This is a five part series on integration of cognitive behavioral therapy (CBT) into primary care practice written by Karen Stephens PhD,

INTRODUCTION:
CBT is the “gold standard” psychological treatment for individuals with a wide range of pain problems. It can reduce pain, distress, pain interference with activities, and disability. And it may well have positive benefits for common comorbid conditions such as depression, diabetes, and cardiovascular disease. It has been shown to be effective regardless of the particular licensing or background of the provider, as long as they have an understanding of basic CBT concepts and skills, and can even be effective in web-based applications. Brief in-office CBT is not designed to replace referral to a professional mental health provider with his/her diagnostic skills and therapy and/or medication options when this seems more appropriate.

CBT is not just for the licensed behaviorist! These CBT Mini Lessons can be used by:

1. The PCP him/herself (using appropriate billing codes to cover the extra 5-10 minutes),
2. Office staff such as nurses, medical assistants, behavioral health providers (using Health & Behavior codes billed to PHC)
3. A co-located Beacon-credentialed behavioral health provider (billed to Beacon)

Having practiced as a cognitive behavioral therapist for 40 years, I’ve seen CBT techniques used effectively in individual and group settings, in both clinical and psycho-educational venues, and provided by both professional and para-professional providers.

What are the advantages of bringing CBT into the primary care office?

1. PCP is best qualified to understand Member’s medical history and current needs.
2. Interventions are made when the Member is most motivated for change, i.e., the very moment when they are asking for help
3. Providing behavioral alternatives allows the PCP to manage the Member’s pain more safely
4. CBT interventions with home practice recommendations and handouts are quite effective in the primary care setting
5. Avoid the stigma and wait time sometimes associated with referral to a behavioral health specialist

What are the basic goals for using CBT for pain management?

• Improved relationship with health professional—Member not shuffled off elsewhere, workable alternatives to medication changes
• Increased functional activities—Focus changes from Member saying, “I can’t…” to Member asking, “How can I…?”
•  Improved mood and quality of life—Decreased depression, more optimism and self-confidence, less risk of side effects from medication
• , Improved symptom control—Better awareness of pain cycles, reducing use of unworkable strategies for managing pain
• Improved self-management—Reliance on self rather than others to provide solutions
• Reduction in unnecessary visits—Reliable self-management options rather than unnecessary appointments when pain increases

Mini Lesson 1: Cognitive Restructuring

MIni Lesson 2: Mindfulness and Relaxation Exercises

Mini Lesson 3: Goal Setting  Mini Lesson

4: Scheduling Fun, Enjoyment, and Achievement