CBT for Chronic Illness and Palliative Care

Nigel Sage is Consultant Clinical Psychologist in cancer and Palliative Care at The Beacon community Specialist Centre for Cancer and Palliative Care in Guildford, Surrey. He is an Accredited Cognitive Behaviour therapist and also works in primary care mental health in Hampshire. Michelle Sowden is Consultant Clinical Psychologist at Frimley Park Hospital where she has provided and developed a service to patients with physical health problems across the Clinical Directorates. She has a special interest in the application of cognitive behavioural and systemic therapies to the management of chronic medical conditions.Elizabeth Chorlton is a Chartered Clinical Psychologist at Frimley Park Hospital, in the Department of Psychological Medicine, with patients who are experiencing psychological difficulties as a result of physical health problems. In addition to her clinical psychology training, she has an MSc in the field of health psychology.Andrea Edeleanu is Director of Specialist Therapies and Service User Involvement for Surrey and Borders Partnership NHS Trust. She works clinically in Community Health Psychology and provides consultancy and clinical supervision to colleagues in health, mental health and community services. She is a consultant Clinical Psychologist, Chartered Health Psychologist and an Accredited Cognitive Behaviour therapist.

?It is very thorough, with clear explanations of the approach, uses, and techniques to assist patients or families in changing behavior so that they may better manage their illnesses and meet their life goals..? (Doody?s , August 2009)

• About the Authors xiAcknowledgements xiiiIntroduction xvPart I: The Workbook: The Cognitive Behavioural ApproachChapter 1: What is the Cognitive Behavioural Approach? 3Chapter 2: The Relevance of a Cognitive Behavioural Approach for People with a Life-changing Illness 10Chapter 3: Does Cognitive Behaviour Therapy Work? The Evidence Base 18Chapter 4: Communication Skills in Health Care 47Chapter 5: Cognitive Behavioural Communication Style 58Chapter 6: Guided Discovery: Using the Socratic Method 66Chapter 7: Assessment 78Chapter 8: Formulation 87Chapter 9: Deciding on a Course of Action: Part 1 97Chapter 10: Goal Setting and the Step-by-Step Process 102Chapter 11: The Practicalities of Setting Goals 113Chapter 12: Bringing About Change 125Chapter 13: Methods of Behaviour Change 132Chapter 14: Methods of Cognitive Change 143Chapter 15: Challenging Unhelpful Thoughts 158Chapter 16: Managing Emotions and Unpleasant Physical Sensations 167Chapter 17: Decision on a Course of Action: Part 2 176Chapter 18: Applying a Cognitive Behavioural Approach to Clinical Practice 182Part II: The Issues: Some Psychological ProblemsHow to Use This Part of the Book 191Glossary of Everyday Terms 191Adjustment Difficulties 193Altered Body Image 195Anger 198Avoidance 201Denial 203Fatigue 206Fear of the Future 208Inactivity 210Indecisiveness 212Intrusive/Distressing Thoughts 214Lack of Motivation 216Loss of Pleasure or Ability to Enjoy Things 218Low Mood 220Low Self-Esteem 222Negative Outlook 224Pain 226Panic Attacks 229Special Note: Safety Behaviours 231Physical Tension 232Poor Concentration 234Problem Solving Difficulties 236Setbacks 238Sleep Difficulties 240Unassertiveness 242Worrying 244Part III: The Toolkit: CBT Methods in PracticeSection 1: TechniquesActivity Monitoring 249Assertiveness Skills 250Assessing Psychological Distress 251Attention Strategies 252Basic Counselling Skills 254Behavioural Change Methods: A Summary 255Behavioural Experiments 256Behavioural Rehearsal 257Believable Alternative Thoughts 258Breathing Control 259Challenging Unhelpful Thoughts 260Cognitive Change Methods: A Summary 261Denial: Strategies for Encouraging Acceptance 263Denial: Strategies for Engaging the Patient 264Denial: Strategies for Reducing Distressing Thoughts 265Denial: Suggestions for Questions to Ask 266Effective Communication Skills 267Emotional Expression 268Expressive Writing 269Graded Activities 270Listening Skills 271Mental Distraction 272Mindfulness 273Pacing 274Problem Solving 275Psycho-education 276Purposeful Planning 278Relaxation Exercises 280Respectfulness Skills 282Socratic Questioning 284Stimulus Control 285Weighing the Pros and Cons 286Section 2: Information SheetsAntidotes to Bad Days 287The Assertiveness Model 288Assertiveness Rights 289Assertiveness Techniques 290Bad Old Habits: Avoiding Relapsing Into Them 292Change: Bringing It About 293Change: The Desire for It 294Change: The Transition Curve 295Coping with Setbacks 1: Physical Health Setbacks 296Coping with Setbacks 2: Mental Attitude Setbacks 297Denial: Advantages and Disadvantages 298Experiential Learning Cycle 299Goal Setting and the Step-by-Step Approach 300Goal Setting: Examples 302Goal Setting Questions 303Mental Traps: Examining the Evidence 307Mental Traps: Examples of How to Get Out of Them 308Mindfulness Attitudes 310Mindfulness Exercises 311Pacing 312Pacing Examples 314The Reactions of Other People 315Reflective Practice Diary Guidance 317Relaxation: Mental Exercise 318Relaxation: Muscle Exercise 319Relaxed Breathing Exercise 320The Serenity Prayer 321Sharing and Mixing with Other People 322SMART Guidelines 323Socratic Questioning: Examples 324Stress: The Effect it Has 325The Stress Response 326A Vicious Cycle Model of Anxious Avoidance 327A Vicious Cycle Model of Anxious Preoccupation 328A Vicious Cycle Model of Hopelessness-Helplessness 329Section 3: Record FormsEvent-Emotion-Thought Analysis Form 332Example of Event-Emotion-Thought Analysis Form 333Believable Alternatives 335Thought Record 336Pacing Record Form 337Denial: Assessing its Costs and Benefits 338Denial: Example of Pros and Cons Assessment 339Action Plan for Denial 340Goal Planning: Step-By-Step Action Plan 342Your Ideas for Goals 342Reflective Practice Diary 351References 357Index 363