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Last updated: Mon, Jul 22, 2024
This page is incomplete. It displays memoes and/or notes.
The goal of cognitive-behavioral therapy is not intellectual awareness or insight, but reduced emotional distress, greater self-efficacy, and improved coping skills and activities.
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 250
...practitioners of cognitive-behavioral therapy also value setting goals, making choices, and taking action and control where realistic. [Dangerous.]
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 9
These clients may have problems with anxiety, depression, relationships, or adjustment to change, or simply with living. They may use too many substances and have self-destructive habits or poor lifestyle balance. They may struggle to make decisions about marriage, their careers, or whether to have children. They may re....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 3
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 13-197
Items to be identified by assessment:
Identify problems
triggers and consequences of problems
reactions of the client, including affect and cognitions
coping and approach/avoidance patterns
skills, deficits, lack of knowledge, etc.
social support, family concerns, interpersonal problems
devel....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 13-30
...a hypothesis about the nature of the psychological difficulty...underlying the problems on the patient's problem list....[Hypothesis is improved during the therapy process.] [Research shows that while analysts agree on the problem list, they disagree on the causative factors. p. 35] ...causative factors...often are....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 32-44
[Client characteristics related to good treatment outcome: lower problem severity, lower chronicity, absence of personality disorder, positive expectations of treatment.]
Therapist factors have been an understudied phenomenon in cognitive-behavioral therapy. When writing this chapter, we could not find a single rev....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 228
Clients may come for treatment with the knowledge that their thinking is negative or pessimistic. These thoughts may be so "powerful" that they feel overwhelmed and unable to respond to them. Often these thoughts seem "true" to clients, so there does not seem to be any effective way to counter them.....
...the provi....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 116-144
Situation: A pain flare-up on a busy day
Emotion: Depressed 60%, Frustrated 50%
Automatic Thought: I can't cope with my pain; my life is miserable
Evidence for: There is too much going on today. I feel overwhelmed and I'm not getting my work done.
Evidence against: I have h....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 42
...our general position is that if there is an evidence-based, manualized treatment for a particular problem, and a client with that same problem, then the clinician should adhere closely to the manual....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 7
Many cognitive-behavioral treatment manuals have been written, often for increasingly specific diagnostic categories of the [DSM].
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 2
Although the typical length of treatment in outcome studies is carefully controlled and tends to be between 8 and 10 sessions for most anxiety disorders, and 16 to 20 sessions for major depressive disorder, the number of sessions varies considerably in clinical practice.
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 248
Transparency in therapy is also likely to be desirable to consumers, with the goals, rationale, and methods of the approach clearly described. These activities are typical of cognitive-behavioral therapy.
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 10
Governments and healthcare policymakers are also aware that people in need don't always get the best treatments, something they refer to as "variability in healthcare practices."
Now healthcare systems around the world are attempting to correct this variability by introducing "evidence-based practice." This simply me....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, v
End of included memoes/notes
This page is incomplete. It displays memoes and/or notes.
Characteristics of the Cognitive-Behavioral Approach to Pain Management
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 594
In behavioral assessment, such descriptive data [activity levels, objective activities such as taking medications or behavior during an exam] are used for several purposes. First, descriptive data can pinpoint problem behaviors that may serve as targets for treatment efforts....Second, descriptive data can be used to e....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 136
[High-level factors, Table 10.1:] Experience of pain and related symptoms, Treatments received and currently receiving, Compensation and litigation, Response by patient and significant others [to pain-related condition], Coping, Educational and vocational history, Social history, Alcohol and substance abuse, Psychologic....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 190-1
Pain is usually temporary; however, for some people pain persists over time and is considered chronic. Chronic pain can create a reliance on medication and can cause emotional distress. It can also affect a person's ability to engage in occupational, social, or recreational activities. A lack of activity can contribu....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 1
The general goals of this treatment program are:
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 8-10
The potential benefits of this program include improved physical functioning and reduced disability, improvements in mood and reduced anxiety associated with activity, a reduction in pain, and improved relations with family/spouse/significant other. CBT for chronic pain management is a very interactive treatment that of....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach: Therapist's Guide", Oxford University Press, 2007, 7
As Van Damme and co-authors (2008, 2010) have noted, one has to take into account the goal orientation of the person, which determines whether a given coping strategy is adaptive or not. [The cite says that the effects of pain in capturing attention are mediated by the goal orientation of the individual.]
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 261
[It may be important to mold treatment programs based on levels of fear-avoidance, and the related constellation of traits. Studies have shown effectiveness with programs from tailored "traditional" CBT to brief educational sessions.]
Taken together, these results suggest that cognitive behavioral programs, and even....
Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma, K and Vlaeyen, JWS, "The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence", Journal of Behavioral Medicine 30: 2006, 86
The primary goal of CBT for pain is to promote the adoption of an active problem-solving approach to tackling the many challenges associated with the experience of chronic pain. A shift from a perspective of helplessness with regard to these challenges to one of personal responsibility, self-control, and confidence is e....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach: Therapist's Guide", Oxford University Press, 2007, 5-6
Primary Objectives of Cognitive-Behavioral Treatment Programs
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 593
[The authors suggest general education campaigns ("The truth about low-back pain"), and suggest identification and specific treatment of those predicted to be vulnerable.]
So far, most of the work on pain-related fear has focused on patients with non-specific medical diagnoses such as back pain, chronic headache, fi....
Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma, K and Vlaeyen, JWS, "The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence", Journal of Behavioral Medicine 30: 2006, 88-9
End of included memoes/notes
This page is incomplete. It displays memoes and/or notes.
Before beginning this program, your therapist will ask you to complete some assessment measures. These questionnaires will ask you about the history of your pain, the impact pain has on your life, your efforts to cope with pain, and other factors....The assessment will help your therapist understand your pain condition....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 3
Session 1: Education in Chronic Pain
Session 2: Theories of Pain and Diaphragmatic Breathing
Session 3: Progressive Muscle Relaxation and Visual Imagery
Session 4: Automatic Thoughts and Pain
Session 5: Cognitive Restructuring
Session 6: Stress Management
Session 7: Time-Based Pacing
Session....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, vii
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 74-89
[The components of CBT for pain include]
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 2
[Pain increases distress (thoughts and feelings) increases disability (behaviors).] When pain persists over time, you may develop negative beliefs about your pain (e.g., "This is never going to get better," "I can't cope with my pain") or negative thoughts about yourself (e.g., "I'm worthless to my family because I can'....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 8
Cognitive errors (Box 42-6), frequently observed in individuals with chronic pain, can be related to the emotional difficulties associated with living with pain. Variability in pain reporting and disability in those with chronic pain may be accounted for by maladaptive thoughts; in contrast, physical factors appear to c....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 596
Now that you know about cognitive errors, you probably want to learn how to stop making them. First you must practice making the connection between the way you think about an event and the way it makes you feel and act. [You use the ABC method of self-observation and analysis: A is for Activating Event. B is for Beliefs....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 35-7
The session will begin with a review of your pretreatment assessment results. Next you will discuss the different ways pain affects your life. You will also learn about how thoughts, feelings, and behaviors maintain the cycle of pain. [Is this saying the chronic pain is sometimes/always/in your case maintained by behav....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 6
[Under thoughts and feeling:] The way a person thinks (e.g., "Life is unfair," "I'm never going to get better") and feels (e.g., worthless, depressed, anxious) can have a big impact on his experience of pain. Research indicates that negative emotions or thoughts tend to increase the focus on pain so that it is more not....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 6-7
...two theories of pain: the specificity theory and the gate control theory.
The specificity theory suggests that the amount of pain a person feels is dirctly related to the amount of tissue damage that has occurred. [THAT's NOT TRUE IN A COuPLE OF WAYS. First, that's not what the speficity idea is. Second, pain is....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 13-15
As discussed in previous chapters, negative thoughts can open the gate to pain. [That sounds like it was closed, and the negative thoughts opened it. Note that this is a total bawdlerization of the "gate" concept.] Even though negative thoughts in general are related to increased pain, negative thoughts specifically abo....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 39-41
Reconceptualization involves continually reorienting patients from their belief that the symptoms or physical impairments are overwhelming, unmanageable, all-encompassing sensory experiences resulting solely from tissue pathological changes to a belief that symptoms and disability as experiences can be differentiated, s....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 595
At this point the therapist introduces the concept of pain behavior and operant learning and discusses the important role that significant others may play in unwittingly and inadvertently reinforcing and thereby maintaining the patient's overt expression of pain, distress, and suffering....
...For example, the impac....
Turk, D. C., and Melzack, R., "Trends and Future Directions", Chapter 25 in Turk et al. 2011, pp. 489-506, 2011, 595-6
Patients with chronic pain are sometimes seen for psychological treatment only after they have had years of pain that has dramatically affected every aspect of their lives, including the lives of their families. Over time, family dynamics and roles can become maladaptive and highly resistant to change. Involving signifi....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach: Therapist's Guide", Oxford University Press, 2007, 10-11
End of included memoes/notes
This page is incomplete. It displays memoes and/or notes.
As patients learn to self-regulate physiological responses and manage problematic situations, they can develop an increased sense of personal control over the pain and the factors that influence pain and combat the pervasive sense of demoralization. [Skill areas include problem solving; muscle relaxation and controlled....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 598
[Developed in late 70s as a treatment for depression. Goal is to help clients increase the amount of positive things in their lives. Identify skills deficits. communication skills, social skills, relaxation]
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 91-102
[behavioral treatment falls in two categories: ] (1) behavior change strategies that increase knowledge, skills, and change-enhancing behaviors, and (2) those that decrease avoidance and self-defeating or problematic behaviors.....the evidence from randomized trials suggests likely intervention strategies, but the clini....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 91-2
...if the exercise routine is to become a stable coping response, four steps must occur: (1) The therapeutic benefit of the prescribed exercise must be believed; (2) the capability to perform the exercise must exist; (3) the exercise must actually be performed; (4) the outcome must contribute to a perception of pain mas....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 74
[Deep breathing for relaxation; homework includes breathing practice and pursuing the other goals "you" established at beginning of course.]
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 15-19
Cognitive changes accompanying headache treatment: The use of a thought-sampling procedure
Abstract
Thirty-six community residents with mixed headache symptomatology were assigned either to a group receiving cognitive-behavioral treatment or to a waiting list control. Treatment focused explicitly upon traini....
Newton, C. R., Barbaree, H. E,, "Cognitive changes accompanying headache treatment: The use of a thought-sampling procedure ", Cognitive Therapy and Research 11: 1987
[Prepare for a flare-up by expecting one and having a plan. Confront the flare-up by using the management strategies you've learned. Replace negative (can't cope) with positive (can cope) thoughts. Review and prepare for the next flare-up. Sounds fun.]
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 79-82
...you may avoid some activites or social events because you do not want to answer annoying questions about your pain (e.g., "You don't look like you're in pain; what's wrong with you?")....[They encourage you to schedule something pleasant. This is another social thing. Norms say that you do your work first. It doesn't....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 59-60
...Cognitive coping strategies inlcude various means of distracting oneself from pain, reassuring oneself about one's own capabilities or about the likelihood that the pain will diminish, and seeking information.
...Often, patients use their pain problem as an excuse to avoid social interactions that they view as st....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 599
The exercise-activity program has four major objectives. First is ameliorating any physiological consequences that may exacerbate the pain. Moreover, for patients with chronic pain and their significant others, pain is a major focus of attention. Each physical sensation and each environmental demand is viewed in terms o....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 599
One of the ways that patients cope with fear of pain or injury is by avoidance of what they anticipate will cause them problems--pain, physical damage, or excessive fatigue. Avoidance of activity, although it is a seemingly rational way to manage a pain problem. can actually play a large role in maintaining chronic pain....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 599
[There is a section on why sleeping is good, then some explanation of sleep hygiene, then a worksheet on sleep hygiene. What if some of these are impracticable? What if they don't work? E.g., I can't avoid napping, or use the bed only for sleep, because I have to lie down for much of the day. Refer to Fishbain's summari....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 73-6
...when you perceive a situation or event as being overwhelming, beyond your abilities to cope, and threatening to your well-being, then it is considered "stressful." [That's one possible view of stress. It's actually the definition of stress that leads to PTSD.] Stress can result in feelings of exhaustion, fatigue, and....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 45-8
Stress is associated with perceptions of limited ability to cope and poor problem-solving skills. [More verbal legerdemain. So if you experience stress, it is because you perceive your ability to cope is finite and/or you have poor skills.] These factors can contribute to depression and negative moods, which can increas....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 48-51
[It seems to suggest that pain patients commonly need to pace themselves more carefully, to schedule rest breaks more often.] Some people are reluctant to pace themselves because they think they can't afford to "slow down." [What if it's others who think or demand a lot of activity? What if it's not possible to take bre....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007
End of included memoes/notes
This page is incomplete. It displays memoes and/or notes.
After successful rehabilitation [Meaning what?] there appears to be an important cognitive shift from beliefs about helplessness and passivity to resourcefulness and ability to function regardless of pain. Clearly, it appears essential for patients with chronic and recurrent acute pain (e.g., migraine)[Another definiti....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 259
In an innovative study designed to evaluate the [THE STUDY ASSUMES THIS DIRECT ASSOCIATION?] direct association between patients' beliefs and pain symptoms, Newton and Barbaree (1987) used a modified thought-sampling procedure to evaluate the nature of patients' thoughts during and immediately following headache, both b....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 259
It is written from a cognitive-behavioral perspective, as this approach has been found to be highly effective when working with patients who have chronic pain. [I think moderately-effective is more accurate, The author could cite figures but doesn't.] An emphasis is placed on behavioral activation and changing negative....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach: Therapist's Guide", Oxford University Press, 2007, 1-2
[Table 11.3, p. 239 shows summary of results of CBT by disorder. CBT is indicated "treatment of choice" for social phobia, specific phobias, PTSD, and bulimia. "Positive evidence" is indicated for OCD, panic, depression, sleep disorder, and "somatization disorder."]
The first potentially harmful cognitive-behavioral....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 239-242
A growing body of research suggests that coping strategies that have previously been hypothesized to play an important role in patient outcomes may, in fact, have no or only a limited impact on outcomes.
Jensen, M. P.,Turner, J. A., and Romano, J. M., "Changes after Multidisciplinary Pain Treatment in Patient Pain Beliefs and Coping Are Associated with Concurrent Changes in Patient Functioning", HHS Public Access Author Manuscript http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1986708/: 2007
;iii) behavioural treatment was more effective than usual care for short-term pain relief (MD -5.18; 95%CI -9.79 to -0.57), but there were no differences in the intermediate- to long-term, or on functional status;iv) there was little or no difference between behavioural treatment and group exercise for pain relief or de....
Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ, "Behavioural treatment for chronic low-back pain. (Abstract)", The Cochrane database of systematic reviews: 2010 (Behavioural treatment for chronic low-back pain. 2010- PubMed - NCBI.html)
End of included memoes/notes
This page is incomplete. It displays memoes and/or notes.
Characteristics of the Cognitive-Behavioral Approach to Pain Management
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 594
In behavioral assessment, such descriptive data [activity levels, objective activities such as taking medications or behavior during an exam] are used for several purposes. First, descriptive data can pinpoint problem behaviors that may serve as targets for treatment efforts....Second, descriptive data can be used to e....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 136
[High-level factors, Table 10.1:] Experience of pain and related symptoms, Treatments received and currently receiving, Compensation and litigation, Response by patient and significant others [to pain-related condition], Coping, Educational and vocational history, Social history, Alcohol and substance abuse, Psychologic....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 190-1
Pain is usually temporary; however, for some people pain persists over time and is considered chronic. Chronic pain can create a reliance on medication and can cause emotional distress. It can also affect a person's ability to engage in occupational, social, or recreational activities. A lack of activity can contribu....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 1
The general goals of this treatment program are:
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 8-10
The potential benefits of this program include improved physical functioning and reduced disability, improvements in mood and reduced anxiety associated with activity, a reduction in pain, and improved relations with family/spouse/significant other. CBT for chronic pain management is a very interactive treatment that of....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach: Therapist's Guide", Oxford University Press, 2007, 7
As Van Damme and co-authors (2008, 2010) have noted, one has to take into account the goal orientation of the person, which determines whether a given coping strategy is adaptive or not. [The cite says that the effects of pain in capturing attention are mediated by the goal orientation of the individual.]
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 261
[It may be important to mold treatment programs based on levels of fear-avoidance, and the related constellation of traits. Studies have shown effectiveness with programs from tailored "traditional" CBT to brief educational sessions.]
Taken together, these results suggest that cognitive behavioral programs, and even....
Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma, K and Vlaeyen, JWS, "The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence", Journal of Behavioral Medicine 30: 2006, 86
The primary goal of CBT for pain is to promote the adoption of an active problem-solving approach to tackling the many challenges associated with the experience of chronic pain. A shift from a perspective of helplessness with regard to these challenges to one of personal responsibility, self-control, and confidence is e....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach: Therapist's Guide", Oxford University Press, 2007, 5-6
Primary Objectives of Cognitive-Behavioral Treatment Programs
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 593
[The authors suggest general education campaigns ("The truth about low-back pain"), and suggest identification and specific treatment of those predicted to be vulnerable.]
So far, most of the work on pain-related fear has focused on patients with non-specific medical diagnoses such as back pain, chronic headache, fi....
Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma, K and Vlaeyen, JWS, "The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence", Journal of Behavioral Medicine 30: 2006, 88-9
End of included memoes/notes
This page is incomplete. It displays memoes and/or notes.
Before beginning this program, your therapist will ask you to complete some assessment measures. These questionnaires will ask you about the history of your pain, the impact pain has on your life, your efforts to cope with pain, and other factors....The assessment will help your therapist understand your pain condition....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 3
Session 1: Education in Chronic Pain
Session 2: Theories of Pain and Diaphragmatic Breathing
Session 3: Progressive Muscle Relaxation and Visual Imagery
Session 4: Automatic Thoughts and Pain
Session 5: Cognitive Restructuring
Session 6: Stress Management
Session 7: Time-Based Pacing
Session....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, vii
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 74-89
[The components of CBT for pain include]
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 2
[Pain increases distress (thoughts and feelings) increases disability (behaviors).] When pain persists over time, you may develop negative beliefs about your pain (e.g., "This is never going to get better," "I can't cope with my pain") or negative thoughts about yourself (e.g., "I'm worthless to my family because I can'....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 8
Cognitive errors (Box 42-6), frequently observed in individuals with chronic pain, can be related to the emotional difficulties associated with living with pain. Variability in pain reporting and disability in those with chronic pain may be accounted for by maladaptive thoughts; in contrast, physical factors appear to c....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 596
Now that you know about cognitive errors, you probably want to learn how to stop making them. First you must practice making the connection between the way you think about an event and the way it makes you feel and act. [You use the ABC method of self-observation and analysis: A is for Activating Event. B is for Beliefs....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 35-7
The session will begin with a review of your pretreatment assessment results. Next you will discuss the different ways pain affects your life. You will also learn about how thoughts, feelings, and behaviors maintain the cycle of pain. [Is this saying the chronic pain is sometimes/always/in your case maintained by behav....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 6
[Under thoughts and feeling:] The way a person thinks (e.g., "Life is unfair," "I'm never going to get better") and feels (e.g., worthless, depressed, anxious) can have a big impact on his experience of pain. Research indicates that negative emotions or thoughts tend to increase the focus on pain so that it is more not....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 6-7
...two theories of pain: the specificity theory and the gate control theory.
The specificity theory suggests that the amount of pain a person feels is dirctly related to the amount of tissue damage that has occurred. [THAT's NOT TRUE IN A COuPLE OF WAYS. First, that's not what the speficity idea is. Second, pain is....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 13-15
As discussed in previous chapters, negative thoughts can open the gate to pain. [That sounds like it was closed, and the negative thoughts opened it. Note that this is a total bawdlerization of the "gate" concept.] Even though negative thoughts in general are related to increased pain, negative thoughts specifically abo....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 39-41
Reconceptualization involves continually reorienting patients from their belief that the symptoms or physical impairments are overwhelming, unmanageable, all-encompassing sensory experiences resulting solely from tissue pathological changes to a belief that symptoms and disability as experiences can be differentiated, s....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 595
At this point the therapist introduces the concept of pain behavior and operant learning and discusses the important role that significant others may play in unwittingly and inadvertently reinforcing and thereby maintaining the patient's overt expression of pain, distress, and suffering....
...For example, the impac....
Turk, D. C., and Melzack, R., "Trends and Future Directions", Chapter 25 in Turk et al. 2011, pp. 489-506, 2011, 595-6
Patients with chronic pain are sometimes seen for psychological treatment only after they have had years of pain that has dramatically affected every aspect of their lives, including the lives of their families. Over time, family dynamics and roles can become maladaptive and highly resistant to change. Involving signifi....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach: Therapist's Guide", Oxford University Press, 2007, 10-11
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As patients learn to self-regulate physiological responses and manage problematic situations, they can develop an increased sense of personal control over the pain and the factors that influence pain and combat the pervasive sense of demoralization. [Skill areas include problem solving; muscle relaxation and controlled....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 598
[Developed in late 70s as a treatment for depression. Goal is to help clients increase the amount of positive things in their lives. Identify skills deficits. communication skills, social skills, relaxation]
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 91-102
[behavioral treatment falls in two categories: ] (1) behavior change strategies that increase knowledge, skills, and change-enhancing behaviors, and (2) those that decrease avoidance and self-defeating or problematic behaviors.....the evidence from randomized trials suggests likely intervention strategies, but the clini....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 91-2
...if the exercise routine is to become a stable coping response, four steps must occur: (1) The therapeutic benefit of the prescribed exercise must be believed; (2) the capability to perform the exercise must exist; (3) the exercise must actually be performed; (4) the outcome must contribute to a perception of pain mas....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 74
[Deep breathing for relaxation; homework includes breathing practice and pursuing the other goals "you" established at beginning of course.]
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 15-19
Cognitive changes accompanying headache treatment: The use of a thought-sampling procedure
Abstract
Thirty-six community residents with mixed headache symptomatology were assigned either to a group receiving cognitive-behavioral treatment or to a waiting list control. Treatment focused explicitly upon traini....
Newton, C. R., Barbaree, H. E,, "Cognitive changes accompanying headache treatment: The use of a thought-sampling procedure ", Cognitive Therapy and Research 11: 1987
[Prepare for a flare-up by expecting one and having a plan. Confront the flare-up by using the management strategies you've learned. Replace negative (can't cope) with positive (can cope) thoughts. Review and prepare for the next flare-up. Sounds fun.]
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 79-82
...you may avoid some activites or social events because you do not want to answer annoying questions about your pain (e.g., "You don't look like you're in pain; what's wrong with you?")....[They encourage you to schedule something pleasant. This is another social thing. Norms say that you do your work first. It doesn't....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 59-60
...Cognitive coping strategies inlcude various means of distracting oneself from pain, reassuring oneself about one's own capabilities or about the likelihood that the pain will diminish, and seeking information.
...Often, patients use their pain problem as an excuse to avoid social interactions that they view as st....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 599
The exercise-activity program has four major objectives. First is ameliorating any physiological consequences that may exacerbate the pain. Moreover, for patients with chronic pain and their significant others, pain is a major focus of attention. Each physical sensation and each environmental demand is viewed in terms o....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 599
One of the ways that patients cope with fear of pain or injury is by avoidance of what they anticipate will cause them problems--pain, physical damage, or excessive fatigue. Avoidance of activity, although it is a seemingly rational way to manage a pain problem. can actually play a large role in maintaining chronic pain....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 599
[There is a section on why sleeping is good, then some explanation of sleep hygiene, then a worksheet on sleep hygiene. What if some of these are impracticable? What if they don't work? E.g., I can't avoid napping, or use the bed only for sleep, because I have to lie down for much of the day. Refer to Fishbain's summari....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 73-6
...when you perceive a situation or event as being overwhelming, beyond your abilities to cope, and threatening to your well-being, then it is considered "stressful." [That's one possible view of stress. It's actually the definition of stress that leads to PTSD.] Stress can result in feelings of exhaustion, fatigue, and....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 45-8
Stress is associated with perceptions of limited ability to cope and poor problem-solving skills. [More verbal legerdemain. So if you experience stress, it is because you perceive your ability to cope is finite and/or you have poor skills.] These factors can contribute to depression and negative moods, which can increas....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007, 48-51
[It seems to suggest that pain patients commonly need to pace themselves more carefully, to schedule rest breaks more often.] Some people are reluctant to pace themselves because they think they can't afford to "slow down." [What if it's others who think or demand a lot of activity? What if it's not possible to take bre....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach", Oxford University Press, 2007
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After successful rehabilitation [Meaning what?] there appears to be an important cognitive shift from beliefs about helplessness and passivity to resourcefulness and ability to function regardless of pain. Clearly, it appears essential for patients with chronic and recurrent acute pain (e.g., migraine)[Another definiti....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 259
In an innovative study designed to evaluate the [THE STUDY ASSUMES THIS DIRECT ASSOCIATION?] direct association between patients' beliefs and pain symptoms, Newton and Barbaree (1987) used a modified thought-sampling procedure to evaluate the nature of patients' thoughts during and immediately following headache, both b....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 259
It is written from a cognitive-behavioral perspective, as this approach has been found to be highly effective when working with patients who have chronic pain. [I think moderately-effective is more accurate, The author could cite figures but doesn't.] An emphasis is placed on behavioral activation and changing negative....
Otis, John D., "Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach: Therapist's Guide", Oxford University Press, 2007, 1-2
[Table 11.3, p. 239 shows summary of results of CBT by disorder. CBT is indicated "treatment of choice" for social phobia, specific phobias, PTSD, and bulimia. "Positive evidence" is indicated for OCD, panic, depression, sleep disorder, and "somatization disorder."]
The first potentially harmful cognitive-behavioral....
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 239-242
A growing body of research suggests that coping strategies that have previously been hypothesized to play an important role in patient outcomes may, in fact, have no or only a limited impact on outcomes.
Jensen, M. P.,Turner, J. A., and Romano, J. M., "Changes after Multidisciplinary Pain Treatment in Patient Pain Beliefs and Coping Are Associated with Concurrent Changes in Patient Functioning", HHS Public Access Author Manuscript http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1986708/: 2007
;iii) behavioural treatment was more effective than usual care for short-term pain relief (MD -5.18; 95%CI -9.79 to -0.57), but there were no differences in the intermediate- to long-term, or on functional status;iv) there was little or no difference between behavioural treatment and group exercise for pain relief or de....
Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ, "Behavioural treatment for chronic low-back pain. (Abstract)", The Cochrane database of systematic reviews: 2010 (Behavioural treatment for chronic low-back pain. 2010- PubMed - NCBI.html)
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A version of CBT. How it is different. The questions that pain sufferers have about why they hurt, and particularly must they hurt, seem to last as long as the pain does, and is a cause, I believe, of much stress in such patients. There is no plan for ameliorating this stress.
Acceptance and commitment therapy [has] a core concept that acceptance of the reality of pain is an important factor in improving adaptation to chronic pain....Pain-related cognitions may support avoidance of pain-related activities, whereas acceptance and lack of avoidance have been associated with better functioning.....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 100
A class of interventions that is becoming more popular involves acceptance of negative experience as a normal part of human existence.
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 144
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Effectiveness of Treatments so far as the knowledge is available, by diagnosis and treatment type. Highlight on most common/most problematic, e.g., low back pain or sleep?? The likely connection between diagnostic categories, diagnostic accuracy, and effectiveness. There is more research of this needed, by me.
A growing body of research suggests that coping strategies that have previously been hypothesized to play an important role in patient outcomes may, in fact, have no or only a limited impact on outcomes.
Jensen, M. P.,Turner, J. A., and Romano, J. M., "Changes after Multidisciplinary Pain Treatment in Patient Pain Beliefs and Coping Are Associated with Concurrent Changes in Patient Functioning", HHS Public Access Author Manuscript http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1986708/: 2007
The professional and scientific communities have also contributed to the development of clinical myths. Most cognitive-behavioral researchers tend to focus on strengths of the treatments rather than limitations.
Dobson, D. and Dobson, K. S., "Evidence-Based Practice of Cognitive-Behavioral Therapy", Guildford Press, 2009, 245
In summary, the current results support cognitive-behavioral models of chronic pain that posit an important role for pain-related beliefs and coping responses in patient adjustment to chronic pain in the time period following multidisciplinary pain treatment. Although the study design does not allow for conclusions rega....
Jensen, M. P.,Turner, J. A., and Romano, J. M., "Changes after Multidisciplinary Pain Treatment in Patient Pain Beliefs and Coping Are Associated with Concurrent Changes in Patient Functioning", HHS Public Access Author Manuscript http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1986708/: 2007
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[Second part of the lecture for patients talks about the id/ego/superego, and] the troublesome, negative, threatening inhabitants of the unconscious like its childlike narcissism, dependency, and feelings of inferiority. Finally, we focus on the unconscious rage, emotional pain, and sadness that are directly responsibl....
Sarno, J. E., "The Divided Mind: The epidemic of mindbody disorders", Harper, 2006, 139-141
Although it is likely that all four of these patients were suffering from psychosomatic pain, it was my clinical judgment that they would not be accepting of that diagnosis. [The doctor relates that he treated each of the four with "standard care", apparently not telling them his opinion.]
Sarno, J. E., "The Divided Mind: The epidemic of mindbody disorders", Harper, 2006, 302
[Patients are screened: They must abjure belief in "structural" causes. Treatment begins with a doctor visit in which the doctor explains why structural explanations that the patient may have heard are incorrect. The doctor presents a lecture (group setting).] After years of experience it is not difficult to determine....
Sarno, J. E., "The Divided Mind: The epidemic of mindbody disorders", Harper, 2006, 134-139
An antidepressant...strengthens the barrier against the repressed but threatening emotions. [So, another general-purpose anti-TMS med. Why would SSRIs be good at this, vs SNRIs? Maybe this was written too early for SNRIs to be on the radar.]
Sarno, J. E., "The Divided Mind: The epidemic of mindbody disorders", Harper, 2006, 225
Interview of the patient with a suspected conversion disorder with the aid of an amytal (sodium amobarbitol) infusion has been a standard tool in psychiatric diagnosis. It is more common that motor and sensory deficits rather than pain will resolve under amytal sedation. Furthermore, some patients have had violent or....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 410
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