|INTERVIEWING TIP OF THE MONTH
# 41 July 2003
Helping AIDS Patients to Cope with Demoralization
TISA Description of the Problem: For patients with AIDS every day presents a multitude of difficult situations, all of which can lead to demoralization and/or depression. One demoralizing topic that does not always receive the attention it deserves is the huge psychological hurdle of having to take fourteen or fifteen pills three or four times a day. It is not an exaggeration to say that some of these pills are the size of "horse pills". Many of these patients must, literally, gag down these pills. In addition, the pills come to symbolize for some AIDS patients not that they are beating their disease but serve as reminders that they are "diseased".
Along these lines, the following tip, by Ed Hamaty, D.O., was offered to me in a recent workshop on improving medication interest. Besides the fact that I feel this tip is exquisitely effective, I am particularly excited by it for Ed has been a lifetime great friend to me and is one of my models for a gifted physician. Let's see how Ed puts it all together with a population - AIDS patients - that he has specialized in helping.
Tip: As the pills become more and more problematic, patients begin to anticipate the unpleasantness of the upcoming pill taking. In essence, they begin to "play a tape" that sounds something like, "Oh God, not this again" or "I can't take this anymore". I have found that by working with the patient to come up with a concrete affirmation to say to themselves as they take their medications, this tape can be re-recorded into something much more comforting and inspiring.
For example, let us say the patient has a powerful desire to continue to live to be there for his or her grandchild, the patient may repeat the following affirmation, "This is for my grandchild."
Or let us assume that a patient gains a sense of satisfaction that he or she is battling back the AIDS virus, then the following simple affirmation may function almost like a personal act of releasing defiance, "Take that!"
Each aphorism must be generated by the patient and have unique meaning to the patient. For instance, if the patient is suffering from intractable pain, as he or she takes his pain medication the patient may say, directed towards the pain, "Not today you won't."
TISA Follow-up: These are great tips from Ed, and the range of affirmations is only limited by the imaginations and unique qualities of each patient. In essence, the range is essentially limitless.
I am finding these techniques to be very effective with certain patients dealing with psychiatric disorders. For instance, many of my younger patients with OCD find it re-affirming to say something like the following: "This one is for you OCD, I'm gonna kick your butt today." Such affirmations externalize the disease so that the patient does not view himself or herself as the problem while focusing the patient on his or her ability to control the OCD symptoms, frequently using CBT techniques as well.
Tip provided by:
Ed Hamaty, D.O., (Specialization - Pulmonology)
Voorhees, New Jersey