Teresa L. Deshields – Behavioral Treatment Interventions for Clients Coping with Medical Illness

Outline

Establishing Whole Person Care

• Formal assessments to identify physical and emotional stressors
• How to ask “What do you think is wrong”
• The client who considers their problem only medical and isn’t open to behavioral interventions
• Setting a collaborative agenda
• Addressing quality of life concerns

Psychological Distress in the Medically Ill

• Distress
  • Manifestations in medical populations
  • Distress screening tools
  • Balance efficiency with depth
  • Identify changing feelings related to disease progression
• Depression
  • Is it really “expected” after diagnosis of an illness?
  • What to do when symptoms of disease overlap with signs of depression
  • Measuring depression
  • Cognitive-Behavioral Therapy interventions
  • Creating balance with ACT
  • Establish an integrated approach
• Anxiety
  • Forms of anxiety that are particularly prevalent in medical illness
  • Assessment measures
  • Interventions when anxiety threatens tolerance for treatment
  • Specific mindfulness and relaxation therapy exercises and scripts
  • CBT tools to address worry and illness related anxiety
• Grief
  • Strategies to address: “I’m not the same physically and emotionally …”
  • Tools for releasing negative and obsessive thinking
  • Working with the emotions and turmoil of Anticipatory Grief

Behavioral Interventions for Physical Symptom Management

• Addressing physical issues
  • Motivational interviewing to help the client process lifestyle changes
  • Self-management skill development
• Strategies to minimize symptoms
  • Help the client determine the what and how of symptom relief
  • Addressing pain with ACT
  • Exercise recommendations for fatigue
  • Increase the likelihood of adherence
  • CBT for insomnia
  • Mindfulness techniques for nausea
• The clinicians “tool box” for symptom management
  • Ensure a wide array of options
  • Determine the next step

End of Life Considerations

• Quality vs. quantity of life
• Assessing patient preferences
• The difference between supportive, palliative, and hospice care
• Managing family disagreements related to treatment options
• What about family dysfunction
• Decision to withhold or withdraw care

Communication Issues

• With clients
  • Client-centered communication
  • Breaking bad news with the SPIKES protocol
• With healthcare professionals
  • Efficient but effective interprofessional communication with the SBAR method
  • Sharing information without breaking confidentiality

Family Caregivers

• Challenges
  • Sociodemographic changes & changes in medical care that make caregiving even more challenging
  • Impact of the family caregiving on the caregiver’s health
• Caregiver psychological issues
  • Prevalence of depression and anxiety in caregivers
  • Relationship with client’s distress
• Financial toxicity
• Limitations of the research and potential risks