A Team Approach to Behavior Change in Primary Care:
It’s Not Just About the SymptomsPatricia Robinson, Ph.D.
Mountainview Consulting Group, Inc., Zillah, WAKirk Strosahl, PhD.
Community Health of Central WashingtonYakima, WA
Collaborative Family Healthcare Association 15th Annual ConferenceOctober 10-12, 2013 Broomfield, Colorado U.S.A.
Session # D2b Friday, October 11, 2013 – 1:30-3:00 (40 minutes)
Faculty Disclosure
• We currently have or have had the following relevant financial relationships (in any amount) during the past 12
months:• Book royalties: New Harbinger
• Book royalties: Gilford• Book royalties: Springer
Objectives
• Participants will be able to – Describe an team-based approach to supporting
patient development of a healthy mind and body – Define psychological flexibility– Use the Life Path worksheet to initiate a behavior
change plan.– Name 6 interventions that all members of the
PCMH can use to increase patient / provider psychological flexibility
What’s the evidence? ACT Meta-Analysis
Powers/Zum Vorde Sive Vording/Emmelkamp Psychother Psychosom 2009; 78:73-80
Healthy Patients, Healthy Providers
HealthyMind &
Life
Act on your Values
Connect with your Values
Be Present
Changing Self, Perspective
Accept
Step Back, Detach
Psychological Flexibility:• Psychological flexibility is learning to be
aware and accepting of the pain that comes into our lives while continuing to pursue what we value.
• Pain is Inevitable, Suffering
is Not!
Psychological Flexibility
Mindfulness
paying attention with flexibility, openness
and curiosity
Values
Staying focused on chosen life directions
Demonstration / Skill Practice
Life Path Worksheet
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Life Path Class
Class One: The Life Path Questions
1.How long have you had the problem that brings you here?
2.What have you tried? Previous treatments? Results from
them?
3.What do you want from life?
4.What are the barriers to doing what you want in life?
5.What do you do when the barriers show up?
6.Are you at war with the barriers? What does that look
like?
7.What are the consequences of being “at war” with the
barriers? 58
Life Path Class with Cardiac Rehab Patients
Some Typical Problems:
•lost, scared, afraid, uncertainty, disbelief, guilt, confusion, stress
•Examples of value connection:– Focused on art work– Loving actions with wife/husband– More quality time with family– More healthy lifestyle behaviors– Patience: Giving self time to heal– To have a joyfully life– To serve and help to others– Be the best I can be
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Life Path Class with Cardiac Rehab Patients
• Examples of control behaviors– Look for excuses not to do things– Avoid other people– Be impatient and try to control the time– Control things another person is doing /
will do– Ignore the feelings– Procrastinate
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Severity of Problem
Connection to Values
Life Path Class with Cardiac Rehab Patients
Life Path Class with Cardiac Rehab Patients
Helpfulness of the Class
Confidence with Homework
6 Interventions to Support Psychological Flexibility
1. Present Moment: Time Line (worksheet)2. Connect with Values: Retirement
Party/Tombstone3. Act on Values: You Are Not Responsible; You
Are Response Able4. Changing Self, Perspective: Be a Witness5. Step Back (Detach): Velcro; Clouds in the Sky6. Accept: Book Chapter
Learning Assessment
What is the name of a practical tool that members of the PCMH may use to initiate behavior change with patients? The Life Path Plan
What is psychological flexibility? Psychological flexibility is learning to be aware
and accepting of the pain that comes into our lives while continuing to pursue what we value.
Do providers need psychological flexibility?yes
FACT Resources
Association for Contextual Behavioral Science”http://www.contextualpsychology.org/ http://www.newharbingeronline.com/real-behavior-change-in-primary-care.html
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Session Evaluation
Please complete and return theevaluation form to the classroom monitor
before leaving this session.
Thank you!
