  11. BLOOD COMPOSITION:Formed Elements, Plasma, THE IMMUNE SYSTEM
  12. SOLDIERS OF THE IMMUNE SYSTEM:Less-Than-Optimal Defenses
  13. THE PHENOMENON OF STRESS:Experiencing Stress in our Lives, Primary Appraisal
  14. FACTORS THAT LEAD TO STRESSFUL APPRAISALS:Dimensions of Stress
  15. PSYCHOSOCIAL ASPECTS OF STRESS:Cognition and Stress, Emotions and Stress
  16. SOURCES OF STRESS:Sources in the Family, An Addition to the Family
  17. MEASURING STRESS:Environmental Stress, Physiological Arousal
  18. PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH
  19. HOW STRESS AFFECTS HEALTH:Stress, Behavior and Illness, Psychoneuroimmunology
  20. COPING WITH STRESS:Prologue, Functions of Coping, Distancing
  21. REDUCING THE POTENTIAL FOR STRESS:Enhancing Social Support
  22. STRESS MANAGEMENT:Medication, Behavioral and Cognitive Methods
  23. THE PHENOMENON OF PAIN ITS NATURE AND TYPES:Perceiving Pain
  24. THE PHYSIOLOGY OF PAIN PERCEPTION:Phantom Limb Pain, Learning and Pain
  25. ASSESSING PAIN:Self-Report Methods, Behavioral Assessment Approaches
  26. DEALING WITH PAIN:Acute Clinical Pain, Chronic Clinical Pain
  27. ADJUSTING TO CHRONIC ILLNESSES:Shock, Encounter, Retreat
  28. THE COPING PROCESS IN PATIENTS OF CHRONIC ILLNESS:Asthma
  29. IMPACT OF DIFFERENT CHRONIC CONDITIONS:Psychosocial Factors in Epilepsy