Palliative and Supportive Care

Review Articles

A review of cognitive therapy in acute medical settings. Part I: Therapy model and assessment

Tomer T. Levina1 c1, Craig A. Whitea2 and David W. Kissanea1

a1 Department of Psychiatry and Behavioral Science, Memorial Sloan-Kettering Cancer Center, New York, New York

a2 School of Health, University of the West of Scotland, Ayr Campus, Ayr, Scotland

Abstract

Introduction: Although cognitive therapy (CT) has established outpatient utility, there is no integrative framework for using CT in acute medical settings where most psychosomatic medicine (P-M) clinicians practice. Biopsychosocial complexity challenges P-M clinicians who want to use CT as the a priori psychotherapeutic modality. For example, how should clinicians modify the data gathering and formulation process to support CT in acute settings?

Method: Narrative review methodology is used to describe the framework for a CT informed interview, formulation, and assessment in acute medical settings. Because this review is aimed largely at P-M trainees and educators, exemplary dialogues model the approach (specific CT strategies for common P-M scenarios appear in the companion article.)

Results: Structured data gathering needs to be tailored by focusing on cognitive processes informed by the cognitive hypothesis. Agenda setting, Socratic questioning, and adaptations to the mental state examination are necessary. Specific attention is paid to the CT formulation, Folkman's Cognitive Coping Model, self-report measures, data-driven evaluations, and collaboration (e.g., sharing the formulation with the patient.) Integrative CT-psychopharmacological approaches and the importance of empathy are emphasized.

Significance of results: The value of implementing psychotherapy in parallel with data gathering because of time urgency is advocated, but this is a significant departure from usual outpatient approaches in which psychotherapy follows evaluation. This conceptual approach offers a novel integrative framework for using CT in acute medical settings, but future challenges include demonstrating clinical outcomes and training P-M clinicians so as to demonstrate fidelity.

(Received October 02 2011)

(Accepted October 27 2011)

Keywords

  • CT;
  • P-M;
  • Acute medical settings;
  • Training

Correspondence

c1 Address correspondence and reprint requests to: Tomer T. Levin, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor New York, New York 10022. E-mail: levint@mskcc.org