PSY 320 Health Psychology, Lecture 10 | Source: Lecture slides / exam notes
Difficulty: Intermediate | Prerequisites: Lecture 9 (Pain) and familiarity with the biopsychosocial model.
This lecture shifts from how pain works (Lecture 9) to the broader question of how chronic illness reshapes a person's entire life. Quality of life is the overarching framework health psychologists use to measure illness impact, and it touches everything from physical functioning to emotional wellbeing, social relationships, and vocational capacity. Understanding these concepts is essential for grasping why treating the disease alone is never enough. You should be comfortable with the pain material from Lecture 9, since chronic pain is one of the key factors that compromises quality of life.
Quality of life measures how much disease and treatment have disrupted a patient's normal activities across physical, psychological, social, and symptom-related domains. Chronic illness triggers emotional responses (denial, anxiety, depression) and reshapes self-concept, body image, relationships, and vocational life. Effective management requires comanagement (patient-led rehabilitation, adherence, family involvement) alongside psychological interventions including CBT, coping skills training, relaxation, social support, and support groups.
Quality of life
A multidimensional assessment of the extent to which a patient's normal life activities have been compromised by disease and treatment. In simple terms, it is a way to measure how much illness is interfering with someone's everyday life.
Denial
A defence mechanism by which patients avoid the implications of their illness. It interferes with the absorption of treatment information and can compromise health outcomes.
Self-concept
A stable set of beliefs about one's personal qualities, evaluated through self-esteem, body image, sense of achievement, social functioning, and private self.
Body image
The perception and evaluation of one's physical functioning and appearance. Poor body image raises the risk of depression and anxiety and influences treatment adherence.
Adherence (in chronic illness)
The degree to which a patient follows their prescribed treatment regimen. Increased by appropriate education, high expectations for health control, self-efficacy, and knowledge of the treatment plan.
Comanagement
An approach where the patient takes an active role in managing their chronic illness alongside healthcare providers, including physical rehabilitation, lifestyle adjustments, and treatment adherence.
Acceptance and commitment therapy (ACT)
A therapeutic approach that encourages patients to accept difficult thoughts and feelings rather than fighting them, while committing to actions aligned with their values. Widely used alongside relaxation training for chronic illness.
Mindfulness-based stress reduction (MBSR)
A structured programme that uses mindfulness meditation to improve adjustment to medical illness.
Support groups
Groups where patients discuss issues of mutual concern arising from their illness. They serve as a low-cost, convenient treatment option.
Quality of life assessments measure the extent to which a patient's normal life activities have been compromised by disease and treatment. The four components are:
Physical functioning
Psychological status
Social functioning
Disease- or treatment-related symptoms
Why study quality of life? It provides a basis for interventions, helps identify problems likely to emerge for patients, assesses the impact of treatments, allows comparison of therapies, and can inform decision-makers about care.
Denial is a defence mechanism by which people avoid the implications of an illness. It interferes with absorbing treatment information and compromises health.
Anxiety occurs when patients become overwhelmed by potential changes in their lives or the prospect of death. It interferes with treatment compliance.
Depression complicates treatment adherence and medical decision-making. Assessing depression in chronically ill patients is complicated because symptoms of the disease can mimic symptoms of depression. People who become depressed tend to experience pain and disability, experience negative life events, and lack social support.
Self-concept is a stable set of beliefs about one's personal qualities, evaluated through several dimensions:
Self-esteem is the evaluative component
Body image is the perception and evaluation of one's physical functioning and appearance. Poor body image raises the risk of depression and anxiety and influences adherence to treatment and willingness to adopt a comanagement role
Achievement is important to self-esteem and self-concept
Social functioning provides information, help, and emotional support
Private self refers to the patient's identity, which can be affected by chronic illness
When asked what aspect of illness causes the most stress, patients report: fear and uncertainty about the future (41%), limitations in physical abilities, appearance, and lifestyle (24%), and pain management (12%).
Coping strategies include social support and direct problem-solving, distancing, positive focus, cognitive escape/avoidance, and behavioural escape/avoidance. Active coping and coping with positive responses tend to be the most effective strategies.
Three dimensions of patient beliefs matter:
Nature of the illness concerns whether patients adopt an appropriate or inappropriate model for their disorder
Cause of the illness is where patients attribute blame (stress, physical injury, bacteria, God's will). Self-blame can lead to guilt, self-recrimination, or depression
Controllability is the most adaptive dimension. Belief in control and a sense of self-efficacy with respect to the disease and its treatment are associated with better outcomes and may even prolong life
Physical rehabilitation involves learning to use one's body as much as possible, sensing environmental changes to make accommodations, acquiring new physical management skills, following the treatment regimen, and controlling energy expenditure.
A comprehensive rehabilitation programme should include a pain management component, assistive technologies where needed, and identification of factors that contribute to recurrence or that exacerbate the disease. Chronic illness also leads to a decrease in sexual activity, which needs to be addressed.
Adherence is increased by appropriate education and predicted by high expectations for controlling one's health, self-efficacy, and knowledge of the treatment regimen.
Vocational issues include discrimination against the chronically ill and financial problems that arise when patients have to cut back on work.
Social interaction problems include negative responses from others, impact on family, and the burden of the caregiving role.
Gender and chronic illness: Women have more deficits in social support, and married women are more likely to be institutionalised than their husbands.
Positive changes can emerge from chronic illness. Patients report experiencing optimism, inspiration to act rather than postpone, greater empathy and compassion, and feeling stronger and more self-assured. Ninety per cent of cancer patients report at least some beneficial changes in their lives.
When the patient is a child: Children are confused because they do not understand the diagnosis, cannot follow the treatment regimen without family help, are exposed to isolating and terrifying procedures, exhibit behavioural problems, and may develop maladaptive coping styles.
Pharmacological interventions include the prescription of antidepressants.
Individual therapy tends to be short-term and episodic, with collaboration between the therapist, the patient's physician, and the family being critical. It requires respect for the patient's defences, a comprehensive understanding of the illness, and is typically guided by CBT.
Coping skills training improves functioning by increasing knowledge about the disease, reducing anxiety, and increasing patients' feelings of purpose and meaning in life.
Relaxation, stress management, and exercise: Relaxation training and ACT are widely used. MBSR improves adjustment to medical illness. Exercise can improve quality of life.
Social support interventions are important because family support enhances physical and emotional functioning, promotes treatment adherence, and improves the course of illness.
Support groups allow patients to discuss issues of mutual concern that arise as a consequence of illness, serving as a low-cost, convenient treatment option.
Students often assume denial is always harmful. In some cases, short-term denial can actually be protective, giving patients time to adjust. The issue is when denial persists and interferes with treatment.
Students sometimes treat quality of life as synonymous with physical health. It is a multidimensional construct that includes psychological, social, and symptom-related components alongside physical functioning.
The idea that chronic illness only causes negative outcomes is incomplete. Ninety per cent of cancer patients report at least some positive changes, including greater empathy, a stronger sense of self, and renewed urgency to act on what matters.
⚠️ Know the four components of quality of life and be able to name them without hesitation.
⚠️ Be able to distinguish how denial, anxiety, and depression each interfere with treatment in different ways.
⚠️ Understand the dimensions of self-concept (self-esteem, body image, achievement, social functioning, private self) and how chronic illness affects each.
⚠️ The 41/24/12 per cent breakdown of illness-related stressors (fear/uncertainty, limitations, pain management) is the kind of specific statistic exams love.
⚠️ Know how controllability beliefs and self-efficacy relate to better outcomes and potentially longer life.
True or False: Quality of life is measured only by physical functioning. (False, it also includes psychological status, social functioning, and disease/treatment-related symptoms.)
Fill in the blank: The most commonly reported source of stress in chronic illness is __________. (Fear and uncertainty about the future, at 41%.)
True or False: Self-blame for illness is associated with better psychological outcomes. (False, it can lead to guilt, self-recrimination, or depression.)
Fill in the blank: __________ per cent of cancer patients report at least some beneficial changes from their illness. (90%.)
True or False: Married women with chronic illness are more likely to be institutionalised than their husbands. (True.)
Q: Name the four components of quality of life assessment and explain why studying quality of life matters.
A: The four components are physical functioning, psychological status, social functioning, and disease- or treatment-related symptoms. Studying quality of life matters because it provides a basis for interventions, helps identify emerging patient problems, assesses treatment impact, allows comparison of therapies, and informs decision-makers about care.
Q: How does denial differ from anxiety and depression as an emotional response to chronic illness?
A: Denial is a defence mechanism that blocks the patient from absorbing treatment information. Anxiety overwhelms patients with potential life changes or the prospect of death and interferes with treatment. Depression complicates both treatment adherence and medical decision-making. Each disrupts care through a different pathway.
Q: Explain how controllability beliefs and self-efficacy influence outcomes in chronic illness.
A: Patients who believe they have some control over their illness and who have a sense of self-efficacy regarding treatment tend to adopt more adaptive behaviours, adhere more closely to treatment, and may even experience longer survival. The experience of control is associated with better psychological adjustment overall.
Q: What are three examples of positive changes patients report in response to chronic illness?
A: Experiencing greater empathy and compassion, feeling inspired to act now instead of postponing things, and feeling stronger and more self-assured. Ninety per cent of cancer patients report at least some beneficial changes.
This material builds directly on the pain content from Lecture 9, since chronic pain is one of the main factors that reduces quality of life. The emotional responses (denial, anxiety, depression) connect to the stress and coping models covered earlier in the course. The comanagement framework and adherence concepts will resurface in Lecture 11 when discussing terminal care and end-of-life decision-making.
Quality of life, QoL, chronic illness, emotional responses to illness, denial, anxiety, depression in chronic illness, self-concept, body image, self-esteem, coping strategies, active coping, avoidance coping, patient beliefs, illness controllability, self-efficacy, comanagement, physical rehabilitation, treatment adherence, vocational issues chronic illness, social support, family support, support groups, CBT chronic illness, ACT, acceptance and commitment therapy, MBSR, mindfulness-based stress reduction, positive changes chronic illness, chronically ill child, health psychology PSY 320