1. CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit
Nigel Sage, Michelle Sowden,
Liz Chorlton and Andrea Edeleanu
Slide Set 1
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2. The CBT Model and Its Relevance in Cancer and Palliative Care
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3. What is CBT?
“…an active, directive, time-limited, structured approach”
(Beck et al, 1979)
The therapy works by helping patients to:
“…recognise patterns of distorted thinking and dysfunctional behaviour. Systematic discussion and carefully structured behavioural assignments are then used to help patients evaluate and modify both their distorted thoughts and their dysfunctional behaviours” (Hawton et al, 1989)
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4. There is nothing either good or bad, but thinking makes it so. Hamlet
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5. Man is troubled, not by events, but by the meaning he gives them.
Epictetus ( AD)
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6. Perception Reaction Event 1st Principle Accept interaction b/w
If No - ie biology
theology
dynamics
Then No CT
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7. Reaction Event Assumptions Beliefs Past Experiences Learning Standards
Other information
Rules of thumb
Social pressures
Reaction
1st Principle
Accept interaction b/w
If No - ie biology
theology
dynamics
Then No CT
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8. The Hot Cross Bun
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9. Environment
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10. Environment Environment Behaviour Physical Sensation Thoughts Emotion
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11. Helpful and Unhelpful Thoughts
The Half Empty Glass
 Empty bit
So what?
Is this helpful?
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12. Helpful and Unhelpful Thoughts
The Half Full Glass
This is helpful/useful to know
Milk
Washing Up Liquid
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13. Cognitive Behaviour Therapy (CBT)
Helps us to :
Recognise our internal dialogue
Challenge its more incapacitating effects
Develop a more constructive perspective
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14. The Relevance of CBT in Physical Health Care
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15. The Cognitive Behavioural Model
Meaning
Event
Thoughts
Decision making
Behaviour
The Cognitive Behavioural Model
“There is nothing good or bad, but thinking makes it so” W. Shakespeare
When Events impact upon us they trigger Thoughts.
Meaning thoughts interpret the event: what’s going on, why it is happening, its “goodness”, its associations with our previous experiences etc.
Decision Making thoughts: its importance, its relevance, what needs to be done about it etc.
The Thoughts lead to Behavioural and Feeling responses.
In the first instance the Behaviour will stem from the Decision Making thoughts, whilst the Feelings will stem from the interpretation in the Meaning thoughts.
The Behaviour splits between:
Reactive responses aimed at coping with the event itself
Proactive responses which attempt to deal with and possibly influence the consequences and recurrence of the event.
Feelings belong to one of two broad categories:
Emotional responses of happiness, sadness, fear, excitement etc
Physical responses of tension, tiredness, sweatiness, relaxation, nausea, cold etc
In fact, it quickly becomes more complicated than that because the Behaviour will have a physical effect on the body and so will produce Feeling effects as well as producing new Events which trigger new thoughts. Similarly, Feelings will affect Decision Making thoughts and so change Behaviour.
In other words, each part of the picture has an impact on every other part of the picture. Changing one element changes all the others – which is how Cognitive Behaviour Therapy works.
Physical Reactions
Emotions
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16. I am completely useless and no one can help me.
Diagnosis of
cancer
My life is over.
I am completely useless
and no one can help me.
Take no action
Withdraw from people
Nausea
Fatigue
Depression
Hopelessness
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17. My life is going to change and I’m going to have to work at it.
It’s going to be tough at times but my family and friends will support me during this difficult patch.
Diagnosis of
cancer
Tell close friends
Plan helpful changes
Tense
Energetic
Sadness
Determination
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18. ? My life is going to change and I’m going to have to work at it.
It’s going to be tough at times but my family and friends will support me during this difficult patch.
My life is over.
I am completely useless
and no one can help me.
Take no action
Withdraw from people
Tell close friends
Plan helpful changes
Depression
Hopelessness
Trivial eg - not always!
1. C - Cut & dried
B - Logical result of C
A - Inevitable feeling from B
2. C - Gloomy but tryng to get persp.
B - Acting “on instruction” not feelings
A- Centred in now
Sadness
Determination ?
Nausea
Fatigue
Tense
Energetic
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19. Environment Behaviour Physical Sensation Thoughts Emotion
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20. Mr Catastrophic The patient has complained to my manager Alarm
Thoughts
Emotions
Physical Sensations
Behaviour
The patient has complained to my manager
Alarm
Heart thudding
Pace about, pick up phone and put down again
I’ve really messed up
Guilt
Sinking feeling
Brooding – staring into space, holding head
My manager will be really angry
Dread
Stomach churning
Go to toilet; avoid people and phone calls
I’m going to be sacked or suspended for years
Despair
Drained of energy
Slump on chair
My friends will shun me
Shame
Skin prickles
Hug self; seek fresh air
My wife will leave me
Hopelessness
Feel sick
Avoid going home – go to pub
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21. Miss Rational The patient has complained to my manager Alarm
Thoughts
Emotions
Physical Sensations
Behaviour
The patient has complained to my manager
Alarm
Heart thudding
Pace about, pick up phone and put down again
I don’t really know why my manager called – best way to find out is to call her back and not wind myself up.
Relief
Calming physical sensations; release of tension
Sit down; breath
It’s interesting I thought of that patient; I’m obviously unhappy about how I handled that.
Concern
Increased tension; increased energy; nervy
Fidgety; fiddle with pen; drum fingers on phone
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22. Miss Rational
Thoughts
Emotions
Physical Sensations
Behaviour
Whether or not the patient has complained, I must think about lessons learnt from this event and perhaps take it to my next supervision.
Interested; curious; feeling motivated
Alert; active; release of tension
Get out notebook; pick up pen; start writing
I’ll phone the manager now and find out what she really wants.
Anxious; determined
Butterflies in stomach; sweaty palms; cold; dry throat
Pick up phone and dial manager’s number
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23. Constructive thinking and behaviour
Stuck/Rigid
More
Mental traps
Failing actions
Constructive thinking and behaviour
Less
Less
More
Helpful/Useful
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24. Environment Environment Behaviour Physical Sensation Thoughts Emotion
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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:
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008