CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit Nigel Sage, Michelle Sowden, Liz Chorlton and Andrea Edeleanu Slide Set 13 Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Weighing Up Denial Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Denial Differentiated DEFINING OUR TERMS: Denial Differentiated Positive (Constructive) Avoidance Fearful Avoidance Refusal to accept (believe) Total Denial Public Denial Ignorance or Confusion Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Positive (Constructive) Avoidance Fully aware of diagnosis Co-operates with treatment Seeks no further information Refuses to consider negative outcomes Normal life style Plans realistically Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Fearful Avoidance Accepts diagnosis Quickly distress when health issues raised Avoids health checks and information Avoids being given direct health feedback Avoids news, tv etc re health issues Fears own negative thoughts Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Refusal to accept (believe) Reluctant to co-operate with treatment Questions the diagnosis Minimises the symptoms Generates alternative explanations Seeks further opinions Prefers alternative therapies and theories Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Total Denial Blanks all memory of the diagnosis Creates own explanation for symptoms Refuses treatment as unnecessary Rejects offers of help and support Irritated by “intrusions” and questioning Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Public Denial Privately accepts diagnosis Co-operates in treatment with conditions Sees the illness as a social stigma or judgement to be hidden away or Fears invasion of privacy and loss of personal control Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Ignorance or Confusion Misunderstands diagnosis Muddled by information received Fails to appreciate or grasp the seriousness of the situation or Disease site, medication or another disorder interfere with assimilating information Powerful “other” refuses to accept Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Advantages of Denial Self protection Maintenance of hope Resilience prevents being overwhelmed can help end stage communication Maintenance of hope preserves a sense of future positive outlook Resilience minimising of symptoms reduces anticipatory anxiety Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Disadvantages of Denial Neglect inadequate reaction to symptoms personal affairs not sorted unrealistic and bad decisions made Obstruction poor compliance and reporting blocks interpersonal relationships blocks professional advice Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Denial Type and Approach Ignorance Public Denial Positive Avoidance Fearful Avoidance Refusal to accept Total denial Educate Become “insider” Help problem solve Reduce anxiety Explore options Build acceptance Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

To Act or Not To Act Weighing the Odds Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

To Act or Not To Act Weighing the Odds Pros Cons To: Advantages of denial Disadvantages of denial Benefits Costs Patient Normal daily life Intolerance of health Stick with current plans discussions Mood normal Disturbed dreams Sudden irritability Family Normal daily routines Restricted communication Plans unchanged Hidden feelings Priorities unchanged Uncertainty or confusion No expressed distress Tense atmosphere Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

To Act or Not To Act Weighing the Odds Pros Cons To: Advantages of denial Disadvantages of denial Benefits Costs Treatment Minimum demands on Poor reporting of staff time symptom changes High tolerance of Poor compliance discomfort Overdoes things Positive outlook Family need lots of Active life support and advice Do nothing Maintain positive Reduce longevity atmosphere for patient Poor symptom control Fail to plan realistically Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

Weighing The Pros & Cons How much would this matter to the patient if he/she realised it? Score each item FROM THE PATIENT’S PERSPECTIVE 0 = It would not matter at all 3 = It would matter very much Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

To Act or Not To Act Weighing the Odds 1 2 2 3 2 1 3 3 3 1 1 1 3 1 3 3 3 3 2 3 1 Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008 20 25

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