There are three forms of prevention. Primary prevention is a method to keep people healthy for as long as possible. The target group of this form of prevention is healthy people. Secondary prevention focuses on finding early signs of an illness. This is done by screening and early treatment. The symptoms that may occur are still reversible at this stage. The target group for secondary prevention is (healthy) people with an increased risk of developing a certain condition. Tertiary prevention is based on the prevention of symptoms growing worse and rehabilitation. The people who this type of prevention is aimed at have already developed a certain condition.

It is important to support healthy behaviour. This is because health behaviour is related to mortality and morbidity. In the 1900s the main cause of death were infections, like flue and lung infections, tuberculoses, measles and typhus. Now, in the 2000s, the main cause of death are chronic diseases, like heart diseases, cancer, diabetes and kidney diseases. Another reason why it is important to change behaviour is because socio-demographical differences in health behaviour increase social economic differences, which is partly responsible for life expectancies between groups. A third reason why it is important to change behaviour is because prevalence of risk behaviours is high. Finally, health behaviour is not always an informed choice. People are not always aware of their unhealthy behaviour, like picking unhealthy food in the supermarket because it is placed on the shelves which are well visible, or the size of plates in restaurant which trick your mind in the portions of your food.

Example: Why do some people smoke and others do not?

In this workgroup we tried to figure out some determinants of (un)healthy behaviour. These factors can occur on individual level, social level and in a social context.

Determinants can be influencable or not. Factors which cannot be influenced are age, gender, SES, ethnicity and personality. Those which can be influenced are explained in the models explain during the first lecture.

Examples of individual level factors are operant conditioning, expectations of outcomes, lack of other coping strategies (smoking is the only thing to get me calmed down), attitude, beliefs and priorities. Examples of social level factors are peer pressure, social norms and upbringing. Examples of factors in a social context are availability of certain services and alternatives, stimuli (commercials) and costs.

This week is about chronic diseases. A chronic disease is a long-term disease which won’t go away. Examples of chronic diseases are RA, diabetes, heart diseases, (most types of) cancer, asthma, psoriasis, epilepsy, Crohn’s disease, Bechterew’s disease and multiple sclerosis. Apart from physiological consequences, psychological consequences may occur as well, like stress, anxiety, depression and anger.

The stress coping model says the degree to which a chronic illness is considered a source of psychological stress depends on individual personal resources, social resources and life goals. Individual adaption processes to stressors are describes by stress coping models. Personal and interpersonal influenced on appraisals and stress responses are coping styles, personality, cognitions, emotions and social support.

Coping styles are interdependent and can occur together as seemingly oppositional strategies to create the overall coping response. They can change dynamically according to the context.

• Problem focused: to reduce demands of stressor or increase personal resources (e.g. confronting the source of stress)
• Emotion focused: managing the emotional response (e.g. by venting anger)
• Approach oriented: e.g. attending to source of stress
• Avoidance: e.g. distraction

Stress influences functioning on different levels: cognitive, emotional and physical. These three levels of functioning all influence each other as well, causing a vicious cycle.

Stress management is an intervention which can break this vicious cycle, by influencing physical processes, giving more feelings of control, changing cognitions and reducing anxieties. During the workgroup three types of stress management are practiced by students, which have been prepared prior to the workgroup. Each student has prepared an intervention for their patient.

Progressive relaxation is about first tensing your muscles and then relaxing them.

Applied relaxation is based on progressive relaxation. However, this type of relaxation is only about relaxing your muscles. The goal is to teach the patient a new coping strategy (relaxing your muscles) and then having the patient being able to apply this new coping strategy in any (stressful) situation. It is also called release-only relaxation.

Mindfulness is a form of meditation, originating from Buddhism. It is about doing things with 100% focus and focusing on the very moment, instead of focusing on the past or the future. During mindfulness, the patient has to let go of bad thoughts and the patient must let thoughts come and go without judging those.

You start the stress management interview with an intro, in which you can ask how things have gone since last time you spoke, give a brief summary of last time you spoke, tell the patient what is going to happen today and you can answer any questions the patient has before you start.

During the interview it is important to sit in a comfortable position (both for you as for the patient), to have the patient close their eyes (unless they don’t feel comfortable to), for you to have a monotone voice and to speak calmly and to have breaks in-between what you have to say, so the patient can adjust.

When finishing up the interview, you ask how relaxed the patient is feeling and evaluate together. Give brief instructions for doing the relaxation at home and give a brief summary of what you have done today. Also answer any questions the patient has.