1. CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit
Nigel Sage, Michelle Sowden,
Liz Chorlton and Andrea Edeleanu
Slide Set 13
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

2. Weighing Up Denial
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

3. Denial Differentiated
DEFINING OUR TERMS:
Denial Differentiated
Positive (Constructive) Avoidance
Fearful Avoidance
Refusal to accept (believe)
Total Denial
Public Denial
Ignorance or Confusion
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

4. Positive (Constructive) Avoidance
Fully aware of diagnosis
Co-operates with treatment
Seeks no further information
Refuses to consider negative outcomes
Normal life style
Plans realistically
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

5. Fearful Avoidance Accepts diagnosis
Quickly distress when health issues raised
Avoids health checks and information
Avoids being given direct health feedback
Avoids news, tv etc re health issues
Fears own negative thoughts
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

6. Refusal to accept (believe)
Reluctant to co-operate with treatment
Questions the diagnosis
Minimises the symptoms
Generates alternative explanations
Seeks further opinions
Prefers alternative therapies and theories
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

7. Total Denial Blanks all memory of the diagnosis
Creates own explanation for symptoms
Refuses treatment as unnecessary
Rejects offers of help and support
Irritated by “intrusions” and questioning
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

8. Public Denial Privately accepts diagnosis
Co-operates in treatment with conditions
Sees the illness as a social stigma or judgement to be hidden away or
Fears invasion of privacy and loss of personal control
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

9. Ignorance or Confusion
Misunderstands diagnosis
Muddled by information received
Fails to appreciate or grasp the seriousness of the situation or
Disease site, medication or another disorder interfere with assimilating information
Powerful “other” refuses to accept
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

10. Advantages of Denial Self protection Maintenance of hope Resilience
prevents being overwhelmed
can help end stage communication
Maintenance of hope
preserves a sense of future
positive outlook
Resilience
minimising of symptoms
reduces anticipatory anxiety
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

11. Disadvantages of Denial
Neglect
inadequate reaction to symptoms
personal affairs not sorted
unrealistic and bad decisions made
Obstruction
poor compliance and reporting
blocks interpersonal relationships
blocks professional advice
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

12. Denial Type and Approach
Ignorance
Public Denial
Positive Avoidance
Fearful Avoidance
Refusal to accept
Total denial
Educate
Become “insider”
Help problem solve
Reduce anxiety
Explore options
Build acceptance
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

13. To Act or Not To Act Weighing the Odds
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

14. To Act or Not To Act Weighing the Odds
Pros
Cons
To:
Advantages of denial
Disadvantages of denial
Benefits
Costs
Patient
Normal daily life
Intolerance of health
Stick with current plans
discussions
Mood normal
Disturbed dreams
Sudden irritability
Family
Normal daily routines
Restricted communication
Plans unchanged
Hidden feelings
Priorities unchanged
Uncertainty or confusion
No expressed distress
Tense atmosphere
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

15. To Act or Not To Act Weighing the Odds
Pros
Cons
To:
Advantages of denial
Disadvantages of denial
Benefits
Costs
Treatment
Minimum demands on
Poor reporting of
staff time
symptom changes
High tolerance of
Poor compliance
discomfort
Overdoes things
Positive outlook
Family need lots of
Active life
support and advice
Do nothing
Maintain positive
Reduce longevity
atmosphere for patient
Poor symptom control
Fail to plan realistically
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

16. Weighing The Pros & Cons
How much would this matter to the patient if he/she realised it?
Score each item FROM THE PATIENT’S PERSPECTIVE
0 = It would not
matter at all
3 = It would matter very much
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

17. To Act or Not To Act Weighing the Odds1 2 2 3 2 1 3 3 3 1 1 1 3 1 3 3 3 3 2 3 1
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008 20 25

18. CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit
Nigel Sage, Michelle Sowden,
Liz Chorlton and Andrea Edeleanu
Publisher: John Wiley & Sons (2008)
ISBN:
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008