Real Behavior Change in Primary Care: Improving Patient Outcomes

1. Session #: G1a October 28, 2011 Real Behavior Change in Primary Care: Improving Patient Outcomes Patricia J. Robinson PhD patti1510@msn.com Mountainview Consulting Group, Inc. patriciarobinsonphd.com Healthcare Consultant and Trainer, Yakima, WA Debra A. Gould MD, MPH deb.gould@commhealthcw.org Central Washington Family Medicine Residency Program, Yakima, Washington Associate Clinical Professor, University of Washington, Seattle Collaborative Family Healthcare Association 13th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

2. Faculty Disclosure • We currently have the following relevant financial relationships during the past 12 months: • New Harbinger Publications – Co-Authors

3. Need/Practice Gap & Supporting Resources What is the scientific basis for this talk? • New CBT contextual behavioral interventions, such as ACT, are useful to primary care providers and patients (particularly to primary care patients with poor outcomes such as those with diabetes, tobacco use, chronic pain, depression, and anxiety). Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007; Gifford, Kohlenberg, Hayes, Antonuccio, Piasecki, et al., 2004; McCracken & Eccleston, 2003; Dahl, Wilson, & Nilsson, 2004; Lundgren, Dahl, Yardi, & Melin, 2008); Zettle & Hayes, 1986; Hayes, Wilson, Gifford, Bissett, Piasecki, et al., 2004; Hayes, Luoma, Bond, Masuda, & Lillis, 2006

4. Objectives • Introduce the “Love, Work, Play and Health” interview as a tool for obtaining an understanding of a a patient’s life context • Introduce the “Three Ts & Workability” interview as a tool for obtaining an understanding of a target problem • Introduce six core processes of psychological flexibility and the “Core Process Assessment Tool” (a case formulation tool) • Introduce the “Real Behavior Change Pocket Guide” (a tool for rapid identification of an experiential or psycho-educational intervention

5. Expected Outcome By learning about the availability of interview, case formulation, and intervention tools, provider interest in learning to apply these tools will increase. With increased awareness of a platform for using contextual behavioral (ACT) interventions amenable to team-based support, primary care clinicians and provider interest in learning and applying these newer interventions as a team will increase.

6. Learning Assessment A learning assessment is required for CE credit. • Rate your level of awareness of tools for obtaining an understanding of a patient’s life context and a completing a brief functional analysis of a target problem in 15 minutes. (1 = not aware; 10 = very aware) • Rate your current level of awareness of contextual behavioral interventions, such as ACT, and their applicability to primary care behavioral health (1 = not aware; 10 = highly aware). • Rate your current interest in learning contextual behavioral interventions, such as ACT, and their applicability to primary care behavioral health (1 = low interest; 10 = high interest). • Rate your current intention to learn contextual behavioral interventions, such as ACT, and their applicability to primary care behavioral health (1 = low intention; 10 = high intention).

7. Experiential Avoidance Behavioral Avoidance

8. Psychological Flexibility(Model of Acceptance and Commitment Therapy) Pain is inevitable, suffering isn’t!

9. Psychological Flexibility Learning to be aware and accepting of the pain that comes into our lives while continuing to pursue what we value. Action & Acceptance Questionnaire II

10. How Can I Be More Psychologically Flexible? How Can I Help Patients Become More Psychologically Flexible?

11. TEAMS (Our Private Experience) Emotions Associations Memories Thoughts Sensations

12. Experience Present Moment Accept TEAMS Connection with Values Step back from Value Consistent TEAMS (Defusion) Action Use Observer Self To See Limiting Self-stories 6 Core Processes – Psychological Flexibility Flexibility

13. Step Back from TEAMS and Unworkable Rules(Defusion) 13

14. Therapist / Provider: Start with Focus, Return to Focus • Breath, Form, Depth • Settling (throughout the practice day) • One in the beginning and one in the end • Letting go • Half Smile • Treating with intention

15. Focused Interviewing: The Love, Work, Play & Health Questions 15

16. Focused Interviewing: The Three Ts & Workability Questions 16

17. Focused Intervening: CaseFormulation and Mindful Intervention • The Core Process Assessment Tool: • Selection of a target process to enhance flexibility • The “Real Behavior Change Pocket Guide” • Rapid identification of experiential and/or psycho-educational interventions • The Bulls Eyes Plan • Development of an on-going intervention amenable to PC team support

18. For Free All Real Behavior Change in Primary Care Tools http://www.newharbingeronline.com/real-behavior-change-in-primary-care.html

19. REAL Behavior Change in Primary Care:Tools and Strategies for Improving Patient Outcomes and Job Satisfaction Robinson, Gould, & Strosahl December 2011Oakland, CA: New Harbinger SEE Patriciarobinsonphd.com for updates

20. ACT in PC Resources “Association for Contextual Behavioral Science” http://www.contextualpsychology.org/ http://www.newharbingeronline.com/real-behavior-change-in-primary-care.html

21. Learning Assessment A learning assessment is required for CE credit. • Rate your level of awareness of tools for obtaining an understanding of a patient’s life context and a completing a brief functional analysis of a target problem in 15 minutes. (1 = not aware; 10 = very aware) • Rate your current level of awareness of contextual behavioral interventions, such as ACT, and their applicability to primary care behavioral health (1 = not aware; 10 = highly aware). • Rate your current interest in learning contextual behavioral interventions, such as ACT, and their applicability to primary care behavioral health (1 = low interest; 10 = high interest). • Rate your current intention to learn contextual behavioral interventions, such as ACT, and their applicability to primary care behavioral health (1 = low intention; 10 = high intention).

22. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!