As you are probably already aware, scientific studies have shown that CBT is extremely effective in treating all forms of anxiety disorders because it combines cognitive and behavioral theories to treat both the underlying thought process and subconscious behavioral response to anxiety triggers that cause a particular disorder.

Cognitive Restructuring

One of the most common issues that people with anxiety disorders experience is a string of negative thoughts that cause them to become worked up. CBT addresses this issue by challenging those negative thoughts and eventually replacing them with more realistic positive thoughts. This process is formally called “cognitive restructuring”, and it takes three simple steps to perform.

Step #1: Spot the negative thoughts that trigger anxiety.

Before you can start working towards changing your client’s train of thought during stressful situations, you have to first understand what their current train of thought is. What are they thinking that’s causing their distress?

Does the agoraphobe think spiders are going to rush him the second he steps out of the house? Does the socially awkward high school student think he’ll be laughed at the second he steps in front of class to deliver his oral report? As you know, you have to fully understand the problem before you can start working towards a solution.

Step #2: Challenge the client’s negative thought process.

As you have found, you don’t want to be overly directive, but you need to find a way to show your client that their thoughts are irrational and get them to start questioning the legitimacy of their anxiety-provoking logic. Their fears may even be justifiable, in which case, as you know, you need to show your client why their disabling anxiety-inducing reaction is still irrational even should the worst case scenario come to pass.

Step #3: Introduce your client to a more positive and realistic outlook.

Once you have the client questioning their own thought process it’s time to introduce them to a better one. Walk your client down a more realistic and positive path so that he or she can start acting in a more positive manner when faced with an anxiety-inducing situation.

Clearly this is just one way CBT can help your clients get control of their anxiety-inducing triggers and turn around their lives in ways they never thought they could before.

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CBT makes use of two schools of psychological thought: cognitive and behavioral psychology. As you know, cognitive psychology focuses on the study of mental processes such as thought, attention and memory. Behavioral psychology focuses on understanding how people interact within their environment. The two are used together within CBT to help clients with psychological disorders change both the way they think and the way they behave.

CBT is typically used to treat anxiety disorders in adults.  It can use proven techniques of desensitization to gradually introduce people to their fearful stimuli and teach them why they don’t need to afraid, or at least as afraid, of the subject of their phobias.

For instance, let’s say your client has arachnophobia, a fear of spiders.  As you may know, the theories behind CBT contend that you’ve been taught to be afraid of spiders (not in the literal sense but that could be the case too) and that slow exposure to your fear will help undo the fearful response.

Depending on just how afraid of spiders you are, you’d start at the lowest comfort level of CBT you can. In the above example, and perhaps you have tried this intervention, the client  would need to be introduced simply to the idea of spiders – being able to talk about them – before they could move on to seeing images, live specimens and possibly even letting one crawl along their arm!

As you know, CBT has been used effectively to treat a wide variety of disorders, such as schizophrenia, major depressive disorder, psychosis, and bipolar disorder.

Do you agree that CBT works by helping your client change the way he or she looks at life and their surroundings in order to help them achieve the goals they set?

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In our search, we found three examples for errors leading to opioid intoxication: inadvertently administering high-dose intrathecal tramadol instead of morphine leading to myoclonus, diaphoresis, and hypotension [10]; escalating the dosage of intravenous opioids too rapidly after withdrawal from the artificial respirator, followed by sedation and respiratory depression[12]; and mixing up basal rate and bolus dose in a pump of patient-controlled analgesia, leading to lethargy of the patient.[14] Although our literature search did not yield articles on errors in the management of symptoms other than pain, it seems plausible that errors occur just as well in treating nausea, vomiting, constipation, dyspnea, delirium, or any other frequent symptom in palliative patients.

Palliative care clinicians usually encounter patients who already have been diagnosed as suffering from a specific life-limiting disease. In some cases, previous preventive or diagnostic errors of colleagues may be retrospectively detected by palliative care clinicians. The example we found was a 48-year-old patient with metastatic cervical cancer, who had shown dysplasia in a Papanicolaou test 3 years prior, which had not been followed-up or prompted a colposcopy because the treating physician moved away and the communication to the new doctor was apparently insufficient.

For Relevance, Detection and Prevention of Medical Errors in Palliative Care go to Medical Errors Course

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