Cognitive behavioral therapy for physical therapists?

[Termy]

I've been looking around trying to find good literature on this subject. I've also used pubmed, but found only a few articles dealing with CBT for physical therapists. Does anyone have any tips as to good material on what we as physical therapists can do with CBT? Techniques for us to use, etc? Efficiency?

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[quorthon]

i believe that few physiotherapy methods rely on cognitive behavioural appoaches.....If u look at a physio's "arsenal" u will see many passive modalities,manipulation techniques (which are also PASSIVE because patient cant interfere with that!)...The only method that contains behavioural apporaches is the Mckenzie one....Encouragement and education of patient, self-treatment prinicples, management for prevention of pain recurrences and many other aspects which has the "behavioural" element are fundamental stone of mckenzie method....As a private clinician i can say that through this approach i spent more time discussing with the patient about his problem than just "manipulate", "stretch" him or whatever....And trust me, the first is far far far more effective in the long-term!

[Termy]

Thanks for the reply. I agree, McKenzie contains a behavioral component. But when it comes to CBT, there are things like "graded activity", "graded exposure" and other "techniques" that try to combat psychological pain defense mechanisms like "fear-avoidance", "catastrophizing" and so on.

For physiotherapists dealing with a lot of patients with chronic pain of some sort, it's important to be able to reach through to the patient... I've seen behavioral techniques here and there but I've heard so many positive things about CBT I wanted to find out more about that method specifically.

[quorthon]

i totally agree with you colleague....The problem is that during training in physio school we NEVER learned or talked about the H-U-G-E matter of chronic pain....Neither the pathophysiology behind it (theories that been proposed are very interesting if u study them...) nor how to manage a chronic patient....
And i believe that every physiotherapy method has to include behavioural aspects, because we must admit that over the 80 per cent of the patients we treat in private clinics are in fact CHRONIC ones, not just in an acute/subacute stage.....I wish they were though, because it will be much easier to treat them

[pudding_bowl]

Here in NZ CBT and chronic pain are covered in our training. So guess we are lucky in that regard. As far as articles go I can't think of any off the top of my head, I just use it as required. Mckenzie is brilliant and does have a fantastic method for involving the patient and using minimal force required. If your looking for information on graded exposure and graded activity then I suggest you research into david butler and laurimer mosely's work. They are brilliant with their chronic pain and have alot of info. Books such as explain pain are a good referance.

[quorthon]

mate i can give only respect to your country only because Mckenzie and Mulligan are from there!!! Both of them are genious in what they gave to our profession,especially the first....As far as concernerd the literature on chronic pain states, have u any other book recommendations on that field?? i mean,i also ve heard that the book "EXPLAIN PAIN" by Butler and Moseley is an excellent reference, but also that it is not so descriptive...For example the classic book "TEXTBOOK OF PAIN" by Wall and Melzack,u think is a good reference especially about chronic pain???

[pudding_bowl]

Sorry I haven't read 'textbook of pain'. Explain Pain was not written for therapists specifically - patients were supposed to be able to follow it also. I suspect this is why it may be considered as not descriptive. I have sent an email to a pain specialist friend of mine asking what he thinks good referances are. will let you know the reply.

[pudding_bowl]

Manage your pain - Michael Nicholas; Allan Molloy; Lois Tonkin; Lee Beetson

Aparently thats a good one.

[quorthon]

thanx mate!i will check it soon