Care Of Anxious Patient

CARE OF ANXIOUS PATIENT Prepared By: Pauleen Rose Balbuena, PRTP, PT AGENDA ❖ Learning Objectives ❖ Cognitive Behavioral Therapy ❖ Irrational & Rational Beliefs ❖ Self-Talk ❖ Imagery ❖ Patient-Centered Therapy LEARNING OBJECTS 1. PTs will be...

CARE OF ANXIOUS PATIENT Prepared By: Pauleen Rose Balbuena, PRTP, PT AGENDA ❖ Learning Objectives ❖ Cognitive Behavioral Therapy ❖ Irrational & Rational Beliefs ❖ Self-Talk ❖ Imagery ❖ Patient-Centered Therapy LEARNING OBJECTS 1. PTs will be able to recognize the components of the ABC framework underpinning Cognitive Behavior Therapy when working with patients experiencing anxiety. 2. Identify irrational and rational beliefs when working with patients 3. Understand the importance of referral and the ABCDE framework of Rational Emotive Behavior Therapy 4. Use simple techniques to ascertain the irrationality and rationality of patients 5. Promote rationality towards injury and rehabilitation 6. PTs will be able to encourage and integrate the use of self-talk and imagery into rehabilitation programs 7. Able to develop a patient-centered approach to consulting COGNITIVE BEHAVIORAL THERAPY 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 COGNITIVE BEHAVIORAL THERAPY COGNITIVE BEHAVIORAL THERAPY - Emotional & behavioral responses are influenced by primary and secondary forms of cognitive appraisal. ❖ PRIMARY APPRAISAL - Individuals appraise an event in terms of the relevance of that event to their goals ❖ SECONDARY APPRAISAL - Individuals will appraise an event in terms of their potential to cope with the demands associated with an event - Individuals with limited coping potential will experience more negative forms of emotions - Individuals with high coping potential will experience more positive forms of emotions COGNITIVE BEHAVIORAL THERAPY ABC FRAMEWORK A B C Activating Emotional & Underlying behavioral Event or beliefs consequences Adversity IRRATION AND RATIONAL BELIEFS IRRATION AND RATIONAL BELIEFS - Rational emotive 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: Pressure of competing Obsession with results View that success and self-worth are positively related IRRATION AND RATIONAL BELIEFS Irrational Beliefs - Rigid, extreme, and illogical ❖ PRIMARY IRRATIONAL BELIEF - “Demandingness" - Assertion of preference is transmitted into a demand - “I want to succeed therefore I must” ❖ SECONDARY IRRATIONAL BELIEF - Characterized by "awfulizing" (assuming bad or negative things will happen), low frustration tolerance, self-depreciation - “It is awful to be injured” - “I cannot stand to be injured” - “I am useless now that I am injured” IRRATION AND RATIONAL BELIEFS Rational Beliefs - Flexible, nonextreme, and logical ❖ PRIMARY RATIONAL BELIEF - “Preferences" - Preference is asserted and a demand is negated - “I want to succeed but that does not mean I must” ❖ SECONDARY RATIONAL BELIEF - "anti-awfulizing," high frustration tolerance, self-acceptance, and acceptance of self and others - “Although it is bad to be injured it is not awful” - “Although it will be tough, I can stand being injured” - “Injury does not mean I am useless; anyone can experience injury” IRRATION AND RATIONAL BELIEFS 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 IRRATION AND RATIONAL BELIEFS Psychologist’s & PT’s Role - Practitioners highlights the role of words and language in the development of rational and irrational beliefs - Suggests that language can guide cognition, emotion, and behavior - Negative language can trigger the release of cortisol which the body interprets as anxiety - 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 IRRATION AND RATIONAL BELIEFS 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” IRRATION AND RATIONAL BELIEFS ABCDE Framework A B C D E Activating Emotional & Underlying behavioral Disputation More rational Event or beliefs consequences or efficient Adversity beliefs SELF-TALK 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 ❖ STRUCTURE OF SELF-TALK: - Single cue words - Specific phrases - Full intact sentences - Self-talk in overt manner (through verbalizing speech) - Self-talk in covert fashion (through inner speech) SELF-TALK FUNCTIONS OF SELF-TALK ❖ MOTIVATIONAL - Beneficial when patients are experiencing psychological or behavioral issue following injury during rehabilitation. - Has 3 specific motivational functions ❖ Motivational Arousal - Assist individuals in manipulating arousal levels - To hype up or calm down ❖ Motivational Mastery - Use self-talk to master challenging situations - Associated with psychological factors including mental toughness, concentration, and self- confidence ❖ Motivational Drive - Use of self-talk for goal achievement and is associated with manipulating effort and persistence SELF-TALK FUNCTIONS OF SELF-TALK ❖ INSTRUCTIONAL - Beneficial when learning the key points associated with practicing a skill or strategy during rehabilitation. - Has 2 specific instructional functions ❖ Instructional Specific - To focus attention on technical aspects of skilled performance - Useful for activities that require precision ❖ Instructional General - Use self-talk to focus attention on general performance strategy IMAGERY 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. IMAGERY PERSPECTIVES ❖ INTERNAL IMAGERY - First Person Perspective - Imaginal experiences conducted through the mind’s eye. - Provides individuals with important kinesthetic information - Ex. How an exercise should feel IMAGERY PERSPECTIVES ❖ EXTERNAL IMAGERY - Third Person Perspective - Imaginal experiences performed as if watching oneself through the eyes of others - Provide individuals with important information regarding the form of bodily movement - Ex. How the exercise should be performed IMAGERY FUNCTIONS ❖ COGNITIVE IMAGERY - Involves imagining general strategies or specific skills - Used to learn and properly perform rehabilitative exercises during rehabilitation IMAGERY FUNCTIONS ❖ MOTIVATIONAL IMAGERY - Involves imagining - goal-oriented behavior - effective coping and mastery of challenging situations - changes in emotion - Used during rehab for a variety of purposes including enhancing mental toughness, maintaining concentration, and fostering a positive attitude towards rehabilitation. IMAGERY 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 IMAGERY GUIDELINES FOR IMAGERY USE 1. Educate 2. Assess 3. Support 4. Recognize & Apply 5. Incorporate IMAGERY MAKING IMAGERY FUNCTIONALLY EQUIVALENT ❖ PETTLEP Model - Ensures that imagery is a close representation of physical practice Physical Environment Task Timing Learning Emotion Perspective PATIENT-CENTERED THERAPY PATIENT-C ENTERED 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 PATIENT-C ENTERED THERAPY CORE CONDITIONS 1. Practitioner should experience unconditional positive regard for their patients at all times. UNCONDITIONAL POSITIVE REGARD - 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 PATIENT-C ENTERED THERAPY CORE CONDITIONS 2. Practitioner should demonstrate empathetic understanding EMPATHY - Related to the ability of a practitioner to understand what a patient is feeling with regards to a situation or event Thank You!