Upload
roderick-grant
View
220
Download
1
Tags:
Embed Size (px)
Citation preview
Psychosocial Interventions for Psychosis
Gemma Stacey
Aims
To gain an overview of the stress vulnerability model
To identify interventions adopted within this model: Coping skills enhancement Relapse prevention
Apply the model to practice based scenarios.
Consider how the model may inform your approach to working with people with psychosis
What do you believe causes psychosis?
Stress
It may be said that all life events cause some degree of stress due to the adaptation involved.
The Stress Vulnerability Model maintains people who eventually suffer psychosis already had a
pre-disposition to the effects of stress.
What do we mean by stress?
Is it a physiological or psychological reaction?
Are there different types of stress? Does it effect every person in the same
way? What happens with short term stress? What happens with long term stress?
Stress and Stress ResponseActual Demand
eg work, child care, life events
Actual Capabilityeg health, resources, coping strategies
Perceived Capability Perceived Demand
Appraisal(How well we think we are doing)
Imbalance = Stress
Physiological Response
Psychological Response
Behavioural Response
Lazarus & Folkman (1984)
What do we mean by vulnerability?
When you think about people you have worked with, what factors do you think make them vulnerable to stress?
Stress Vulnerability Model
Vulnerability Factors pre-dispose individuals to develop problems e.g psychosis
Problems are triggered by stress
If vulnerability is high, low levels of environmental stress may trigger distress
Use and effectiveness of coping strategies goes some way to explain why some have problems and others don’t
A Stress &Vulnerability Perspective Assumes The experience of psychosis is
understandable.
Problems associated with the effects of stigma, social exclusion and poverty are of equal importance.
We take a collaborative approach to assessing, planning, formulating and delivering care.
A Stress &Vulnerability perspective assumes Each person is an expert in their own care.
Psychosis is on a continuum with other human experiences.
Psychosis can be an enriching, as well as a frightening/confusing experience.
The person over time, can make a recovery, in terms of what that actually means to them
Stress Vulnerability Model
Zubin, J. and Spring, B. (1977) Vulnerability. A New View on Schizophrenia. Journal of Abnormal Psychology 86, 103-126. APA. Reprinted with permission
The bucket
Formulation
Personal vulnerabilities
Environment stressors
Personal protectors
Environmental protectors
Family History
Disruptions in early years
Coping strategies
Self management
External factors that cause the person increased stress.
External sources of support.
Coping
Defined as: The active self generation of cognitive and behavioural procedures
intended either to impact upon situation directly or to minimise the resultant distress. (Nuechterline and Dawson 1984)
Functions of coping:
- To alter the source of stress
- To regulate the emotional response
(Lazarus et al 1985)
Coping
As part of the appraisal process in a stressful situation we examine our coping resources
The development of these coping strategies is affected by a number of factors including….....
Coping
Personality Psychosocial development Locus of Control - Is it my fault? - Was it fate? Social Support - What relationships will help me
fulfil my needs for coping Implications for isolated groups such as people
with mental health problems and the elderly (Shaw 1999)
Aims of Working with Coping Strategies
To foster feelings of self control and to help the client manage their own experiences and problems
To reduce distress and/or disability
Coping Styles
Detachment - Being independent from the event, not taking anything personally, not seeing the situation as a threat, keeping things into proportion
Rational Coping - looking for a reasonable response, using past experience to work out how to resolve a situation, problem solving
Coping Styles
Emotional Coping- Emotions dominate, taking frustrations out on other people, feeling overpowered and helpless
Avoidance Coping - Ignoring or denying the problem, hoping it will go away, thinking about something else and talking about it as little as possible.
Classification of Coping Strategies Cognitive Strategies attention switching attention narrowing self-statement Think of something
different Read silently Look for explanations of
what's going on
Behavioural Strategies increased activity levels increased social activity decreased social activity Talk to someone about
the stressor
Classification of Coping Strategies Sensory Strategies
Relaxation exercises
Meditation
Relax in bath or shower
Hum or sing to self
What is relapse prevention?
Service users, carers and MH workers identify each individuals early warning sings of relapse (relapse signature)
Agree and record in advance the nature of
and timing of interventions if the signs return (relapse drill).
Benefits of Relapse Prevention
Collaborative process were service users are viewed as the experts of their experience.
Acknowledges personal strategies, skills and resources for self management.
Enables relapse to be predicted and interventions put in place to prevent or minimise negative impact on the individual.
Evidence based.
Stages of Relapse Prevention
Psycho-education Two way process where the service user and
practitioner work together to understand the individual nature of the persons experience.
Can involve the use of Stress Vulnerability Model to facilitate the process.
Stages of Relapse Prevention Identification of Early Warning Signs (prodromal
symptoms)
Highly diverse and vary from person to person.
General examples Anxiety Agitation Mistrust
Specific behavioural patterns (idiosyncratic) Eccentric clothing Flamboyant hair styles
Identifying Early Warning Signs Card sorting exercise
Client identifies early warning signs using cards Arranges into early, middle, late and constant
Review information from both exercises with close family/ friends to identify gaps that service user finds difficult to remember.
Limitations Tendency to overlook EWS which are individual to
that person. Formulated in the MH workers language
Identifying Early Warning Signs
Timeline A detailed account of the persons narrative of the events and
experiences leading up to previous relapse.
Also identifies factors that have an impact on the onset of relapse eg external and internal stressors.
What might be the limitations/challenges of this approach?
Monitoring
Direct- Presence or absence of EWS are scored by the service user.
Indirect- Changes in circumstances, stressful life events or reoccurrence of circumstances which led to previous relapse.
Stages of Relapse Prevention
The development of a relapse drill
A 3 stage action plan developed collaboratively and focuses on client strengths, family and service resources
at each stage the relapse drill should consider 3 areas for intervention Pathway to support. Service interventions. Personal coping strategies.
Relapse Signature
1. Feel worried about what Cathy next door thinks of me
2. Cant get to sleep at night
3. Loose my temper with John
4. Stay inside and don’t see Cathy
5. Here my mums voice talking about how nobody likes me
6. Cut my arms to punish myself for being a horrid person.
Relapse Drill
1. Talk to John and Gemma about how I am feeling
2. Challenge my thoughts about Cathy
3. Watch TV to talk my mind of my worries
4. Have a bath and listen to music
5. Talk to Gemma about medication options.
6. Consider going into hospital
Emergency Contact Details
Challenges to Relapse Prevention
The service user may not agree with the perceptions of carers or MH workers.
Some people cope with MH problem by “sealing over” and are therefore unlikely to want to consider past experiences and the possibility of future relapse.
Many people experience difficulty with structuring their
own reality (lack of insight) leading up to relapse.
Feelings of guilt in the service user if relapse still occurs.
Using the Stress Vulnerability Model to Assess and Plan Care Use the case study to complete the SVM
formulation.
Is their any other information you would need to assess this person.
How would you use this information to plan care.
References Lazarus, R.S. & Folkman, S. (1984). Stress, Appraisal
and coping. New York: Springer. Nuechterlein, K. and Dawson, M. E. (1984) A Heuristic
Vulnerability-Stress model of Schizophrenia Schizophrenia Bulletin, 10,300-12
Shaw, C. (1999) A framework from the study of coping illness behaviour and outcomes. Journal of Advanced Nursing 295 1246-1255
Zubin, J. and Spring, B. (1977) Vulnerability. A New View on Schizophrenia. Journal of Abnormal Psychology 86, 103-126.