Table Of ContentR
US $59.95 PSYCHOLOGY
Behavior
Real
e
A Toolkit for Creating Lasting a
PATRICIA J. ROBINSON, PH.D., is director l Change in
Behavior Change in Your Patients Behavior
of training for Mountainview Consulting B Real
Group and received the American Psychological
e Primary Care
Association’s 2009 Innovative Practice Award. As a primary care provider, you are on the front lines of medical treatment.
h
She consults and trains internationally and is Oftentimes, you’re the fi rst medical professional patients come to when
author of Behavioral Consultation and Primary they experience problems with their health. While some of these problems a
Care. can be resolved by traditional medical treatment, many others are driven by v Change in What is acceptance and
i
underlying psychological issues and unhealthy lifestyle choices that you may commitment therapy?
o
DEBRA A. GOULD, MD, MPH, is associate
feel powerless to aff ect. Between repeat patient visits and the frustrating
clinical professor at the University of Washington r
School of Medicine. She practices at Central progression of preventable symptoms and conditions, it’s no wonder so Acceptance and commitment therapy, or
C
many medical and behavioral health providers feel burned out and at a loss
Washington Family Medicine Residency ACT, is a type of cognitive behavioral
Program in Yakima, WA, and has taught medical for eff ective solutions. h Primary Care therapy that has shown remarkable results
students and family medicine residents for more with patients and has been empirically
a
than seventeen years. Th is guide was designed to help you fi nd those solutions and recapture the
proven to improve patients’ diabetes man-
n
ability to eff ectively help patients achieve optimal health and happiness.
agement habits, lessen chronic pain, lower
KIRK D. STROSAHL, PH.D., is associate Real Behavior Change in Primary Care off ers ten-minute interventions g seizure rates in patients with uncontrolled
clinical professor at the University of Washington e
that provide your patients with the tools they need to change unworkable
seizure disorder, improve rates of smoking
School of Medicine. He practices at Central
and unhealthy behaviors. Each short yet powerful intervention utilizes i cessation, and reduce depression and anxi-
Washington Family Medicine Residency n
empirically supported skills from acceptance and commitment therapy
ety. ACT can motivate patients to work col-
Program in Yakima, WA, and is cofounder of
(ACT), a form of cognitive behavioral therapy, to help you empower
acceptance and commitment therapy. P laboratively with health care providers in an
patients to take charge of the psychological blocks that keep them from
ongoing eff ort to align daily behaviors with
resolving their health problems. You’ll also apply ACT skills to your own r
core life values. In this book, you’ll learn to
i
life and learn to better manage stress, recover from burnout, and rediscover
m teach patients the ACT techniques that can
the meaning behind your work as a health care provider.
IMPROVING PATIENT OUTCOMES & help them become more aware of avoidant
a
behavior patterns that may be negatively
Help patients suff ering with: r aff ecting their health.
y INCREASING JOB SATISFACTION
• Chronic disease • Alcohol and substance abuse
C Real Behavior Change in Primary Care
• Chronic pain • Anxiety and depression
is fascinating reading for any medical or
• Trauma and abuse a behavioral health care provider interested
r
in exploring the link between mind and
e
body health, and can potentially make a
PATRICIA J. ROBINSON, PH.D.
dramatic impact on health care as we know
ISBN: 978-1-57224-832-8
S R it. By making ACT techniques available to
TGO DEBRA A. GOULD, MD, MPH
ROB patients, and using these techniques your-
O I
UN KIRK D. STROSAHL, PH.D. self to prevent burnout and increase job
newharbingerpublications, inc. S
ALS
Jacket image by Comstock/Getty Images www.newharbinger.com HDO satisfaction, primary care providers can reap
Jacket design by Amy Shoup L N the benefi ts of one of the most eff ective psy-
Also available as an ebook at newharbinger.com
9781572 248328 55995 chotherapeutic modalities available today.
“One of the most difficult tasks faced by primary care providers is convincing
patients to engage in positive behaviors such as maintaining a diet. Robinson,
Gould, and Strosahl’s Real Behavior Change in Primary Care adds ACT to
the growing list of techniques that are available to help the primary care
provider convince patients to change their behaviors for the better. In simple,
readable prose, they outline a strategy with wide implications for improving
primary care practice.”
— Robert McGrath, PhD, professor of psychology at
Fairleigh Dickinson University
“The authors have provided an outstanding set of assessment and interven-
tion tools that primary care providers can use with patients who are stuck
in maladaptive health patterns. The downloadable tools, practical advice,
and focused clinical examples can be easily incorporated into everyday prac-
tice, leading to better patient outcomes, decreased provider burnout, and
increased job satisfaction.”
— Christopher L. Hunter, PhD, ABPP, coauthor of
Integrated Behavioral Health in Primary Care
“This book is a tremendous resource to primary care providers and providers
of behavioral health in primary care. Readers can expect greater satisfaction
in seeing their patients reach positive health outcomes. Our organization is
appreciative to the authors for enhancing both the career satisfaction of our
providers and the quality of care our patients receive.”
— Bill Rosenfeld, LPC, director of integrated behavioral
health at Mountain Park Health Center
“Real Behavior Change in Primary Care is succinct, practical, and easy to read.
It provides the primary care clinician with a fresh view of the complex patient
and an array of tools that are easy to implement in a busy clinic, even without
a psychotherapy background. The techniques offered can help primary care
providers improve management of the complex patient while also healing
themselves of the frustration and stress that can accompany a caseload of
challenging patients. The authors’ values-driven approach to care is neither
paternalistic nor unrealistic. Rather, it supports providers and patients in
developing activities congruent with personal values and life directions. I
enjoyed reading the book and will be using the techniques illustrated with
my patients, my medical and psychology trainees, and myself!”
— Jeannie A. Sperry, PhD, associate professor and director
of behavior science education at West Virginia University
Department of Family Medicine
“The authors have adapted the latest advances in evidence-based behavioral
and cognitive therapies for use in the fast-paced primary care environment.
The straightforward explanations, rich array of resources, and practical
handouts are immediately beneficial for helping patients live life in a way
that is more consistent with their values. Many primary care providers may
particularly appreciate the authors’ discussion of how to self-apply ACT
interventions to reduce burnout and become reinvigorated with patient care
and other valued life activities. This book is an essential resource for any
primary care provider working to help patients change what they do and
how they think.”
— Jeffrey L. Goodie, PhD, ABPP, clinical health psychologist
at Uniformed Services University of Health Sciences
in Bethesda, MD, and coauthor of Integrated Behavioral
Health in Primary Care
Behavior
Real
Change in
Primary Care
IMPROVING PATIENT OUTCOMES &
INCREASING JOB SATISFACTION
PATRICIA J. ROBINSON, PH.D.
DEBRA A. GOULD, MD, MPH
KIRK D. STROSAHL, PH.D.
New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the
subject matter covered. It is sold with the understanding that the publisher is not engaged in
rendering psychological, financial, legal, or other professional services. If expert assistance or
counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2010 by Patricia J. Robinson, Debra A. Gould, & Kirk D. Strosahl
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Text design by Tracy Marie Carlson
Acquired by Catharine Sutker
Edited by Nelda Street
All rights reserved
PDF ISBN: 978-1-57224-833-5
The Library of Congress has cataloged the print edition as:
Robinson, Patricia J.
Real behavior change in primary care : improving patient outcomes and increasing job
satisfaction / Patricia J. Robinson, Debra A. Gould, and Kirk D. Strosahl.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-57224-832-8 (pbk.) -- ISBN 978-1-57224-833-5 (pdf ebook) 1. Clinical
health psychology. 2. Acceptance and commitment therapy. 3. Health behavior. 4.
Primary care (Medicine) I. Gould, Debra A. II. Strosahl, Kirk, 1950- III. Title.
[DNLM: 1. Cognitive Therapy--methods. 2. Burnout, Professional--prevention &
control. 3. Patient Compliance--psychology. 4. Patients--psychology. 5. Physicians,
Family--psychology. 6. Primary Health Care--trends. WM 425.5.C6]
R726.7.R625 2010
616.001’9--dc22
2010043965
To Dr. Kay Funk, who encouraged me to write this book; to Dr. Mark
Sauerwein, who encouraged me to teach; and to all the other wise people I
have known who committed their lives to providing primary care.
—Patti
To Michael Joseph Aquilino for his unconditional love and support in making
all of this possible, to ZaChoeje Rinpoche for his brilliance, to Leslie Gray
for starting me on this path, and to my mother Vera Rock Gould, who always
told me that if I could read a book, I could learn how to do anything.
—Deb
To my brother (and Patti’s brother-in-law), Mark Strosahl; we wish you were
here to read this book, as with the other books. We miss you, buddy—every
day, in every way.
—Kirk (and Patti)
Contents
Acknowledgments .................................... ix
Introduction ..........................................1
PART 1
A New Model for Addressing
Psychological Problems
CHAPTER 1
Beyond Mind as a Machine ........................... 11
CHAPTER 2
How People Get Stuck ............................... 29
CHAPTER 3
Creating a Context for Change ........................ 39
CHAPTER 4
Takin’ It to the Streets: Real Behavior Change Tools .....61
Real Behavior Change in Primary Care
PART 2
Promoting Real Behavior
Change in Patient Care
CHAPTER 5
The Struggle: Engaging Patients with Chronic Disease ... 87
CHAPTER 6
The Solution That Becomes the Problem:
Intervening with Alcohol and Substance Abuse ........ 103
CHAPTER 7
“Doc, This Pain Is Killing Me”:
Addressing Chronic Pain with Compassion ............ 119
CHAPTER 8
A Fresh Approach to the Daily Duo:
Anxiety and Depression ............................. 137
CHAPTER 9
Living in the Past, Dying in the Present:
Trauma and Violence ............................... 155
PART 3
Applying Real Behavior Change
Tools in Daily Practice
CHAPTER 10
Better and Faster: The Risk of Burnout ............... 177
CHAPTER 11
Provider Wellness: Preventing Burnout and
Improving Job Satisfaction ........................... 193
vi
APPENDIX A
Acceptance and Action Questionnaire (AAQ-II) ....... 205
APPENDIX B
Primary Care Provider Acceptance and
Action Questionnaire (PCP-AAQ) .................. 207
APPENDIX C
Primary Care Provider Stress Checklist (PCP-SC) .... 210
APPENDIX D
Real Behavior Change Interviewing—The Three-T
and Workability Questions . . . . . . . . . . . . . . . . . . . . . . . . . . 215
APPENDIX E
Real Behavior Change Interviewing—
The Love, Work, Play, and Health Questions ......... 216
APPENDIX F
Six Core Processes—Psychological Flexibility ......... 218
APPENDIX G
Core Process Assessment Tool (CPAT) ............... 219
APPENDIX H
Real Behavior Change Pocket Guide ................. 221
APPENDIX I
Patient Education—Bull’s-Eye Worksheet ............ 224
APPENDIX J
Provider Tool—Retirement Party Worksheet .......... 226
vii
