1. 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

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

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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:
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008