ON Chiropractic Fall 2014 - Page 11

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. www.chiropractic.on.ca 11