Her nuanced client portraits also show how individual patients can vary-even within themselves. This book offers clinicians invaluable help with - Conceptualizing patient problems - Developing the therapeutic relationship - Pacing of therapy - Cognitive restructuring - Behavioral modification - Problem solving - Fostering coping and adapting skills Taylor's coverage is both clean and hands-on, with helpful assessments and therapy worksheets for quick reference.
Cognitive Behavioral Therapy for Chronic Illness and Disability gives practitioners of CBT new insights into this population and provides newer practitioners with vital tools and tactics. All therapists will benefit as their clients can gain new confidence and regain control of their lives.
Cognitive behavioral therapy for chronic illness and disability. N2 - Severe pain, debilitating fatigue, sleep disruption, severe gastrointestinal distress - these hallmarks of chronic illness complicate treatment as surely as they disrupt patient's lives, in no small part because of the overlap between biological pathology and resulting psychological distress. It is a debilitating condition, sapping individuals of their desire for life, for hope, for movement. This article will describe the negative effects depression has on chronic illness, how to recognize it, and how to encourage clients toward self-care.
When his experiments failed to validate the psychoanalytic conceptualization of depression, Beck sought another way to understand the disorder. He recognized that depressed individuals had a negative view of the self, of others and the world, and of the future. How am I going to deal with this? I have no more inner strength to continue this battle. The theme is loss: He was frustrated by. James would stay home, waiting for the phone to ring.
Severe pain, debilitating fatigue, sleep disruption, severe gastrointestinal distress – these hallmarks of chronic illness complicate treatment as surely as they. Cognitive Behavioral Therapy for Chronic Illness and Disability cuts across formal diagnostic categories to apply proven therapeutic techniques.
Depression can be likened to a hibernation instinct. James saw himself negatively: He saw his personal world negatively: And he saw his future negatively: Such ideas are painful and powerful.
And they are untrue. When our clients believe them, though, they can give up, and go into a hibernation mode. Like James, their motivation drops. Their interest in life drops. And their energy level drops. Depression tells people to slow down, shut down, and retreat to their caves. When illness triggers a loss of functioning, individuals may be prone to developing depression. These symptoms have a powerful effect. They were just less apt to care for themselves; they were less vigilant in maintaining healthy habits and more apt to give up once they got sick.
Without treatment, James could have easily gone this route.
Two patients may have the same physical health problems, yet have markedly different psychological responses. For example, a man with multiple sclerosis who believes that his ability to make a useful contribution to life is finished is likely to experience depressed mood and avoidance of previously enjoyed activities.
But a different man with the same condition who acknowledges that his life will have to change, but who believes that he will be able to discover new ways to make a contribution, is likely to make a better psychological adjustment to his illness. These differences in patient psychological responses can be understood by examining patients' thoughts about their illness. This is a fundamental principle behind cognitive therapy—a focused, structured, collaborative, and usually short-term psychological therapy that aims to facilitate problem solving and to modify dysfunctional thinking and behavior figure.
Several factors make a cognitive therapy framework particularly suited to address the problems associated with chronic disease:. The generic cognitive model outlines how the thoughts, behaviors, moods, and physical reactions that patients have each tend to contribute to the other components in the model.
This in turn will lower energy levels, which further depresses mood and so on.
There is a growing number of psychological disorders for which cognitive behavioral models and therapy protocols have been developed, many of which have been shown in research trials to be effective. Cognitive therapy sessions are usually structured by a collaboratively agreed-on agenda. Active participation is encouraged by giving patients homework assignments to do between therapy sessions. Treatment involves the application of a range of cognitive and behavioral strategies designed to alter the factors that trigger, maintain, or exacerbate symptoms.
The strategies are effective in helping patients to gain control over both psychological and physical symptoms. A number of simple cognitive therapy techniques can be used by primary care physicians to care for their patients with chronic diseases—agenda setting, self-monitoring, experimentation, and changing distressing thoughts.
Patients with chronic medical problems have many physical, social, and psychological problems. Physicians do not always have time to address all of these within a single consultation.
This fact, combined with the fact that some presenting problems have no apparent solution, can be overwhelming for physicians, who may not know where to start. Setting an agenda is one method for maximizing the chance that a consultation will make some progress toward solving a patient's problems. We have about 15 minutes today, and I want to make sure that we use the time we have to the best effect. The best way I have found to do this is to set an agenda that highlights the main things we want to talk about.
Is there something that you particularly wanted to cover today? Agenda setting reflects the collaborative stance of cognitive therapy in that both physician and patient can assign agenda items. This minimizes the risk that patients will disclose their main concern just as they are leaving the consulting room. When a series of appointments is being arranged, there may be a standing item that always appears on the agenda, such as symptom severity or the presence of side effects.
During assessment, this often involves selfmonitoring in the form of diary keeping see sample above.
Examples of this might be recording mood fluctuations, discrete episodes of problem behavior, or the thoughts and images associated with a negative mood state. In a patient with a chronic illness, this approach need not be restricted to psychological symptoms; it could equally be focused on collecting data to inform medical management, such as keeping a diary of physical symptom severity.
There are hours in the week, and I am in contact with you for only part of 1 of them. It will be useful for you to keep a record of some aspects of your rheumatoid arthritis. Today we talked about how you find that your energy is particularly low at the moment. I think it might help me to help you if you could start maintaining a diary of how much energy you have at particular times during the day.
There are no limits to the range of monitoring assignments that might result from a session. For example, you might ask your patients to write about their thoughts and feelings about their illness, its effects, and its treatment; to compile a list of unanswered questions; to write down thoughts related to worries for the future; to rate the extent to which pain interferes with certain activities; or to count the number of times that a relative provides reassurance.
Patients who have medical problems with an uncertain cause may develop unhelpful and inaccurate beliefs that in turn influence their psychological adjustment for example, the beliefs provoke anxiety states and behavioral responses they seek unconventional cures. Inviting them to write a brief account of their understanding of a particular condition may reveal inaccurate beliefs that require correction or thoughts that mediate psychosocial difficulties or both. Patients often report psychological benefits from assignments that have a purely monitoring role.
Indeed, some homework tasks can be assigned primarily as a therapeutic intervention. If you suspect that a patient's symptoms are being triggered by a certain event, you could ask that patient to keep a symptom diary to note any triggers. For example, you might suspect that the patient's mood and adherence to medication vary according to the presence of family disagreements. In a spirit of collaboration, you first acknowledge that your views differ from the patient's before suggesting that the experiment can test out these differing views.
I have been wondering if there is a link between the times that you take your medication and when you are feeling anxious. I know you don't think that there is a strong link patient agrees. I may be wrong. It could be that there is no link at all.