Wednesday, February 28, 2007

Why people develop persistent maladaptive beliefs

Continuing the thread of beliefs and health, I will now examine why people develop maladaptive beliefs systems and why they’re so difficult to change.

A belief is a type of thought (cognition, attitude, assumption, theory) that emerges as one’s mind converts patterns of electro-chemical brain activity into internal dialogue (“self-talk”), images in the “mind’s eye,” emotions, and behavioral reactions. Since this occurs automatically and unconsciously, we are typically unaware of these thoughts and feelings as they happen.
 
How do these beliefs develop and persist? The kind of beliefs I’ve been discussing—attributions, appraisals and irrational beliefs—are created by our experiences and cultural teachings. These belief systems (interrelated set of beliefs) function as mental/perceptual “filters” through which we view the world, the future and ourselves, which ultimately affects the state of our physical, psychological and spiritual health.
 
There are many reasons why humans develop and maintain maladaptive beliefs, and the negative emotions and behaviors accompanying them. They include the following (adapted from Albert Ellis’ book, “Reason and Emotion in Psychotherapy” pp. 381-414):
 
  • We have a prolonged period of childhood during which time we are—relative to healthy adults—vulnerable, weak, ignorant, unintelligent, incompetent, highly impressionable, and over-emotional creatures. This is poor training ground and preparation for the kind of thinking, emoting, and acting we will have to do to live sanely and healthily as adults.
  • We often have difficulty unlearning something, even as we learn new things that contradict it. So, once certain beliefs are acquired, it often requires constant work and practice to change them. In other words, beliefs become habitual.
  • Inertia is the tendency of an object at rest to remain at rest, and of an object in motion to remain in motion. Changing an object’s motion by starting it or stopping it, therefore, requires extra energy. The same is true for people’s tendency to think, feel and act in ways we’re accustomed. It takes extra effort to modify the thoughts, emotions and behaviors familiar to us. Unfortunately, we tend to have trouble with sustained effort (as discussed below), so once a strong beliefs are in place, our inertia makes them resistant to change.
  • People tend to be short-sighted and want their desires satisfied immediately (“short-term hedonism”), even when they would be better off postponing satisfaction or living without. Examples of things momentarily desirable, but undesirable or harmful in the long run, include consumption of alcohol, drugs and too much food. This is one reason why we find it so easy to believe we need what we want when we want it, without consideration of the long-term consequences.
  • People have a tendency to be over-suggestible, which makes us prone to adopting the beliefs of our families our cultures, rather than rejecting conformity in favor of independent critical thinking.
  • Humans tend to be overly vigilant, cautious and misfocused, which means, for example, that we focus too intently on certain things we wrongly believe pose a threat, where in fact we’d be better off concentrating on other things that pose a more serious threat to our well-being.
  • Extremism is a human tendency that makes it very easy for us to accept radical beliefs, rather than taking a middle-ground view.
  • People are prone to wishful thinking, which makes it very easy for us to have self-deceiving beliefs that minimize problems and that enable us to foolishly justify inaction (e.g., “No need to bother … everything will work out on its own”).
  • Humans have (a) trouble sustaining their focus effectively on what’s most important, (b) difficulty organizing many diverse elements of one’s existence into integrated wholes, and (c) problem engaging in disciplined & sustained effort, especially when frustrated. Belief change, however, requires competence and will in all these areas.
  • Our culture reinforces beliefs that over-emphasize guilt and blame, and make us prone to envy and jealousy.
  • We have a tendency to over-generalize, which means we apply our beliefs about particular people or things to other people and things believe are similar, but that are, in fact, really quite different. When combined with “people appraisal,” this tendency is the foundation of racial, ethnic, gender and religious prejudice.
  • It is easy for humans to exist with disturbed beliefs and the maladaptive emotions and behaviors associated with them.
And here are some reasons why people have trouble refuting invalid beliefs:
  • We tend to have a form of “selective attention” that makes us focus on a specific aspect of an experience while ignoring other aspects, as well as “hindsight bias” makes us recall only certain things from memory. The problem is that the things we focus on and remember tend to support our preconceived beliefs (assumptions/theories), while ignoring contradictory evidence. Belief change, however, requires just the opposite, i.e., examining situations objectively, through critical thinking, by seeking out evidence that refutes our assumptions and hypotheses.
  • We also tend to be overconfident in the accuracy of our attributions and appraisals. So, rather than fully investigating contradictory evidence, we develop and maintain beliefs based on judgments supported by insufficient and misleading information.
In my next post, I will answer the questions: Why are certain belief systems so emotional? and What types of beliefs are associated with good health?

Wednesday, February 21, 2007

Beliefs, emotions, behaviors and health: Examining 3 categories of beliefs

Last time I discussed how people’s beliefs affect their health. This time I dissect three common categories of beliefs associated with exaggerated negative emotions and self-defeating behaviors: They are attributions, appraisals and irrational beliefs.
 
Attributions are inferences (conclusions) people draw about causality (i.e., who/what is responsibility, at fault, to blame for a problematic situation); changeability (i.e., prediction of whether a problematic situation is changeable and within you control or intractable and beyond your ability to change).
 
Negative beliefs about the attributes of causality and changeability tend to be associated with feelings and actions such as (a) angry emotions and hurtful behavior (e.g., if you believe someone in particular caused your problems and you blame them for it); (b) shame/embarrassment, avoidant behavior or self-destructive actions (e.g., if you believe your problem is your own fault); and (c) depression or sadness, low frustration tolerance, anxiety or fear (if you believe the problem will never change). Not only does this increase one’s stress levels (which would have an adverse affect on one’s health), but it prevents a person from being an effective problem-solver, which, when it comes to dealing with one’s health problems, means poorer health and quality of life.
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Positive beliefs about causality and changeability, on the other hand, tend to be associated with optimism and hope, courage, assertive/proactive problem solving, persistence in the face of frustration and disappointment, self-respect, willingness to accept help from others, effective coping strategies, etc.
 
Appraisals are judgments about the degree of benefit (or potential reward) and harm (or threat) something or someone has caused (or will cause). If, for example, a patient believes a doctor’s advice won’t provide much help for his/her condition, the patient is unlikely to comply, and visa versa.
Another form of appraisal is what I call “People-Appraisals,” which involves measuring the amount of inherent worth and goodness people possess. 
 
People who receive positive appraisals (from themselves and others) are believed to have successful, competent, powerful, valuable, superior, important, precious, worthy, noble, good, moral, virtuous, righteous, pure, respectable inner-selves. They are called successes, winners, stars, or good people, saints, heros, gems, respectable citizens. They develop a favorable opinion about who and what they are; they have a positive self-image and high self-esteem.
 
People who have negative appraisals, on the other hand, are believed to have worthless, useless, unlovable, unworthy, good-for-nothing, flawed, defective, inferior, weak, or wicked, degenerate, rotten, detestable inner-selves. They are called failures, losers, no-bodies, louses, flunkies, derelicts, bums, jerks, turds, shits, bad people, bastards, bitches, skunks, rats, swine, animals, sinners, evildoers, devils, criminals, scum of the earth, dregs of society. They develop an unfavorable opinion about who and what they are; they have a negative self-image and low self-esteem.
 
Just like attributions, appraisals affect one’s emotions and behaviors in powerful ways, including being a foundational component of racial/ethnic prejudice, the “deadly sin” of pride and deservingness, suicide and murder, and more.
 
Irrational beliefs are erroneous assumptions and perceptions, which include exaggerations, overgeneralizations, dogmatic demands, minimizations, personalizations, selective attention, polarized (dichotomous, black & white) thinking, and the elevation of wants/desires into needs.
In my next post, I discuss why people develop persistent maladaptive beliefs .

Wednesday, February 14, 2007

Beliefs and Physical Health

How can a person’s beliefs affect one’s physical health? A belief, after all, is a type of cognition (thought) … it’s a mental phenomenon. So, why are beliefs important when it comes to the health of one’s body?

The answer lies in the relationship between beliefs, emotions and behaviors. Being a student of cognitive-behavioral and rational-emotive psychotherapy (Aaron Beck and Albert Ellis), I was trained in techniques of belief change designed to facilitate changes in people’s emotional and behavioral responses to situations they find distressing.

People who are stressed or upset may have certain types of erroneous beliefs, which exacerbated their distress levels. These beliefs include distorted/faulty (a) attributions (e.g., assigning the cause of the problem to the wrong person or thing, or believing that one is powerless to do anything about it) and (b) appraisals (e.g., making incorrect judgments about how bad a situation is, or prejudging certain people without adequate evidence). They are often expressed as irrational beliefs that are based on dogmatic demands that certain things shouldn’t happen; that elevate wants and desires into “needs;” that relate to a sense of “deservingness” or “deservingness;” that view things as black & white (e.g., all good or all bad) rather than in shades of grey); and that over-generalize, personalize, etc. When this happens, their negative emotions tend to be exacerbated, causing them to feel dread, stressed-out, hostile, hopeless depression, debilitating guilt or shame, etc. in situations where concern, frustration, annoyance, sadness, regret, etc. would be more appropriate emotions.

Instead of logically evaluating the situation with a calm and rational mind—looking for reasonable solutions and ways to cope—people maintaining these beliefs act in a self-defeating manner by, for example:

  • Being overly passive and avoid dealing with problematic situations
  • Having very low frustration tolerance and giving up quickly
  • Being self-deceptive
  • Feeling helplessness and hopeless
  • Feeling ashamed and embarrassed
  • “Eating themselves up inside” with stress
  • Over-reacting by, for example, attacking, blaming and ridiculing
  • “Self-medicating” with drugs and alcohol, over-eating, etc. in an attempt to lessen their emotional pain.
All these maladaptive reactions are self-defeating because they typically make things worse instead of better, or do nothing to improve the situation.
So, what does this have to do with physical health? A great deal! This belief-emotion-behavior connection is function of the mind-body connection. For example, many people do not follow their doctor’s advice to change their lifestyle (e.g., to exercise and eat better) because of beliefs that:
  • Exaggerate how difficult it is (“I can’t stand doing it…it’s just intolerable!”)
  • Minimize their own abilities (“I’m helplessness … it’s hopeless … I just can’t do it!”)
  • Focus on how unfair it is (“This shouldn’t be happening to me … I shouldn’t have to change … it’s not fair!”), rather than focusing on what they must do to improve their health
  • Blame others for their problems (“It’s my mother’s fault for over-feeding me …”) and seek to punish them (“So I’ll eat myself to death to show her”)
  • Result in self-loathing (“I’m worthless and don’t deserve to get healthy”).
People with belief systems such as these are unlikely to be effective in self-management of risk-factors and chronic conditions. They may have low frustration tolerance and motivation, become easily discouraged, “bury their heads in the sand” and deny the problem, become hopelessly depressed and give up, angrily lash out at others trying to help them, and some may actually want to die.

Furthermore, many people living or working in high stress conditions feel strong emotional distress related to similar kinds of beliefs, e.g., they may think “I can’t tolerate this place … They shouldn’t treat me this way … I’m trapped and there’s nothing I can do about it … “). These beliefs are erroneous because:
  • They ARE tolerating the situations, even though they are, no doubt, having unpleasant experiences
  • Everything that happens has causes; just because someone doesn’t like it, it doesn’t mean those things “shouldn’t” happen
  • People are never “trapped” in a bad ob or marriage; there are always alternatives, although they might not be comfortable and pleasant.
Beliefs such as these are likely to exacerbate negative emotions and stress levels, and there is ample research on mind-body medicine that demonstrates a strong connection between stress, negative emotions and illness.

They would all be much better off if they changed their beliefs, so they could think rationally and act responsibly by keeping things in perspective, evaluating options objectively, getting constructive feedback from others, developing a game plan and executing it assertively.

So, can a person’s beliefs affect one’s physical health? You bet!

The topic continues here.

Saturday, February 10, 2007

Attending to patients' sense of security

I think one of the most important things to patients/consumers is to feel secure in the belief that they do and will receive the best possible care -- tailored to their particular needs, characteristics, and preferences -- which is delivered in a safe, timely, and efficient (cost-effective) manner.

This is an emotional issue related to having trust and confidence in (a) the knowledge and competence of their providers, (b) the safety of the healthcare delivery system, and (c) the ability for the system to be prepared and respond effectively in emergencies (bioterrorism, pandemics, natural disasters, etc.).
An informed consumer would likely feel quite insecure considering the knowledge gap problem, safety and quality problems, our insane economic and competition models, and the split between sick-care and well-care and between mind and body care, which reflect today’s healthcare environment.

If I’m correct, rallying the public first requires educating them about why feeling insecure about their health and finances is the most rational reaction to the current healthcare system. They then have to debate what changes are necessary to transform the system, which requires further education, along with good collaborative communication for discussing and evaluating ideas. Emerging from this dialogue would be a transformational model detailing the strategies and tactics necessary to make them feel more secure. It will likely include recommendations for policies, practices, models and processes designed to help their providers deliver continually improving care quality and reward them for doing it efficiently and effectively, to monitor populations for outbreaks and have responding to emergencies, as well as ways to make universal coverage a reality.

Monday, February 05, 2007

Supporting First Responders and Hospital Staff in a Disaster

One aspect of the healthcare continuum that should receive more attention is support for first responders and hospital staff in the ER and beyond. In a disaster situation, this involves complex processes in chaotic environments.

We’ve been studying this issue and developing an innovative way to use information technology systems to support all involved personnel by:

  • Deploying a "man-down" device that detects when a first responder, such as a firefighter, is not responsive and needs assistance.
  • Helping locate and extract victims from buildings in a way that minimizes risk to both the victims and the first responders rescuing them.
  • Guiding first responders in selecting appropriate trauma centers by mapping victim needs to facility capability.
  • Giving timely feedback about each victim’s health profile and condition to healthcare providers from first encounter through transport to the nearest trauma center equipped to handle the victim.
  • Monitoring the availability of resources (including personnel, beds, medications, equipment, etc.) in the treatment facility and informing staff of shortages, so prescribed care is delivered with minimal disruption.
  • Alerting clinicians when a patient’s plan-of-care orders are not carried out in a timely manner, in order to help avoid adverse events by speeding plan of care adjustments.

In a disaster, pandemic or terrorist attack, this system supplies ongoing critical feedback that (a) facilitates coordination of care between first responders, trauma center staff and other hospital personnel and (b) enables rapid response when problems arise. It includes new types of software systems that work in tandem with a Personal Health Record (PHR), Electronic Health Record (EMR) and Computer Physician Order Entry (CPOE) applications. It also support the Saint Francis University’s Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA) ambulance of the future, which is capable of providing continuous voice and data transmission through a variety of communications links, and has the ability to transmit and receive live video through a satellite video conferencing system.

I think few would argue that we should be doing everything possible to prepare and support first responders and ER staff for large scale crises.

We have a document that shows how these technologies would be used in a disaster, pandemic, or terrorist attack. For a copy, please contact me (Steve Beller) at sbeller@nhds.com