Surviving and Thriving in Medicine
Clare Gerada, Zaid Al-Najjar in Beneath the White Coat, 2020
‘Thinking’ one’s way out of psychological distress is efficacious. One of the most constructive coping mechanisms is called ‘cognitive reframing’. Much of the anxiety we feel in stressful situations is linked to how we interpret the threat we face. For example, if we haven’t obtained the necessary blood result needed for the ward round, our automatic thoughts might be something along the lines, ‘I am terrible, I am a bad doctor, I am never going to get passed as competent’. These thoughts are more than likely then to induce feelings of anxiety. Identifying and challenging these negative and largely irrational thoughts and replacing them with more realistic ones is the essence of cognitive reframing. It is the technique that underpins cognitive behavioural therapy (CBT). Many doctors fret about failing exams. Failure for them equates with imperfection and thoughts of being useless and undeserving. Reframing this cognitive distortion by perhaps thinking, ‘well, it was a very difficult exam’ or ‘others have failed exams before and gone on to have really good careers’, can help. I talk more about these techniques in Chapter 23.
Pain and psychiatry
Ad (Sandy) Macleod, Ian Maddocks in The Psychiatry of Palliative Medicine, 2018
Teasing out cause and effect of a particular psychological variable is clinically neither easy nor rewarding. Pain management needs to incorporate psychological interventions aimed at effect rather than cause. Pragmatic and ‘here-and-now’ interventions are necessary, rather than analysis of the cause. Explanation, reassurance, cognitive reframing of negative ideation, and refreshing coping strategies using relaxation, hypnosis, mindfulness meditation, and distraction can be of benefit. Reinforcing coping and cognitive reappraisal augments analgesic pharmacotherapies. Analgesic medications are the foundation of cancer pain management. A pill can be of benefit, but a pill and supportive words can be of greater benefit. The nurse is a powerful analgesic. The destructive psychological spiral initiated by a painful stimulus can be checked by short and simple psychotherapy, enhancing the prospects of a better response to medication.
Does health promotion teaching make a difference to students, teachers, patients and populations? Where is the evidence?
Ann Wylie, Tangerine Holt, Amanda Howe in Health Promotion in Medical Education, 2018
As research demonstrates the effectiveness of health promotion activity, healthcare professionals will need to consider what is generalisable, transferable and applicable in their context. The large-scale, multisite ‘DESMOND’ programme (diabetes education and self-management programme for people with newly diagnosed type 2 diabetes), for example, resulted in significant and sustained improvements for patients, using a structured group education programme. There were improvements in weight loss, smoking status, physical activity and depression.12 Such findings need to be given considerable attention of course, but what is important with this work is that it builds on evidence that educational programmes with a theoretical basis and using cognitive reframing are associated with improved outcomes. The philosophy was based on patient empowerment and incorporated theories such as self-efficacy and behavioural change.
Shifting Maladaptive Fall Risk Appraisal in Older Adults through an in-Home Physio-fEedback and Exercise pRogram (PEER): A Pilot Study
Published in Clinical Gerontologist, 2020
Ladda Thiamwong, Helen J. Huang, Boon Peng Ng, Xin Yan, Mary Lou Sole, Jeffrey R. Stout, Steven Talbert
A systematic review also confirmed that engaging community-dwelling older adults with visual biofeedback was found to be effective and could improve balance capacity (Alhasan et al., 2017). Visual biofeedback supports older adults with information related to their body functions with a goal of developing a change in behaviors (Alhasan et al., 2017) or tasks that cause falls. The previous study indicated that older adults who received positive feedback reported greater levels of balance confidence (Lamarche, Gionfriddo, Cline, Gammage, & Adkin, 2014). Additionally, visual physio-feedback could help in shifting maladaptive beliefs and direct participants toward adaptive behaviors (e.g., regular exercise) in a safe manner. A systematic review suggested that interventions with feedback and monitoring tend to improve exercise adherence (Room, Hannink, Dawes, & Barker, 2017). Furthermore, we used cognitive reframing, which is a method for identifying maladaptive thoughts and for changing perception to more closely align with reality. A recent meta-analysis revealed that cognitive and behavioral treatment showed positive effects on fear of falling and falls efficacy outcomes immediately after treatment and over the longer term (Papadimitriou & Perry, 2019).
A multimodal approach to cancer-related cachexia: from theory to practice
Published in Expert Review of Anticancer Therapy, 2021
Alice Avancini, Ilaria Trestini, Daniela Tregnago, Massimo Lanza, Jessica Menis, Lorenzo Belluomini, Michele Milella, Sara Pilotto
In this sense, psycho-educational and psychological intervention should favor action-orientated, brief interventions, delivering a condensed package of ‘core’ cognitive-behavioral skills [3,66,67]. Such strategies may include, but are not limited to, cognitive restructuring or cognitive reframing techniques, identification of dysfunctional thinking patterns, stress and relaxation management skills, behavioral activation, social skills improvement, and expressive supportive therapy [68]. The shift to the conscious control of eating is often useful, through a reframe of eating as a necessity, rather than a pleasure, for promoting health outcomes such as slowing the disease progression, tolerating the side effects of chemotherapy, and maintaining strength and resistance [69]. Teaching cognitive reframing strategies also permits patients to take control of eating habits, supporting self-efficacy, empowering themselves and improving their QoL [69]. Despite some trials have investigated the impact of psychotherapy in advanced cancer patients [70,71], currently ongoing studies may confirm the positive effect also in cachectic patients [72].
Perspectives on Components of an Online Training and Support Program for Dementia Family Caregivers in India: A Focus Group Study
Published in Clinical Gerontologist, 2020
Upasana Baruah, Prafulla Shivakumar, Santosh Loganathan, Anne Margriet Pot, Kala M. Mehta, Dolores Gallagher-Thompson, Tarun Dua, Mathew Varghese
The current study was conceptualized considering the effectiveness of online interventions for dementia in developed countries and the promising nature of digital technologies in developing countries. The therapeutic techniques found effective in earlier studies including elements of cognitive behavioral therapy, such as psycho-education, relaxation, behavioral activation, cognitive reframing, and problem-solving were considered as the foundation for the development of an online support and training program (Egan et al., 2018; Pot et al., 2019). The framework for the content of the online training and support program was based on Kitwood’s person-centered approach of dementia care in which care is envisioned as an interaction according to each individual’s needs, personality, and ability (Kitwood, 1997). The objective of our study was to understand the perspectives of caregivers and health professionals about an online training and support program for dementia and identify the components of such a program for Indian caregivers.