Psychological Approaches In Primary Care II Bradford GP VTS

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Psychological Approaches In Primary Care II
(Bradford GP VTS

• Dr Andrew R. Wilson

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Objectives

• Reflect on validation homework to embed and share
  successes and acknowledge and deal with some of
  the difficulties
• Have sufficient understanding of the rationale
  therapies to facilitate referral for
  psychological interventions
• Explore some ways of bringing focus and
  facilititating change when working with
  psychological problems in primary care.

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Today Session

• Summary of previous session
• Rationale therapies / therapist presentations
• Homework review (tying in some of the learning
  from summer school counselling subschool.
• Tools for change
• Summary and feedback

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Review of Session I

• Pairs Work

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Review of Session I

• What works
• Empathy
• Genuiness
• Warmth
• negotiation of Goals
• Reflecting

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Review of Session I

• What works
• Repairing rupture in therapeutic relationship
• If patient satisfied
• Alliance
• Cohesion between pt and therapist
• Emotional expression
• Changing view of self

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Review of Session I

• What works broad classification
• Validation
• Goal orientation/change techniques

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2. Rationale therapies

• Presentations

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Homework Review

• Validation
• In Groups
• What worked well
• What worked less well

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4. Tools for change

• Problem and goal lists
• Cognitive continuum methods breaking down
  global thinking
• Behavioural Activation

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Problem and Goal Lists

• Give Focus
• Breaks things up into smaller parts
• Uses patients definition of problems
• Collaborative
• Problem and present orientated
• Directional
• Gives in time a sense of progress made

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Sources for problem lists

• Situational problems
• Medical and traditional psychological problems
• What other observe (family/doctors)
• Effect of pt on others
• ?symptom/problem diaries

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Patients may under report

• Embarrassed/shame
• Not be aware it is a problem
• Believe problem to be insoluable
• Overwhelmed
• Not consider it a problem

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Goals

• Specific
• Measurable
• Acheiveable
• Realistic
• Time Limited

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Challenging Global Thinking

• Lots of forms of negative global thinking
• Worksheets in 3s

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Common Thinking Errors

• All or nothing/Black or White/Polarised Thinking
• Overgeneralising
• Mental filter/selective abstraction
• Jumping to conclusions/catastrophising
• Mind reading
• Fortune telling
• Magnifying or minimizing

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Common Thinking Errors

• Emotional Reasoning
• Shoulds and must
• Labelling
• Personalising
• Tunnel Vision
• Disqualifying or discounting the positive

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Cognitive Continuum

• Identify the global thinking
• Im a bad mum
• Score it 0-100
• Break up Im a bad mum into constituent parts
  and re score

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Good Mother belief at beginning 50

• Patient 0 x100
• Loving 0 x100
• Warm and
• Fed 0 x100
• Quality Time 0 x 100
• Build their
• Self Esteem 0 x 100

Good Mother belief at end 70-80
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Behavioural Activation

• Some behaviours result in positive mood changes
• Evidence that scheduling activities can result in
  improvement in patients with anxiety and
  depression, independent of traditional medical
  interventions
• Probably the main treatment effect of CBT