1. Ruth Nutting, MA, PLMHP, Behavioral Medicine Specialist Jennifer Harsh, PhD, LMFT, Behavioral Medicine Program Director Sean Hearn, MD, Family Medicine Physician Session #A6b October 17 th, 2015 Brief Couple-Based Interventions: Getting to the Heart of Coping with Chronic Illness Collaborative Family Healthcare Association 17th Annual Conference October 15-17, 2015 Portland, Oregon U.S.A.

2. Faculty Disclosure The presenters of this session Have NOT had any relevant financial relationships during the past 12 months.

3. Learning Objectives At the conclusion of this session, the participant will be able to: Identify the benefits of brief couple-based interventions. Implement brief couple-based interventions in a healthcare setting. Describe an approach to training residents to incorporate brief couple-based interventions into patient care.

4. References Canavarro, M. C. & Dattilio, F. (2011). Family therapy and medical issues. Contemporary Family Therapy, 33, 87-90. Centers for Disease Control and Prevention. (2014). Chronic disease prevention and health promotion. Retrieved from http://www.cdc.gov/chronicdisease/overview/ Lister, Z. C., Fox, C., & Wilson, C.M. (2013). Couples and Diabetes: A 30-Year Narrative Review of Dyadic Relational Research. Contemporary Family Therapy: An International Journal, 35, 613-638. McLean, L. M. (2013). A couple-based intervention for patients and caregivers facing end- stage cancer: Outcomes of a randomized controlled trial. Psycho-Oncology, 22 (1), 28-38. Pakenham, K. C., & Samios, C. (2013). Couples coping with multiple sclerosis: A dyadic perspective on the roles of mindfulness and acceptance. Journal of Behavioral Medicine, 36 (4), 389-400.

5. Prevalence Over ½ of adults live with chronic illness Psychosocial needs of patient Psychosocial needs of partners

6. Couple-oriented interventions more effective than individual-focused interventions in promoting positive coping Why are they more effective? Increase communication Increase treatment adherence Increase attachment bonds Reduce relationship and psychological distress

7. Commonly Used Individual Interventions Solution Focused Brief InterventionCollaborative Goal SettingBehavioral Activation

8. Solution Focused Interventions Past Success - Increased confidence/solutions Behavior Change - What has worked well before? Emotional Difficulties -What helps you feel less down? Create Strategies

9. Collaborative Goal Setting CoupleIndividual Our goal is: _______________________ We will: __________________________ When: ___________________________ We will do this first: _________________ Challenges that may arise: ___________ We will handle them by: _____________ We will reward ourselves when: _______ Our reward will be: _________________ My goal is: ____________________ I will: _________________________ When: ________________________ I will do this first: ________________ Challenges that may arise: ________ I will handle them by: ____________ I will reward myself when: _________ My reward will be: _______________ Khatri, P., & Mays, K. (2011). Brief interventions in primary care [PowerPoint slides]. Retrieved from http://www.integration.samhsa.gov/Brief_Intervention_in_PC,_pdf.pdf

10. Behavioral Activation What has been pleasurable? Make Plan Do Something Feel Better

11. Provider Training Many healthcare providers are not trained to intervene at the couple level. What is training focused on? Individual interventions that providers DO learn can be modified to target couples. Easier for providers to incorporate in care.

12. UNMC-Resident Education Noon Conferences Presentation and experiential activities Seminar Video review Attention to bio-psycho- social needs Rapport; agenda; psychoeducation; couple- based interventions; teach back Couple Focused SFBT Stress Relief Behavioral Activation Goals

13. Case Example Garth was diagnosed with Type II DM one year ago. Since his dx he has struggled to change his eating habits and his A1C has remained at 8.0. He checks his blood glucose levels solely when he is “feeling off”.

14. Individual Intervention

15. Couple Intervention

16. Summary Couple Centered Interventions Couple focus on healthcare goals. Committing to lifestyle changes. Taking control Maintaining bonds Individual Interventions Individual focus on healthcare goals.

17. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!

19. Contact Information Ruth Nutting, MA, PLMHP ruth.nutting@unmc.edu Jennifer Harsh, PhD, LMFT jennifer.harsh@unmc.edu Sean Hearn, MD seanhearnmd@gmail.com

20. Video Links Couple Intervention link http://webmedia.unmc.edu/eLearning/COM/IntM ed/couple%20intervention%20mp4.mp4 http://webmedia.unmc.edu/eLearning/COM/IntM ed/couple%20intervention%20mp4.mp4 Individual Intervention link http://webmedia.unmc.edu/eLearning/COM/IntM ed/individual%20intervention%20mp4.mp4 http://webmedia.unmc.edu/eLearning/COM/IntM ed/individual%20intervention%20mp4.mp4