CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit Nigel Sage, Michelle Sowden, Liz Chorlton and Andrea Edeleanu Slide Set 12 Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Managing Emotions and Unpleasant Physical Sensations Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Behaviour Physical Sensation Thoughts Emotion Environment Environment Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

INTENSE NEGATIVE EMOTIONS – NOT ALL BAD Intense Emotional Reactions at diagnosis points of relapse When recurrent health events pose threat to well being and life itself Are Usually Common & Short-lived Understandable & normal Rarely do lasting harm And are important in the process of adjustment and becoming resilient to further changes Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

EMOTIONAL EXPRESSION Probably not therapeutic in its own right/as the sole approach Works best if accompanied by cognitive processing Ventilation of feelings often necessary before patients can proceed to problem solving Some patients experience negative emotions but don’t express them openly Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

INDICATIONS FOR OTHER INTERVENTIONS Prolonged negative mood state – anxiety, depression, anger Overwhelming affect Behavioural deficits or avoidance Presence of maladaptive emotions – guilt, self blame, severe hopelessness try Problem Solving, target specific behaviours or Avoidance first Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

WHY FACILITATE EMOTIONAL EXPRESSION? Help the Patient engage with their all their feelings (improves outcomes) Clarify the personal meaning of problem situations (aids selection of appropriate treatment goals) Establish and maintain the therapeutic alliance (by validating the patient’s feelings) Accepting emotions allows people to step back and diffuse the situation Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

ENCOURAGING EXPERIENCING OF APPROPRIATE AFFECT 1 Educate / normalise of emotional reactions Reduce activity. Be quiet. Allow emotions to emerge Probe - Open ended > closed questions Encourage Patient to attend to emotional experience “What’s it like for you now?” Keep focus on here and now experience Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

ENCOURAGING EXPERIENCING OF APPROPRIATE AFFECT 2 pay attention to patient’s manner and postural expressions use reflective comments “Thinking about how things have been for you makes me feel very sad for you” encourage Patient to use 1st Person language challenge negative thoughts about emotional expression Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

TECHNIQUES FOR OFF-LOADING (altered body image, anger, prolonged low mood, negative outlook) Allow time to feel low and frustrated Talk to a friend (who will just listen, not counsel) Meet others like yourself Expressive writing Dear Diary, un-posted letters, free-form Remembering – photos, letters, places Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

TECHNIQUES FOR REDUCING EMOTIONAL REACTIONS: Excessive Worry & Fear of the Future Mental Distraction Relaxation exercises Attention Strategies Mindfulness Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

PAIN & PHYSICAL TENSION Pacing Purposeful Planning Relaxation exercises & breathing control Mindfulness Mental distraction & Attention Strategies Assertive skills Ergonomics & lifestyle review Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

TECHNIQUES FOR INCREASING +VE EMOTIONAL REACTIONS/EXPRESSION: pleasure, ability to enjoy things Do things which gave pleasure in the past In small doses (quit whilst ahead, before fatigue/pain too severe) Follow advance plan, don’t wait until ‘I feel like it’ Aim for doing, not enjoying Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

VENTILATING ANGER Anger is emotional response to feeling the situation is unjust. If it is denied/not expressed/bottled up it smoulders and escalates Set aside time to be emotional Tell someone you are angry with them if possible Or find other ways to let off steam Then look at the thoughts associated with the feelings and find a better way of dealing with them Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit Nigel Sage, Michelle Sowden, Liz Chorlton and Andrea Edeleanu Publisher: John Wiley & Sons (2008) ISBN: 978-0470517079 Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008