Common Behavioral and Cognitive Interventions in Primary Care

Common Behavioral and Cognitive Interventions in Primary Care Based on: Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention Hunter et al, 2009 Presented August 2011 by Katherine M. Dollar, Ph. D. ,

What’s in Your Toolbox? 2

The Co-located, Collaborative Provider’s Toolkit n The following 8 techniques are effective for addressing a wide variety of symptoms and functional impairment seen in primary care (Hunter et al. , 2009) n 1. Relaxation training n 2. Goal setting n 3. Identifying and disputing negative cognitions n 4. Motivational Interviewing n 5. Problem Solving n 6. Self-monitoring n 7. Behavioral Activation n 8. Assertive Communication 3

Relaxation Training n n Deep Breathing Cue-controlled relaxation Progressive muscle relaxation Visual imagery 4

Goal Setting n n n Are the goals well defined in behavioral terms? (S. M. A. R. T) Realistic/achievable With in realm of control/influence Break into sub goals Personally important Whose goals are they anyway? 5

Identifying and Disputing Negative Cognitions n n n Help to indentify unhealthy cognitions (predictions, expectations, evaluations) Use thought logs Question thought process “Cognitive Disputation” Self-help books for highly motivated n Mind Over Mood: Greenberger and Padesky 6

Motivational Interviewing n n n Examine readiness to change (Readiness Ruler) Examine importance and confidence for change Elicit pros and cons of change 7

Problem Solving n A five-step problem-solving model is recommended for the PC setting (Nezu, personal communication, 2011) 1. Minimize emotional arousal to focus on next 4 steps 2. Set an achievable goal, identify major obstacles 3. Brainstorm multiple alternatives to overcoming obstacles 4. Identify pros and cons of each idea, cost-benefit analysis 5. Implement an action plan and assess the outcome (either fine-tune or go back through steps 1 -4) Please note: Additional PST trainings will be available in the future. 8

Self-Monitoring n Help track progress towards a goal Use a calendar n Keep a tally n Chart on a graph n 9

Behavioral Activation • • • Difficult to feel depressed when engaged in actives that provide pleasure and accomplishment Re-establish routines Increase reinforcing experiences Overcome avoidance patterns Distraction from problems or unpleasant events 10

Behavioral Activation Techniques • • • Choose and schedule daily pleasurable activities (Pleasant Events Schedule or Life Activities Checklist) List activities and rate for mastery and pleasure Keep activity logs 11

Assertive Communication n n Assess patterns of communication Explain differences in passive, assertive, and aggressive communication Help patient to learn how to speak assertively (Honest, Appropriate, Respectful, Direct) Practice through role-play n The Anxiety and Phobia Workbook 12

Helpful Resources n Hunter, C. L. , Goodie, J. L. , Oordt, M. S. , & Dobmeyer, A. C. (2009). Integrated Behavioral Health in Primary Care: Step-by-step Guidance for Assessment and Intervention, American Psychological Association. n Gatchel, R. J. & Oordt, M. S. (2003). Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration: Washington, DC; American Psychological Association. n n P. Robinson & J. Reiter (2007) Behavioral consultation and primary care: A guide to integrating services. New York: Springer Science. Media. W. O'Donohoe, M. Byrd, N. Cummings, D. Henderson (2005). Behavioral integrative care: Treatments that work in the primary care setting. New York: Brunner-Routledge. 13

Questions? 14

Helpful IPC Resources n n n http: //vaww. visn 2. med. va. gov/bh/cih/index. html http: //vaww 4. va. gov/pcmhi/ http: //www. cfha. net E-mail address: katherine. dollar@va. gov 15