Quiz Study Guide & Paper Guidelines
Quiz will be Week 8 (Week 9 for Tuesday's class)
–format is short answer questions and some multiple choice.
Be able to give some examples of cognitive distortions
all or nothing thinking, catastrophizing, overgeneralization "I suck", mental filter, disqualifying the positive, jumping to conclusions, emotional reasoning, shoulds, personalization when it is not about you
Be able to describe what they are and why it is important to recognize them.
CDs are recurring irrational thoughts that provoke an emotional response, or "hot thoughts". It is important to recognize and defuse them because they can immobilize a person with painful emotions, cause depression and anxiety, drain away any hope for change. Once these thoughts are exposed for the irrational ideas that they are, a patient may be better able to believe that things can get better, and to act for their own benefit.
Know one method of taking a spiritual assessment (One of the mnemonics)
Faith: what do you believe
Influence: how does it impact your life
Community: do you have a support network among others who share your fait
Application: how does it matter to your medical care
Be able to give an example of a mind-body method
meditation, breathing, yoga, progressive muscle relaxation
Be able to give an example of a spiritual quality
calm, trust, forgiveness, acceptance, unconditional love
Understand what makes up a “spiritual prescription”
PROBLEM--METHOD--QUALITY (Shapiro's method)
1) name problem
2) pick a spiritual quality for cultivation relative to that problem
3) pick a method by which you will cultivate that quality
Delivering Bad News
Know the components of the mnemonic SPIKES and important considerations of each step
SPIKES: setting, perception, invitation, knowledge, emotion, strategy
SETTING: private, safe, seated, supported, no interruptions
PATIENT PERCEPTION: check in, denial, fear?, support
INVITATION: are you ready to hear? do you want to bring a friend? good news first or last?
KNOWLEDGE: warn of bad news, state results clearly, small chunks, no jargon, ask pt to restate
EMOTION: allow it, name it, respect it
STRATEGY: what are you most afraid of?, make immediate plan, give info, resources, can I call?
Be able to read a mini case and pick out what stage of change the person is in.
Stages: precontemplation, contemplation, preparation, action, maintenance, relapse
PRECONTEMPLATION: hadn't ever even thought of changing that, not a problem
CONTEMPLATION: was wondering about changing that, weighing pros and cons
PREPARATION: wants to change that but hasn't yet, is getting ready, help support, set start date
ACTION: is changing that, help fine tune plan, know diff btw slip and relapse, support
MAINTENANCE: has changed that and will keep doing so, support and admire, reflect on long term, it can become routine
RELAPSE: changed it, but then couldn't maintain, returned to old behavior, learning opportunity, "when" you try again (not "if")
Know how these words pertain to behavioral change:
Ambivalence: feelings and values support both change and not change, *get clear
Psychological Reactance: a healthy defense vs confrontation to protect self esteem: "I'm OK"
Importance and Confidence: does it matter? what do I care about? can I do it? what obstacles?
Values: good and right? look good? be healthy? *develop discrpancy btw goals and behavior
THIS IS AFTER YOU KNOW WHAT STAGE THEY ARE IN
Recognize the potential problems in Phase 2 of behavioral change—putting together a plan-- (what is phase 2???)
HAZARDS OF PHASE 2
insufficient direction: you have to come up with a plan
my ideas and not from notes:
lack of confidence
not convinced of importance
costs too much
interferes with favorite activity
support system is against it
lack of trust of doctor
lack of respect for doctor
GUIDING THRU PHASE 2
recapitulate, reinforce, review
ask what change want to make and how
reinforcing change talk
Be able to give the components of either TICS or CAGE
TICS (two item screen: used more than meant to, want to cut down)
Two-item Conjoint Screen (TICS)
In the last year, have you ever drunk or used drugs more than you meant to?
Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?
Scoring and interpretation:
One or more affirmative responses indicates a need for more in-depth assessment.
Adapted with permission. Table 1 from A Two-Item Conjoint Screen for Alcohol and Other Drug Problems. March-April 2001. Volume 14(2):95-106. Copyright American Board of Family Medicine.
CAGE: cut down, annoyed, guilt, eye opener (do you drink in the morning?)
Understand the concept of Harm Reduction
Idea is to limit the damages of the addiction even if cessation is not an option. Minimize potential consequences of injecting heroin by providing clean needles, etc. Support quality of life and provide coping mechanisms so that the drug/alc coping mechanism is no longer so imp.
1) Recognize diversity of users, substances: drugs not good or bad, users not same
2) Abstinence is not only objective: drug use causing problems or problems causing drug use? can't remove coping mechanism without meeting basic needs.
3) Abstinence is a final goal in a series of small changes made to reduce or eliminate use. Every step toward change is progress: document these. Reduce harm by improving quality of life.
4) Services provided without judgment, labeling or "agendas". Users competent to make choices and changes. Holistic view of individuals.
5) Services are client centered and user friendly. Based on realistic client needs, fit client's goals.
Know at risk levels for alcohol use for both men and women
men: 14 drinks/week or 4/occasion
women: 7 drinks/week or 3/occasion
Be able to differentiate substance dependence from substance abuse
DEPENDENCE: tolerance, withdrawal, loss of control: more ingested than meant to, can't cut down, spend much time getting/using/recovering, give up soc life, ctd use in spite of probs
ABUSE: probs at work/school/home, dangerous, legal problems, stubborn usage in spite of probs
Know the elements of an addictive experience
substance has these qualities:
potent modifier of mood or sensation
prompt predictable effects on person or environment
decr pain, tension, awareness
incr sense of control, power, self esteem