Description
Apply CBT techniques to emotional challenges of long-term illness
CBT Frontline Action for Long-Term Conditions and Palliative Care is a guide to the sensitive application of CBT to promote psychological well-being in people with life-changing physical illnesses such as cancer, diabetes, heart problems and multiple sclerosis.
Living with a long-term condition or life-limiting illness brings challenges that extend far beyond the physical. For many people, emotional distress, unhelpful habits, anxieties, dilemmas, and setbacks become part of the landscape of daily life. Those providing care—whether in hospitals, community teams, social care, or specialist palliative services—encounter these difficulties every day, often without the psychological tools they wish they had.
This book is written for those practitioners.
CBT Frontline Action offers a practical, respectful way of bringing psychological understanding into routine clinical work. It is designed for busy professionals who want to respond more confidently and sensitively when distress gets in the way of treatment, recovery, or quality of life. Its aim is not to turn readers into therapists, but to help them use proven cognitive behavioural ideas in straightforward, timely ways that fit naturally into their established roles.
Drawing on many years of practice in physical health, mental health, and palliative care, the authors describe a clear pathway for using CBT Frontline Action (CFA): how to spot when it may help, how to understand what is happening for the person in front of the practitioner, and how to choose small, focused interventions that can make a meaningful difference.
The book is arranged in three parts:
- Practitioner Briefings, which outline the key actions and decisions in CFA, illustrated with practitioner characters whose experiences mirror those of real-world staff.
- The Manual, which explains the evidence, skills, and principles underpinning CBT in long-term conditions, accompanied by case examples that reflect the complexity and humanity of the work.
- The Toolkit, a practical resource containing problem guides, techniques, information sheets, and record forms to support day-to-day practice.
Throughout the book, collaboration, empathy, and the importance of working with, not on, the people being supported are emphasised. The authors also highlight the value of self-awareness and self-care for practitioners, recognising that emotionally demanding work requires attention to personal wellbeing.
Whether working in health care, social care, or community settings, readers are encouraged to feel more equipped to respond to distress, more attuned to the psychological dimensions of illness, and more confident in the small actions that often make the biggest difference.
Written by practitioners for practitioners, this book aims to support the shared endeavour of helping people live as fully as possible in the face of long-term and life-changing conditions.
Table of Contents
List of Figures xi
List of Tables xiii
About the Authors xiv
About the Contributors xv
Acknowledgements and Foreword xvi
Introduction 1
a. The Structure of the book 1
b. Defining terms 3
Part 1: The Practitioner Briefings for CBT Frontline Action Book structure 8
A. CFA in Your Work 9
More About Our Practitioner Characters 10
B. Is Using CFA in My Work for Me? 19
C. Preparing to Use CFA 25
D. Deciding to Use CFA 30
E. Action 1 – Identifying the Problem 33
Explaining the Model 34
F. Action 2 – Understanding the Problem Better 38
Five Areas Mapping 40
G. Action 3 – Agreeing a Goal and Action Plan 45
H. Action 4 – Session Structure 50
I. Action 5 – Applying CFA to the Plan 55
A Practicable Plan 55
Achieving Steps and Overcoming Obstacles 56
J. Maintaining Skills and Personal Wellbeing 60
Reflective Practice 61
Feedback 61
Clinical Supervision 62
Backup Support Promptly Available 62
Applying CFA to Teamwork 62
Skill Maintenance and Self- Care Checklist 63
Part 2: The CFA Manual
Chapter 1: CBT and Long- Term Conditions 69
‘It’s Not All in My Mind: It’s Real!’ 69
The Cognitive Behavioural Approach 71
The Relevance of CBT for People with Long- Term Conditions 75
Chapter 2: Does Cognitive Behaviour Therapy Work? – Researching the Evidence 82
Researching Your Patient 82
Do Psychological Therapies Work? 82
Assessing the Research Data 84
Applying Research Findings to Clinical Practice 87
The Effectiveness of CBT for Specific Conditions 88
Experimental Design in Clinical Practice 88
Some Clinical Examples 89
Ethical Issues in Psychological Research Interventions 92
In Conclusion 92
Chapter 3: Core Skills in CBT Frontline Action 97
Determining a Role for CBT Frontline Action 97
Communication Skills in Health Care 101
Specific Features of the CBT Communication Style 110
Guided Discovery: Using the Socratic Method 117
Chapter 4: Deciding to Use CBT Frontline Action 128
Assessment 128
Formulations 143
Putting the Assessment and Formulation to Work 178
Chapter 5: Goals, Purpose, Values and Hope 182
Goals and Action Planning 183
Purpose and Hope: Values and Wellbeing 194
Conclusion 201
Chapter 6: Bringing About Change and Sustaining It 202
Change, the Five Areas Model and Formulation 205
Methods of Behaviour Change 209
Methods of Cognitive Change 213
Dealing with Unpleasant Emotional and Physical Experiences 218
The Physical and Emotional Aspects of Living with an LTC 228
Resilience and Sustaining Change 236
Chapter 7: Supervision and Self- care 241
The Nature of Supervision 241
Setting Up Clinical Supervision 245
Self- Care 252
Part 3: The Toolkit: CBT Methods in Practice
Section 1: Guide to Problem Identification and Decision- Making 257
How to Use This Part of the Book 257
Deciding on a Course of Action Decision Tree and 5 Step Assessment 258
5 Step CFA Assessment 258
The CFA Decision Tree 260
Problem Identification 261
Adjustment Difficulties 263
Altered Body Image 265
Altered Body Functioning 267
Anger 269
Anxiety and Stress 271
Avoidance 273
Breathing Difficulties 274
Concentration and Memory Difficulties 275
Denial 277
Dilemmas 279
Existential Distress 280
Fatigue 282
Fear of the Future 284
Inactivity 286
Indecisiveness 288
Intrusive/Distressing Thoughts 289
Lack of Motivation 291
Loss of Pleasure or Ability to Enjoy Things 293
Low Mood 295
Low Self Esteem 297
Negative Outlook 299
Pain 300
Panic Attacks 302
Physical Tension 304
Problem Solving Difficulties 305
Safety Behaviours 307
Setbacks and Illness Progression 308
Sleep Difficulties 310
Unassertiveness 312
Uncertainty 314
Worrying 315
Section 2: Techniques 317
Acceptance: Promoting Constructive Use 317
Activity Monitoring 319
Activity Planning 320
Assessing Psychological Distress 321
Attention Strategies 322
Behavioural Activation 324
Behavioural Experiments 325
Behavioural Rehearsal 326
Breathing Regulation 327
Challenging Unhelpful Thoughts 328
Consultation Skills 329
Continuum Thinking 330
Distraction 331
Drop Anchor 333
Effective Communication Skills 335
Emotional Expression 336
Environmental and Stimulus Control 337
Expressive Writing 338
Graded Activities 339
Health Condition: Enhancing Understanding 340
Imagery: Creating a Helpful Image 341
Mindfulness 342
Motivation Enhancement 343
Pacing 344
Problem Solving 345
Psychoeducation 346
Responsibility Pie 347
Socratic Questioning 348
Weighing the Pros and Cons 349
Section 3: Information Sheets 351
Antidotes to bad days 351
The Assertiveness Model 352
Assertiveness Rights 353
Bad old habits: avoiding relapsing into them 354
Behavioural Activation and depression 355
Body image changes 357
Breathing: learning self- help regulation 358
Change: motivation 359
Change: the desire for it 360
Change: the transition curve 361
Choice points: notes and an example 362
Coping with setbacks 1: Physical Health Setbacks 363
Coping with setbacks 2: mental attitude setbacks 364
Denial: advantages and disadvantages 365
Experiential learning cycle 366
Goal setting and the step- by- step approach 367
Goal setting: step ladder and stepping stones 369
Goal setting questions 370
Living in the here and now 372
Mental traps: 7 ways to escape them 374
Mental traps: examining the evidence 375
Mental traps: examples of how to get out of them 376
Mindfulness attitudes 378
Mindfulness exercises 379
Mindfulness: learning to be in the present moment 380
Mindfulness practice 381
Motivational enhancement 382
Pacing 383
Pacing examples 385
Personal development planner 386
The reactions of other people 388
Relaxation: mental exercise 389
Muscle relaxation exercise 390
Relaxed breathing exercise 391
The serenity prayer 392
Sharing and mixing with other people 393
SMART guidelines 394
Socratic questioning: examples 395
Values, valued direction and goal setting 396
A vicious cycle model of anxious avoidance 399
A vicious cycle model of anxious preoccupation 400
A vicious cycle model of hopelessness- helplessness 401
Wellbeing 402
Section 4: Record Forms 403
Thought Record 403
Pacing Record Form 404
Goal Planning: Step- By- Step Action Plan 405
CBT Diary 406
Activity Schedule 407
Choice Points 408
“Clean” Versus “Dirty” Discomfort 409
Maintenance cycle 410
Vicious Flower: Issue and Petals that maintain it 411
Illness coping strategies formulation 412
Motivation and Commitment Formulation 413
ABC Record Form 414
Personal Development Planner 415
Willingness- and- Action Plan 416
Daily Mood Record 417
Index 418
