Psychological Approaches In Psychological Approaches In Primary Care II (Bradford GP Primary Care II (Bradford GP

VTSVTS

Dr Andrew R. WilsonDr Andrew R. Wilson

ObjectivesObjectives

Reflect on validation homework to embed Reflect on validation homework to embed and share successes and acknowledge and and share successes and acknowledge and deal with some of the difficultiesdeal with some of the difficulties

Have sufficient understanding of the Have sufficient understanding of the rationale therapies to facilitate referral for rationale therapies to facilitate referral for psychological interventionspsychological interventions

Explore some ways of bringing focus and Explore some ways of bringing focus and facilititating change when working with facilititating change when working with psychological problems in primary care.psychological problems in primary care.

Today SessionToday Session

1.1. Summary of previous sessionSummary of previous session

2.2. Rationale therapies / therapist – Rationale therapies / therapist – presentationspresentations

3.3. Homework review (tying in some of the Homework review (tying in some of the learning from summer school “counselling” learning from summer school “counselling” subschool.subschool.

4.4. Tools for changeTools for change

5.5. Summary and feedbackSummary and feedback

Review of Session IReview of Session I

Pairs WorkPairs Work

Review of Session IReview of Session I

What worksWhat works EmpathyEmpathy GenuinessGenuiness WarmthWarmth negotiation of Goalsnegotiation of Goals ReflectingReflecting

Review of Session IReview of Session I

What worksWhat works Repairing rupture in therapeutic relationshipRepairing rupture in therapeutic relationship If patient satisfiedIf patient satisfied AllianceAlliance Cohesion between pt and therapistCohesion between pt and therapist Emotional expressionEmotional expression Changing view of selfChanging view of self

Review of Session IReview of Session I

What works broad What works broad classificationclassification

ValidationValidation

Goal orientation/change techniquesGoal orientation/change techniques

2. Rationale therapies 2. Rationale therapies

PresentationsPresentations

Homework ReviewHomework Review

Validation Validation

In GroupsIn Groups What worked wellWhat worked well

What worked less wellWhat worked less well

4. Tools for change4. Tools for change

1.1. Problem and goal listsProblem and goal lists

2.2. Cognitive continuum methods – breaking Cognitive continuum methods – breaking down global thinkingdown global thinking

3.3. Behavioural ActivationBehavioural Activation

Problem and Goal ListsProblem and Goal Lists

Give FocusGive Focus Breaks things up into smaller partsBreaks things up into smaller parts Uses patients definition of problemsUses patients definition of problems CollaborativeCollaborative Problem and present orientatedProblem and present orientated DirectionalDirectional Gives in time a sense of progress madeGives in time a sense of progress made

Sources for problem listsSources for problem lists

1.1. Situational problemsSituational problems

2.2. Medical and traditional psychological Medical and traditional psychological problemsproblems

3.3. What other observe (family/doctors)What other observe (family/doctors)

4.4. Effect of pt on othersEffect of pt on others

5.5. ?symptom/problem diaries ?symptom/problem diaries

Patients may under reportPatients may under report

1.1. Embarrassed/shameEmbarrassed/shame

2.2. Not be aware it is a problemNot be aware it is a problem

3.3. Believe problem to be insoluableBelieve problem to be insoluable

4.4. OverwhelmedOverwhelmed

5.5. Not consider it a problemNot consider it a problem

GoalsGoals

SSpecificpecific

MMeasurableeasurable

AAcheiveablecheiveable

RRealisticealistic

TTime Limitedime Limited

Challenging Global ThinkingChallenging Global Thinking

Lots of forms of negative global thinkingLots of forms of negative global thinking

Worksheets in 3’sWorksheets in 3’s

Common Thinking ErrorsCommon Thinking Errors

1.1. All or nothing/Black or White/Polarised All or nothing/Black or White/Polarised ThinkingThinking

2.2. OvergeneralisingOvergeneralising3.3. Mental filter/selective abstractionMental filter/selective abstraction4.4. Jumping to conclusions/catastrophisingJumping to conclusions/catastrophising

1.1. Mind readingMind reading2.2. Fortune tellingFortune telling

5.5. Magnifying or minimizing Magnifying or minimizing

Common Thinking ErrorsCommon Thinking Errors

6.6. Emotional ReasoningEmotional Reasoning

7.7. Shoulds and mustShoulds and must

8.8. LabellingLabelling

9.9. PersonalisingPersonalising

10.10. Tunnel VisionTunnel Vision

11.11. Disqualifying or discounting the positiveDisqualifying or discounting the positive

Cognitive Continuum Cognitive Continuum

Identify the global thinkingIdentify the global thinking

““I’m a bad mumI’m a bad mum

Score it 0-100Score it 0-100

Break up “I’m a bad mum “ into constituent Break up “I’m a bad mum “ into constituent parts and re scoreparts and re score

PatientPatient 00 x100x100

LovingLoving 00 x100x100

Warm and Warm and

FedFed 00 x100x100

Quality TimeQuality Time 00 xx 100 100

Build their Build their

Self EsteemSelf Esteem 00 xx 100100

Good Mother belief at beginning 50%

Good Mother belief at end 70-80%

Behavioural ActivationBehavioural Activation

Some behaviours result in positive mood Some behaviours result in positive mood changeschanges

Evidence that scheduling activities can Evidence that scheduling activities can result in improvement in patients with result in improvement in patients with anxiety and depression, independent of anxiety and depression, independent of traditional medical interventionstraditional medical interventions

Probably the main “treatment” effect of CBTProbably the main “treatment” effect of CBT