Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-24T01:51:09.591Z Has data issue: false hasContentIssue false
  • English
  • Français

A review of cognitive therapy in acute medical settings. Part I: Therapy model and assessment

Published online by Cambridge University Press:  22 November 2012

Tomer T. Levin ,
Craig A. White  and
David W. Kissane
Tomer T. Levin*
Affiliation:
Department of Psychiatry and Behavioral Science, Memorial Sloan-Kettering Cancer Center, New York, New York
Craig A. White
Affiliation:
School of Health, University of the West of Scotland, Ayr Campus, Ayr, Scotland
David W. Kissane
Affiliation:
Department of Psychiatry and Behavioral Science, Memorial Sloan-Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Tomer T. Levin, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor New York, New York10022. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Although cognitive therapy (CT) has established outpatient utility, there is no integrative framework for using CT in acute medical settings where most psychosomatic medicine (P-M) clinicians practice. Biopsychosocial complexity challenges P-M clinicians who want to use CT as the a priori psychotherapeutic modality. For example, how should clinicians modify the data gathering and formulation process to support CT in acute settings?

Method:

Narrative review methodology is used to describe the framework for a CT informed interview, formulation, and assessment in acute medical settings. Because this review is aimed largely at P-M trainees and educators, exemplary dialogues model the approach (specific CT strategies for common P-M scenarios appear in the companion article.)

Results:

Structured data gathering needs to be tailored by focusing on cognitive processes informed by the cognitive hypothesis. Agenda setting, Socratic questioning, and adaptations to the mental state examination are necessary. Specific attention is paid to the CT formulation, Folkman's Cognitive Coping Model, self-report measures, data-driven evaluations, and collaboration (e.g., sharing the formulation with the patient.) Integrative CT-psychopharmacological approaches and the importance of empathy are emphasized.

Significance of results:

The value of implementing psychotherapy in parallel with data gathering because of time urgency is advocated, but this is a significant departure from usual outpatient approaches in which psychotherapy follows evaluation. This conceptual approach offers a novel integrative framework for using CT in acute medical settings, but future challenges include demonstrating clinical outcomes and training P-M clinicians so as to demonstrate fidelity.

Keywords

CTP-MAcute medical settingsTraining
Type
Review Articles
Information
Palliative & Supportive Care , Volume 11 , Issue 2 , April 2013 , pp. 141 - 153
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Text Revision. Washington DC: American Psychiatric Association.Google Scholar
Astin, J.A., Beckner, W., Soeken, K., et al. (2002). Psychological interventions for rheumatoid arthritis: A meta-analysis of randomized controlled trials. Arthritis and Rheumatism, 47, 291–302.CrossRefGoogle ScholarPubMed
Ballard, E., Pao, M., Henderson, D., et al. (2008). Suicide in the medical setting. The Joint Commission Journal on Quality and Patient Safety, 34, 474–481.Google Scholar
Bardwell, W., Natarajan, L., Dimsdale, J., et al. (2006). Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. Journal of Clinical Oncology, 24, 2420–2427.Google Scholar
Beck, A.T. (1964). Thinking and depression: II. Theory and therapy. Archives of General Psychiatry, 10, 561–571.CrossRefGoogle ScholarPubMed
Beck, A.T. & Emery, G. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.Google Scholar
Beck, A.T., Rush, A.J., Shaw, B.F., et al. (1979). Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Beck, J.S. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford Press.Google Scholar
Bostwick, J.M. & Levenson, J.L. (2005). Suicidality. In The American Psychiatry Publishing Textbook of Psychosomatic Medicine. Levenson, J., (ed.), pp. 219–234. Washington, DC: American Psychiatric Publishing.Google Scholar
Bostwick, J.M. & Rackley, S. (2007). Completed suicide in medical/surgical patients: Who is at risk? Current Psychiatry Reports, 9, 242–246.CrossRefGoogle ScholarPubMed
Bourgeois, J.A., Wegelin, J.A., Servis, M.E., et al. (2005). Psychiatric diagnoses of 901 inpatients seen by consultation–liaison psychiatrists at an academic medical center in a managed care environment. Psychosomatics, 46, 47–57.Google Scholar
BrintzenhofeSzoc, K., Levin, T.T., Li, Y., et al. (2009). Mixed anxiety–depression in a large cancer cohort: Prevalence by cancer type. Psychosomatics, 50, 383–391.Google Scholar
Bronheim, H.E., Fulop, G., Kunkel, E.J., et al. (1998). The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. The Academy of Psychosomatic Medicine. Psychosomatics, 39, 30.Google Scholar
Brown, L.F. & Kroenke, K. (2009). Cancer-related fatigue and its association with depression and anxiety: A systematic review. Psychosomatics, 50, 440–447.CrossRefGoogle ScholarPubMed
Butler, A.C., Chapman, J.E., Forman, et al. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31.Google Scholar
Clarke, D. & Kissane, D. (2002). Demoralization: Its phenomenology and importance. Australian and New Zealand Journal of Psychiatry, 36, 733–742.Google Scholar
Cohen-Cole, S. (1991). The Medical Interview: The Three-Function Approach. St. Louis: C.V. Mosby.Google Scholar
Dattilio, F.M. (2007). Families in crisis. In Cognitive-Behavioral Strategies in Crisis Intervention, Dattilio, F. M. & Freeman, A., (eds.), pp. 327–351. New York: Guilford.Google Scholar
Dattilio, F.M. & Freeman, A. (2007). Cognitive-Behavioral Strategies in Crisis Intervention, New York: Guilford.Google Scholar
DeFrances, C.J., Lucas, C.A., Buie, V.C., et al. (2008). 2006 National Hospital Discharge Survey. National Health Statistics Report, 5, 1–20.Google Scholar
Devine, E.C. (2003). Meta-analysis of the effect of psychoeducational interventions on pain in adults with cancer. Oncology Nursing Forum, 30, 75–89.CrossRefGoogle ScholarPubMed
DiMatteo, M.R., Taranta, A., Friedman, H.S., et al. (1980). Predicting patient satisfaction from physicians' nonverbal communication skills. Medical Care, 18, 376–387.CrossRefGoogle ScholarPubMed
Druss, B. & Pincus, H. (2000). Suicidal ideation and suicide attempts in general medical illnesses. Archives of Internal Medicine, 160, 1522–1526.Google Scholar
Engel, G.L. (1997). From biomedical to biopsychosocial. Being scientific in the human domain. Psychosomatics, 38, 521–528.Google Scholar
Folkman, S., Lazarus, R.S., Dunkel-Schetter, C., et al. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 992–1003.Google Scholar
Fulop, G. & Strain, J.J. (1986). Psychiatric emergencies in the general hospital. General Hospital Psychiatry, 8, 425–431.Google Scholar
Himelhoch, S.S., Medoff, D.R. & Oyeniyi, G. (2007). Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: A systematic review and meta-analysis. AIDS Patient Care and STDs, 21, 732–739.Google Scholar
Hollon, S.D., Jarrett, R.B., Nierenberg, A.A., et al. (2005). Psychotherapy and medication in the treatment of adult and geriatric depression: Which monotherapy or combined treatment? The Journal of Clinical Psychiatry, 66, 455–468.CrossRefGoogle ScholarPubMed
Hotopf, M., Lee, W. & Price, A. (2011). Assisted suicide: Why psychiatrists should engage in the debate. British Journal of Psychiatry, 198, 83–84.CrossRefGoogle ScholarPubMed
Hunot, V., Churchill, R., Silva de Lima, M., et al. (2007). Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews Jan 24;(1):CD001848.Google Scholar
Huyse, F., Stiefel, F. & de Jonge, P. (2006). Identifiers, or “red flags,” of complexity and need for integrated care. The Medical Clinics of North America, 90, 703–712.Google Scholar
Kissane, D.W. & Bloch, S. (2002). Family Focused Grief Therapy: A Model of Family-Centred Care during Palliative Care and Bereavement. Buckingham: Open University Press.Google Scholar
Kissane, D.W., Grabsch, B., Love, A., et al. (2004). Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Australian and New Zealand Journal of Psychiatry, 38, 320–326.Google Scholar
Lazarus, R.S. (2000). Toward better research on stress and coping. American Psychologist, 55, 665–673.CrossRefGoogle ScholarPubMed
Lederberg, M. & Levin, T.T. (2009). Consultation psychiatry. In Psychiatric Ethics, 4th ed., Bloch, S. & Green, S. (eds.), pp. 495–570. Oxford: Oxford University Press.Google Scholar
Leentjens, A.F.G., Rundell, J., Diefenbacher, A., et al. (2011). Psychosomatic medicine and consultation–liaison psychiatry: scope of practice, processes, and competencies for psychiatrists or psychosomatic medicine specialists. A consensus statement of the European Association of Consultation–Liaison Psychiatry and the Academy of Psychosomatic Medicine. Psychosomatics, 52, 19–25.Google Scholar
Levin, T.T. (2003). Mood vs. affect. Psychiatric News, 38, 48.Google Scholar
Levin, T.T., Agid, O. & Abramowitz, M. (2003). A guide to the psychiatric interview for the Part Two Oral Israeli Board Exams. The Israel Journal of Psychiatry and Related Sciences, 40, 103–117.Google Scholar
Levin, T.T. & Kissane, D.W. (2006). Psychooncology – the state of its development in 2006. European Journal of Psychiatry, 20, 183–197.Google Scholar
Levin, T.T., Riskind, J.H. & Li, Y. (2007). Looming threat processing style in a cancer cohort. General Hospital Psychiatry, 29, 32–38.CrossRefGoogle Scholar
Levin, T.T., White, C.A., Bialer, P., et al. (2011). A review of cognitive therapy in acute medical settings. Part II: Strategies and complexities. Palliative & Supportive care, doi: 10.1017/S147895151200082X.Google Scholar
Lichtenthal, W.G., Nilsson, M., Zhang, B., et al. (2008). Do rates of mental disorders and existential distress among advanced stage cancer patients increase as death approaches? Psychooncology, 18, 50–61.CrossRefGoogle Scholar
Mermelstein, H.T. & Wallack, J.J. (2008). Confidentiality in the age of HIPAA: A challenge for psychosomatic medicine. Psychosomatics, 49, 97–103.Google Scholar
Moorey, S., Cort, E., Kapari, M., et al. (2009). A cluster randomized controlled trial of cognitive behaviour therapy for common mental disorders in patients with advanced cancer. Psychological Medicine, 39, 713–723.Google Scholar
Moorey, S., Greer, S., Bliss, J., et al. (1998). A comparison of adjuvant psychological therapy and supportive counselling in patients with cancer. Psycho-oncology, 7, 218–228.Google Scholar
Nezu, A.M., Nezu, C.M., Felgoise, S.H., et al. (2003). Project Genesis: Assessing the efficacy of problem-solving therapy for distressed adult cancer patients. Journal of Consulting and Clinical Psychology, 71, 1036–1048.Google Scholar
Osborn, R.L., Demoncada, A.C. & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analyses. The International Journal of Psychiatry in Medicine, 36, 13–34.Google Scholar
Overholser, J.C. (1995). Elements of the Socratic method: IV. Disavowal of knowledge. Psychotherapy: Theory, Research and Practice, 32, 283–292.Google Scholar
Paddison, P.L., Strain, J.P. & Strain, J.J. (1989). Psychiatric consults on medical and surgical wards: a six year study. International Journal of Psychiatry in Medicine, 19, 347–361.Google Scholar
Pitceathly, C., Maguire, P., Fletcher, I., et al. (2009). Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Annals of Oncology, 20, 928–934.Google Scholar
Rabkin, J.G., Albert, S.M., Del Bene, M.L., et al. (2005). Prevalence of depressive disorders and change over time in late-stage ALS. Neurology, 65, 62–67.CrossRefGoogle ScholarPubMed
Ratcliffe, D., MacLeod, A. & Sensky, T. (2006). Anxiety in patients who have had a myocardial infarction: The maintaining role of perceived physical sensations and causal attributions. Behavioural and Cognitive Psychotherapy, 34, 201–217.CrossRefGoogle Scholar
Spitzer, R., Kroenke, K. & Williams, J. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association, 282, 1737–1744.CrossRefGoogle ScholarPubMed
Spitzer, R.L., Kroenke, K., Williams, J.B., et al. (2006). A brief measure for assessing generalized anxiety disorder: the GAD–7. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle ScholarPubMed
Stiefel, F., Huyse, F., Sllner, W., et al. (2006). Operationalizing integrated care on a clinical level: the INTERMED project. The Medical Clinics of North America, 90, 713–758.Google Scholar
Strain, J.J., Smith, G.C., Hammer, J.S., et al. (1998). Adjustment disorder: a multisite study of its utilization and interventions in the consultation–liaison psychiatry setting. General Hospital Psychiatry, 20, 139–149.Google Scholar
Syrjala, K.L., Langer, S.L., Abrams, J.R., et al. (2004). Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. Journal of the American Medical Association, 291, 2335–2343.CrossRefGoogle ScholarPubMed
Tatrow, K. & Montgomery, G.H. (2006). Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis. Journal of Behavioral Medicine, 29, 17–27.CrossRefGoogle ScholarPubMed
Thase, M.E., Greenhouse, J.B., Frank, E., et al. (1997). Treatment of major depression with psychotherapy or psychotherapy–pharmacotherapy combinations. Archives of General Psychiatry, 54, 1009.CrossRefGoogle ScholarPubMed
Thomson, A.B. & Page, L.A. (2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews, 4, CD006520.Google Scholar
Vittengl, J.R., Clark, L.A., Dunn, T.W., et al. (2007). Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy's effects. Journal of Consulting and Clinical Psychology, 75, 475–488.Google Scholar
White, C.A. (2001). Cognitive Behaviour Therapy for Chronic Medical Problems. A Guide to Assessment and Treatment in Practice. Chichester: Wiley.Google Scholar