Unlocking radical behavioral change with PCBH and ACT: Applying contextualism within the PCBH framework and primary care system

• David Bauman, PsyD, Behavioral Health Education Director, CWFM

• Bridget Beachy, PsyD, Director of Behavioral Health, CHCW

Session H7

CFHA 19th Annual ConferenceOctober 19-21, 2017 • Houston, Texas

Faculty DisclosureThe presenters of this session currently have or have had the

following relevant financial relationships (in any amount)

during the past 12 months.

Mountainview Consulting Group, LLC – Associate

Consultants

Conference Resources

Slides and handouts shared in advance by our Conference Presenters are available on the CFHA website at http://www.cfha.net/?page=Resources_2017

Slides and handouts are also available on the mobile app.

Learning Objectives

At the conclusion of this session, the participant will be able to:

• Describe the basic philosophy of contextualismand how it fits harmoniously within the PCBH model

• Identify contextual interventions and techniques within the PCBH framework for a variety of common medical and behavioral health conditions

• Identify ways of inundating their medical clinics with contextualism

1. Strosahl, K. D., Robinson, P. J., & Gustavsson, T. (2012). Brief Interventions for Radical Change: Principles and Practice of Focused Acceptance and Commitment Therapy. Oakland, CA: New Harbinger..

2. Robinson, P., & Reiter, J. (2016). Behavioral consultation and primary care: A guide to integrating services (2nd ed.). Springer: New York.

3. Hacker, T., Stone, P., & MacBeth, A. (2016). Acceptance and commitment therapy - Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. Journal of Affective Disorders, 190, 551-565. DOI: 10.1016/j.jad.2015.10.053

4. Hunter, H. L., Funderburk, J. S., Polaha, J., Bauman, D., Goodie, J. L., & Hunter, C. M. (in review). Primary care behavioral health (PCBH) research: Current state of the science and a call to action. Journal of Clinical Psychology in Medical Settings

5. Hayes, S. C., Barnes-Holmes, D., & Wilson, K. G. (2012). Contextual Behavioral Science: Creating a science more adequate to the challenge of the human condition. Journal of Contextual Behavioral Science, 1, 1-16.

Bibliography / Reference

Learning Assessment

A learning assessment is required for CE credit.

A question and answer period will be conducted

at the end of this presentation.

Welcome!Our journey today:◦ Introductions

◦ What is this contextualism all about?

◦ Why context and PCBH?

◦ How can apply contextual approaches (e.g., ACT, FACT) in PCBH?

◦ How can I make my clinic more contextually aware?

Bridget Beachy, PsyD◦ Director of Behavioral Health for Community Health of Central Washington

◦ Roles include: PCBH clinical, admin, and faculty for FM residency residents and psych interns

David Bauman, PsyD◦ Behavioral Health Education Director for Central Washington Family

Medicine

◦ Roles include: PCBH clinical, core faculty for FM residency, RTD of PCBH psychology internship

We both live and breathe PCBH and contextual approaches (e.g., Acceptance and Commitment Therapy)

Who we are

Who you are?What is your professional background?◦ Clinician

◦ Administrator

◦ Research or academia?

Are you familiar with contextual approaches?◦ Yes

◦ Kinda

◦ What the hell is contextualism, I wanted to learn about ACT!!!

Before we begin…Surreal moments in life…

After this presentation you will know Contextualism and how to complete and make up metaphors on the spot… ◦ Maybe instead you will want to learn more, we can help with that!

…Our why of contextualism and PCBH

Contextualism in a nutshell

It’s a matter of context…Behaviors do not happen in vacuums◦ Symptoms arise due to one’s context, thus, for us to intervene appropriately we must

understand the context

◦ What if instead of focusing on what shows up at 5 PM (symptoms), we focus on what show’s up at 8 AM (the person’s context)

What happens when we start to do this?◦ Disorders and pathologies go away… It makes sense why this is here!

Why contextualism and PCBHWhat are the goals of PCBH?◦ Population based

◦ See anything and everything

◦ Need to intervene quickly

◦ Needs to be transdiagnositc

◦ …the question almost becomes, why NOT contextualism and PCBH

Everything is a response to context…◦ Depression, anxiety, diabetes, obesity, high blood pressure

How does ACT/FACT relate to contextualism?ACT and FACT are rooted in the philosophy of functional contextualism

Okay, I am with you, context is importantBut, bro, I got 20 – 30 minutes with a patient… what you are asking takes at least an hour◦ Yeah, we had the same thought…

What if there was a way to gather the context intentionally, systematically, and sequentially…◦ I give you the Contextual Interview

Contextual interviewLove, Work, Play & Health Behaviors; 3 T’s

LOVE◦ Living Situation

◦ Relationship

◦ Family

◦ Friends

◦ Spiritual, community life?

Work/School◦ Work/school situation

Play ◦ Fun/Hobbies

◦ Relaxation

Health Behaviors◦ Exercise

◦ Sleep

◦ Substance use (alcohol, drugs, cigarettes, caffeine)

◦ Sex

◦ Diet, supplements, medications?

3 T’s◦ Time, Trigger, Trajectory

Initial visit: Contextual InterviewOur story…

Every.Single.Time◦ Depression – Yep, Anxiety – Yep, Treatment Adherence – Yep, DM – Yep… you get the point

◦ Need to practice

Most radical shift in our clinical practice… interventions are great but the CI is paramount

Same sequence and in the same order every time◦ Why?

Not a checklist, but a story builder◦ Symptoms/behaviors do not happen in vacuums, they happen in a context

◦ We cannot intervene without knowing the context

Teach both our psychology interns/fellows and our residents to do this

Hold on…What if I only have 5 minutes???

What if the patient does not want these questions asked?

How does learning about the individual’s relationship impact their DM?

Alright… I’m intrigued I can maybe consider doing the CI… but what about interventions?

Why I love PCBH◦ It makes you use all of your skills

◦ The ninjas of the BH providers

◦ Have to be quick, intentional, radical, outside the box

How do I implement an intervention that encompasses all of the ACT hexaflex or FACT pillars?◦ … you guessed it… metaphors

Metaphors to utilize We have some for you!◦ The Movie of Self-Compassion

◦ The Program

◦ Three Little Pigs

◦ The Baseball Pitcher or Boxer

◦ Sunburn

How can I make ones up myself?Let’s practice…

How can I get my clinic to be more contextual?Contextual Interview trainings

When completing feedback loop, talk about the context

Have CIs in nursing/provider stations, precepting rooms

Session Evaluation

Use the CFHA mobile app to complete the

evaluation for this session.

Thank you!