1. A Team Approach to Behavior Change in Primary Care: It’s Not Just About the Symptoms Patricia Robinson, Ph.D. Mountainview Consulting Group, Inc., Zillah, WA Kirk Strosahl, PhD. Community Health of Central Washington Yakima, WA Collaborative Family Healthcare Association 15 th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A. Session # D2b Friday, October 11, 2013 – 1:30-3:00 (40 minutes)

2. Faculty Disclosure We currently have or have had the following relevant financial relationships (in any amount) during the past 12 months: Book royalties: New Harbinger Book royalties: Gilford Book royalties: Springer

3. Objectives Participants will be able to – Describe an team-based approach to supporting patient development of a healthy mind and body – Define psychological flexibility – Use the Life Path worksheet to initiate a behavior change plan. – Name 6 interventions that all members of the PCMH can use to increase patient / provider psychological flexibility

4. What’s the evidence? ACT Meta-Analysis Powers/Zum Vorde Sive Vording/Emmelkamp Psychother Psychosom 2009; 78:73-80

5. Healthy Patients, Healthy Providers Healthy Mind & Life Act on your Values Connect with your Values Be Present Changing Self, Perspective Accept Step Back, Detach

6. Psychological Flexibility: Psychological flexibility is learning to be aware and accepting of the pain that comes into our lives while continuing to pursue what we value. Pain is Inevitable, Suffering is Not!

7. Psychological Flexibility Mindfulness paying attention with flexibility, openness and curiosity Values Staying focused on chosen life directions

8. Demonstration / Skill Practice Life Path Worksheet

9. 57 Life Path Class

10. Class One: The Life Path Questions 1. How long have you had the problem that brings you here? 2. What have you tried? Previous treatments? Results from them? 3. What do you want from life? 4. What are the barriers to doing what you want in life? 5. What do you do when the barriers show up? 6. Are you at war with the barriers? What does that look like? 7. What are the consequences of being “at war” with the barriers? 58

11. Life Path Class with Cardiac Rehab Patients Some Typical Problems: lost, scared, afraid, uncertainty, disbelief, guilt, confusion, stress Examples of value connection: –Focused on art work –Loving actions with wife/husband –More quality time with family –More healthy lifestyle behaviors –Patience: Giving self time to heal –To have a joyfully life –To serve and help to others –Be the best I can be 11

12. Life Path Class with Cardiac Rehab Patients Examples of control behaviors –Look for excuses not to do things –Avoid other people –Be impatient and try to control the time –Control things another person is doing / will do –Ignore the feelings –Procrastinate 12

13. Severity of Problem Connection to Values Life Path Class with Cardiac Rehab Patients

14. Helpfulness of the Class Confidence with Homework

15. 6 Interventions to Support Psychological Flexibility 1.Present Moment: Time Line (worksheet) 2.Connect with Values: Retirement Party/Tombstone 3.Act on Values: You Are Not Responsible; You Are Response Able 4.Changing Self, Perspective: Be a Witness 5.Step Back (Detach): Velcro; Clouds in the Sky 6.Accept: Book Chapter

16. Learning Assessment What is the name of a practical tool that members of the PCMH may use to initiate behavior change with patients? The Life Path Plan What is psychological flexibility? Psychological flexibility is learning to be aware and accepting of the pain that comes into our lives while continuing to pursue what we value. Do providers need psychological flexibility? yes

17. FACT Resources Association for Contextual Behavioral Science” http://www.contextualpsychology.org/http://www.contextualpsychology.org/ http://www.newharbingeronline.com/real- behavior-change-in-primary-care.htmltml 17

18. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!