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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
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
Corresponding
E-mail address:

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.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2013 

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