CBT for Chronic Illness and Palliative Care A Workbook and Toolkit

Transcription

1 CBT for Chronic Illness and Palliative Care A Workbook and Toolkit Nigel Sage Michelle Sowden Elizabeth Chorlton Andrea Edeleanu

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3 CBT for Chronic Illness and Palliative Care

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5 CBT for Chronic Illness and Palliative Care A Workbook and Toolkit Nigel Sage Michelle Sowden Elizabeth Chorlton Andrea Edeleanu

6 Copyright 2008 John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England Telephone ( 44) (for orders and customer service enquiries): cs-books@wiley.co.uk Visit our Home Page on All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except under the terms of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London W1T 4LP, UK, without the permission in writing of the Publisher. Requests to the Publisher should be addressed to the Permissions Department, John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England, or ed to permreq@wiley.co.uk, or faxed to ( 44) Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The Publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the Publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Other Wiley Editorial Offices John Wiley & Sons Inc., 111 River Street, Hoboken, NJ 07030, USA Jossey-Bass, 989 Market Street, San Francisco, CA , USA Wiley-VCH Verlag GmbH, Boschstr. 12, D Weinheim, Germany John Wiley & Sons Australia Ltd, 42 McDougall Street, Milton, Queensland 4064, Australia John Wiley & Sons (Asia) Pte Ltd, 2 Clementi Loop #02-01, Jin Xing Distripark, Singapore John Wily & Sons Canada Ltd, 6045 Freemont Blvd, Mississauga, ONT, L5R 4J3, Canada Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Anniversary Logo Design: Richard J. Pacifico Library of Congress Cataloging-in-Publication Data CBT for chronic illness and palliative care : a workbook and toolkit / Nigel Sage... [et al.]. p. cm. Includes bibliographical references and index. ISBN (pbk. : alk. paper) 1. Chronic diseases Psychological aspects. 2. Palliative treatment Psychological aspects. 3. Chronically ill Rehabilitation. 4. Cognitive therapy. I. Sage, Nigel. RC108.C dc British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN Typeset in 11/13pt Times by Thomson Digital, New Delhi, India Printed and bound in Great Britain by Antony Rowe, Chippenham, Wiltshire This book is printed on acid-free paper responsibly manufactured from sustainable forestry in which at least two trees are planted for each one used for paper production.

7 Contents About the Authors Acknowledgements Introduction xi xiii 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 Chapter 18: Applying a Cognitive Behavioural Approach to Clinical Practice 182

8 Contents 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 vi

9 Contents 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 vii

10 Contents 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 viii

11 Contents 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 ix

12 Contents 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 x

13 About the Authors 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 working 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.

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15 Acknowledgements This book grew from material prepared originally for a training project for staff working in either palliative care or with cancer patients in other settings. The authors gratefully acknowledge the vital contribution of Surrey, West Sussex and Hampshire (SWSH) Cancer Network, in sponsoring that training project. We would also like to acknowledge the enormous influence on the content and structure of this book of Drs Stirling Moorey and Kathryn Mannix. Stirling has done so much to establish the role of Cognitive Behaviour Therapy (CBT) in the fields of oncology and palliative care that it is rapidly becoming a service requirement and many health professionals are now seeking some training. For us, his work at St Christopher s Hospice has been especially important because, along with the training project in Newcastle led by Kathryn Mannix, it has shown that staff with no background in mental health work can acquire and use cognitive behavioural skills. This has provided the inspiration for our own training programme and ultimately this book. Kathryn has also offered us encouragement and practical guidance with our training project for which we are very appreciative. Grateful thanks are extended to Joanne Coombs for her help in preparing the chapter on the effectiveness of CBT to Ann Hatch, whose experience and skills as a physiotherapist have influenced numerous items included and to Maralyn Sage for her tireless work and patience with both the book and the training project that preceded it. A special thank you is also due to all the participants from our training courses who have taken the trouble to provide constructive feedback and persuaded us to publish. Their suggestions have enabled us to revise our course materials and make this a better book. In this regard a particular mention must be made of Maureen Adam and Susan Kobler who in dual roles as participants and seminar supervisors regularly provided ideas for improvements. Finally, we wish to express our debt of gratitude to all the patients who, by sharing their experiences with us, have spurred us on to write this. We hope that the resulting book contributes to more people getting more help sooner.