CBT for Chronic Illness and Palliative Care

Nigel Sage is Consultant Clinical Psychologist in cancer and Palliative Care at The Beacon community Specialist Centre for Cancer and Palliative Care in Guildford, Surrey. He is an Accredited Cognitive Behaviour therapist and also works in primary care mental health in Hampshire. Michelle Sowden is Consultant Clinical Psychologist at Frimley Park Hospital where she has provided and developed a service to patients with physical health problems across the Clinical Directorates. She has a special interest in the application of cognitive behavioural and systemic therapies to the management of chronic medical conditions. Elizabeth Chorlton is a Chartered Clinical Psychologist at Frimley Park Hospital, in the Department of Psychological Medicine, with patients who are experiencing psychological difficulties as a result of physical health problems. In addition to her clinical psychology training, she has an MSc in the field of health psychology. Andrea Edeleanu is Director of Specialist Therapies and Service User Involvement for Surrey and Borders Partnership NHS Trust. She works clinically in Community Health Psychology and provides consultancy and clinical supervision to colleagues in health, mental health and community services. She is a consultant Clinical Psychologist, Chartered Health Psychologist and an Accredited Cognitive Behaviour therapist.

About the Authors xi

Acknowledgements xiii

Introduction xv

Part I: The Workbook: The Cognitive Behavioural Approach

Chapter 1: What is the Cognitive Behavioural Approach? 3

Chapter 2: The Relevance of a Cognitive Behavioural Approach for People with a Life-changing Illness 10

Chapter 3: Does Cognitive Behaviour Therapy Work? The Evidence Base 18

Chapter 4: Communication Skills in Health Care 47

Chapter 5: Cognitive Behavioural Communication Style 58

Chapter 6: Guided Discovery: Using the Socratic Method 66

Chapter 7: Assessment 78

Chapter 8: Formulation 87

Chapter 9: Deciding on a Course of Action: Part 1 97

Chapter 10: Goal Setting and the Step-by-Step Process 102

Chapter 11: The Practicalities of Setting Goals 113

Chapter 12: Bringing About Change 125

Chapter 13: Methods of Behaviour Change 132

Chapter 14: Methods of Cognitive Change 143

Chapter 15: Challenging Unhelpful Thoughts 158

Chapter 16: Managing Emotions and Unpleasant Physical Sensations 167

Chapter 17: Decision on a Course of Action: Part 2 176

Chapter 18: Applying a Cognitive Behavioural Approach to Clinical Practice 182

Part II: The Issues: Some Psychological Problems

How to Use This Part of the Book 191

Glossary of Everyday Terms 191

Adjustment Difficulties 193

Altered Body Image 195

Anger 198

Avoidance 201

Denial 203

Fatigue 206

Fear of the Future 208

Inactivity 210

Indecisiveness 212

Intrusive/Distressing Thoughts 214

Lack of Motivation 216

Loss of Pleasure or Ability to Enjoy Things 218

Low Mood 220

Low Self-Esteem 222

Negative Outlook 224

Pain 226

Panic Attacks 229

Special Note: Safety Behaviours 231

Physical Tension 232

Poor Concentration 234

Problem Solving Difficulties 236

Setbacks 238

Sleep Difficulties 240

Unassertiveness 242

Worrying 244

Part III: The Toolkit: CBT Methods in Practice

Section 1: Techniques

Activity Monitoring 249

Assertiveness Skills 250

Assessing Psychological Distress 251

Attention Strategies 252

Basic Counselling Skills 254

Behavioural Change Methods: A Summary 255

Behavioural Experiments 256

Behavioural Rehearsal 257

Believable Alternative Thoughts 258

Breathing Control 259

Challenging Unhelpful Thoughts 260

Cognitive Change Methods: A Summary 261

Denial: Strategies for Encouraging Acceptance 263

Denial: Strategies for Engaging the Patient 264

Denial: Strategies for Reducing Distressing Thoughts 265

Denial: Suggestions for Questions to Ask 266

Effective Communication Skills 267

Emotional Expression 268

Expressive Writing 269

Graded Activities 270

Listening Skills 271

Mental Distraction 272

Mindfulness 273

Pacing 274

Problem Solving 275

Psycho-education 276

Purposeful Planning 278

Relaxation Exercises 280

Respectfulness Skills 282

Socratic Questioning 284

Stimulus Control 285

Weighing the Pros and Cons 286

Section 2: Information Sheets

Antidotes to Bad Days 287

The Assertiveness Model 288

Assertiveness Rights 289

Assertiveness Techniques 290

Bad Old Habits: Avoiding Relapsing Into Them 292

Change: Bringing It About 293

Change: The Desire for It 294

Change: The Transition Curve 295

Coping with Setbacks 1: Physical Health Setbacks 296

Coping with Setbacks 2: Mental Attitude Setbacks 297

Denial: Advantages and Disadvantages 298

Experiential Learning Cycle 299

Goal Setting and the Step-by-Step Approach 300

Goal Setting: Examples 302

Goal Setting Questions 303

Mental Traps: Examining the Evidence 307

Mental Traps: Examples of How to Get Out of Them 308

Mindfulness Attitudes 310

Mindfulness Exercises 311

Pacing 312

Pacing Examples 314

The Reactions of Other People 315

Reflective Practice Diary Guidance 317

Relaxation: Mental Exercise 318

Relaxation: Muscle Exercise 319

Relaxed Breathing Exercise 320

The Serenity Prayer 321

Sharing and Mixing with Other People 322

SMART Guidelines 323

Socratic Questioning: Examples 324

Stress: The Effect it Has 325

The Stress Response 326

A Vicious Cycle Model of Anxious Avoidance 327

A Vicious Cycle Model of Anxious Preoccupation 328

A Vicious Cycle Model of Hopelessness-Helplessness 329

Section 3: Record Forms

Event-Emotion-Thought Analysis Form 332

Example of Event-Emotion-Thought Analysis Form 333

Believable Alternatives 335

Thought Record 336

Pacing Record Form 337

Denial: Assessing its Costs and Benefits 338

Denial: Example of Pros and Cons Assessment 339

Action Plan for Denial 340

Goal Planning: Step-By-Step Action Plan 342

Your Ideas for Goals 342

Reflective Practice Diary 351

References 357

Index 363