Health Psychology: Going Through a Breast Cancer Diagnosis

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Table of Contents

Helen’s recent decline in well-being
Non-adherence to medical advice
Conclusion
References

Helen’s recent decline in well-being

Health psychology theory asserts that illness has more than one cause with various factors combining to bring about illness. The biomedicine model commonly applied in the health system is that disease has a single causal factor. The approach used in health psychology is a reflection of the biopsychosocial model of health and illness which is an attempt to integrate the psychological aspects of health (these include fear of treatment, health expectations, behavior like diet, smoking, exercise, and the social aspect such as social status, ethnicity, the value that are placed on health, pressures for behavior change (Ogden, 2004).

Various factors play a role in increasing risk factors for depression. Loss of a loved one, work stress, financial setbacks, and unwelcome life change are some issues that can trigger a depressive episode (Psychology Information online, 2007). Helen has multiple issues like this to deal with. They include the going away of her daughter to Australia who she is very close. Her wish that it had been her daughter or husband accompanying her to get the results for her test to indicate that they are her significant social supports. Helen’s social supports have also been reduced by the fact that her husband has to work more hours at their shop. This means that he is not available for her to provide support and encouragement. He is unaware that she has been diagnosed with depression and that she is going for breast screening

Stress from work is also a contributing factor to her condition. This is tied in with the financial setback that they may have to experience due to the downturn in the retail business. Even with reduced hours at work, Helen still has a lot on her plate because she still needs to take care of her ailing mother who has a chronic illness, another significant issue that is likely to cause her a lot of stress.

Separation from someone important, giving up a hobby and few social growth events are some of the issues identified by a group of scientists as predictive for the incidence of dependence in women. (Kivela et al, 2005). These are features characteristic of Helen’s life. She has not been attending her book club meetings. This has reduced her social support system further contributing to the decline in her condition.

The process of going through a breast cancer diagnosis is also stressful for Helen. Depression is common among patients undergoing breast cancer diagnosis (www.breastcancer.org/). The stress levels associated with the anticipation of the results may contribute to a client deteriorating faster when they have depression. Helen had feelings of fear and she is also overwhelmed by the potential outcome of the biopsy results. These feelings of anxiety coupled with the fact that she does not have adequate social support are vulnerability factors for the decline in her condition. A pending potential diagnosis of cancer is a significantly stressful event. Research indicates that negative life events are more predominant among depressed patients than those people who are not depressed (Jenway and Paykel, 1997 Real Age Depression).

Another factor that has contributed to the decline in Helen’s condition is her non-adherence to the treatment she was given. Helen’s belief that she was not depressed led her to stop taking the anti-depressant medication given to her. Helen appears to have a self-sacrificing personality. Though she receives a diagnosis of mild depression from her general practitioner she does not tell her husband because she does not want to burden him with her problems. Her view is that he would not be able to do anything. David, her husband also does not know about her attendance of breast screening even though it causes her great anxiety causing her to sleep poorly. Helen needs support from her husband and loving daughter because she wishes either one was present when she was going to take her biopsy result.

Her self-sacrificing attitude is also evident from her failure to take prescribed medicine and follow the doctor’s advice because she feels her mother requires a lot of supervision which she would be unable to do well due to the side effects of the drugs. She is willing to neglect her condition so that she can take care of her mother who has Alzheimer’s.

Research shows that depression is associated with some personality traits with self-sacrifice being one of them (Joiner, Coyne and Blalock, 1994, Real Age Depression). This means that Helen due to her self-sacrificing nature is already predisposed to depression and in continuing to do so she denies herself important support from her family and opportunities to manage her condition leading to her decline to clinical depression.

The failure of the doctor to consider the psychological factors at work in Helen’s condition has also contributed to the decline of her condition. When Helen had the needle biopsy done she felt violated and very frightened. She would have liked to ask many questions but being unable to verbalize them she drove home badly shaken. The diagnosis process made her more anxious increasing the probability of deterioration of her condition.

The correlation between anxiety and depression cannot be ignored. In a study, about 85 percent of patients diagnosed with major depression also had a diagnosis of generalized anxiety disorder while approximately 35 percent of the patients had a panic disorder. (www.healthyplace.com/). Increased anxiety levels lead to a feeling of loss of control in one’s life which contributes to depression as is evident in Helen’s case where the two weeks of waiting for her biopsy results made her sleep poorly indicating that her depression was becoming worse.

Health psychology maintains that the body and mind interact to influence an individual’s health (Ogden, 2004). This then means that a situation that results in the agitation of an individual will likely manifest physically, either by making one’s condition worse or causing their health to be impaired. This explains Helen’s inability to sleep due to her anxiety.

Non-adherence to medical advice

The Health Belief Model has been used for intervention in illness health screening; precautionary behavior has four main components, susceptibility, severity, effectiveness, and cost. The concept of perceived susceptibility predicts whether an individual thinks they are susceptible to a certain condition. Generally, people underestimate how vulnerable they are to a condition. (Redding et al, 2000). Helen does not believe that she could have depression, as she considers herself to have a comfortable life and that were her problems were not worse than those of other people. In her evaluation, she could cope just as well as other people.

Perceived cost refers to an individual’s evaluation of the barriers or losses associated with a particular action to achieve an expected outcome. It has to do with a relationship between benefits and barriers such that benefits are greater than barriers. Perceived benefits refer to an individual’s evaluation of how following some advised action will lower risk or cause a moderation in the impact caused by a condition (Redding et al, 2000). Helen was not very keen on taking the antidepressants us she did not feel any better for taking them. As far as she was concerned the medications were ineffective in managing her condition. Perceived barriers make it difficult for an individual to follow a recommended action (Redding et al, 2000). The lightheadedness and peculiar affect the antidepressant medication had on Helen are a perceived barrier in her case. In addition, the doctor’s advice that she be involved in some form of exercise daily and she does something enjoyable daily seemed impractical to her because she felt her mother required more supervision which would take her time. For her the barriers to the advised actions outweigh any benefits that may come from following the doctor’s advice, causing her lack of adherence. These factors acted in concert to cause Helen to disregard her doctor’s advice thus contributing greatly to the decline in her condition.

Health psychology argues that the whole person should be treated; since it is not just physical changes that occur when someone is unwell. Some of the treatments may involve behavior change such as encouragement of beliefs, coping, and strategies that are compliant with medical recommendations (Ogden, 2004). Part of the reason that Helen has not adhered to her treatment is that the doctors have only been trying to treat what is biologically and physically wrong with her.

Her general practitioner prescribed antidepressants for her; recommended exercise and involvement in enjoyable activities without seeking to find out what factors could have led to the development of the depression. He is not aware of her lack of social support, that even though she has family and friends none of them are aware that she has been to see the doctor apart from her friend, Gillian who would have otherwise not known if she had not met her at the post office. Helen felt that his approach was impersonal.

It is important to note that if psychological factors have a role in the etiology of a condition, then they may also have a role in treatment (Ogden, 2004). Consequently the failure of the general practitioner and another doctor, who should have allowed her to ask questions and also counseled her to increase her sense of control despite the illness.

An attempt at understanding the beliefs of Helen would have promoted greater adherence to treatment. By understanding these beliefs the general practitioner would have targeted them and attempted to change her belief that she cannot be suffering from mild depression.

The social cognitive theory includes environmental and social factors in addressing issues of behavior change (Redding et al 2006). Using it, the doctor can achieve a more comprehensive approach in managing Helen’s depression. Helen compares herself with other people using the logic that her problems are not worse than other people’s and if other people could manage their situations, she figured she should also be able to do so.

The social cognitive theory involves various concepts; the concept of person is associated with personal characteristics, coping, emotional arousing, and behavioral capacity among others. The concept of environment is important in showing the relationship between the person and environment. Helen’s environment is a highly stressful one because of the presence of her elderly sick mother and the business that is experiencing difficulty. Helen being a self-sacrificing individual that she is unlikely to perform risk reduction behavior (stress management, exercise, taking part in enjoyable activities).

In SCT the individual’s view of the environment is referred to as situations. They can help to enhance or inhibit behavior. In Helen’s case, her situations inhibit adherence to her treatment regime.

Further demonstration of the effect of Helen’s environment on her health behavior is her postponement of attendance of a mammogram clinic even when she had received a letter to attend. Her decision was influenced by her friend’s description of the process that it was embarrassing and uncomfortable.

According to social cognitive theory, influence on behavior that involves the environment may be physical, cultural, social, economic, or political (Redding et al, 2000). In Helen’s case, the influences are mainly social as they involve her friends and family.

Poor communication between the doctor and Helen has also contributed to her lack of adherence to medical advice. Most consultations are doctor-centered where the doctor directs the patient and the patient answers questions. The problem with this is that it creates a sense of hierarchy and inspires ignorance in the patient. As a result, many patients dislike it but show a preference for consultations centered on the patient because their primary focus is the needs of the patient. This approach is more acceptable because it means that the doctor will listen to the patient completely and will include the patient in choosing the treatment plan and also finding a diagnosis (Banyard 2002). A patient is more likely to stick to medical advice when he or she understands how their diagnosis was reached and is well informed about their condition. Helen’s consultation with her general practitioner was unsatisfactory as far as she was concerned and she felt that he was impersonal hence her poor understanding of her condition and the importance of sticking to the medication regime and following the advice to exercise and be involved in enjoyable characteristics. While there has been evidence that a patient-centered approach may not always result in the best clinical outcomes, on the other hand, several studies prove the benefits of a positive experience during consultations which result in better health of the patient (Weineman and Petrie, 2000).

A patient’s perception of their illness will determine how they respond to the treatment program developed for them. Research shows that patients’ ideas concerning their illness are centered on 5 major components which are identity, cause, timeline, consequences, and cure or control. These components interrelate logically to determine treatment adherence (Weinman and Petrie, 2000). For instance when a patient believes that an illness can be cured they associate the illness with a short duration and minor consequences’ (Weinman and Petrie, 2000). When a patient’s perception of their illness is dysfunctional they are likely to fail to adhere to their treatment or medical advice. Helen decided not to attend a breast cancer clinic despite getting the letter a year before. She did not see any urgency in getting the screening done because she did not think she was at risk since there was no history of cancer in her family. Upon screening, however, she was discovered to have a cyst.

The self-regulatory model developed by Leventhal et al shows that illness perceptions are important when assessing and helping the client to cope with the condition and the patient’s outcome (Weinman and Petrie, 2000).

Weinman and Petrie argue that there’s a close relationship between adherence to treatment and the beliefs the patient has about how necessary the medication is and also the concern about specific tablets (Weinman and Petrie, 2000). This explains Helen’s failure to adhere to medication because she did not feel that the antidepressants were necessary. In addition, the drugs made her feel light-headed and strange, showing that she had not been warned about the side effects inadequately. Her concerns about their effectiveness and their side effects made her stop taking drugs.

Helen’s non-adherence to medical advice can also be attributed to a lack of understanding of the information discussed during the consultation. Her perception that she did not have depression but her willingness to buy anti-depressant medication indicates that she does not fully understand her condition. Her dissatisfaction with the consultation further indicates this.

Though the relationship between non-adherence and poor understanding may be obvious, it is not very clear since some studies show a positive association while others fail to demonstrate how they two are linked (Weinman and Petrie, 2000). Satisfaction with medical consultation and medical care does not necessarily guarantee adherence but where there is dissatisfaction with medical care adherence is lowered as the patient has decreased motivation for treatment (Weinman and Petrie, 2000).

Conclusion

Health psychology, through the study of the psychological processes that occur in health, illness, and health care has helped in the development of many interventions to improve healthcare. The discipline however still requires more insights so that it can provide truly comprehensive models that explain health and illness behavior.

The long-term effect of the discipline will be increased effectiveness in health care delivery as a result of using psychological intervention for the prevention and management of health problems.

References

Banyard P, 2002 Psychology in Practice, Halder and Stoughton
Causes of Depression, Psychology Information Online. Web.
Jenaway M and Paykel S, 1997 Risk Factors for Depression, RealAge Depression Center.
Kivela SK, Sviaro-Kongas P, Laippala P, Pakhala K and Kesti E, 2005 Social and Psychological Factors predicting Depression: A longitudinal Study, International Psychogeriatric Association (8), 635-644
Leventhal H, Nerenz DR and Steele DJ 1984, Illness representation and coping with Health Threats , In a Handbook of Psychology and Health, vol 4 (ed. A Baum and Singer J) pp. 219-52, Erlbaum, Hillsdale NJ
Ogden J, 2007, Health Psychology: A Textbook (4th edition) Burkingham: Open University Press
Redding CA, Rossi JS, Rossi SR, Velicer NR and Prochaska OJ 2000, Health Behavior Models, International Electronic Journal of Health Education, (3), 180-193
The Relationship between Anxiety and Depression.
Weinman J and Petrie KJ, 2000 Health Psychology New Oxford Textbook of Psychiatry vol 2, 5.7 p1225-36
Redding CA, Rossi JS, Rossi SR, Velicer NR and Prochaska OJ 2000, Health Behavior Models, International Electronic Journal of Health Education, (3), 180-193

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Health Psychology: Going Through a Breast Cancer Diagnosis

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