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Suzanne Ruff, PhDHealth Psychologist
Cleveland VA Medical CenterCleveland, Ohio
Chronic Medical ConditionsThere are three tasks in managing a chronic
medical conditionCare for your condition, learn about your
conditionManage any emotional changes that your
condition may bring aboutReturn to your pre-diagnosis life as fully and as
soon as possiblePartner with your medical caregivers
and your family and friends
Stages of diagnosisPre-diagnosis
Anxiety Signs and symptoms not recognized YOU know there is something wrong Medical providers may not know what is wrong You may begin to second guess yourself – especially
in a condition with varying symptomsAnger
You can’t do what you used to do You want your life back
Stages of diagnosisDiagnosis
Relief It’s not all in my head
Anxiety Can be heightened – especially with relatively rare
condition Diagnosis known, but prognosis uncertain
Anger “Why me?”
Depression Later in time
Stages of diagnosisAfter diagnosis, mood varies with:
acuity of disease, number and severity of flaressupport availablemedical care availableability to return to life before diagnosis
1978 study on mood variation with significant eventSpinal cord injuryWinning the lottery
Stages of diagnosis
Most people return to their baseline mood about a year after injury or winning the
lottery
Psychology of chronic illnessWhat does this mean to patients with a
chronic medical condition?Chronic medical conditions can lead to
depression over timeOften unrecognized
Overlap of symptoms No pathognomic feature in depression Most common is anhedonia, not a sad mood Lack of restorative sleep, daytime fatigue Cognitive changes
Diagnosis and treatmentRecognize symptoms
Mood, somatic symptoms, cognitive symptoms, Anhedonia
Relationships Activities Meaning and purpose in life
Seek responsible treatment Partner with your medical providers and especially
MG provider Think about therapy rather than medications
Psychological therapiesCognitive Behavioral TherapyCognitive Processing TherapyNarrative TherapyAcceptance and Commitment TherapyPositive Psychology Therapy
Combination therapiesPartner with your providers
Positive PsychologyMartin Seligman, PhD, University of
Pennsylvania founded the field of Positive Psychology in the late 1990’s
He first studied “Learned Helplessness” in the 1960’s
He then turned to “Learned Optimism” President of APA
A return to what is right with peopleFormed a panel to study happinessPhenomenally successful
Positive PsychologyDefine happiness – essentially a sense of well-
beingNot hedonism, not about material things
Must be measurable and changeable Deconstructed the unwieldy term of happiness
into:Positive emotionPurposeEngagementPositive relationshipsPositive accomplishments
Positive PsychologyPositive emotions
Studied by Barbara Fredrickson, PhD at UNCPositivityratio.com
Measures positive emotion to negative emotion ratio
FREE!
Positive character strengthsCommunity involvement – values in action
Positive PsychologyPositive emotion
Broaden and build theory Broaden
Positive emotions lead to more flexible thinking Positive emotions lead to more expansive vision Positive emotions lead to more creative thinking
Build Positive emotions build stronger relationships Positive emotions build emotional reserves Positive emotions build future protection
Positive PsychologyMost studied positive emotion
JoyLoveInspirationHumorAwePrideTranquilityGratitudeInterestHope
Positive PsychologyIncrease positive emotions and decrease
negative emotionsGratitude journalDevelop new interestsDeepen current interestsMindfulness Savor positive events, conversations, Distraction when negative thoughts occurDefuse negative ‘landmines’
Positive PsychologyPurpose and engagement
Positive character traitsPanel formed to look for universal character
strengths Ubiquitous character strengths What enables a community or culture to survive and
flourish? Read philosophical, religious, and historical works
Six meta traitsWisdom Temperance Humanity JusticeCourage Transcendence
Positive PsychologyAuthentichappiness.org
Take the VIA test – long versionFREE!Your top 5 strengths
WISDOM - Love of learning, perspective HUMANITY - Love, kindness COURAGE - Persistence, vitality TEMPERANCE – Prudence, self-regulation JUSTICE – Leadership, fairness TRANSCENDENCE – Humor, spirituality
Positive Psychology“Bloom where you’re planted” or increase the
Big FiveThe Big Five
GratitudeCuriosityHope/optimismAppreciation of beauty and excellenceVitality
Jumped categories – from transcendence to courage
Positive PsychologyHow to become depressed
Dwell on the negativeLose interest in most things and peopleBecome convinced that negative things are
permanent, pervasive, and not under your controlLose your sense of wonderStop moving
Not exercising is like taking a “depressant”
Compare these to the Big Five
Positive PsychologyPositive relationships and positive
accomplishmentsMost easily achieved through use of your strengthsFamily, friends, social circlesCommunity involvementWork, volunteering
What are your values? What are you committed to? What makes your heart beat faster? What makes
you get up in the morning? What drives you?
Stages of ChangePre-contemplationContemplationPlanningActionMaintenance
Identify, target, make a plan and carry it out
Stages of ChangeLife balance
What do you value?Pillars of life
FamilyIntimate relationshipFriendsCommunity involvementSpiritual lifeWork, volunteeringHobbies, funLearning/growingPhysical healthPhysical space_____________
Stages of ChangeIdentify your values
How are you actually spending your time?How would you like to spend your time?
Target areas for changeWhat is balanced? Keep thoseWhat is necessary? Be realisticWhat would you like to change? Make a plan
Plan for change and maintenance
Stages of ChangeLife balance worksheet, part 1
Average day or weekDifficult to do unless you carry sheet around –
memory is not great for this type of activityLife balance worksheet, part 2
+ column, - column, = columnMaintain – no stealing from balanced row
Life balance worksheet, part 3Make a planBe realistic, flexible, positive
PositivityPositivityratio.com
10 questions on positive emotions10 questions on negative emotions1 point assigned for any negative emotion
Due to negativity bias1 point assigned for any positive emotion
experienced at a moderate level
3:1 ratio is associated with flourishing
Positive PsychologyVery promising new field for Positive Health
Not absence of diseaseStrong results with studies involving literally
hundreds of thousands participants in Health Psychology
EmpoweringNeeds to be personalized
Positive stepsKeep a gratitude journalSavor the good timesUse the Life Balance chart to help you decide
where to spend your timeGet involved with what or who you lovePace yourself
Use some of your “good” days to spend in pleasurable and meaningful activities
Be activeKeep it up!