Focus on your breath Applying contextual behavioural approaches to - PowerPoint PPT Presentation

Focus on your breath Applying contextual behavioural approaches to working with adults with Cys9c Fibrosis Jennifer Kemp Clinical Psychologist Royal Adelaide Hospital Cys:c Fibrosis State Wide Service

What is Cys:c Fibrosis?

Mul:ple medical problems • Respiratory problems • Secondary illnesses • Respiratory failure • Reproduc:ve problems • Nutri:onal deficiencies • Transplant Normal lungs CF lungs

Working with the hexaflex & matrix hKp://drkevinpolk.blogspot.com.au/p/matrix-and-hexaflex.html

Challenges of working with people with CF • Cynical, disengaged, guarded • Treatment fa:gue, just another interven:on • Long term view, slow to trust • Some ins:tu:onalised, passive • Resistant to mo:va:onal interviewing

Acceptance • Avoiding thoughts & feelings • Avoiding physical reminders of CF • Pretending • Changes with age and developmental stage, esp. adolescence

Acceptance, avoidance & adherence People with low levels of acceptance may be less likely to: • Engage with health care professionals • Do daily preventa:ve treatments • AKend clinic appointments • Undergo IV treatment un:l already very sick

Other factors in adherence Past learning Goal a>ainment & trauma vs health Adherence Acceptance of Reinforcement/ severity & Punishment urgency Schedules Acceptance of having CF

Crea:ve hopelessness and the gradual accommoda:on of symptoms

Evalua:ng & building acceptance • Ask specific ques:ons • Recognise the baKle with thoughts and feelings • Metaphors – Tennis – The Box

Defusion • “I’m going to die early” • “I’m too sick” • “I’m going to get sicker and sicker” • “I am my lung func:on” • “I’m different”

Encouraging defusion • Thought as just thoughts • Debunk myths • Maintain a flexible, posi:ve expectancy • Don’t accept the sick role • Lots of ‘future talk’

Being in the present moment Mindfulness, the breath & CF

Self as context • Self as CF • Self as sick • Self as normal • Risks to each approach

Values • Lack of values clarity • Limited life experiences • Themes: – Rela:onships – Helping/caring – Achievement • What about ‘health’?

CommiKed ac:on • Focus on balance • Treatment burden • Disrup:on due to illness • Unclear :me to achieve goals • Developmental delays • Impact of health on goals (e.g. fer:lity)

In summary … • Acceptance as a pathway to adherence • Focus on balance not treatment directly • Maintain perspec:ve that they can have a life worth living • Build on small successes • All ACT strategies can be used – even mindfulness of breath

Thank you jennifer@preciousminds.com.au jennifer.kemp2@sa.gov.au