Behavioral Health/Psychology
Andrew L. Cohen, Ph.D.
CBT: Cognitive Techniques
- Help patient challenge their cognitive distortions
- Anxious brain vs. rational brain
- Rational brain
- What is the evidence for and against the thought?
- What is the likelihood that your concern will happen?
- Perspective taking
- Will it matter in a year?
- How would you think about this if it were your friend?
- Use category of cognitive distortion to help with thought challenging
- e.g., if the thought is “all-or-nothing,” introduce doubt to make it a “maybe” thought
CBT: Behavioral Techniques
- Evidence-based coping strategies that can decrease pain / stress experience
- Choose two or more coping strategies – practice daily and use as needed:
- Diaphragmatic breathing
- Progressive muscle relaxation
- Mindfulness
- Meditation
CBT: Behavioral Techniques
- Evidence-based coping strategies that can decrease pain / stress experience
- Choose two or more coping strategies – practice daily and use as needed:
- Diaphragmatic breathing
- Progressive muscle relaxation
- Mindfulness
- Meditation
CBT: Behavioral Techniques – Diaphragmatic Breathing (DB)
- AKA deep breathing or belly breathing
- Basics
- Lie down (or sit comfortably) with knees bent and shoulders, head, and neck relaxed.
- Place one hand on your upper chest and the other hand just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
- Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible.
- Exhale through pursed lips by tightening your stomach muscles and letting them fall inward as you exhale. The hand on your chest should remain as still as possible.
- Practice 5 minutes at a time, starting with 1-2 practice sessions per day.
CBT: Behavioral Techniques – Progressive Muscle Relaxation (PMR)
Basics
- First, you systematically tense particular muscle groups in your body, such as your neck and shoulders.
- Second, you release the tension and notice how your muscles feel when you relax them.
- Tense for 5 seconds, and then release for 5 seconds and notice the difference between the tension and relaxation.
- Head-to-toe or toe-to-head, it does not matter as long as you are tensing and releasing in a stepwise manner across your body’s muscle groups.
- It is helpful to follow a stepwise script (paper) or a voice recording (mobile health app).
Role of Social Support (Family and Friends)
- Pain reducing behaviors (DOs):
- Distraction
- Engagement
- Coping skills
- Humor
- Pain promoting behaviors (DON’Ts):
- Empathy (by itself)
- Apologizing
- Resting (by itself)
- Family and friends should:
- Minimize their reactions to patient’s pain
- Praise patient for self-management of pain
- Praise patient for engaging in normal activities, despite pain
- Eliminate pain status checks, such as "How are you feeling?"
Transition from Pediatric to Adult Care
- Transition is a process, not a single discussion
- Current recommendation is to start the conversation at age 12 years
- Providers can:
- Help patient and family to think ahead, starting early
- Discuss gradual transfer of control of health and disease management from parent to adolescent
- Encourage patient's development of self-management motivation and skills
- Encourage patient to engage in self-advocacy
- Discuss challenges of moving from a pediatric to an adult style of care
- Refer patient to adult providers who understand the patient's disease
- Transfer needed information to the adult provider
- Follow-up to ensure that transfer really occurred
- www.gottransition.org
- Aligned with American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians
