ON Chiropractic
Guided Discovery
Written in 1995 by Dr. Christine Padesky
and Dr. Dennis Greenberger, the book
takes patients and practitioners through the
fundamentals of CBT and how it works.
The workbook style approach provides a
very tangible guide for readers seeking to
better understand barriers to recovery. A
clinician’s guide to the book is also available,
which includes chapters on utilizing the
Mind Over Mood approach in therapy
and individualizing it for patients. These
resources were recommended as valuable
reference texts by both mental health and
chiropractic professionals.
Identifying Patients with Cognitive
Barriers to Recovery
T
he next step in incorporating CBT
principles into your practice is
to identify which patients might
benefit from CBT. Dr. Valerie Vorstenbosch
and Dr. Jenny Rogojanski are Ph.D.
psychologists working with Sunnybrook
Health Sciences Centre as practitioners
and researchers in cognitive therapies. Both
believe that increasing the capacity of health
care practitioners, like chiropractors, to
identify and aid patients whose cognitive
barriers may be impeding their recovery
would be beneficial.
“Patients with chronic pain benefit
most from cognitive and behavioural
interventions aimed at changing patients’
perception of pain by reducing their
avoidance of activities which they believe
exacerbate their pain,” Dr. Vorstenbosch
said. “By increasing their ability to complete
such activities, patients are able to develop a
new relationship with pain and utilize more
effective coping strategies, which in turn
improve their subjective quality of life.”
The Clinician’s Guide to Mind Over
Mood provides very helpful examples and
scripts of conversations that can help
chiropractors identify when a cognitive issue
Guided Discovery is a tool used by a variety of educators
and mental health providers to help individuals better
understand and contextualize their behaviours by reflecting
on how they process information and automatic thoughts.
Version 1
Patient:
I will never live without pain. It’s a fact of my life.
Chiropractor: Yes you will. I’ve seen lots of patients improve and go on to live pain-free lives.
Patient:
It might have worked for them but it won’t ever work for me.
Version 2
Patient:
I will never live without pain. It’s a fact of my life.
Chiropractor: How long have you been feeling this way?
Patient:
The last few weeks for sure. But I think part of me has felt this way since the car
accident.
Chiropractor: What makes you think that you can’t ever be pain-free again?
Patient:
I start every day feeling sore and going through the day trying to experience a
moment without pain.
Chiropractor: I can see why you’re so discouraged. I am confused about one thing though.
Patient:
What’s that?
Chiropractor: Have you ever been injured or had a prolonged period of pain before?
Patient:
Yes, I broke my arm when I was a kid and in my twenties I hurt my back working
construction.
Chiropractor: I’ve never heard you mention the broken arm before. Does it still cause trouble?
Patient:
Not really, but you know what they say — “It’ll never be as strong as before the
break.”
Chiropractor: I understand that, but it sounds like you haven’t really felt that pain or worried
about the break in many years.
Patient:
I suppose so.
Chiropractor: And what about the back injury? Before the car accident there were periodic flareups that you attributed to that injury, but you’re 45 now — did you have any days
in the last 20 years when your back felt good?
Patient:
Sure, lots of days. I guess I did bounce back from those other problems. But this
injury is more severe.
Chiropractor: It’s helpful to understand how you’re feeling, thank you. I believe you can come
back from this injury too. Do you think you can keep your past successes in
recovery in mind as we work together? Especially on the days you feel like it’s not
getting any better.
Patient:
I can try.
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