Biopsychosocial Therapy:

Communication Aspects of Care

Applying the skills of Motivational Interviewing, Therapeutic Neuroscience Education,

and Emotional Intelligence

Brian G. Burkhardt

June 20, 2016

Outline

ò Part I: Background

ò What is Chronic Pain and Fear Avoidance Behavior?ò How do we currently address these challenges in

PT?

ò Part II: Applying the Biopyschosocial Model

ò What is EI, MI, & TNE?ò How can we use these tools in PT for better

outcomes?

ò Conclusion & Questions

Part I Background

ò Chronic Pain: pain that persists beyond the normal healing time or without identifiable organic causes

ò Chronic pain affects approximately 48 million people in the US (Columbia University)

ò Probability of developing chronicity is related to the extent two parts of the brain, related to emotional and motivational behavior interact. (Northwestern University, 2012)

Columbia University Medical Center. "Columbia University Researchers Discover On-off Switch For Chronic Pain." ScienceDaily. ScienceDaily, 20 July 2006. <www.sciencedaily.com/releases/2006/07/060720095621.htm>.

Virginia Mason Story

ò Insurers were looking to cut costs due to rising cost associated with LBP

ò Acute LBP clinics were setup to funnel all patients with mechanical LBP to PT, as early as possible

ò Cut costs in half, improved patient satisfaction

ò Aetna reward VM with 16% higher reimbursement

Credit: Paul Mintken, DPT

Next Steps

ò So what can we do once chronic pain has already set-in?

ò How can we educate and influence our patients to ensure acute pain doesn’t progress to chronic, during and after our care?

ò How do we communicate empathy and respect towards our patients, while simultaneously forcing them to do something may not want or believe they can do?

Current Screens

ò FABQ

ò Depression

ò Pain scale & Description

ò Screens ≠ Interventions

ò Severity vs. referral vs. actually helping

Part II

Successful Application of the Biopsychosocial Model

3 Points

1. Establish patient trust

ò Look them in the eyes

ò Regularly use their name

ò Don’t label

ò LISTEN

2. Avoid reliance on passive treatments (modalities, rest)

3. Modify patient education

Credit: P. Mintken, DPT

Motivational Interviewing

ò Respect for patient: knowledge, wisdom, and ability to make decisions

ò PT role: work in partnership, see pt’s perspective, explore pt’smotivations, evoke thoughts and ideas

ò Understanding:

ò changes comes from within rather than from others

ò negative messages and confrontations are usually ineffective

ò knowledge and encouragement are not enough

ò reducing ambivalence is the key to change

4 Steps of MI

1. Engage: “How do you like to be addressed?”, “How are you?”, “How can I help you?”

2. Focusing: What makes this person unique? How did they get here? What education should I provide?

3. Evoking: What drives this person? What do they love/miss? *Scaling Questions*

4. Planning: Goal Setting (SMART). “Is this what you want to do?”

OARS

ò Open Questions

ò “How…”, “What…”, “Why…”

ò Ie) “How does that make you feel”, “Tell me more about that”, “What do you think YOU can do?”, “What do you fear?”, “What do you hope for?

ò Affirmations

ò “I believe you”

ò Reflective Listening

ò “If I’m hearing you correctly, it sounds like…”

ò Summarizing

ò “Overall, it sounds like your primary goals/concerns are..”

Scaling Questions

ò Used to assess motivation

ò “On a scale of 1-10, with 1 being not important and 10 extremely important, how important is it to you to be able to… / to increase your.. Etc.”

ò Follow up with: “Why not a 2 or a 9?” (higher/lower #)

Emotional Intelligence (EQ)

ò The ability to recognize and dissociate emotions of self and others and apply them to guide thinking and behavior.

ò Empathy and emotional awareness drives success

From TIME EQ:

1. A robust emotional vocabulary

2. A curiosity about others

3. A good judge of character and social awareness

4. Difficult to offend

http://motto.time.com/4117921/emotional-intelligence-signs/?xid=time_socialflow_facebookColeman, Andrew (2008). A Dictionary of Psychology (3 ed.). Oxford University Press. ISBN 9780199534067.

Therapeutic Neuroscience Education (TNE)

ò Pain is signaled via nerves, which can become more or less sensitive despite the health of tissues

ò Central Sensitization & Neuroplasticity

ò *Fear and Emotions* (Sensation Book)

http://www.instituteforchronicpain.org/treating-common-pain/what-is-pain-management/therapeutic-neuroscience-education

Words & Phrases

ò Good phrases: “I believe you…”, “Let me see what I can do”, “Good news”, “You seem…”

ò Poor phrases: “Unfortunately”, “can’t”, “I understand”, “I know”, “No”

ò Look them in the eyes

ò Say their name (often!)

Outcome Measures

ò Confidence Scale:

ò “On a scale of 1-10, how much do you believe your condition will improve?”

ò Work Scale:

ò “On a scale of 1-10, how much time/effort are you able/willing to put into improving?”

Inspiration, References, Thanks

ò MI & TNE education from CU DPT programhttps://www.ted.com/talks/celeste_headlee_10_ways_to_have_a_better_conversation?language=en

Questions & Comments

Thanks for sharing your time, knowledge, and feedback!