Too Tired To Keep Juggling

Transcription

1 Too Tired To Keep Juggling A Treatment for Teachers April 29, 2004 Dr. Wesley Buch, BHC 1

2 Summary Teachers have always been jugglers. Many juggle too much for too long and get too tired. Some may eventually seek the help of a psychologist. They may present with tormenting fears, sickening depression, and relentless pains. I describe a two-phase hot cognitive-behavioural approach to these conditions that may include EMDR and biofeedback components. April 29, 2004 Dr. Wesley Buch, BHC 2

3 Learning Objectives Can identify 3 reasons that teachers avoid psychological treatment Can identify 3 psychological conditions common to teachers Can briefly describe CBT Can describe 2 core approaches to stress April 29, 2004 Dr. Wesley Buch, BHC 3

4 Juggling What? Covering curriculum Managing special needs in class Involvement on committees Extra-curricular activities Communication with parents April 29, 2004 Dr. Wesley Buch, BHC 4

5 And That s Not All Budget cuts Greater teacher:student ratio Less teacher support for special needs students (e.g., TAs) Losing counsellor & library positions The downside of greater parent involvement in school-based decisions April 29, 2004 Dr. Wesley Buch, BHC 5

6 And That s Still Not All Children at home? Elderly parents? Partner/Spouse? Other social commitments (friends)? Financial commitments? April 29, 2004 Dr. Wesley Buch, BHC 6

7 What to Do? Change the Stressors Remove, postpone, delegate, alter the stressor Or Adjust to the Stressors RESPONSE-ability: if can t change stressor, change personal response to it perceptual change (pain: from enemy that is fought to border that is lived around) behavioural change (pain: ergonomic changes) April 29, 2004 Dr. Wesley Buch, BHC 7

8 What is done? Stop working (Absenteeism) Keep working (Presenteeism) Intermittent Working (Absent/Presenteeism?) April 29, 2004 Dr. Wesley Buch, BHC 8

9 Get Help? Maybe Not It s not that bad. I don t have time. I ll get over it (And other variations on denial) It s not psychological It s me I m not good enough (And other variations on selfblame) What will others think? (stigma) April 29, 2004 Dr. Wesley Buch, BHC 9

10 What Help? Implement anti-stress strategies Talk to a friend (on staff?) Get informed (workshops, books) Consult a physician? EAP provider? (the pros, cons) April 29, 2004 Dr. Wesley Buch, BHC 10

11 When When It All Falls Falls Down Down April 29, 2004 Dr. Wesley Buch, BHC 11

12 Tormenting Fears Generalized fears (GAD) Specific fears (Specific Phobia) Posttraumatic fears (PTSD) Obsessive fears (OCD) Somatoform fears (Hypochondriasis) Sheer panic (Panic Disorder; Agoraphobia) April 29, 2004 Dr. Wesley Buch, BHC 12

13 Sickening Depression Mood vs. feelings Depressed mood Apathy or anhedonia Other signs & symptoms April 29, 2004 Dr. Wesley Buch, BHC 13

14 Relentless Pains Persistent pain, often in several locations May seem disproportionate Lasts longer than is typical Does not respond to rehab. Caused and/or perpetuated by psychological factors (sleep, anxious/depressed mood, addictions, excessive protection & avoidance) April 29, 2004 Dr. Wesley Buch, BHC 14

15 Full Meal Deal Pain Anxiety - Depression Perverse synergy Poorer prognosis Good news April 29, 2004 Dr. Wesley Buch, BHC 15

16 What do teachers want from a psychologist? Education An exit strategy Reassurance Safe place to crash Coping Strategies A care taker New hope/vision April 29, 2004 Dr. Wesley Buch, BHC 16

17 Toffee April 29, 2004 Dr. Wesley Buch, BHC 17

18 Treatment Phases Phase 1: Off-work tx towards sx improvement sufficient for RTW trial Phase 2: Testing tx gains in real work situation April 29, 2004 Dr. Wesley Buch, BHC 18

19 Cognitive-Behavioural Therapy April 29, 2004 Dr. Wesley Buch, BHC 19

20 What is CBT? A hybrid: Cognitive therapy + Behaviour therapy = CBT An attempt to increase BT success by modifying thoughts Assumption: modifying thoughts & behaviour changes feelings April 29, 2004 Dr. Wesley Buch, BHC 20

21 What is CBT? Time limited (12 24 tx hours) Active (in session; homework) Present centred Goal oriented Equipping with knowledge & skills April 29, 2004 Dr. Wesley Buch, BHC 21

22 Cognitive Interventions Mood monitoring Identifying cognitive distortions automatic thoughts (e.g., black/white) Choosing & testing alternative thinking in real life experiments April 29, 2004 Dr. Wesley Buch, BHC 22

23 Hot CBT Using experiential strategies to access hot cognitions Expanding affect Working with metaphors April 29, 2004 Dr. Wesley Buch, BHC 23

24 Behavioural Interventions Functional analysis What changed (increases, decreases) in your thoughts & activities since you last felt well as a teacher? What changed in your teaching environment? Other environments? (home, neighbourhood, province, country, world) April 29, 2004 Dr. Wesley Buch, BHC 24

25 Behavioural Interventions Increase pleasant, social, & mastery activities Self-calming strategies (breathwork) Systematic desensitization Acceptance vs. change work April 29, 2004 Dr. Wesley Buch, BHC 25

26 Relapse Prevention Normalize recurrence of some sx Anticipate triggers & stressors Develop social supports Review & rehearse adaptive coping April 29, 2004 Dr. Wesley Buch, BHC 26

27 EMDR April 29, 2004 Dr. Wesley Buch, BHC 27

28 EMDR Method Use of bilateral eye movements by following the therapist s fingers back & forth. Common alternatives are bilateral clicks (finger snaps), tones and tapping (usually on the knees). There are also one-eye techniques and an EMDR variant called One Eye Integration. April 29, 2004 Dr. Wesley Buch, BHC 28

29 Hooper April 29, 2004 Dr. Wesley Buch, BHC 29

30 EMDR Rationale EMDR method as a form of Accelerated Information Processing Perhaps EMDR taps into the same mechanisms used in learning and memory identified with REM sleep. Perhaps EMDR initiates improved hemispheric communication. Perhaps EMDR causes an orienting reflex change in neurophysiological functioning. April 29, 2004 Dr. Wesley Buch, BHC 30

31 EMDR Tx Phases 1. Client History 2. Preparation 3. Assessment 4. Desensitization 5. Installation 6. Body Scan 7. Closure 8. Re-evaluation April 29, 2004 Dr. Wesley Buch, BHC 31

32 EMDR Distinctives Bilateral activation Less talk Re-exposure to trauma important Client-centred Somatic focus Change can be unexpected April 29, 2004 Dr. Wesley Buch, BHC 32

33 Biofeedback Traditional Neurofeedback Hemoencephalography April 29, 2004 Dr. Wesley Buch, BHC 33

34 Time for a Break April 29, 2004 Dr. Wesley Buch, BHC 34

35 RTW Phase (2) Generalizability of treatment gains A graduated RTW (GRTW) The help of a mentor or colleague April 29, 2004 Dr. Wesley Buch, BHC 35

36 Outcome Evaluation April 29, 2004 Dr. Wesley Buch, BHC 36

37 CBT for Depression Strong support for CBT randomized controlled studies meta-analytic reviews Also support for: Cognitive Therapy Behaviour Therapy Interpersonal Therapy April 29, 2004 Dr. Wesley Buch, BHC 37

38 Alternative Treatment (Depression) Combined psychosocial & medication Strongly supported by at least one major study SSRIs & several new compounds (Wellbutrin) Support from RCT with placebo controls April 29, 2004 Dr. Wesley Buch, BHC 38

39 CBT for Pain Disorder CBT Individual or Group Reduces pain-related distress & disability (usually not pain) Several favourable RCTs April 29, 2004 Dr. Wesley Buch, BHC 39

40 Alternative Treatment (Pain Disorder) Cognitive Therapy, Behaviour Therapy Some support Medications Antidepressants (numerous supportive RCTs); reduce pain and associated sleep & mood disturbance. E.g. large metaanalytic study of amitriptyline April 29, 2004 Dr. Wesley Buch, BHC 40

41 CBT for Anxiety Exposure Therapy, Anxiety Management Therapy Strong support from good studies (RCT) April 29, 2004 Dr. Wesley Buch, BHC 41

42 Alternative Treatment EMDR (Anxiety) Good support for PTSD treatment from studies of civilian trauma vs. controls Antidepressants Strong support (RCTs with placebo controls) Behaviour Therapy, SSRI Meds, EMDR Meta-analytic studies April 29, 2004 Dr. Wesley Buch, BHC 42

43 Howard April 29, 2004 Dr. Wesley Buch, BHC 43

44 The Happy Juggler April 29, 2004 Dr. Wesley Buch, BHC 44

45 Learning Objective #1 Can identify 3 reasons that teachers avoid psychological treatment Denial Self-blame Stigma April 29, 2004 Dr. Wesley Buch, BHC 45

46 Learning Objective #2 Can identify 3 psychological conditions common to teachers Pain Anxiety Depression April 29, 2004 Dr. Wesley Buch, BHC 46

47 Learning Objective #3 Can briefly describe CBT A brief, active & goal-oriented therapy that uses cognitive and behavioural strategies to decrease abnormal emotional states. April 29, 2004 Dr. Wesley Buch, BHC 47

48 Learning Objective #4 Can describe 2 core approaches to stress Change stressor (e.g., remove) Adjust to stressor April 29, 2004 Dr. Wesley Buch, BHC 48

49 Thanks for the invitation! April 29, 2004 Dr. Wesley Buch, BHC 49

50 What Do YOU Think? OPEN DISCUSSION April 29, 2004 Dr. Wesley Buch, BHC 50

51 Remember Please visit us for slides! April 29, 2004 Dr. Wesley Buch, BHC 51