Based on Integrated Behavioral Health in Primary Care StepbyStep Guidance for Assessment and Intervention Hunter et al 2009 Presented August 2011 by Katherine M Dollar PhD Whats in Your Toolbox ID: 495136
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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.,Slide2
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 Solving6. 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 Padesky6Slide7
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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