Suzanne Ruff, PhD
Health Psychologist
Cleveland VA Medical Center
Cleveland, Ohio
Chronic Medical Conditions
 There are three tasks in managing a chronic medical
 Care for your condition, learn about your condition
 Manage any emotional changes that your condition may
bring about
 Return to your pre-diagnosis life as fully and as soon as
Partner with your medical caregivers
and your family and friends
Stages of diagnosis
 Pre-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 symptoms
 Anger
You can’t do what you used to do
You want your life back
Stages of diagnosis
 Diagnosis
 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 diagnosis
 After diagnosis, mood varies with:
 acuity of disease, number and severity of flares
 support available
 medical care available
 ability to return to life before diagnosis
 1978 study on mood variation with significant event
 Spinal cord injury
 Winning the lottery
Stages of diagnosis
Most people return to their baseline
mood about a year after injury or
winning the lottery
Psychology of chronic illness
 What does this mean to patients with a chronic
medical condition?
 Chronic medical conditions can lead to depression
over time
 Often 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 treatment
 Recognize symptoms
 Mood, somatic symptoms, cognitive symptoms,
 Anhedonia
Meaning and purpose in life
 Seek responsible treatment
Partner with your medical providers and especially MG
Think about therapy rather than medications
Psychological therapies
 Cognitive Behavioral Therapy
 Cognitive Processing Therapy
 Narrative Therapy
 Acceptance and Commitment Therapy
 Positive Psychology Therapy
 Combination therapies
 Partner with your providers
Positive Psychology
 Martin Seligman, PhD, University of Pennsylvania
founded the field of Positive Psychology in the late
 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 people
 Formed a panel to study happiness
 Phenomenally successful
Positive Psychology
 Define happiness – essentially a sense of well-being
 Not hedonism, not about material things
 Must be measurable and changeable
 Deconstructed the unwieldy term of happiness into:
 Positive emotion
 Purpose
 Engagement
 Positive relationships
 Positive accomplishments
Positive Psychology
 Positive emotions
 Studied by Barbara Fredrickson, PhD at UNC
Measures positive emotion to negative emotion ratio
 Positive character strengths
 Community involvement – values in action
Positive Psychology
 Positive emotion
 Broaden and build theory
 Positive emotions lead to more flexible thinking
 Positive emotions lead to more expansive vision
 Positive emotions lead to more creative thinking
 Positive emotions build stronger relationships
 Positive emotions build emotional reserves
 Positive emotions build future protection
Positive Psychology
 Most studied positive emotion
 Joy
 Love
 Inspiration
 Humor
 Awe
 Pride
 Tranquility
 Gratitude
 Interest
 Hope
Positive Psychology
 Increase positive emotions and decrease negative
 Gratitude journal
 Develop new interests
 Deepen current interests
 Mindfulness
 Savor positive events, conversations,
 Distraction when negative thoughts occur
 Defuse negative ‘landmines’
Positive Psychology
 Purpose and engagement
 Positive character traits
 Panel 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 traits
Positive Psychology
 Take the VIA test – long version
 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 Five
 The Big Five
 Gratitude
 Curiosity
 Hope/optimism
 Appreciation of beauty and excellence
 Vitality
Jumped categories – from transcendence to courage
Positive Psychology
 How to become depressed
 Dwell on the negative
 Lose interest in most things and people
 Become convinced that negative things are permanent,
pervasive, and not under your control
 Lose your sense of wonder
 Stop moving
Not exercising is like taking a “depressant”
Compare these to the Big Five
Positive Psychology
 Positive relationships and positive accomplishments
 Most easily achieved through use of your strengths
 Family, friends, social circles
 Community involvement
 Work, 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 Change
 Pre-contemplation
 Contemplation
 Planning
 Action
 Maintenance
 Identify, target, make a plan and carry it out
Stages of Change
 Life balance
 What do you value?
 Pillars of life
 Family
 Intimate relationship
 Friends
 Community involvement
 Spiritual life
 Work, volunteering
 Hobbies, fun
 Learning/growing
 Physical health
 Physical space
 _____________
Stages of Change
 Identify your values
 How are you actually spending your time?
 How would you like to spend your time?
 Target areas for change
 What is balanced? Keep those
 What is necessary? Be realistic
 What would you like to change? Make a plan
 Plan for change and maintenance
Stages of Change
 Life balance worksheet, part 1
 Average day or week
 Difficult to do unless you carry sheet around – memory
is not great for this type of activity
 Life balance worksheet, part 2
 + column, - column, = column
 Maintain – no stealing from balanced row
 Life balance worksheet, part 3
 Make a plan
 Be realistic, flexible, positive
 10 questions on positive emotions
 10 questions on negative emotions
 1 point assigned for any negative emotion
Due to negativity bias
 1 point assigned for any positive emotion experienced at
a moderate level
 3:1 ratio is associated with flourishing
Positive Psychology
 Very promising new field for Positive Health
 Not absence of disease
 Strong results with studies involving literally hundreds
of thousands participants in Health Psychology
 Empowering
 Needs to be personalized
Positive steps
 Keep a gratitude journal
 Savor the good times
 Use the Life Balance chart to help you decide where to
spend your time
 Get involved with what or who you love
 Pace yourself
 Use some of your “good” days to spend in pleasurable
and meaningful activities
 Be active
 Keep it up!