Psych-HDPT L5/L6 Reviewer PDF

PSYCH -HDPT L5: CARE OF ANXIOUS PATIENT COGNITIVE BEHAVIORAL THERAPY is a structured, goal-oriented type of talk therapy. helps patients become aware of inaccurate or negative thinking so they can view challenging situations more clearly and respond to them in a more effective way....

PSYCH -HDPT L5: CARE OF ANXIOUS PATIENT COGNITIVE BEHAVIORAL THERAPY is a structured, goal-oriented type of talk therapy. helps patients become aware of inaccurate or negative thinking so they can view challenging situations more clearly and respond to them in a more effective way. is a type of psychotherapeutic treatment that helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions Individual’s perception of the world is subjective and cognitively mediated What individuals think about an event or in a situation will influence what they feel and how they behave Emotional & behavioral responses are influenced by primary and secondary forms of cognitive appraisal. PRIMARY APPRAISAL SECONDARY APPRAISAL o Individuals appraise an event in terms of the o Individuals will appraise an event in relevance of that event to their goals terms of their potential to cope with the demands associated with an event o Individuals with limited coping potential will experience more negative forms of emotions o Individuals with high coping potential will experience more positive forms of emotions ABC FRAMEWORK OORGANIZED BY E.S PSYCH -HDPT IRRATION AND RATIONAL BELIEFS RATIONAL EMOTVE BEHAVIOR THERAPY (REBT) is a type of cognitive behavioral therapy (CBT) developed by psychologist Albert Ellis. Suggests psychological disturbances are caused by a patient’s judgement of an event rather than the event itself. is an action-oriented approach that’s focused on helping people deal with irrational beliefs and learn how to manage their emotions, thoughts, and behaviors in a healthier, more realistic way. Emphasizes that the effect of an event on emotion and behavior will be mediated by a patient’s beliefs regarding factors such as pain, failure, rejection, and poor treatment suggests that a shift from rational to irrational thinking often stems from: o Pressure of competing o Obsession with results o View that success and self-worth are positively related IRRATIONAL BELIEFS Rigid, extreme, and illogical PRIMARY IRRATIONAL BELIEF SECONDARY IRRATIONAL BELIEF “Demandingness" Characterized by "awfulizing" Assertion of preference is transmitted into a (assuming bad or negative things will demand happen), low frustration tolerance, “I want to succeed therefore I must” self-depreciation “It is awful to be injured” “I cannot stand to be injured” “I am useless now that I am injured” RATIONAL BELIEFS Flexible, nonextreme, and logical PRIMARY RATIONAL BELIEF SECONDARY RATIONAL BELIEF “Preferences" "anti-awfulizing," high frustration Preference is asserted and a demand is tolerance, self-acceptance, and negated acceptance of self and others “I want to succeed but that does not “Although it is bad to be injured it is not mean I must” awful” “Although it will be tough, I can stand being injured” “Injury does not mean I am useless; anyone can experience injury” PSYCHOLOGIST’s & PT’s ROLE PTs should aim to refer patients harboring irrational beliefs to psychologists. REBT’s ultimate goal is to identify and replace irrational beliefs with rational beliefs with the aim of reducing dysfunctional emotions including anxiety, unhealthy anger, and depression Psychologists will encourage a patient or group to appreciate that it is their irrational beliefs and not the event itself, that are causing maladaptive emotional and behavioral responses. Practitioner should work with patient or group to dispute the irrational beliefs and replace them with rational alternatives Practitioners highlights the role of words and language in the development of rational and irrational beliefs o Suggests that language can guide cognition, emotion, and behavior o Negative language can trigger the release of cortisol which the body interprets as anxiety o Positive language can provide the body with instruction and encourage adaptive responding PTs should communicate rational perspectives following injury and during rehabilitation to encourage patients to positively appraise injury to experience positive emotion and adopt adaptive behavior PTs should use language during consultations aligned to the primary and secondary beliefs characteristics of rational beliefs to promote rational perspectives OORGANIZED BY E.S PSYCH -HDPT DISPUTATION PHASE Enable a patient or group to understand that their irrational beliefs are false, illogical, and unhelpful, whereas rational alternatives are true, logical, and helpful. FIVE PRIMAY DISPUTATION TECHNIQUES INCLUDED IN REBT 1. Being pragmatic – “How is B helping you?” 2. Thinking empirically – “Where is the evidence B is true?” 3. Being logical – “Does B make sense?” 4. Being philosophical – “Can you live a satisfying life if B persists?” 5. Referring to a friend – “What would you tell a friend in your situation” ABCDE FRAMEWORK SELF-TALK Represents the dialogue in which an individual interprets feelings and perceptions, regulates changes, evaluations, and convictions, and gives themselves instructions and reinforcement Much more than having a conversation with oneself, it has to be purposeful and intentional o STRUCTURE OF SELF-TALK: o Single cue words - Specific phrases o Full intact sentences o Self-talk in overt manner (through verbalizing speech) o Self-talk in covert fashion (through inner speech) FUNCTIONS OF SELF-TALK MOTIVATIONAL o Beneficial when patients are experiencing psychological or behavioral issue following injury during rehabilitation. o Has 3 specific motivational functions MOTIVATIONAL AROUSAL MOTIVATIONAL MASTERY MOTIVATIONAL DRIVE ✓ Assist individuals in ✓ Use self-talk to master ✓ Use of self-talk for goal manipulating arousal challenging situations achievement and is levels ✓ Associated with associated with ✓ To hype up or calm down psychological factors manipulating effort and including mental persistence toughness, concentration, and self- confidence INSTRUCTIONAL o Beneficial when learning the key points associated with practicing a skill or strategy during rehabilitation. o Has 2 specific instructional functions INSTRUCTIONAL SPECIFIC INSTRUCTIONAL GENERAL ✓ To focus attention on technical aspects of ✓ Use self-talk to focus attention on general skilled performance performance strategy ✓ Useful for activities that require precision OORGANIZED BY E.S PSYCH -HDPT IMAGERY A technique in which a person visualizes positive images or scenarios in their mind The process of creating or recreating an experience in the mind using multiple senses (sight, sound, touch, smell, taste) Is also performed under volitional control and can occur in the absence of the real stimulus normally associated with an actual experience PERSPECTIVES INTERNAL IMAGERY EXTERNAL IMAGERY o First Person Perspective o Third Person Perspective o Imaginal experiences conducted through o Imaginal experiences performed as if the mind’s eye. watching oneself through the eyes of o Provides individuals with important others kinesthetic information o Provide individuals with important - Ex. How an exercise should feel information regarding the form of bodily movement - Ex. How the exercise should be performed FUNCTIONS COGNITIVE IMAGERY MOTIVATIONAL IMAGERY o Involves imagining general strategies or o Involves imagining specific skills - goal-oriented behavior o Used to learn and properly perform - effective coping and mastery of rehabilitative exercises during challenging situations rehabilitation - changes in emotion o Used during rehab for a variety of purposes including enhancing mental toughness, maintaining concentration, and fostering a positive attitude towards rehabilitation. GUIDELINES FOR IMAGERY USE 1. Introduce imagery by providing education about the potential benefits of imagery use within injury and rehabilitation. 2. Patient’s imagery ability should be assessed formally through an imagery ability questionnaire and informally through questioning 3. Patients should be supported with developing basic imagery skills depending on their imagery ability 4. Practitioners should recognize the types of imagery applicable to a patient’s needs and work with a patient to apply the types of imagery use within injury and rehabilitation 5. Incorporate in the rehab program 6. Educate 7. Assess 8. Support 9. Recognize & Apply 10. Incorporate MAKING IMAGERY FUNCTIONALLY EQUIVALENT PETTLEP MODEL Ensures that imagery is a close representation of physical practice o Physical o Learning o Environment o Emotion o Task o Perspective o Timing OORGANIZED BY E.S PSYCH -HDPT ORGANIZED BY E.S PATIENT-CENTERED THERAPY Is an approach supporting people psychologically and holds an assumptive position that people have the potential to self-direct Practitioner-patient relationship should be focused on working with a patient and incorporating a more holistic approach that considers the patient as a human being CORE CONDITIONS 1. Practitioner should experience unconditional positive regard for their patients at all times. UNCONDITIONAL POSITIVE REGARD o Achieved when practitioner maintains a positive attitude towards a patient even when the practitioner does not necessarily approve of a patient’s thoughts or actions 2. Practitioner should demonstrate empathetic understanding EMPATHY o Related to the ability of a practitioner to understand what a patient is feeling with regards to a situation or event L6: USING COUNSELING AND PSYCHOLOGICAL STRATEGIES WITHIN PHYSIOTHERAPY WHY DO WE NEED PSYCHOLOGICAL STRATEGIES? A To improve the therapeutic relationship and allow the patient to engage in treatments and strategies to improve their health. I Patients or family members who are struggling to manage their emotions and mood can be challenging for the physiotherapists. M We are not meant to act as psychiatrists but we need to use such strategies to supplement our assessment and management skills in physiotherapy. A RECALL: THERAPEUTIC ALLIANCE A therapeutic alliance is the bond Establishing such relationship has that is created between two parties been shown to improve patient in a care or treatment-giving outcomes and is a long-standing relationship, and the subsequent acknowledged dimension of the collaboration and agreement on counsellor-client relationship. treatment goals. OUTCOMES Improved empathy, congruence and unconditional positive regard that is necessary and sufficient to create positive change in patients Improved adherence to treatment and improved satisfaction. Patients improve in self-efficacy with regards to patients following a treatment plan. THE NECESSARY INTERPERSONAL SKILLS Clear Understanding of The transparency Confidence The nature of communication people of progress professional relationships THE ZONE OF ATTENTION ZONE 1 ZONE 2 ZONE 3 OORGANIZED BY E.S PSYCH -HDPT act of listening to the patient act of paying attention to the therapist is theorizing and and attending to linguistic, therapist’s own thought interpreting what is happening paralinguistic and non-verbal processes and being aware of to the patient aspects what the patient is saying in the background. NEUROLINGUISTIC PROGRAMMING Is the study of the dynamics between the brain (neuro) and language (linguistics) and how these two aspects interact to affect behavior. Bandler and colleagues studied language patterns used by therapists who excel in their fields. Will serve as a guide to how we may not always be able to control what goes around us; however, we can always control how we respond to it. NEUROLINGUISTIC BELIEFS 1. THE MAP AND TERRITORY o the map is a presentation of how we organize our experiences in the world and that this is different than the ‘territory’ o Territory which is actually what's happening around us. o A good communicator can remind themselves to be responsive to what is actually happening and not just our preconceived perceptions 2. THE MEANING OF COMMUNICATION IS THE ELICITED RESPONSE o people will respond to what they think you mean, regardless of whether that is an accurate or inaccurate representation of what you had intended. o Good communicators will be constantly aware of other people’s responses and adjust their communication (both verbally and nonverbally) accordingly in order to get their achieved outcome. 3. YOU CANNOT NOT COMMUNICATE o Despite people imagining they can avoid communication by saying nothing, nonverbal communication illustrates the thoughts and feelings inside of you. o We are contently communicating not just by what we say but by what we do not say. With this basis, a good communicator will realize that there is more to be gained by verbalizing rather than by staying aloof. 4. THERE IS NO SUCH THING AS FAILURE, ONLY FEEDBACK o Every result will give you information. o Instead of something being wrong, we can view this as a learning experience and are therefore prepared to try again. 5. EVERYONE HAS ALL THE RESOURCES THEY NEED o People will already have the knowledge of how their problem occurred and therefore already have the capacity top be able to deal with. o Often people may not have considered that their skills in another arena can be utilized elsewhere to solve their own problem. o Equally people may know how to find the skills they don not have elsewhere. OORGANIZED BY E.S PSYCH -HDPT 6. IF YOU WANT SOMETHING DIFFERENT, YOU MUST DO SOMETHING DIFFERENT o There is a solution to every problem if you can be prepared to keep looking for it. 7. EVERY BEHAVIOR HAS ITS APPROPRIATE CONTEXT o Behavior that was exhibited alongside previous events or experiences can limit your current potential. o Think not about past feelings, thought or emotions but look for new ways to adapt to new behaviors that are most beneficial for the experiences now. 8. MIND AND BODY ARE INSEPARABLE o It was previously though that mind and body were separate entities. o Now it’s recognized that your thoughts and emotions affect your body and vice versa. 9. IF ONE PERSON CAN LEARN TO DO SOMETHING, ANYONE ELSE CAN LEARN TO DO IT o This is about modelling behavior. o Recognizing that in one person can achieve something, looking at the way in which they did and replicating it will also bring similar results. 10. CHANGE MAKES CHANGE o This acknowledging that if your behaviour changes it will have an effect on those around you. 11. ACTION DEVELOPS UNDERSTANDING o You do not really understand something until you personally do it. 12. EVERY BEHAVIOUR HAS A POSITIVE INTENTION o This presupposition can be often misinterpreted and controversial. – It alludes to the fact that the person exhibiting the behaviour is looking for a positive intention. THE PATIENT CENTERED APPROACH Derived from ideas introduced by Dr Carl Rogers. His view of human natural was that everyone had the potential for growth if the conditions and environment, as perceived by the client were sufficient. Physio’s can follow these “ways of being” to provide a more patient-centered approach. Viewed that everyone had potential for growth if conditions and environment, as perceived by the client, were sufficient 6 NECESSARY AND SUFFICIENT CONDITIONS FOR THERAPEUTIC CHANGE 1. Two persons in psychological contact 2. The first, whom we shall refer to as the client, is in a state in incongruence, Vulnerability, or anxiety. 3. The second person, whom we shall term the therapist is congruent and integrated in the relationship 4. The therapist experiences unconditional positive regard for the client 5. The therapist experiences and empathic understanding of the client’s internal frame of reference and endeavours to communicate this experience to the client. 6. The therapist’s empathic understanding and unconditional positive regard is communicated to the client to a minimal degree. A THERAPIST’S WAYS OF BEING TO PROMOTE EMOTIONAL GROWTH CONGRUENCE Also termed as genuineness, honesty or realness OORGANIZED BY E.S PSYCH -HDPT The therapist is real in the relationship without playing roles, or being untruthful in their reaction or expression of feelings It means not pretending to be something that they are not. Any negative feelings are not suppressed but only shared if it is felt to be therapeutically relevant EMPATHETIC UNDERSTANDING Empathetic understanding is the understanding of the other person’s experiences, feelings and behaviours. By sensing underlying feelings and reflecting on them, it may encourage the other person to feel more intensely and recognize incongruence. UNCONDITIONAL POSITIVE REGARD Deep and genuine caring for the other person. It is not necessarily about liking the person, but acceptance of them as they are.. This is important in allowing the other person to feel free to express themselves honestly and without fear of loss. MOTIVATIONAL INTERVIEWING Defined as directive, client-centered counselling style for eliciting behaviour change by Rollnick and Miller (1995) Is a strategy that could easily be adopted by physiotherapists when discussing behaviour changes or treatment adherence It involves exploring ambivalence to change and assisting the patient to resolve it. THE SPIRIT OF MOTIVATIONAL INTERVIEWING 1. Motivation to change is elicited from the client and is not imposed 2. It is the client’s task, not the counsellor’s, to articulate and resolve his or her ambivalence. 3. Direct persuasion is not and effective method for resolving ambivalence 4. The counselling style is generally a quiet and eliciting one. 5. The counsellor is direct in helping the client examine and resolve ambivalence. 6. Readiness to change is not a client trait but a fluctuating product of interpersonal interaction 7. The therapeutic relationship is more like a partnership or companionship than one with expert/recipient roles. MINDFULNESS ‘nonevaluative, present-focused awareness of physical and psychosocial experiences’. It cultivates the presence of thinking to that particular moment in time, fostering clear thoughts and disengaging from strong attachments to any negative emotions or beliefs. ACCEPTANCE AND COMMITMENT THERAPY The fundamental principle of acceptance commitment therapy (ACT) is to construct to a meaningful and full life whilst being in acceptance of the idea that pain may be inevitable part of it. ACT is acknowledgement of a commitment to try and transform our affiliation with our feelings and emotions. The third wave of Cognitive Behavioral Theory TWO MAIN PRINCIPLES OF ACT When personal experiences that are out of your Making a commitment and taking action towards control occur, you learn to accept them a valued life CORE AREAS OF ACT OORGANIZED BY E.S PSYCH -HDPT ACCEPTANCE The willingness to accept our feelings and sensations. To acknowledge that our thoughts and worries will change over time and have the ability to dismiss any resistance we have towards them. COGNITIVE DIFFUSION Attempts to modify the thoughts and language that we are immersed in. Often we can be caught in the literal meaning of those thoughts and language and they can have and enormous effect on our behaviour. CONTACT WITH PRESENT MOMENT The ability to identify internal and external influences and to engage fully with a positive attitude in whatever is occurring at the present moment. Allow thoughts and feelings to come and go but keep focus on what is happening in the here and now. VALUES Being able to identify what is most important to you, what significant values you hold and what direction you would like your life to take. THE OBSERVING SELF The process by which you allow any negative thoughts and feelings to pass through you without being defined by them. But not allowing yourself to be defined by any negative thoughts and feelings, you are able to establish that they are not as threatening and disabling as they are not as threatening and disabling as they initially may have seemed. COMMITTED ACTION Setting goals and continuing to behave in a committed way in order to achieve those goals. This is not just a promise or an agreement to achieve the goals set, but effective action to ensure they are accomplished, and the continuation of setting further goals. OTHER PSYCHOTHERAPY & COUNSELLING APPROACHES 6 MAJOR COUNSELING THEORIES & APPROACHES HUMANISTIC Humanistic counseling theories hold that people have within themselves all the resource they need to live healthy and functional lives, and that problems occur as a result of restricted or unavailable problem-solving resources. COGNITIVE Cognitive counseling theories hold that people experience psychological and emotional difficulties when their thinking is out of sync with reality BEHAVIORAL Behavioral counseling theories hold that people engage in problematic thinking and behavior when their environment supports it. When an environment reinforces or encourages these problems, they will continue to occur. OORGANIZED BY E.S PSYCH -HDPT PSYCHOANALYTIC Psychoanalytic counseling theories hold that psychological problems result from the present-day influence of unconscious psychological drives or motivations stemming from past relationships and experiences. CONSTRUCTIONIST Constructionist counseling theories hold that knowledge is merely an invented or “constructed” understanding of actual events in the world SYSTEMATIC Systemic counseling theories hold that thinking, feeling and behavior are largely shaped by pressures exerted on people by social systems within which they live. TO WRAP IT UP: 1. For physiotherapy to be effective and to engage the patient in the process of rehabilitation, attention must be paid to the relationship between the patient and physiotherapist. 2. In some situations, patients may need enhances psychological support using counselling or psychotherapy and structured therapy but that is beyond psychotherapy. 3. When supporting a patient in adhering to a suggested treatment plan or improving their health and behaviour, physiotherapists can use other strategies such as motivational interviewing, acceptance and commitment therapy and mindfulness QUIZ: 1. OORGANIZED BY E.S