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!