There is a growing awareness of the need to address the psychological distress associated with physical ill health; however, current resources are limited and difficult to access. The best way to tackle the issue is by enhancing the skills of those professionals who have routine contact with them. CBT provides the evidence-based skills that most readily meet these requirements in a time and cost efficient manner. Based on materials prepared for a Cancer Network sponsored training programme and modified to address the needs of a larger client population of people experiencing psychological distress due to physical ill-health, this innovative workbook offers a basic introduction and guide to enable healthcare professionals to build an understanding of the relevance and application of CBT methods in everyday clinical practice.
Table of Contents:
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
