The Fifteen Minute Hour Practical Therapeutic Interventions in ...
The Fifteen Minute Hour Practical Therapeutic Interventions in ...
The Fifteen Minute Hour Practical Therapeutic Interventions in ...
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Marian R. Stuart, Ph.D.<br />
Professor, Dept of Family Medic<strong>in</strong>e<br />
UMDNJ‐Robert Wood Johnson Medical School
Focus of Presentation<br />
• <strong>The</strong> BATHE Technique: Brief history and recent<br />
empirical evidence for its effectiveness<br />
• Positive Psychology: <strong>The</strong> new focus of research and<br />
cl<strong>in</strong>ical practice<br />
• <strong>The</strong> Positive BATHE: A procedure to enhance health<br />
by foster<strong>in</strong>g affirmative th<strong>in</strong>k<strong>in</strong>g
<strong>The</strong>rapy <strong>in</strong> Primary Care<br />
• Family physicians can treat emotional problems without<br />
label<strong>in</strong>g them mental problems<br />
• Emotional concerns are addressed normally dur<strong>in</strong>g medical<br />
treatment<br />
• Family physicians are <strong>in</strong> a unique position to understand<br />
body‐m<strong>in</strong>d <strong>in</strong>teractions<br />
• Every visit should <strong>in</strong>volve attention to the emotional<br />
component
Goals of 15 <strong>M<strong>in</strong>ute</strong> <strong>The</strong>rapy<br />
• Prevent<strong>in</strong>g dire consequences<br />
• Re‐establish<strong>in</strong>g patient’s pre‐morbid level of<br />
function<strong>in</strong>g<br />
• Expand<strong>in</strong>g the behavioral repertoire<br />
• Enhanc<strong>in</strong>g patient’s self esteem
<strong>The</strong> 2008 Edition
Two Basic Human Needs...<br />
• To feel competent<br />
• To feel connected<br />
Andrus Angyal
<strong>The</strong> BATHE Technique<br />
Background<br />
Affect/Feel<strong>in</strong>g<br />
Trouble<br />
Handl<strong>in</strong>g<br />
Empathy
How to B.A.T.H.E. your<br />
patients as you S.O.A.P. them:<br />
Background: What is go<strong>in</strong>g on <strong>in</strong> your life?<br />
Affect: How does that make you feel?<br />
Trouble: What about it troubles you most?<br />
Handl<strong>in</strong>g: How are you handl<strong>in</strong>g that?<br />
Empathy: That must be very difficult.
<strong>The</strong> Study<br />
• Dr. Sandra Leiblum, Eliezer Schnall and psychology<br />
<strong>in</strong>terns designed it<br />
• IRB Approved<br />
• 4 doctors, 10 patients with BATHE, 10 patients no<br />
BATHE<br />
• Research assistant (RA) obta<strong>in</strong>ed <strong>in</strong>formed consent<br />
<strong>in</strong> wait<strong>in</strong>g room<br />
• RA <strong>in</strong>formed physicians of condition and collected<br />
data after the visit
Friendl<strong>in</strong>ess/courtesy of your<br />
doctor<br />
Explanations your doctor<br />
provided about any<br />
problems/condition you may<br />
have<br />
Concern your doctor showed for<br />
your questions/worries<br />
1 = Very Poor, 5 = Very Good<br />
<strong>The</strong> Results<br />
BATHE<br />
Non-<br />
BATHE Significance<br />
4.71 4.45 NS<br />
4.47 3.95 0.01<br />
4.46 3.95 0.03
Your doctor's efforts to <strong>in</strong>clude<br />
you <strong>in</strong> decisions about your<br />
treatment<br />
Information your doctor gave<br />
you about medications<br />
Instructions your doctor gave<br />
you about follow-up care<br />
1 = Very Poor, 5 = Very Good<br />
<strong>The</strong> Results<br />
BATHE<br />
Non-<br />
BATHE Significance<br />
4.11 3.47 0.05<br />
4.59 3.92 0.00<br />
4.63 3.94 0.00
Degree to which your doctor<br />
talked with you us<strong>in</strong>g words you<br />
could understand<br />
Amount of time your doctor<br />
spent with you<br />
<strong>The</strong> Results<br />
BATHE<br />
Non-<br />
BATHE Significance<br />
4.73 4.55 NS<br />
4.35 3.85 0.05<br />
Your confidence <strong>in</strong> this doctor 4.62 4.40 NS<br />
1 = Very Poor, 5 = Very Good
Likelihood of your<br />
recommend<strong>in</strong>g this doctor to<br />
others<br />
Please rate your overall<br />
satisfaction with today's visit to<br />
your doctor<br />
1 = Very Poor, 5 = Very Good<br />
<strong>The</strong> Results<br />
BATHE<br />
Non-<br />
BATHE Significance<br />
4.65 4.20 0.02<br />
4.68 3.95 0.00
Did your doctor ask what has<br />
been go<strong>in</strong>g on <strong>in</strong> your life, or<br />
what may have changed<br />
recently?<br />
Did your doctor ask how your<br />
mood or feel<strong>in</strong>gs have been<br />
affected by what has been go<strong>in</strong>g<br />
on <strong>in</strong> your life lately?<br />
Did your doctor ask what<br />
worries or concerns you may<br />
have about what has been go<strong>in</strong>g<br />
on <strong>in</strong> your life lately?<br />
BATHE Compliance<br />
BATHE<br />
86.8%<br />
(33)<br />
64.9%<br />
(24)<br />
75.7%<br />
(28)<br />
Non-<br />
BATHE Significance<br />
50.0%<br />
(20)<br />
0.00<br />
20% (8) 0.00<br />
27.5%<br />
(11)<br />
0.00
Did your doctor ask how you are<br />
handl<strong>in</strong>g or cop<strong>in</strong>g with what has<br />
been go<strong>in</strong>g on <strong>in</strong> your life lately?<br />
Was your doctor sympathetic to<br />
your needs or concerns?<br />
BATHE compliance<br />
BATHE<br />
75.7%<br />
(28)<br />
97.3%<br />
(36)<br />
Non-<br />
BATHE Significance<br />
25.0%<br />
(10)<br />
75.0%<br />
(30)<br />
0.00<br />
0.00
Core Foci of Positive Psychology<br />
• Understand who we are and how we cope with adversity<br />
• Study populations to understand what makes some<br />
people more resilient than others<br />
• Recognize that optimism and other resilient thoughts<br />
and behaviors are learned behaviors<br />
• Teach resilience and help <strong>in</strong>dividuals tap <strong>in</strong>to their<br />
already exist<strong>in</strong>g core strengths and virtues<br />
• Study and promote happ<strong>in</strong>ess despite circumstances
<strong>The</strong> Language of Positive Psychology<br />
• Well-be<strong>in</strong>g<br />
• Self-esteem<br />
• Happ<strong>in</strong>ess<br />
• Interpersonal relationships<br />
• Perseverance<br />
• Courage<br />
• Optimism<br />
• Gratitude<br />
• Hope and Faith<br />
• Mean<strong>in</strong>gfulness & purpose<br />
• Psychological well-be<strong>in</strong>g<br />
• Self-efficacy<br />
• Positive affect<br />
• Social support<br />
• Hard<strong>in</strong>ess<br />
• Challenge<br />
• Benefit f<strong>in</strong>d<strong>in</strong>g<br />
• Spirituality and prayer<br />
• Forgiveness<br />
• Sense of coherence
Confirmatory Research<br />
• Recent studies highlight the strik<strong>in</strong>g effects of<br />
positive thoughts<br />
• <strong>The</strong>y enhance the ability of the immune system to<br />
protect the body<br />
• <strong>The</strong>y help overcome depression<br />
• <strong>The</strong>y promote both physical and mental health<br />
(Psychological Bull 2005:131(6)925‐971)
Positive vs. Negative Thoughts<br />
• Positive thoughts or attitudes release<br />
endorph<strong>in</strong>s and have a tonic effect on organs<br />
• Adverse stimuli release adrenal<strong>in</strong>e and cause<br />
weakness and enervation of specific organs<br />
• Positive attitudes = Welfare emotions<br />
• Negative attitudes = Emergency emotions
• B: Best What’s the best th<strong>in</strong>g that’s happened to you<br />
this week? Or s<strong>in</strong>ce I saw you?<br />
• A: Affect or Account: How did that make you feel?<br />
Or How to you account for that?<br />
• T: Thankfulness: For what are you most grateful?<br />
• H : Happen: How can you make th<strong>in</strong>gs like that<br />
happen more frequently?<br />
• E: Empathy or Empowerment: That sounds<br />
fantastic. I believe that you can do that.
Benefits of Accent<strong>in</strong>g the Positive<br />
• Studies overwhelm<strong>in</strong>gly connect life satisfaction with<br />
<strong>in</strong>creased health and longevity<br />
• Physicians’ ability to promote positive affect <strong>in</strong> their patients<br />
becomes an important skill<br />
• <strong>The</strong> Positive BATHE can also be used among residents,<br />
faculty and staff to overcome negativity related to<br />
circumstances that can’t be changed
<strong>The</strong> 2008 Edition
“<strong>The</strong> art of medic<strong>in</strong>e is to keep the<br />
patient amused until nature effects a<br />
cure”<br />
Voltaire
www.marianstuart.com<br />
www.15m<strong>in</strong>utehour.com
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