Behavioural Treatment Interventions for Clients Coping with Medical Illness

CPD

Handouts

Faculty

Teresa L. Deshields, PhD, ABPP Related seminars and products

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Teresa L. Deshields, PhD, ABPP, is a licensed clinical psychologist and a board-certified health psychologist. She is adjunct professor of medicine and psychiatry & behavioral sciences at Rush University School of Medicine in Chicago. She is a Fellow of the American Psychological Association, as well as a Fellow of the American Psychosocial Oncology Society and its past president. She has worked for over 20 years as a clinician in psycho-oncology, treating cancer patients and survivors and their family members, throughout the cancer continuum. She has published over 50 peer-reviewed manuscripts, several invited papers, and a book on psychological treatment of cancer patients.

 

Speaker Disclosures:
Financial: Dr. Teresa Deshields has an employment relationship with Rush University Medical Center and receives royalties as a published author. She is a consultant with AstraZeneca and R3 Continuum. Dr. Deshields receives a grant from the American Cancer Society. She receives a speaking honorarium and recording royalties from PESI, Inc. All relevant financial relationships with ineligible organizations have been mitigated.
Non-financial: Dr. Teresa Deshields is a member of the American Psychological Association, the Society for Health Psychology, and the American Psychosocial Oncology Society.

Objectives

1. Determine the psychological challenges for the medically ill and their family caregivers.
2. Choose psychological/behavioural interventions to address psychological distress and distressing symptoms.
3. Point out challenges in communication with different disciplines.
4. Specify the differences between supportive care, palliative care and hospice care.
5. Utilize mindfulness-based strategies, ACT and CBT tools to decrease symptoms of pain, nausea, fatigue and insomnia.
6. Assess the psychological, social and behavioural factors that contribute to chronic illness and articulate their treatment implications.

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 behavioural 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

Behavioural 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

Target Audience

• Social Workers
• Psychologists
• Counselors
• Occupational Therapists
• Psychotherapists
• Marriage and Family Therapists
• Case Managers
• Physical Therapists
• Physical Therapy Assistants
• Nurses
• Nurse Practitioners
• Other Helping Professionals