E-Book, Englisch, Band Vol. 2, 91 Seiten
Freedland / Skala / Carney Heart Disease
1. Auflage 2005
ISBN: 978-1-61676-313-8
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
E-Book, Englisch, Band Vol. 2, 91 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61676-313-8
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
This volume in the series "Advances in Psychotherapy" provides readers with a succinct introduction to behavioral and psychosocial treatment of the two most prevalent cardiac conditions, coronary heart disease and congestive heart failure. It summarizes the latest research on the intricate relationships between these conditions and psychosocial factors such as stress, depression, and anger, as well as behavioral factors such as physical inactivity and non-adherence to cardiac medication regimens. It draws upon lessons learned from a wide range of studies, including the landmark ENRICHD and SADHART clinical trials. It then goes on to provide practical, evidence-based recommendations and clinical tools for assessing and treating these problems. "Heart Disease" is an indispensable treatment manual for professionals who work with cardiac patients.
The Authors
Judith A. Skala, RN, PhD, is a Research Instructor in the Department of Psychiatry at Washington University School of Medicine in St. Louis, MO, and an Instructor in Health Behavior and Health Psychology in the Department of Psychology at Washington University. After 20 years of experience in cardiac and psychiatric nursing, Dr. Skala completed the doctoral program in Clinical Health Psychology at Washington University. She was a Research Coordinator of the landmark ENRICHD clinical trial and has been a cognitive behavior therapist for several other clinical trials of treatments for patients with heart disease.
Kenneth E. Freedland, PhD, is a Professor of Psychiatry and Clinical Health Psychology at Washington University School of Medicine in St. Louis. He is an Associate Editor of Psychosomatic Medicine and is on the editorial board of Health Psychology. His research focuses on the role and treatment of depression and related problems in heart disease. He is a member of the Academy of Behavioral Medicine Research, a Fellow of the Society of Behavioral Medicine, and a Founding Fellow of the Academy of Cognitive Therapy. Dr. Freedland was a CBT supervisor for ENRICHD and has supervised several other clinical trials of CBT for patients with heart disease or other medical illnesses.
Robert M. Carney, PhD, is a Professor of Psychiatry and the Director of the Behavioral Medicine Center at Washington University School of Medicine in St. Louis. Dr. Carney is best known for his pioneering research on the role of depression in coronary heart disease, and he was one of the principal investigators of the ENRICHD clinical trial. He has served on the editorial boards of Annals of Behavioral Medicine, Psychosomatic Medicine, and Journal of Consulting and Clinical Psychology. He has extensive experience as a cognitive behavior therapist and clinical supervisor, and has particular expertise in the treatment of comorbid depression in medically ill patients.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
1;Preface;6
1.1;Acknowledgments;7
2;Table of Contents;8
3;1 Description;10
3.1;1.1 Terminology;10
3.2;1.2 Definitions;15
3.3;1.3 Epidemiology;18
3.4;1.4 Course and Prognosis;21
3.5;1.6 Comorbidities;27
4;2 Theories and Models of the Disorder;28
4.1;2.1 Depression;28
4.2;2.2 Anxiety;31
4.3;2.3 Anger, Hostility, and Type A Behavior;32
4.4;2.4 Stress;33
4.5;2.5 Low Perceived Social Support;34
4.6;2.6 Personality Characteristics;36
4.7;2.7 Relationships Among Psychosocial Risk Factors;36
5;3 Diagnosis and Treatment Indications;38
5.1;3.1 Introduction;38
5.2;3.2 Medical History and Diagnosis;38
5.3;3.3 Psychological Evaluation;39
6;4 Treatment;44
6.1;4.1 Methods of Treatment;44
6.2;4.2 Mechanisms of Action;72
6.3;4.3 Efficacy and Prognosis;73
6.4;4.4 Combination Therapy;73
6.5;4.5 Problems in Carrying Out Treatment;74
7;5 Case Vignettes;75
7.1;Case 1: A Woman in her Sixties with Heart Disease and Diabetes;75
7.2;Case 2: A Man in his Fifties with Congestive Heart Failure;76
7.3;Case 3: A Man in his Seventies who Had Had a Heart Attack, Open Heart Surgery, and a Stroke;78
8;6 Further Reading;80
9;7 References;81
10;8 Appendix: Tools and Resources;85
10.1;8.1 Overview;85
10.2;8.2 Dysfunctional Attitudes About Health;85
10.3;8.3 Techniques for Overcoming Depression;85
10.4;8.4 CBT Problem List;86
10.5;8.5 CBT Treatment Planning Table for Cardiac Patients;86
10.5.1;Dysfunctional Attitudes About Health ( Supplement to the Dysfunctional Attitudes Scale);87
10.5.2;Techniques for Overcoming Depression;88
10.5.3;CBT Problem List;89
10.5.4;Cognitive Therapy for Cardiac Patients Treatment Planning Table;90
(p. 29-30)
3.1 Introduction
Whether to begin an evaluation with a focus on medical or psychological problems depends largely on the presentation. A patient may be an "unhappy referral" who believes that his/her medical complaints are not being taken seriously, or he/she may identify himself or herself as primarily having problems with coping or depression.
3.2 Medical History and Diagnosis
In our experience, most medical patients prefer to begin with the more familiar territory of their medical history and diagnoses. Usually any problems with understanding and coping with their medical condition will become clear during this phase of the interview. It is often difficult to obtain a complete medical history, because soon after starting to talk about their medical problems, patients switch to talking about the impact of these problems on themselves and their loved ones. Some practitioners are comfortable allowing an interview to weave around a variety of topics while adding notes to different parts of an outline, while others prefer a more structured approach. With either method, it is important to identify patients’ major medical diagnoses, their understanding of them, how long these problems have been present, and their predictions about the future impact of their health problems. Clearly, it is also important to obtain a working knowledge of common diagnoses in order to make reasonable judgments about patients’ understanding and expectations. In some cases, basic misunderstandings lie at the root of anxiety and depression and consultation with the patient’s physician may be required. If so, it is important to discuss this with the patient, obtain permission, and come to an agreement regarding the limits of disclosure.
In addition to getting information about illnesses and conditions, it is important to obtain a list of all medications being taken, including over-thecounter drugs, biologicals, and supplements. They may have an impact on symptoms of depression and anxiety, and they may also provide information about additional medical conditions that the patient may have forgotten to mention. It is also important to ascertain whether the patient routinely takes his or her medications as prescribed. For example, a patient presenting with loss of interest, low mood, and fatigue may simply be forgetting or neglecting to take a thyroid supplement.
3.3 Psychological Evaluation
When working with a distressed heart patient, it is generally most helpful to focus on present difficulties. This does not mean that historical problems are irrelevant, but that historical information is used in the service of treating current problems and improving functioning as quickly as possible. Once depression, anxiety, or other problems have resolved or lessened, patients may choose to address other, more longstanding issues.
Many patients assume that they have been referred for psychological or psychiatric services because they complained too much, because their physician thinks they are "crazy," or because their physician believes that their persistent problems are "all in their head." These assumptions are barriers to forming a therapeutic relationship. Addressing them explicitly and describing them as common, understandable beliefs, is generally successful. Another common therapy-interfering belief is that accepting psychological therapy would connote weakness, particularly if the patient has observed other heart patients who appear to be coping well. A collaborative approach with a problem-solving focus often helps to allay this concern, especially if it is made clear that it is the patient who will be doing the real "work" of getting better.
