Suzanne Ruff, PhDHealth Psychologist

Cleveland VA Medical CenterCleveland, Ohio

Chronic Medical ConditionsThere are three tasks in managing a chronic

medical conditionCare for your condition, learn about your

conditionManage any emotional changes that your

condition may bring aboutReturn to your pre-diagnosis life as fully and as

soon as possiblePartner with your medical caregivers

and your family and friends

Stages of diagnosisPre-diagnosis

Anxiety Signs and symptoms not recognized YOU know there is something wrong Medical providers may not know what is wrong You may begin to second guess yourself – especially

in a condition with varying symptomsAnger

You can’t do what you used to do You want your life back

Stages of diagnosisDiagnosis

Relief It’s not all in my head

Anxiety Can be heightened – especially with relatively rare

condition Diagnosis known, but prognosis uncertain

Anger “Why me?”

Depression Later in time

Stages of diagnosisAfter diagnosis, mood varies with:

acuity of disease, number and severity of flaressupport availablemedical care availableability to return to life before diagnosis

1978 study on mood variation with significant eventSpinal cord injuryWinning the lottery

Stages of diagnosis

Most people return to their baseline mood about a year after injury or winning the

lottery

Psychology of chronic illnessWhat does this mean to patients with a

chronic medical condition?Chronic medical conditions can lead to

depression over timeOften unrecognized

Overlap of symptoms No pathognomic feature in depression Most common is anhedonia, not a sad mood Lack of restorative sleep, daytime fatigue Cognitive changes

Diagnosis and treatmentRecognize symptoms

Mood, somatic symptoms, cognitive symptoms, Anhedonia

Relationships Activities Meaning and purpose in life

Seek responsible treatment Partner with your medical providers and especially

MG provider Think about therapy rather than medications

Psychological therapiesCognitive Behavioral TherapyCognitive Processing TherapyNarrative TherapyAcceptance and Commitment TherapyPositive Psychology Therapy

Combination therapiesPartner with your providers

Positive PsychologyMartin Seligman, PhD, University of

Pennsylvania founded the field of Positive Psychology in the late 1990’s

He first studied “Learned Helplessness” in the 1960’s

He then turned to “Learned Optimism” President of APA

A return to what is right with peopleFormed a panel to study happinessPhenomenally successful

Positive PsychologyDefine happiness – essentially a sense of well-

beingNot hedonism, not about material things

Must be measurable and changeable Deconstructed the unwieldy term of happiness

into:Positive emotionPurposeEngagementPositive relationshipsPositive accomplishments

Positive PsychologyPositive emotions

Studied by Barbara Fredrickson, PhD at UNCPositivityratio.com

Measures positive emotion to negative emotion ratio

FREE!

Positive character strengthsCommunity involvement – values in action

Positive PsychologyPositive emotion

Broaden and build theory Broaden

Positive emotions lead to more flexible thinking Positive emotions lead to more expansive vision Positive emotions lead to more creative thinking

Build Positive emotions build stronger relationships Positive emotions build emotional reserves Positive emotions build future protection

Positive PsychologyMost studied positive emotion

JoyLoveInspirationHumorAwePrideTranquilityGratitudeInterestHope

Positive PsychologyIncrease positive emotions and decrease

negative emotionsGratitude journalDevelop new interestsDeepen current interestsMindfulness Savor positive events, conversations, Distraction when negative thoughts occurDefuse negative ‘landmines’

Positive PsychologyPurpose and engagement

Positive character traitsPanel formed to look for universal character

strengths Ubiquitous character strengths What enables a community or culture to survive and

flourish? Read philosophical, religious, and historical works

Six meta traitsWisdom Temperance Humanity JusticeCourage Transcendence

Positive PsychologyAuthentichappiness.org

Take the VIA test – long versionFREE!Your top 5 strengths

WISDOM - Love of learning, perspective HUMANITY - Love, kindness COURAGE - Persistence, vitality TEMPERANCE – Prudence, self-regulation JUSTICE – Leadership, fairness TRANSCENDENCE – Humor, spirituality

Positive Psychology“Bloom where you’re planted” or increase the

Big FiveThe Big Five

GratitudeCuriosityHope/optimismAppreciation of beauty and excellenceVitality

Jumped categories – from transcendence to courage

Positive PsychologyHow to become depressed

Dwell on the negativeLose interest in most things and peopleBecome convinced that negative things are

permanent, pervasive, and not under your controlLose your sense of wonderStop moving

Not exercising is like taking a “depressant”

Compare these to the Big Five

Positive PsychologyPositive relationships and positive

accomplishmentsMost easily achieved through use of your strengthsFamily, friends, social circlesCommunity involvementWork, volunteering

What are your values? What are you committed to? What makes your heart beat faster? What makes

you get up in the morning? What drives you?

Stages of ChangePre-contemplationContemplationPlanningActionMaintenance

Identify, target, make a plan and carry it out

Stages of ChangeLife balance

What do you value?Pillars of life

FamilyIntimate relationshipFriendsCommunity involvementSpiritual lifeWork, volunteeringHobbies, funLearning/growingPhysical healthPhysical space_____________

Stages of ChangeIdentify your values

How are you actually spending your time?How would you like to spend your time?

Target areas for changeWhat is balanced? Keep thoseWhat is necessary? Be realisticWhat would you like to change? Make a plan

Plan for change and maintenance

Stages of ChangeLife balance worksheet, part 1

Average day or weekDifficult to do unless you carry sheet around –

memory is not great for this type of activityLife balance worksheet, part 2

+ column, - column, = columnMaintain – no stealing from balanced row

Life balance worksheet, part 3Make a planBe realistic, flexible, positive

PositivityPositivityratio.com

10 questions on positive emotions10 questions on negative emotions1 point assigned for any negative emotion

Due to negativity bias1 point assigned for any positive emotion

experienced at a moderate level

3:1 ratio is associated with flourishing

Positive PsychologyVery promising new field for Positive Health

Not absence of diseaseStrong results with studies involving literally

hundreds of thousands participants in Health Psychology

EmpoweringNeeds to be personalized

Positive stepsKeep a gratitude journalSavor the good timesUse the Life Balance chart to help you decide

where to spend your timeGet involved with what or who you lovePace yourself

Use some of your “good” days to spend in pleasurable and meaningful activities

Be activeKeep it up!