The ABC of CBT: Part Two
In Part One of this three part series we got to know Ms W, a data entry-ist suffering from wrist strain due to repetitive computer work. During her sessions with a Cognitive Behavioural Therapist, Ms W learnt to challenge her perception that all her coworkers thought she was faking her injury. Instead, Ms W came to acknowledge that some people at work were supportive of her recovery, that people’s responses to her weren’t necessarily a reflection on her or her injury, and that she was better off focusing on her own rehabilitation than worrying about proving to all and sundry that her pain was legitimate.
Now, Ms W needs to tackle the ‘B’ of CBT: her behaviour.
You might remember that Ms W’s thoughts about her injury led to her feeling anxious and depressed and that these feelings led her to withdraw from the workplace. According to Dr Peter McEvoy, a specialist clinical psychologist with the Centre for Clinical Interventions in WA, this kind of unhelpful behaviour is common.
“There’s a tendency amongst some people who experience loss of function to respond in a way that makes them feel better in the short term but ultimately compounds their depression, or their physical problem. Someone with back pain might be reluctant to do anything that could possibly exacerbate their physical problem. The problem with that is that the more restricted they become, the less they’re testing their belief that things are hopeless, or that they can’t do anything. As they withdraw more, the depression might follow, or worsen.”
Scary as it might sound for someone in Ms W’s position, the CBT approach is to tackle such problems head on, by conducting behavioural experiments. The goal of these experiments is to trial new, more helpful ways of behaving and to thus further erode unhelpful thoughts and beliefs.
Dr McEvoy told us that “behavioural change is really about doing things in a way that helps people test their beliefs about difficult situations. When people avoid situations that they find difficult, they don’t have the chance to test their fears and beliefs. We encourage people to gradually confront the situations that they’ve been avoiding and find evidence for or against their beliefs.”
So Ms W will need to whip out her lab coat again – but this time, she’ll be doing rather than just thinking.
Let’s recap some of Ms W’s thoughts and beliefs, examine how these led her to behave, and then suggest more helpful behaviour she might like to test run. We’ll also look at how Ms W’s new behaviour might impact what she believes.
| Old Belief | Old Behaviour | New Behaviour | New Belief |
| Everyone thinks I’m faking my injury. | Avoiding coworkers. Eating lunch alone. | Asked Shannon the receptionist if she wanted to have a coffee with me. We talked and she told me about her back pain and a yoga class that helped her recover. I said I’d check with my physio to see if I could go along. | Some people at work take my injury seriously and recognise that I am in pain. Talking to people about my problem means that they are more likely to understand it. |
| The way people respond to me is a reflection of me and my injury. | When Sam from accounting was impatient with me for asking her to take over some of my data entry, I did not raise the matter with her again, or mention it to my manager. | I approached Sam again, in the morning before she was swamped with other requests. She said that she could do some but not all of my data entry. Asked my manager to reallocate the rest of my data entry. | People at work are often busy and stressed. How they respond to me isn’t just a reflection on me. Most people are reasonable and will help out if they can. |
| I have to convince everyone at work that my injury is real. | Limiting my activities at work, so that people don’t see me moving my wrist and think I’m faking. Staying away from work when I feel too stressed about going. | Going to work but having good coping strategies, such as taking frequent breaks, stretching, and talking to Shannon when I feel anxious. Staying active. Talking to my manager about my concerns regarding how other people perceive my injury. | I can cope with work and with my injury. When things are difficult, I have strategies for dealing with that and I can manage. My recovery is more important than other people’s perceptions of my injury. |
When a worker or CBT client is in pain the focus, according to Dr McEvoy, should be on getting them to “think about what can be done at that point in time. Tomorrow might be different. Tomorrow they might be able to do more or less. But we want to anchor them in the present moment, to teach them skills to be able to cope with the pain that they have in the present moment and also gradually get them back to some level of function. We want them to focus on what CAN be done rather than on the function that has been lost.”
Sounds like the ABC of CBT might have a lot in common with best practice RTW, doesn’t it?
But before we get carried away with TLAs (Three Letter Acronyms, for the uninitiated) let’s not forget about the last instalment in our series, the big ‘T’: therapy. Part three is coming right up…
Thanks to Dr Peter McEvoy for his assistance with this series of articles. You can find out more about the Centre for Clinical Interventions, a specialist state-wide service funded by the WA government, here.