Common Behavioral and Cognitive Interventions in Primary Care Based on: Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment.

Common Behavioral and Cognitive Interventions in

Primary CareBased on: Integrated Behavioral Health in Primary Care: Step-by-Step Guidance

for Assessment and Intervention Hunter et al, 2009

Presented August 2011 byKatherine M. Dollar, PhD.,

What’s in Your Toolbox?

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The Co-located, Collaborative Provider’s

Toolkit The following 8 techniques are effective for addressing a wide

variety of symptoms and functional impairment seen in primary care (Hunter et al., 2009)

1. Relaxation training 2. Goal setting 3. Identifying and disputing negative cognitions 4. Motivational Interviewing 5. Problem Solving 6. Self-monitoring 7. Behavioral Activation 8. Assertive Communication

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Relaxation Training

Deep Breathing Cue-controlled relaxation Progressive muscle relaxation Visual imagery

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Goal Setting

Are the goals well defined in behavioral terms? (S.M.A.R.T)

Realistic/achievable With in realm of control/influence Break into sub goals Personally important Whose goals are they anyway?

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Identifying and Disputing Negative Cognitions

Help to indentify unhealthy cognitions (predictions, expectations, evaluations)

Use thought logs Question thought process “Cognitive Disputation” Self-help books for highly motivated

Mind Over Mood: Greenberger and Padesky 6

Motivational Interviewing

Examine readiness to change (Readiness Ruler)

Examine importance and confidence for change

Elicit pros and cons of change

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Problem Solving A five-step problem-solving model is

recommended for the PC setting (Nezu, personal communication, 2011)

1. Minimize emotional arousal to focus on next 4 steps

2. Set an achievable goal, identify major obstacles

3. Brainstorm multiple alternatives to overcoming obstacles

4. Identify pros and cons of each idea, cost-benefit analysis

5. Implement an action plan and assess the outcome (either fine-tune or go back through steps 1-4)

Please note: Additional PST trainings will be available in the future.  

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Self-Monitoring

Help track progress towards a goal Use a calendar Keep a tally Chart on a graph

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Behavioral Activation

• Difficult to feel depressed when engaged in actives that provide pleasure and accomplishment

• Re-establish routines • Increase reinforcing experiences• Overcome avoidance patterns• Distraction from problems or unpleasant

events

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Behavioral Activation Techniques

• Choose and schedule daily pleasurable activities (Pleasant Events Schedule or Life Activities Checklist)

• List activities and rate for mastery and pleasure

• Keep activity logs

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Assertive Communication

Assess patterns of communication Explain differences in passive,

assertive, and aggressive communication

Help patient to learn how to speak assertively (Honest, Appropriate, Respectful, Direct)

Practice through role-play The Anxiety and Phobia Workbook 12

Helpful Resources

Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated Behavioral Health in Primary Care: Step-by-step Guidance for Assessment and Intervention, American Psychological Association.

Gatchel, R. J. & Oordt, M. S. (2003). Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration: Washington, DC; American Psychological Association.

P. Robinson & J. Reiter (2007) Behavioral consultation and primary care: A guide to integrating services. New York: Springer Science-Media.

W. O'Donohoe, M. Byrd, N. Cummings, D. Henderson (2005). Behavioral integrative care: Treatments that work in the primary care setting. New York: Brunner-Routledge.

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Questions?

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Helpful IPC Resources

http://vaww.visn2.med.va.gov/bh/cih/index.html

http://vaww4.va.gov/pcmhi/ http://www.cfha.net

E-mail address:[email protected]

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