Werfel / Durán / Trettin Multiple Sclerosis

2016
ISBN: 978-1-61334-409-5
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 126 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

Comprehensive, practical, concise, and up-to-date guidance on the most effective medical, psychological, and neuropsychological diagnostic methods and interventions with multiple sclerosis (MS)
This innovative book will help both mental health and medical professionals empower patients or clients to live well with multiple sclerosis (MS).
It is a practical, evidence-based, culturally relevant guide to the most effective current medical, psychological, and neuropsychological diagnostic methods and interventions. The book describes a biopsychosocial, multidisciplinary, and integrative approach to treatment and provides information on psychological, mind-body, and complementary interventions for symptom management and to increase quality of life.

Both seasoned practitioners and students will find this volume useful in helping clients cope with this complex, unpredictable, and chronic neurological disorder.

Zielgruppe

For clinical psychologists, psychiatrists, psychotherapists and counselors, as well as students.

Autoren/Hrsg.

Werfel, Pearl B.

Durán, Ron E. Franco

Trettin, Linda J.

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
• Sozialwissenschaften Psychologie Psychologische Disziplinen Gesundheitspsychologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Neurologie, Klinische Neurowissenschaft
• Sozialwissenschaften Psychologie Allgemeine Psychologie Biologische Psychologie, Neuropsychologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Leseproben

[36][37]2 Theories and Models Most models of chronic illness and disability (CID) tend to focus on the individual – how the diagnosed patient is affected by the diagnosis, treatment, and progression of the disorder. This may be a reflection of the prevailing values of autonomy, independence, and individualism in many modern Western cultures. However, there are professions – such as family medicine and social work – that understand chronic illness from a systems perspective and strive to treat the whole family. When an individual is diagnosed with CID, the entire family system is affected, and the goal of treatment is to assist family members to cope effectively with changes in roles resulting from the MS diagnosis, treatment, and progression. The systemic perspective of these professions may be particularly compatible with the worldviews of clients from more traditional, collectivistic cultural backgrounds for whom family is highly valued. Mental health professionals should recognize the important role of family when treating clients living with MS. 2.1 Models of Illness and Disability There are many ways that people living with MS, their families, and their associates may attempt to fathom the complexities of MS. Understanding how a client and significant others are conceptualizing MS will aid in the assessment and increased ability to tailor your interventions. In addition, educating clients about different models of illness and disability, and their implications, will allow your client to evaluate the effect of their beliefs on their ability to cope. Olkin (1999) described three models of disability: the moral, medical, and minority models. The biopsychosocial model is increasingly prevalent. 2.1.1 Moral Model This model views MS as a defect caused by a moral lapse or sin. A diagnosis of MS might cause shame for the person with MS and their family and the diagnosed person and/or family members may feel responsible for causing MS. Through this lens, MS may also be viewed as a test of faith. Although, this model is not prevalent in Western culture, if it is part of a client’s or family’s belief system then exploration in therapy is important. Additionally, consultation with a client’s religious leader will enable a psychotherapist to gain insight into how to best address coping. [38]2.1.2 Medical Model This model views MS as a medical problem that results from a defect or failure of the bodily system. The person with MS is referred to as a “patient” who needs to be helped by trained professionals. In the medical model, disability is a pathology located within the individual that deviates from norm and treatment is focused on “fixing” the individual. The impact of this model can be disempowering. The expertise lies with professionals, so self-management is not encouraged and the person living with MS is not considered a knowledgeable participant in their own healthcare team. 2.1.3 Minority Model This model defines MS-related disability as a social construct brought about by attitudes and other features of the social environment. The problems lie not with the individual but with the environment. With this model, MS-related disability becomes a socially created problem and an attribute of an individual. The solutions needed to address MS-related disabilities involve social and political fields, including universal design, education, and changes in the law. 2.1.4 Biopsychosocial Model In 2001, the World Health Organization developed The International Classification of Functioning, Disability and Health (ICF) based on the biopsychosocial model. The ICF provides a coherent view of different perspectives of health: biological, individual, and social. Disability and functioning are viewed as outcomes of interactions between health conditions (diseases, disorders, and injuries) and contextual factors. Contextual factors can be external and environmental (social attitudes, architectural characteristics, legal and social structures, climate, terrain, etc.) or internal and personal (gender, age, coping styles, social background, education, profession, past and current experience, overall behavior patterns, character and other factors that influence how disability is experienced by the individual). 2.2 Minority Stress Model The minority stress model has been used to explain health-related consequences of oppression in minority-status populations, including sexual minorities (e.g., Meyer, 1995) and African Americans (e.g., Clark, Anderson, Clark, & Williams, 1999). Briefly, the minority stress model is a biopsychosocial model that explains how various actual and perceived forms of oppression (e.g., prejudice, exclusion, aggression) from different others (out group), similar others (in group), and self can influence the onset and progression of a wide variety of disease processes (physical and emotional) via the stress response. Although it may be applicable to persons living with MS, it is important to[39] note that the minority stress model has not specifically been investigated in this population. Nevertheless, there are important notions about the minority stress model to consider when working with anyone living with a chronic illness or disease. For persons living with MS, stressors associated with the unpredictability of disease course include challenges to expectations from self, as well as from others. For example, physical functioning in persons living with MS may suddenly become severely compromised one day and return a few days later. How one cognitively “frames” (perceives, understands) these unpredictable changes may have a dramatic influence over how one may directly (e.g., by way of stress-related hormones) or indirectly (e.g., by way of coping behaviors) affect the disease course. Similarly, how others perceive these changes has a great influence on their own responses, which can be adaptive (e.g., offering social support) or maladaptive (e.g., expressing doubt of the symptom’s authenticity) for the person living with MS. There are two remarkable aspects of the minority stress model. First, the consequences of oppression are believed to be just as robust when oppression is perceived as when it is objectively experienced. This speaks to the strength of perceptions and schemas (cognitive frames of experience). Second, major sources of oppression include one’s self and similar others. That is, internalized oppression and in-group oppression can have robust direct and indirect influence on disease processes – as much, if not more, than persecution from the majority group. 2.3 Depression 2.3.1 Depression and Psychosocial Factors Some investigators have suggested that a relationship between physical disability and depression exists and is indirect; they note that disability affects psychosocial outcome to the degree that impairment is intrusive and personal control is threatened. Unemployment among individuals with MS is associated with a lower quality of life and is a strong predictor of a major depressive episode in persons with MS. In addition, depression is associated with reduced perceived social support. Qualitative changes in social networks and personal relationships, as a result of their disease, are often reported. 2.3.2 Depression and Neurologic Integrity Given that MS attacks myelin and affects the integrity of nerve conduction, mood changes may be a direct neurological consequence of the disease. Mood symptoms are often found in neurological diseases when there is a subcortical component. An association between brain atrophy, as well as lesion volume (Mohr et al., 2003) and lesion location (i.e., the right temporal region or arcuate fasciculus), with depression has also been noted. [40]2.4 Anxiety Disorders Anxiety is also a salient issue in MS, with perceptions of increased psychosocial stressors and decreased social support presenting as important factors in the development of an anxiety disorder, particularly generalized anxiety disorder (Korostil & Feinstein, 2007). In addition, other risk factors for the development of anxiety within MS have been identified and include female gender and a comorbid diagnosis of depression. Unexpected disrupting events in daily life serve as a reminder of MS (Kalb, 2007). For instance, among individuals with MS, those who experience relapses were shown to have the highest levels of anxiety as compared with those in remission. The assumption that anxiety emerges as a reactive phenomenon to a variety of situations is strengthened by the lack of association between anxiety and MRI abnormalities (Sá, 2008). In addition, the onset of anxiety related to needles/injections associated with treatment (i.e., self-injectable immunomodulatory drugs) may affect 50% of MS patients (Mohr, D. C., et al., 2002), although lower prevalence rates have been cited and may reflect anxious avoidance about injections rather than a frank needle phobia. 2.5 Cognitive Impairment 2.5.1 Primary Contributors to Cognitive Impairment Primary contributions to cognitive dysfunction include brain changes Advances in technology, such as neuroimaging, have provided insights into the association between the development of cognitive dysfunction to overall disease burden in MS (e.g., lesions, atrophy) and other specific neuropathological contributors (Julian, 2011). Cognitive difficulties can be a direct consequence of the location and extent of neuropathology and are generally not considered to be...