1. Psychological Approaches In Primary Care II (Bradford GP VTS Dr Andrew R. Wilson

2. Objectives Reflect on validation homework to embed and share successes and acknowledge and deal with some of the difficulties Reflect on validation homework to embed and share successes and acknowledge and deal with some of the difficulties Have sufficient understanding of the rationale therapies to facilitate referral for psychological interventions Have sufficient understanding of the rationale therapies to facilitate referral for psychological interventions Explore some ways of bringing focus and facilititating change when working with psychological problems in primary care. Explore some ways of bringing focus and facilititating change when working with psychological problems in primary care.

3. Today Session 1.Summary of previous session 2.Rationale therapies / therapist – presentations 3.Homework review (tying in some of the learning from summer school counselling subschool. 4.Tools for change 5.Summary and feedback

4. Review of Session I Pairs Work Pairs Work

5. Review of Session I What works Empathy Empathy Genuiness Genuiness Warmth Warmth negotiation of Goals negotiation of Goals Reflecting Reflecting

6. Review of Session I What works Repairing rupture in therapeutic relationship Repairing rupture in therapeutic relationship If patient satisfied If patient satisfied Alliance Alliance Cohesion between pt and therapist Cohesion between pt and therapist Emotional expression Emotional expression Changing view of self Changing view of self

7. Review of Session I What works broad classification Validation Validation Goal orientation/change techniques Goal orientation/change techniques

8. 2. Rationale therapies Presentations

9. Homework Review Validation In Groups What worked well What worked well What worked less well What worked less well

10. 4. Tools for change 1.Problem and goal lists 2.Cognitive continuum methods – breaking down global thinking 3.Behavioural Activation

11. Problem and Goal Lists Give Focus Give Focus Breaks things up into smaller parts Breaks things up into smaller parts Uses patients definition of problems Uses patients definition of problems Collaborative Collaborative Problem and present orientated Problem and present orientated Directional Directional Gives in time a sense of progress made Gives in time a sense of progress made

12. Sources for problem lists 1.Situational problems 2.Medical and traditional psychological problems 3.What other observe (family/doctors) 4.Effect of pt on others 5.?symptom/problem diaries

13. Patients may under report 1.Embarrassed/shame 2.Not be aware it is a problem 3.Believe problem to be insoluable 4.Overwhelmed 5.Not consider it a problem

14. Goals S pecific S pecific M easurable M easurable A cheiveable A cheiveable R ealistic R ealistic T ime Limited T ime Limited

15. Challenging Global Thinking Lots of forms of negative global thinking Lots of forms of negative global thinking Worksheets in 3s Worksheets in 3s

16. Common Thinking Errors 1.All or nothing/Black or White/Polarised Thinking 2.Overgeneralising 3.Mental filter/selective abstraction 4.Jumping to conclusions/catastrophising 1.Mind reading 2.Fortune telling 5.Magnifying or minimizing

17. Common Thinking Errors 6.Emotional Reasoning 7.Shoulds and must 8.Labelling 9.Personalising 10.Tunnel Vision 11.Disqualifying or discounting the positive

18. Cognitive Continuum Identify the global thinking Identify the global thinking Im a bad mum Im a bad mum Score it 0-100 Score it 0-100 Break up Im a bad mum into constituent parts and re score Break up Im a bad mum into constituent parts and re score

19. Patient0x100 Loving0x100 Warm and Fed0x100 Quality Time0x 100 Build their Self Esteem0x100 Good Mother belief at beginning 50% Good Mother belief at end 70-80%

20. Behavioural Activation Some behaviours result in positive mood changes Some behaviours result in positive mood changes Evidence that scheduling activities can result in improvement in patients with anxiety and depression, independent of traditional medical interventions Evidence that scheduling activities can result in improvement in patients with anxiety and depression, independent of traditional medical interventions Probably the main treatment effect of CBT Probably the main treatment effect of CBT