Brief psychological treatments of use in the medically ill

Prevention

There are two broad approaches to prevention, namely education and support.

Education and the provision of information and advice about the illness and its management is desirable as an informed patient is more likely to be an effective partner in treatment, and because it is popular with patients. Disappointingly, however, it is not an effective means of preventing psychiatric problems. This is probably because, while it facilitates primary appraisal, it does nothing to facilitate secondary appraisal or the use of effective coping strategies.

Provision of support is also popular. It takes a number of forms, including self-help groups, volunteer visiting, and professional support workers—usually with knowledge of a particular disease such as AIDS or stroke. Again, it is popular, but there is little evidence that it prevents psychiatric problems. Perhaps this is because it usually provides emotional support; which in itself may be worthwhile but which is insufficient if not combined with a more problem-focused approach.

In conclusion, there are no clear indications that we can prevent the development of adjustment disorders. The mainstay of current management is therefore to identify existing cases and to offer specialist care to those who are most symptomatic or handicapped, and to those who are not improving spontaneously.

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