CBT Gets ‘Smart’

 

As clinicians, we are always seeking new and better healthcare delivery methods. One of  the most promising is telehealth.

Described as a way to enhance healthcare, public health, and health education delivery and support using telecommunications technologies, this creative use of technology offers improved accessibility and access to injured workers, which has been shown to increase motivation. Additional benefits we are seeing include neuroplasticity exercises and real time functional outcomes.

The injured worker can go on his smartphone, computer or tablet to reap the many advantages. Telehealth offers another opportunity to improve outcomes in the workers’ compensation system.

e-COPE Telehealth

Cognitive behavioral therapy (CBT) is one of the most effective strategies to help injured workers with chronic pain. It has been proven time and again to prevent and eliminate delayed recoveries.

One of the major components of (CBT) is homework. CBT is a goal-oriented therapy that is most effective when the patient practices the skills he learns during face-to-face sessions.

Telehealth enables the injured worker to practice the skills  24-hours-a-day with the help and encouragement of our CBT-trained psychologists. This can only serve to further enhance the effectiveness of this therapy.

e-COPE is the name given to our CBT telehealth app. It includes a variety of interactive resources, such as:

• Educational videos\whiteboards.
• Assessments.
• CBT treatment plan\modalities.
• CBT games.

It can also be used for many of the specific components we use in CBT. Monitoring the injured worker’s heart rate can help with biofeedback. It can help with training in mindfulness, mirror therapy, and brain plasticity. It can track their medication and screen their cognitive function. And it allows for real-time reporting.

The app can be personalized for each injured worker. The ‘My COPE with Pain Plan’ accesses the specifics of the employee’s CBT program.

Therapist drift

An important function of the telehealth app is a reduction of so called ‘therapist drift.’ This is a phenomenon in which the counselor ‘drifts’ away from using evidence-based treatment for the patient’s symptoms.

In the case of chronic pain patients, not all therapists are fully trained in CBT. Those who are versed more in person-centered therapy and don’t see the results they expect might be inclined to abandon CBT principles and engage in more traditional therapy. As we know, CBT is very specific and is successful when it is employed as designed. But it must be followed to the letter to truly help the injured worker with chronic pain.

Therapist drift is a glaring reason why it’s imperative to partner with psychologists appropriately trained in CBT. It points up the significant differences between this therapy and traditional psychotherapy.

CBT as a Therapy

CBT promotes patient coping and adjustment. It teaches mind-body techniques to control and offset pain, which is vital to treating injured workers with chronic pain. It helps the injured worker make lifestyle changes that may be impacting their pain.

The goal of CBT is to help the injured worker cope with and manage his pain, not to ‘cure’ it. He learns actionable skills that allow him to take back control of his life, allowing him to return to functionality and, possibly, work.

More traditional psychotherapies seek to help the patient understand why he feels the way he does and behaves as he does. It involves talking to help uncover deep and even unconscious motivators for his actions. It can be a lengthy process.

CBT, on the other hand, is a short term service that trains the injured worker to replace dysfunctional thinking, perceptions and behavior, and does not insight into the deep-seeded emotions.

It is highly structured and instructional. It revolves around goals mutually agreed upon by the therapist and injured worker. It focuses on the present, rather than past experiences and emotions.

Both CBT and psychotherapy have a place in helping patients address underlying psychological issues. For injured workers in chronic pain, CBT is the therapy that offers the best hope for improved function. But it must be undertaken by a psychologist who is experienced and has a strong belief in its effectiveness.

The e-COPE app ensures the injured worker is engaged in the practices specific to CBT.

Conclusion

Telehealth is an exciting new addition to the toolkit for helping injured workers in chronic pain. CBT itself is a short-term strategy. Used in conjunction with telehealth can lead to superior clinical outcomes.

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at The Ascellus Group, or visit our website http://www.cope-with-pain.com.  Please join our LinkedIn group, at COPE with Pain.