1
Q
What are the factors that make up the psychological component of the BPS?
A
Learning, memory, attitudes/ beliefs, past experiences, expectations of future experiences, personality, behaviours and coping skills
2
Q
What are the factors that make up the social component of the BPS?
A
social supports, family background, cultural traditions, socioeconomic situation and education
3
Q
What are the factors that make up the biological component of the BPS?
A
genetic vulnerability, sex, immune function, stress reactivity, impairments, neurochemistry, medication effects and environment interactions
4
Q
Is each component of the BPS model equally contributing?
A
No, the framework is fluid because people are individual and situations change
5
Q
What are the components of the common sense model?
A
situational stimuli, illness representation, coping strategies, outcomes and coping appraisal
6
Q
What does situational stimuli the the CSM refer to?
A
lay information stored in memory:
- expert sources
- past experiences
- symptoms
7
Q
What does illness representations in the CSM refer to?
A
cognitive
- identity
- consequence
- causes
- timeline
- control
- coherence
emotional
8
Q
What does the situational stimuli tell you?
A
Where i get my information
9
Q
What does the illness representations tell you?
A
what I believe, expect and feel
10
Q
What does the coping strategies component of the CSM refer to?
A
-avoidance
- cognitive reappraisal
- emotion venting
- problem focussed coping
- seeking social support
11
Q
What does the coping strategies tell you?
A
How do I manage?
12
Q
What does the outcomes component of the CSM refer to?
A
progress of illness (disease state)
- physical
- role
- social
emotional:
- distress
- psychological wellbeing
13
Q
What does the outcomes tell you?
A
what impact is it having?
14
Q
What does the coping appraisal component of the CSM refer to?
A
evaluation of impact of coping strategies on illness outcomes
15
Q
What does the coping appraisal tell you?
A
is it working?
16
Q
How can stress be defined?
A
Stress is a stimulus (stressor), response (to stimuli) or process
‘stress is the non-specific response of the body to any demand’
17
Q
What are the different type of stressors?
A
brief naturalistic, acute time-limited, stressful event sequences, chronic stressors and distant stressors
18
Q
What are brief naturalistic stressors?
A
a real-life short term challenge
19
Q
What is the duration of a brief naturalistic stressor?
A
uncertain but brief
20
Q
What are egs of brief naturalistic stressors?
A
zoom technology glitch, assignment
21
Q
What are acute time-limited stressors?
A
a short term challenge
22
Q
What is the duration of an acute time limited stressor?
A
known and short
23
Q
what is an example of an acute time limited stressor?
A
work task, public speaking or health consult
24
Q
What are stressful event sequences?
A
a focal event giving rise to a series of related challenges
25
What is the duration of stressful event sequences
duration uncertain but will improve/ end at some point in the future
26
What is an eg of a stressful event sequence?
loss of a spouse or a major natural disaster [covid]
27
what are chronic stressors?
pervade a person's life, forcing them to restructure identity or social roles
28
what is the duration of a chronic stressor?
long duration, uncertain when or if the challenge will end
29
what is an example of chronic stressors?
traumatic disabling injury/ condition, providing care for a spouse with severe dementia, or being a refugee forced out of one's native country by war
30
what are distant stressors?
experiences in the distant past have ongoing potential to modify immune system function [cognitive and emotional sequelae]
31
what is the duration of distant stressors?
long duration
32
What is an example of distant stressors?
physical/ sexually assault as a child/ adult, witnessing violence/ traumatic deaths, detained as a prisoner of war, criminal system, refugee
33
What is the acute stress response?
When a threat is perceived, hormones flood the body for emergency action. Physical changes in the body such as increased RR,BP, HR all increase strength and stamina to enhance focus to fight or flee
34
what is the first step when the HPA axis is activated?
corticotrophin-releasing hormone and arginine vasopressin (AVP) are released from the hypothalamic paraventricular nucleus
35
What is the second step when the HPA axis is activated?
this induces the release of adrenocorticotropic hormone from the pituitary gland into the systemic circulation
36
What is the third step when the HPA axis is activated?
ACTH will activate cortisol synthesis in the cortex of the adrenal gland
37
Does cortisol negatively regulate the HPA axis?
Yes
38
What is allostatic load?
“Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria."
39
What is result the physiological and behavioural changes due to stress?
Adaptation
40
What are the axis' of the stress continuum?
Performance and stress level
41
Is stress an ongoing process where the brain adapts to our daily experiences?
“…stress biology is not simply an “emergency system,” but rather an ongoing process: the body and brain adapt to our daily experiences whether we call them stressful or not.
42
Does the acute stress response start in the limbic system?
Yes
43
What are the 6 F's of the stress response?
Freeze
Flight
Fight
Fright
Flag
Faint
44
what is a sign?
what other people see/ measure
45
What is a symptom?
only the person experiencing it
46
What are bodily signs of stress?
pounding heart, muscle tension, muscle pain, headaches, shallow breathing, sweating, nausea
47
What are emotional symptoms/ feelings of being?
overwhelmed, frustrated, irritable, guilty, unhappy, helpless, angry, resentment, impatient, agitated and lonely
48
What are cognitive symptoms?
memory problems, inability to concentrate, poor judgement, racing thoughts, anxiety, constant worrying
49
What are some stress behaviours?
eating more or less, sleeping more or less, isolating yourself, procrastination, nervous habits, using alcohol, cigarettes or drugs
50
Cardiovascular consequences of long term stress include?
atherosclerosis, angina, myocardial infarction, rhythm disturbances, renal disease, cerebral vessel disease = stroke
51
what is the difference between stress and anxiety?
Stress is the body’s reaction to a threat, whereas anxiety is the body’s reaction to the stress.”
52
What are some other stress related illnesses?
hypertension
anxiety
depression
diabetes
heart attack
53
what does INTJ stand for?
introverted, intuitive, thinking, judging
54
What does introverted in INTJ mean?
thought orientated, reserved, reflective, observant
55
What does intuitive in INTJ mean?
imaginative, future orientated, conceptual, abstract
56
What does thinking in INTJ mean?
logical, reasonable, level headed, values fairness
57
what does judging in INTJ mean?
organised, systemic, achievement orientated, planner
58
What is burnout?
burnout is a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. it is characterised by three dimensions: exhaustion, mental distance, reduced professional efficacy
59
What are the physical signs and symptoms of burnout?
* Feeling tired and drained most of the time, lowered immunity, feeling sick a lot, frequent headaches, back pain, muscle aches, Change in appetite or sleep habits
60
What are the emotional signs and symptoms of burnout?
* Sense of failure and self-doubt, feeling helpless, trapped, and defeated
* Detachment, feeling alone in the world, loss of motivation. Increasingly cynical and negative outlook, decreased satisfaction and sense of accomplishment
61
What are the behavioural signs and symptoms of burnout?
* Withdrawing from responsibilities, isolating yourself from others, procrastinating, taking longer to get things done, using food, drugs, or alcohol to cope, Taking out your frustrations on others, skipping work or coming in late and leaving early
62
What are the four methods to manage stress?
attention - centering technique, expressive - creative strategy, reflection exploration strategies, and healthy lifestyle values
63
Does exposure to threats/ stress cause associative learning?
Yes
64
What are survival sensations that can cause a fear response?
Thirst
Hunger
Nausea
Breathlessness
Pain
65
does the more a threat increases, motivate more of a behavioural response?
Yes
66
What is interoception?
'Interoception refers to the process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body’s internal landscape across conscious and unconscious levels.”
67
Why would individuals delay seeking help for a symptom?
Individuals may delay seeking help for a symptom if they:
* are ‘poor perceivers’ -ie do not perceive the symptom
* Misinterpret the symptom
* Are worried about:
o finding a ‘bad’ cause
o Feeling dismissed
67
What are sensations?
Sensations are perceptions created centrally from multiple sources of information from the body and the brain
68
Do explanations impact beliefs and expectations?
Yes
69
What is the emotional response of breathlessness?
Frightened, anxious, depressed, uncomfortable, worried
70
What are the sensory symptoms of breathlessness?
tight, puffing, suffocating, SOB, hard work
71
What scale does breathlessness follow?
pleasant to unpleasant
72
What are some examples of acute events that cause unpleasant breathlessness?
Respiratory infections [e.g Covid, pneumonia]
Cardiovascular [e.g heart attack, heart failure]
Trauma/injury [e.g chest trauma]
Inflammatory events [e.g asthma attack, anaphylaxis]
73
What are some chronic conditions that cause dysopnea?
COPD, asthma, heart failure, renal failure, MND, severe kyphoscoliosis
74
Does the body sense tightness from airway receptors when breathless?
Yes
75
Does the body become air hungry and unsatisfied with inspiration when breathless?
Yes
76
Does altering afferent input about breathlessness help as a therapeutic option?
Yes, changing the beliefs about breathlessness can help to treat breathlessness. For example (the more you exercise, the more you are going to believe exercise helps with breathlessness)
77
What happens when we do talk about breathlessness?
unintended consequences + feeds maladaptive beliefs /expectations
78
Does oxygen saturation have to be low for you to feel breathless?
No
79
Is oxygen prescribed to help those with breathlessness?
No
80
Is pain an illusion based off of previous experiences and how dangerous we perceived them to be?
Yes
81
What are some Influences on a Delay Behavioral Response to Symptoms?
* Financial reasons for delay
* Cultural influences
* Age
* Gender
* Symptom type
* Symptom location
* Symptom prevalence
* Influence of other people
* Emotions and traits
* Treatment beliefs
82
How is health defined?
“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
83
What is a health behaviour?
‘. . . overt behavioral patterns, actions and habits that relate to health maintenance, to health restoration and to health improvement’
84
What is a behavioural immunogen?
protective /beneficial for health
(daily exercise, average weight, diet, socially connected)
85
What is a behavioural pathogen?
increased risk for poor health (sedentary, smoking, elicit drugs, overweight, socially isolated)
86
What does SCI stand for?
systemic chronic inflammation
87
What are the big 6 modifiable health behaviours?
physical inactivity, obesity, diet, isolation and chronic stress, disturbed sleep and xenobiotics
88
What are motivators to increasing physical activity?
* Physical fitness
* Weight loss
* Improve appearance
* Maintain or enhance health – belief
* Improve self image
* Improve mood
* Reduce stress
* Socialise
* My friends /significant others exercise – perceived as being really important
* Grew up in a family/culture where exercise was usual/expected
89
What are barriers to increasing physical activity?
* Lack of time
* Cost
* Lack of access (geographical/safety)
* Embarrassment
* Lack of self belief
* No perceived immediate benefit
* Lack of support person
* My friends /significant others don’t exercise
* Grew up in a family/culture where exercise was not usual /expected
90
is behaviour change simple?
rarely, it rarely occurs that you give someone information and their attitude change is enough to sustainably change behaviour
91
What are the core constructs of the health belief model?
* Perceived susceptibility & perceived severity (individual perception)
* Perceived benefits & perceived barriers
* Cues to action (public health messaging)
* Self-efficacy
92
What is the transtheoretical model of change?
The Transtheoretical Model (TTM) of behaviour change proposes that people are at different stages of readiness to adopt healthful behaviours.
93
What are the stages of change in the transtheoretical model?
1. precontemplation
2. contemplation
3. preparation
4. action
5. maintenance `
94
What is social cognitive theory?
interactions between personal factors, behaviours and environmental influences.
95
What is the social ecological model?
Social ecological models emphasize multiple levels of influence (such as individual, interpersonal, organizational, community and public policy) and the idea that behaviours both shape and are shaped by the social environment.
96
What are the components of the COM-B model?
capability, motivation, opportunity and behaviour
97
Why do we talk about behaviour change?
Our treatment is rarely effective without the commitment of the patient outside of the clinic, voluntary behaviours are very important
98
What is a behaviour change technique?
“A BCT is the smallest component of behaviour change interventions that on their own in favourable circumstances can bring about change.”
99
What are the 16 categories of BCTs?
goals and planning
feedback and monitoring
social support
shaping knowledge
natural consequences
comparison of behaviour
associations
repetition and substitution
comparison of outcomes
reward and threat
regulation
antecedents
identity
schedule consequences
self-belief
convert learning
100
What are some examples of BCTs?
behavioural substitution, habit formation, habit reversal, overcorrection, graded tasks and framing
101
What are acute or rehabilitative recovery behaviours?
* Learn a new behaviour
* Relearn a behaviour
* Improve a behaviour
102
What is an explanation?
* Contextual [context or situation]
* Relevant [Cause /situation/context]
* May describe mechanism of action or proposed/desired outcome
* May include a contrast [what it is not]
103
What is an instruction?
Instructions advise someone what to do.
* Set of actions
* Usually has an order
* Usually has a context
* May include -What to do if..? or
* ‘What not to do/be careful of…”
104
Are explanations behaviour change techniques?
Yes
105
Is chronic safe jargon?
No, patients think their condition is incurable
106
Is wear and tear safe jargon?
no, people believe there is nothing to help wear and tear and they simply have to put up with it
107
What is jargon?
“Jargon is a type of language that is only understood by a particular group of people.”
108
How do typical patients see OA?
* knee OA is “bone on bone”
* caused by “wear and tear”
* loading knee = further damage “vulnerable” joint
* pain will deteriorate over time
* exercise interventions will increase pain
109
What is feedback?
* Specific to context /component
* Unambiguous
* Timely
* Based on previous performance
* Includes successful component and areas for improvement
* May have threshold for achievement
* Feedback can take a lot of forms e.g. written or verbal
110
What is effective feedback influenced by?
* Education /training
* Confidence/comfort levels
* Prior experience of similar situations
* Habitual /default positions
* Gender / culture
111
What are some non-verbal forms of feedback?
- Tactile [reposition]
- Facial expression
112
What are affirmations?
* Motivational statements [“well done”, “cool, cool” “great”
* Nonspecific - imply have achieved performance outcome?
* Default /automatic statements
113
Are affirmations important?
yes, but it is important that affirmations are given alongside good feedback
114
What is inherent self-talk?
“ refers to thoughts individual experience
intrinsically, also referred to as automatic self-talk, because these are the things we say to ourselves which are not planned or prepared.”
115
What is strategic self-talk?
“refers to the instrumental use of cues or phrases that are planned or used in a systematic way as a mental self-regulatory strategy
116
What does feedback inform the participant about?
Informs the recipient:
* about their progress
* skills attained (what you are doing well /correctly)
where skill can be improved (what can be improved/corrected)
117
What are some barriers to feedback?
* Generalised feedback not related to specific facts
* Lack of advice on how to improve behaviour
* A lack of respect for the source of feedback
* Fear of upsetting colleagues
* Fear of damaging professional relationships
* Defensive behaviours /resistance when receiving feedback
* Physical barriers: noise or improper time, place or space
* Personal agendas
* Lack of confidence
118
What are some tips to giving effective feedback?
* Plan in advance
* Give promptly, right after the event
* Think about what you want to achieve and drive discussion accordingly
* Start gently
* Be specific
* Encourage self-reflection
* Be aware of non verbal cues (facial expression, body language)
* Self reflect after the feedback session is completed
119
What is the definition of motivation?
enthusiasm for doing something
120
What are the intrinsic and extrinsic concepts of motivation?
intrinsic motivation is something you want to do, whereas extrinsic is something that you have to do
121
What is important about therapeutic alliance?
that the patient and the therapist are as much on the same level of power that they can be
122
Why do we care about compliance?
for example, a significant relationship was found between academic success and the number of hours students participated in and interacted with the online learning system
123
motivators to exercise
* Physical fitness
* Weight loss
* Improve appearance
* Maintain or enhance health
* Improve self image
* Improve mood
* Reduce stress
* Socialise
* My friends /significant others exercise
* Grew up in a family/culture where exercise was usual/expected
124
list some barriers to exercise?
* Lack of time
* Cost
* Lack of access (geographical/safety)
* Embarrassment
* Lack of self belief
* No perceived immediate benefit
* Lack of support person
* My friends /significant others don’t exercise
* Grew up in a family/culture where exercise was not usual /expected
125
What is motivational interviewing?
“Motivational interviewing is a collaborative, person-centered form of guiding to elicit and strengthen motivation for change.”
126
What are ten things that motivational interviewing is not?
(1) the transtheoretical model of change
(2) a way of tricking people into doing what you want them to do
(3) a technique
(4) decisional balance
(5) assessment feedback
(6) cognitive-behavior therapy
(7) client-centered therapy (type of psychotherapy)
(8) easy to learn
(9) practice as usual
(10) a panacea. (not a magic bullet that will fix everything)
127
What are the four general principles of motivational interviewing?
resist, understand, listen, and empower
128
What does resist refer to in motivational interviewing?
resist the urge to change the individual’s course of action through didactic means
129
What does understand refer to in motivational interviewing?
understand it’s the individual’s reasons for change, not those of the practitioner, that will elicit a change in behaviour
130
What does listen refer to in motivational interviewing?
listening is important; the solutions lie within the individual, not the practitioner (active listening and listening with empathy)
131
What does empower mean in motivational interviewing?
empower the individual to understand that they have the ability to change their behaviour.
132
What does OARS stand for in the OARS framework?
Open ended questions
Affirmations
Reflective listening
Summarizing
133
What are the motivational interviewing techniques?
planning technique, reflective statements, summary statements, affirmations, open ended questions, importance ruler and confidence ruler
134
When might you use the MI techniques?
* Whenever you are information gathering?
* Subjective assessments? [depending on how acute the client is]
* During Objective assessments?
* During treatment?
135
What two categories fall in between opportunity and behaviour?
social and physical
136
What two categories fall in between behaviour and motivation?
reflective and automatic
137
What two categories fall in between capability and behaviour?
psychological and physical
138
What are the four categories of the cycle of anxiety?
bodily sensations, thoughts, feelings/ emotions and actions/ behaviours
139
what does bodily sensations refer to in the cycle of anxiety?
how conscious we are of body sensations - and if we are very aware of sensations... what thoughts do we have about these sensations. what do we tell ourselves to explain these? (^HR, RR, sweating etc)
140
What does the thoughts section of the cycle of anxiety refer to?
thoughts can be helpful - this is normal, always feel like this// or not helpful - my heart is racing, i can't breathe, i am going to faint
141
What does the feelings/ emotions section of the cycle of anxiety refer to?
thoughts influence our ability to regulate our emotions. regulation is helpful explanations and thoughts whereas unregulated is reactive explanations and thoughts
142
What does actions/ behaviours refer to in the cycle of anxiety?
immediate actions: endure and continue in the situation? exit the situation? safety behaviours? helpful or not helpful in the short or longer term?
143
Do we learn from each occasion and apply or avoid future similar situations?
yes
Biopsychosocial Practice
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