Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-24T16:14:23.392Z Has data issue: false hasContentIssue false
  • English
  • Français

A review of cognitive therapy in acute medical settings. Part II: Strategies and complexities

Published online by Cambridge University Press:  04 July 2013

Tomer T. Levin ,
Craig A. White ,
Philip Bialer ,
Robert W. Charlson  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, Scotland
Philip Bialer
Affiliation:
Department of Psychiatry and Behavioral Science, Memorial Sloan-Kettering Cancer Center, New York, New York
Robert W. Charlson
Affiliation:
Department of Psychiatry and Behavioral Science, Memorial Sloan-Kettering Cancer Center, New York, New York
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

Objective:

Cognitive therapy (CT) has considerable utility for psychosomatic medicine (PM) in acute medical settings but, to date, no such cohesive adaptation has been developed. Part I delineated a CT model for acute medical settings focusing on assessment and formulation. In Part II, we review how CT can be applied to common PM clinical challenges. A pragmatic approach is helpful because this review targets PM trainees and educators.

Methods:

Narrative review is used to discuss the application of CT strategies to common challenges in acute medical settings. Treatment complexities and limitations associated with the PM setting are detailed. Exemplary dialogues are used to model techniques.

Result:

We present CT approaches to eight common scenarios: (1) distressed or hopeless patients; (2) patients expressing pivotal distorted cognitions/images; (3) patients who catastrophize; (4) patients who benefit from distraction and activation strategies; (5) panic and anxiety; (6) suicidal patients; (7) patients who are stuck and helpless; (8) inhibited patients. Limitations are discussed.

Significance of results:

A CT informed PM assessment, formulation and early intervention with specific techniques offers a novel integrative framework for psychotherapy with the acutely medically ill. Future efforts should focus on dissemination, education of fellows and building research efficacy data.

Keywords

CTP-MAcute medical settingsTraining
Type
Review Articles
Information
Palliative & Supportive Care , Volume 11 , Issue 3 , June 2013 , pp. 253 - 266
Copyright
Copyright © Cambridge University Press 2013 

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 Psychological Association. (2003). ACGME Program Requirements for Graduate Medical Education in Psychosomatic Medicine. Acreditation Council for Graduate Medical Education.Google Scholar
Beck, A.T. & Emery, G. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.Google Scholar
Beck, A.T., Kovacs, M. & Weissman, A. (1975). Hopelessness and suicidal behavior. An overview. Journal of the American Medical Association, 234, 1146–1149.CrossRefGoogle ScholarPubMed
Beck, A.T., Rush, A.J., Shaw, B.F. et al. (1979). Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Beck, A.T., Steer, R.A., Kovacs, M. & Garrison, B. (1985). Hopelessness and eventual suicide: A 10-year prospective study of patients hospitalized with suicidal ideation. The American Journal of Psychiatry, 142, 559–563.Google Scholar
Beck, J.S. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford Press.Google Scholar
Bialer, P., Roth, A.J., Kissane, D.W., et al. (2009). Communication Skills Training (CST) for psychosomatic medicine fellows. 56th Academy of Psychosomatic Medicine Meeting, Las Vegas, Nevada.Google Scholar
Bruera, F., Kuehn, N. & Miller, M.J. (1991). Edmonton symptom assessment system (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7, 6–9.CrossRefGoogle ScholarPubMed
Clarke, D. & Kissane, D. (2002). Demoralization: Its phenomenology and importance. Australian and New Zealand Journal of Psychiatry, 36, 733–742.CrossRefGoogle ScholarPubMed
Dimidjian, S., Hollon, S., Dobson, K., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670.Google Scholar
Dobson, K., Hollon, S., Dimidjian, S., et al. (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 468–477.Google Scholar
Folkman, S. (2010). Stress, coping, and hope. Psycho-oncology, 19, 901–908.CrossRefGoogle ScholarPubMed
Folkman, S. & Lazarus, R.S. (1988). The relationship between coping and emotion: Implications for theory and research. Social Science & Medicine, 26, 309–317.Google Scholar
Fredrickson, B. (2004). The broaden-and-build theory of positive emotions. Philosophical Transactions of the Royal Society B: Biological Sciences, 359, 1367–1378.Google Scholar
Goodwin, R. & Roy-Byrne, P. (2006). Panic and suicidal ideation and suicide attempts: Results from the National Comorbidity Survey. Depression and anxiety, 23, 124–132.CrossRefGoogle ScholarPubMed
Hawton, K. & van Heeringen, K. (2009). Suicide. Lancet, 373, 1372–1381.Google Scholar
Hughes, S.L. & Neimeyer, R.A. (1993). Cognitive predictors of suicide risk among hospitalized psychiatric patients: a prospective study. Death studies, 17(2), 103–124.CrossRefGoogle ScholarPubMed
Jacobsen, P.B. & Butler, R.W. (1996). Relation of cognitive coping and catastrophizing to acute pain and analgesic use following breast cancer surgery. Journal of Behavioral Medicine, 19, 17–29.CrossRefGoogle ScholarPubMed
Jacobsen, P.B., Meade, C.D., Stein, K.D., et al. (2002). Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. Journal of clinical oncology, 20, 2851–2862.CrossRefGoogle ScholarPubMed
Kiely, B., Tattersall, M.H.N. & Stockler, M. (2010). Certain death in uncertain time: Informing hope by quantifying a best case scenario. Journal of Clinical Oncology, 28, 2802–2804.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.Google Scholar
Levin, T.T., White, C.A. & Kissane, D.W. (2011). A review of cognitive therapy in acute medical settings. Part I: Therapy model and assessment. Palliative and Supportive Care, 11, 141–153.CrossRefGoogle Scholar
McHugh, R.K., Smits, J.A.J. & Otto, M. (2009). Empirically supported treatments for panic disorder. Psychiatric Clinics of North America, 32, 593–610.CrossRefGoogle ScholarPubMed
Moorey, S., Greer, S. & Gill, P. (2002). Cognitive Behaviour Therapy for People with Cancer. Oxford: Oxford University Press.Google Scholar
Nepon, J., Belik, S.-L., Bolton, J., et al. (2010). The relationship between anxiety disorders and suicide attempts: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depression and anxiety, 27, 791–798.Google Scholar
Nezu, A.M., Maguth Nezu, C., Friedman, S.H., Faddis, S. & Houts, P.S. (1998). Helping cancer patients cope. A problem solving approach., Washington, DC.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
Nock, M., Park, J., Finn, C., et al. (2010). Measuring the suicidal mind: Implicit cognition predicts suicidal behavior. Psychological science, 21, 511–517.Google Scholar
Robson, A., Scrutton, F., Wilkinson, L., et al. (2010). The risk of suicide in cancer patients: A review of the literature. Psycho-oncology, 19, 1250–1258.Google Scholar
Sudak, D. (2009). Training in cognitive behavioral therapy in psychiatry residency: An overview for educators. Behavior Modification, 33, 124–137.CrossRefGoogle ScholarPubMed
Sullivan, M.J., Thorn, B., Haythornthwaite, J.A., et al. (2001). Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain, 17, 52–64.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
Winterowd, C., Beck, A.T. & Gruener, D. (2003). Cognitve Therapy with Chronic Pain Patients, New York: Springer.Google Scholar