1. Common Behavioral and Cognitive Interventions in Primary Care Based on: Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention Hunter et al, 2009 Presented August 2011 by Katherine M. Dollar, PhD.,

2. What’s in Your Toolbox? 2

3. The Co-located, Collaborative Provider’s Toolkit The following 8 techniques are effective for addressing a wide variety of symptoms and functional impairment seen in primary care (Hunter et al., 2009) The following 8 techniques are effective for addressing a wide variety of symptoms and functional impairment seen in primary care (Hunter et al., 2009) 1. Relaxation training 1. Relaxation training 2. Goal setting 2. Goal setting 3. Identifying and disputing negative cognitions 3. Identifying and disputing negative cognitions 4. Motivational Interviewing 4. Motivational Interviewing 5. Problem Solving 5. Problem Solving 6. Self-monitoring 6. Self-monitoring 7. Behavioral Activation 7. Behavioral Activation 8. Assertive Communication 8. Assertive Communication 3

4. Relaxation Training Deep Breathing Deep Breathing Cue-controlled relaxation Cue-controlled relaxation Progressive muscle relaxation Progressive muscle relaxation Visual imagery Visual imagery 4

5. Goal Setting Are the goals well defined in behavioral terms? (S.M.A.R.T) Are the goals well defined in behavioral terms? (S.M.A.R.T) Realistic/achievable Realistic/achievable With in realm of control/influence With in realm of control/influence Break into sub goals Break into sub goals Personally important Personally important Whose goals are they anyway? Whose goals are they anyway? 5

6. Identifying and Disputing Negative Cognitions Help to indentify unhealthy cognitions (predictions, expectations, evaluations) Help to indentify unhealthy cognitions (predictions, expectations, evaluations) Use thought logs Use thought logs Question thought process Question thought process “Cognitive Disputation” “Cognitive Disputation” Self-help books for highly motivated Self-help books for highly motivated Mind Over Mood: Greenberger and Padesky Mind Over Mood: Greenberger and Padesky 6

7. Motivational Interviewing Examine readiness to change (Readiness Ruler) Examine readiness to change (Readiness Ruler) Examine importance and confidence for change Examine importance and confidence for change Elicit pros and cons of change Elicit pros and cons of change 7

8. Problem Solving A five-step problem-solving model is recommended for the PC setting (Nezu, personal communication, 2011) A five-step problem-solving model is recommended for the PC setting (Nezu, personal communication, 2011) 1. Minimize emotional arousal to focus on next 4 steps 2. Set an achievable goal, identify major obstacles 3. Brainstorm multiple alternatives to overcoming obstacles 4. Identify pros and cons of each idea, cost-benefit analysis 5. Implement an action plan and assess the outcome (either fine-tune or go back through steps 1-4) Please note: Additional PST trainings will be available in the future. Please note: Additional PST trainings will be available in the future. 8

9. Self-Monitoring Help track progress towards a goal Help track progress towards a goal Use a calendar Use a calendar Keep a tally Keep a tally Chart on a graph Chart on a graph 9

10. Behavioral Activation Difficult to feel depressed when engaged in actives that provide pleasure and accomplishment Difficult to feel depressed when engaged in actives that provide pleasure and accomplishment Re-establish routines Re-establish routines Increase reinforcing experiences Increase reinforcing experiences Overcome avoidance patterns Overcome avoidance patterns Distraction from problems or unpleasant events Distraction from problems or unpleasant events 10

11. Behavioral Activation Techniques Choose and schedule daily pleasurable activities (Pleasant Events Schedule or Life Activities Checklist) Choose and schedule daily pleasurable activities (Pleasant Events Schedule or Life Activities Checklist) List activities and rate for mastery and pleasure List activities and rate for mastery and pleasure Keep activity logs Keep activity logs 11

12. Assertive Communication Assess patterns of communication Assess patterns of communication Explain differences in passive, assertive, and aggressive communication Explain differences in passive, assertive, and aggressive communication Help patient to learn how to speak assertively (Honest, Appropriate, Respectful, Direct) Help patient to learn how to speak assertively (Honest, Appropriate, Respectful, Direct) Practice through role-play Practice through role-play The Anxiety and Phobia Workbook The Anxiety and Phobia Workbook 12

13. Helpful Resources Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated Behavioral Health in Primary Care: Step-by-step Guidance for Assessment and Intervention, American Psychological Association. Gatchel, R. J. & Oordt, M. S. (2003). Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration: Washington, DC; American Psychological Association. P. Robinson & J. Reiter (2007) Behavioral consultation and primary care: A guide to integrating services. New York: Springer Science-Media. W. O'Donohoe, M. Byrd, N. Cummings, D. Henderson (2005). Behavioral integrative care: Treatments that work in the primary care setting. New York: Brunner-Routledge. 13

14. Questions? 14

15. Helpful IPC Resources http://vaww.visn2.med.va.gov/bh/cih/index.html http://vaww.visn2.med.va.gov/bh/cih/index.html http://vaww.visn2.med.va.gov/bh/cih/index.html http://vaww4.va.gov/pcmhi/ http://vaww4.va.gov/pcmhi/ http://vaww4.va.gov/pcmhi/ http://www.cfha.net http://www.cfha.net http://www.cfha.net http://www.cfha.net E-mail address: katherine.dollar@va.gov 15