Common Behavioral and Cognitive Interventions in Primary Care - PowerPoint Presentation

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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, PhD.,

What’s in Your Toolbox?

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The Co-located, Collaborative Provider’s Toolkit The following 8 techniques are effective for addressing a wide variety of symptoms and functional impairment seen in primary care (Hunter et al., 2009)

1. Relaxation training

2. Goal setting

3. Identifying and disputing negative cognitions

4. Motivational Interviewing

5. Problem Solving

6. Self-monitoring7. Behavioral Activation8. Assertive Communication

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Relaxation TrainingDeep Breathing

Cue-controlled relaxation

Progressive muscle relaxation

Visual imagery

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Goal SettingAre 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?

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Identifying and Disputing Negative Cognitions Help to indentify unhealthy cognitions (predictions, expectations, evaluations)

Use thought logs

Question thought process

“Cognitive Disputation”

Self-help books for highly motivated

Mind Over Mood:

Greenberger and Padesky6

Motivational Interviewing Examine readiness to change (Readiness Ruler)

Examine importance and confidence for change

Elicit pros and cons of change

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Problem Solving

A five-step problem-solving model is recommended for the PC setting

(

Nezu

, personal communication, 2011)

Minimize emotional arousal to focus on next 4 stepsSet an achievable goal, identify major obstaclesBrainstorm multiple alternatives to overcoming obstacles

Identify pros and cons of each idea, cost-benefit analysisImplement

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.

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Self-Monitoring Help track progress towards a goal

Use a calendar

Keep a tally

Chart on a graph

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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

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Behavioral Activation TechniquesChoose and schedule daily pleasurable activities

(Pleasant Events Schedule or Life Activities Checklist)

List activities and rate for mastery and pleasure

Keep activity logs

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Assertive CommunicationAssess 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

The Anxiety and Phobia Workbook

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Helpful Resources

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.

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.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.

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Questions?

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Helpful IPC Resources

http://vaww.visn2.med.va.gov/bh/cih/index.html

http://vaww4.va.gov/pcmhi/

http://

www.cfha.net

E-mail address:

katherine.dollar@va.gov

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