Common Behavioral and Cognitive Interventions in Primary Care

1. Common Behavioral and Cognitive Interventions in Primary Care Based on: Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention Hunter et al, 2009 Presented August 2011 by Katherine M. Dollar, PhD.,

2. What’s in Your Toolbox?

3. 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

4. Relaxation Training • Deep Breathing • Cue-controlled relaxation • Progressive muscle relaxation • Visual imagery

5. 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?

6. 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

7. Motivational Interviewing • Examine readiness to change (Readiness Ruler) • Examine importance and confidence for change • Elicit pros and cons of change

8. Problem Solving • A five-step problem-solving model is recommended for the PC setting (Nezu, personal communication, 2011) • Minimize emotional arousal to focus on next 4 steps • Set an achievable goal, identify major obstacles • Brainstorm multiple alternatives to overcoming obstacles • Identify pros and cons of each idea, cost-benefit analysis • 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.

9. Self-Monitoring • Help track progress towards a goal • Use a calendar • Keep a tally • Chart on a graph

10. 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

11. 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

12. 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

13. 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.

14. Questions?

15. 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: katherine.dollar@va.gov