Join Log in Profile Search

Article summary with Health psychology and stress: psychological interventions in chronic illness by Maes & Elderen - 1998

Back to top

Psychological interventions in chronic diseases

The article shows a model in which an attempt is made to structurally represent the variety of psychological interventions in the case of chronic illness. We look at differences in terms of:

  • Intervention goals.
  • Intervention level.
  • Intervention channel.
Back to top

The intervention goals: the quality of life and self-management

Every psychological intervention is aimed at improving the quality of life and/or self-management. Interventions with a primary focus on quality of life aim to increase physical, psychological or social well-being. The goal here is to minimize the negative impact of the chronic disease. However, the effects on the quality of life are limited and temporary.

Interventions with a primary focus on stress management include relaxation techniques and work with cognitive restructuring. The effectiveness of these types of interventions has been demonstrated for patients with coronary heart disease and patients with cancer. Accurate stress management programs can affect both the quality of life and the progression of the chronic disease. Mortality in cancer and coronary heart disease can also be influenced by stress management interventions.

With hypertension, relaxation is seen as an effective intervention. It is not yet known why this is so effective. The psychological and physical effects of stress on the immune system have recently been the subject of research.

Social skills training and/or assertiveness training aim to reduce social anxiety. People are also taught to replace dysfunctional reactions in situations that provoke social anxiety.

There are also palliative interventions. These interventions are aimed at improving the quality of life through emotional support. The goal is to reduce stress and speed up acceptance of the disease. These types of interventions are particularly effective just after diagnosis or when the patient is terminal.

Previous intervention types relate to improving the quality of life. In addition, there are also interventions that focus in particular on improving self-management in patients with a chronic disease. Living with a chronic disease often requires a change in lifestyle. In addition, the patient must follow medical advice to reduce disease progression (secondary prevention) and also to reduce the consequences and complications (tertiary prevention).

Approximately half of the patients with a chronic illness do not follow medical advice properly. Whether or not to follow medical advice is not related to personal characteristics or disease characteristics. Whether people follow medical advice is related to the nature of the advice, social support, illness perception, understanding of the advice and treatment plan and characteristics of the relationship between the professional and the patient.

Different techniques are applied in interventions related to self-management:

  • Self-monitoring and self-observation.
  • Setting goals.
  • Drawing up a contract.
  • Shaping (the goal is divided into small steps).
  • Self reward.
  • Stimulus-control.
  • Modeling and observational learning.

The programs combine these and other techniques into an intervention. Such interventions exist for various chronic diseases such as hypertension, coronary heart disease and asthma. These types of programs seem to be more effective than traditional health programs.

Arborelius (1996) has drawn up a model that focuses on individual health support for lifestyle issues. She set up seven principles, which are successful in this:

  1. Patient centered instead of patient oriented.
  2. Reflection on the patient's own behavior.
  3. Finding out the readiness to change of the patient.
  4. Provide neutral knowledge instead of judgment.
  5. The focus is on behavior rather than providing information.
  6. The health ideas of the patient are emphasized.
  7. The pros and cons are discussed.
Back to top

The intervention level: individual patient, group or environment

Professionals are often trained with the idea that interventions aimed at the individual are the best. In The Netherlands, however, one professional is available for every five thousand chronically ill people. In most other countries, one professional has even more chronically ill people under his or her care. It is therefore important to pay attention to more indirect forms of intervention aimed at groups or the larger environment.

Most interventions are based on cognitive behavioral therapy or social learning theory. They use the previously discussed techniques. An example of such an intervention is the 'Heart and Health' program, aimed at patients with coronary heart disease. This intervention is given to groups of 8 patients with partner. A specific topic is discussed during each session based on the needs of the patients. The program has positive effects on patient satisfaction, smoking, eating habits and the use of medical means. Interventions at the environmental level are regularly underestimated. Nevertheless, psychological help is also very important with interventions of this kind.

Back to top

The intervention channel: direct and indirect interventions

Many psychologists prefer direct interventions (psychological interventions performed by a psychologist). However, this type of intervention is not cost-effective. In addition, not all patients require intensive direct interventions. Besides, direct interventions are not always better than indirect interventions. In addition, indirect interventions have the advantage that they can also be carried out by other professionals, who are often closer to the patient.

An example of a successful indirect intervention is 'weight watchers'. Most of these programs are initially designed by a psychologist. Then others were trained to be able to carry out the intervention. This does not seem to affect the effectiveness of the intervention.

Back to top

Conclusion and discussion

The first conclusion is that intervention programs can clearly have many positive effects, especially combined programs.

Secondly, it can be concluded that it is important to pay attention to the different levels of a patient. Psychological interventions now focus primarily on the individual level and ignore the rest. This must be taken into account in the development of new intervention programs. Furthermore, it should be noted that there is often a theoretical base missing, not only for the intervention itself, but also for the measuring instruments used. Secondly, methodological shortcomings in current evaluation studies are often problematic.

General conclusions and discussion

The question that is often asked is: is this intervention effective? While it would be better to ask: for which subgroup is this intervention effective and under which conditions and in relation to what?

Intervention developers must be informed of developments in health psychology and health psychologists must be willing to share this knowledge with many. A collaboration with the World Health Organization to bring health psychology knowledge to the world would be a possible solution to get health psychology on the map worldwide. Unfortunately, there is no interest in this from the field. As a result, the cost effectiveness of many intervention programs is certainly not optimal.

The influence of the social context is often not well represented in most models. A subsequent problem of this is: minority groups that often could benefit the most from interventions are often not reached.

People who are more at risk are becoming a bigger problem to handle. Due to medical developments there are more possibilities to identify risk groups (for example the presence of breast cancer genes). Health psychologists can play an important role in the development of screening procedures for such risks.

Finally, it is noted that the psychological and medical basis should go more together. Both disciplines should be trained in important aspects of each other's disciplines.

Back to top

Image

Check summaries and supporting content in full:
Artikelsamenvatting bij Health psychology and stress: psychological interventions in chronic illness van Maes en Elderen - 1998
Access: 
Public

Image

This content refers to .....
Psychology and behavorial sciences - Theme
Click & Go to more related summaries or chapters:

Study guide with Positive psychology, stress and health: the best scientific articles summarized

Artikelsamenvatting bij Het effect van de geest op het lichaam van Brosschot - 2017
Artikelsamenvatting bij Welbevinden van bijzaak naar hoofdzaak van Bohlmeijer - 2013
Artikelsamenvatting bij Positive Clinical Psychology: A new vision and strategy for integrated research and practice van Wood & Tarrier - 2010 - Exclusive
Artikelsamenvatting bij Back to the future: the effect of daily practice of mental time travel into the future on happiness and anxiety van Quoidback e.a. - 2009
Article summary with Reflections on positive emotions and upward spirals by Fredrickson & Joiner - 2017
Article summary with The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions by Fredrickson - 2001
Artikelsamenvatting bij Negatieve Emoties van Brosschot - 2017
Artikelsamenvatting bij Emotionele Cognitieve Perseveratie van Brosschot - 2017
Artikelsamenvattin bij Onbewuste stress van Brosschot - 2017
Artikelsamenvatting bij Stress in organisaties van Sonnentag & Frese - 2012
Article summary with Workplace Stress Management Interventions and Health Promotion by Tetrick & Winslow - 2015
Artikelsamenvatting bij Workplace Stress Management Interventions and Health Promotion van Tetrick & Winslow - 2015
Article summary with Subjective health complaints, sensitization, and sustained cognitive activation (stress) by Eriksen & Ursin - 2004 - Exclusive
Artikelsamenvatting bij Subjective health complaints, sensitization, and sustained cognitive activation (stress) van Eriksen & Ursin - 2004
Article summary with Concerns about appearing prejudiced get under the skin: Stress responses to interracial contact in the moment and across time by Trawalter a.o. - 2012
Article summary with Health psychology and stress: stress and coping with chronic disease by Maes & Elderen - 1998
Artikelsamenvatting bij Health psychology and stress: stress and coping with chronic disease van Maes en Elderen - 1998
Article summary with Health psychology and stress: psychological interventions in chronic illness by Maes & Elderen - 1998
Artikelsamenvatting bij Health psychology and stress: psychological interventions in chronic illness van Maes en Elderen - 1998
Psychology and behavorial sciences - Theme
Join WorldSupporter!

Join with a free account for more service, or become a member for full access to exclusives and extra support of WorldSupporter >>

This content is related to:
Article summary with Health psychology and stress: stress and coping with chronic disease by Maes & Elderen - 1998
Check more of topic:
Going abroad?
Study with summaries

Image

 

 

Contributions: posts

Help other WorldSupporters with additions, improvements and tips

Image

Spotlight: topics

Check the related and most recent topics and summaries:
Activities abroad, study fields and working areas:

Image

Check how to use summaries on WorldSupporter.org
Submenu: Summaries & Activities
Follow the author: Psychology Supporter
Work for WorldSupporter

Image

JoHo can really use your help!  Check out the various student jobs here that match your studies, improve your competencies, strengthen your CV and contribute to a more tolerant world

Working for JoHo as a student in Leyden

Parttime werken voor JoHo

Statistics
External and related links:
Klinische psychologie & Gezondheidspsychologie - studie en kennis
Coach & Psycholoog: stagelopen tot werken in het buitenland
Studeren in het buitenland verzekeren
Therapeutische vaardigheden: leren of versterken
Search a summary, study help or student organization

Select any filter and click on Search to see results