Chronic Medical Illness: ACT, CBT, and MI to Improve Anxiety, Grief, Pain, and Functioning

CPD

Planning Committee Disclosure - No relevant relationships

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

Handouts

Speaker

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.

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Objectives

1. Utilize screening and assessment instruments to monitor depression and anxiety symptoms in clients coping with chronic medical illness to inform treatment planning. 
2. Appraise the impact of at least three client losses related to chronic medical illness.  
3. Conduct cognitive restructuring to reduce catastrophizing related to medical illness. 
4. Utilize at least two interventions to decrease symptoms of pain, nausea, fatigue, and insomnia. 
5. Demonstrate at least two strategies for supporting family caregivers. 
6. Apply the SBAR method to communication with healthcare professionals.

Outline

Establishing Whole Person Care
What it is and why it’s important

• How to talk with clients about medical problems
• Facilitating engagement with the client who considers their problem to be only medical
• Social desirability and other challenges in identifying symptoms and stressors
• Collaborative agenda-setting
• Top quality of life domains to address

What Does Grief Have to Do With It?
Psychological distress in the medically ill

• Relationship between medical symptoms, pain, and distress
• Expected manifestations of distress in the context of medical illness
• Factors that increase risk of distress
• Bi-directional relationship distress and illness
• Top screening tools for distress
• The 5 key losses associated with illness
• Working with anticipatory grief

Depression and Anxiety
Are they inevitable after diagnosis of an illness?

• Diagnostic issues when symptoms of disease overlap with signs of depression
• Forms of anxiety that are particularly prevalent in medical illness
• Key assessment tools and techniques
• Barriers to diagnosing depression and anxiety in medical patients
• Medical consequences of untreated depression
• What to do when anxiety interferes with compliance with medical treatments
• Suicide risk and severe illness

CBT and ACT Interventions for Clients with Medical Illness
Top techniques for fears of death, fears of recurrence, and other distressing outcomes

• Effective strategies for illness-related cognitive distortions
• Cognitive restructuring to reframe, dial down, and challenge unhelpful thoughts
• Mindfulness and acceptance strategies
• Cognitive defusion to address negative and obsessive thinking
• Stimulus control for triggers
• Effective relaxation techniques and exercises
• How to decrease time in bed and other maladaptive behaviours
• Activity scheduling and health-promoting behaviours
• Values clarification in the context of medical illness
• SMART goals for committed action
• Gratitude exercises to increase resilience

How Behavioral Health Providers Can Assist with Management of Physical Symptoms
CBT, ACT, MI and other interventions to improve mood, pain, and functioning

• Symptom burden: how to prioritize concerns
• Motivational interviewing to harness clients’ reasons and resources
• How to address catastrophizing with CBT for pain
• How to help clients with pacing
• Making room for pain with ACT
• Mindfulness, yoga, and movement for management of fatigue
• How to improve clients’ sleep with CBT – stimulus control, sleep restriction, and more
• Relaxation, imagery, mindfulness, hypnosis, and more for nausea

Terminal Illness and End of Life Considerations
Disentangling quality versus quantity of life

• How to talk with clients about readiness to die and quality of dying
• Four things that matter most for a good death
• Top worries related to desire for hastened death
• Differences between supportive, palliative, and hospice care
• Ethics in medical decision-making
• Managing family disagreements and dysfunction related to treatment options
• Decisions to withhold or withdraw care

Clinical Considerations
Ethics and professional issues in working with medically ill clients

• Best practices for communication with healthcare professionals: the SBAR method
• How to share information without breaking confidentiality
• Understanding and working with caregivers who may be as distressed as the client
• Foster resilience in family caregivers
• Management of therapist reactions, disclosures, and burnout
• Limitations of the research and potential risks

Target Audience

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