1. What is CBT?
Cognitive-behavioural therapy (CBT) is a short-term, evidence-based approach focused on providing the client with coping skills to manage their difficulties more effectively. CBT focuses on the way people think about things(including their attitudes and beliefs) and the way they do things. CBT helps people identify where their thoughts and actions are self-defeating, and then to replace these "bad habits" with more helpful thoughts and responses. In doing so, CBT has been proven to be the most effective intervention for problems such as depression, anxiety, panic, stress, insomnia, relationship difficulties and coping with chronic illness such as pain.
CBT is also effective for the management of problems with a physical cause, such as chronic pain. Indeed, a cognitive behavioural approach is recommended by Workcover in their recent document, "Work Related Activity Program (WRAP): For the prevention of long-term disability in workers with injuries (non-red flag)". This document reflects the findings of the research, which states that psychosocial factors have a far greater influence on functional and RTW outcomes than does the severity of injury. The document states that workers who have been off work for 12 weeks following a physical injury should be considered for CBT to maximise the chances of a successful RTW.
2. What does the pain management program involve?
The cognitive-behavioural approach to pain management involves examining and then changing unhelpful thoughts, beliefs and behaviours that may be affecting the client’s ability to manage their pain and associated problems. The treatment will not provide a cure for their pain, but a way of coping despite the pain, aimed at minimising its effect on the client’s life.
Treatment is typically aimed at:
- educating clients about the nature of chronic pain and the associated problems
- establishing functional goals
- upgrading their activities gradually and systematically
- reducing clients’ reliance on medications and rest to manage their pain
- learning techniques to remain calmer during flare-ups in pain
- challenging the unhelpful beliefs that typically develop with a pain condition
- minimising pain-related distress
- improving sleep
Useful information you can give your clients.
3. What is pacing?
Clients with chronic pain often find themselves in what we call an “overactivity/underactivity” cycle. They do more activity on their “good days” when their pain is lower, but then their pain is aggravated because they have overdone it and they require more rest and/or medications to recover from their burst of activity.
Pacing is a pain management technique aimed at teaching clients to plan and spread activities evenly over the day and week so that flare-ups in pain are minimised. Clients are also taught to gradually and systematically increase the amount of activity performed. Another important aspect of pacing is taking regular short breaks before the pain becomes very strong, and alternating between tasks and activities as required.
We encourage clients to pace all of their activities (at home and at work) in order to obtain the full benefit of this technique. If you are developing a return to work plan, it is important that you are aware of the client’s current tolerances (which can be found on their pacing plan), so that this can be incorporated into the return to work plan. When this doesn’t occur, clients often become very confused and unsure as to what to do.
4. What is exposure therapy?
Exposure therapy is a very important component of treatment for overcoming anxiety. It involves the client gradually and repeatedly exposing themself to situations and activities that they have been avoiding so that they learn to manage their anxiety. Whilst understandable, avoidance actually serves to maintain the fear cycle because the client never learns that their feared outcome is highly unlikely. Using graded exposure therapy, in conjunction with challenging unhelpful thoughts, the client gains confidence with each stage and can return to doing all of the things that they have been missing out on.
In a less structured way this is also part of our programs for chronic pain. When we gradually encourage clients to engage in more activities (which may include returning to work or attending a gym program), they are learning that they do not have to be fearful of the pain and that they can cope with their pain.
5. Can you help clients with specific pain conditions (e.g. tennis elbow)?
Our pain management program is appropriate for clients with persisting pain, regardless of their specific condition. It is generally important that the person has completed any intensive medical management of their condition prior to being referred, and that it is medically appropriate for them to gradually increase their activity levels. If this is the case, all of the usual pain management strategies can be safely and effectively taught to them.
6. When should the client start an active exercise program?
If it is medically appropriate, the psychologist may recommend an active exercise program for clients with chronic pain. Such programs focus on physical upgrading despite persisting pain, and this together with cognitive behavioural therapy is likely to assist the client to return to work faster and more successfully. Typically, we recommend that the exercise program begin 2-3 weeks after the commencement of pain management treatment, to ensure that the client has been provided with adequate education about their pain and associated problems and to prepare them for the exercise program.
7. How long does treatment take?
There is no “magic” number of sessions or a set length of treatment. In general we provide a short-term intervention, and typically we see clients for 10-15 sessions on a weekly or fortnightly basis. This will vary from person to person depending on factors such as the number and complexity of the client’s presenting problems and how quickly the client begins to apply the strategies taught in sessions.
8. What happens if the client is not complying with treatment?
We expect our clients to participate actively in their treatment, to attend appointments regularly and punctually, and to comply with the home tasks assigned between appointments. If the client is demonstrating a consistent failure to participate effectively in their treatment, this would necessitate a thorough review of their treatment plan. This would be addressed with the client and with the other treatment providers involved in the case. The psychologist will only continue with sessions if the client can demonstrate active participation in their psychological treatment.
9. How will I find out about the client’s progress?
We emphasise a collaborative approach and we pride ourselves on keeping up frequent communication with the other treatment providers involved in our client’s case. The psychologist will provide the initial assessment report within one week of assessing the client, and once treatment commences a progress report will be provided at least every five sessions and there will also maintain regular contact via e-mails and telephone calls.
10. When is a case conference helpful?
Case conferences can be very helpful when there are numerous treating professionals involved in the client’s treatment, and particularly when there are significant obstacles to the client progressing or when the client is receiving inconsistent advice from their various treating providers. The client’s treating psychologist can offer an invaluable perspective in this regard, and we therefore welcome the opportunity to be involved in this process.
11. Does cognitive-behavioural therapy work when you use an interpreter?
CBT can definitely work when using an interpreter, and in fact, we often work with interpreters. It is worth noting that typically more sessions are required when treating non-English speaking clients as the communication of treatment concepts takes longer when an interpreter is being used.
12. How do I refer?
Referring your client is simple! Please fill in the details in the online referral form, or alternatively if you would like further information please contact us on 9231 2522 and we will be able to provide you with some assistance or direction.
13. How do I ensure that the client is seen as soon as possible?
To ensure your client commences their treatment program as soon as possible, we recommend that the rehabilitation provider sends or faxes us a copy of the written approval from the insurer. We will then be able to proceed with the referral within 24 hours of receiving the written approval. In cases where there is no written approval from the insurer, we recommend that the rehabilitation provider advises the insurer of the referral immediately so that we can follow up with the insurer for treatment approval. We also recommend that the rehabilitation provider and insurer communicate on a regular basis regarding the clients’ progress.
14. What is the cost of a treatment session?
A 50 – 60 minute session is $192+GST (Based on the Australian Psychological Society's recommended fee)
15. What happens if a client cancels an appointment?
A cancellation fee applies to appointments that are not attended, cancelled or re-scheduled without sufficient notice. Insurers will be billed according to The Australian Psychological Society recommended guidelines.
These fees are as follows:
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0-24 hours notice
25-48 hours notice
49 hours-4 days notice
Over 4 days
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Full hourly rate
50% of the hourly rate
25% of the hourly rate
No cancellation fee applies
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It is essential that your client notify the practice as soon as possible if they are unable to attend an appointment. Cancellation of three appointments or more could result in termination of your client’s treatment program.
In cases where sessions are able to be re-scheduled for the same day, or if your psychologist is able to schedule in another appointment for the cancelled time slot, no cancellation fee will apply.
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