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Thoughts about CBT and behavior change (Long)

Posted by gardenergirl on December 4, 2004, at 21:54:28

In reply to Re: What type of therapy helps Hypochondria (Long), posted by Emily Elizabeth on December 4, 2004, at 13:22:02

I agree with Emily Elizabeth that it could be the individual T versus the approach that is hard for you. And meds can help, as hypochondria has a strong component of anxiety to it. The anxiety just manifests in physical symptoms. At least that is the theory.

It's also important to have a family doctor or internist who is sensitive to your condition and not belittling. And someone who will be able to work with you to determine what is a real physical worry and what is part of the hypochondria.

I think someone else said that your recognition of hypochondria is a huge step. Many who have this do not know or do not acknowledge it to themselves, which is part of the disorder. So good for you.

I think perhaps it might be helpful for you to share your questions, maybe even your post, with your T. Perhpas she is moving you along in an action phase when you are not quite ready for it. There is a model of change of behavior put out by Prochaska and DiClemente which is well known in addiction circles, but also has great value in any kind of behavior change. It looks at change as a series of stages.

1. Precontemplation: this is when the client is not aware of or denies that the behavior is a problem. No change will happen here until the T helps the client move to contemplating the pros and cons of the behavior. Most people are not in therapy at this stage unless they are forced to go for some reason.

2. Contemplation: In this stage, the client accepts that the behavior might be a problem and is beginning to consider changing it. It's important in this stage to highlight how making this change will affect things...what are the beneficial consequences AND what will be lost. For example, in someone who is trying to stop smoking, what might be lost is social contact with others on smoke breaks, the temporary good feeling that accompanies smoking a cigarette, and a sense of control that comes with the ability to smoke to deal with stress. The benefits of course are numerous (I'm a non-smoker).

3. Preparation: This stage occurs when the client has made a committment to change, and is beginning to gather information about how to go about doing it.

4. Action: This stage is when the actual behavior change plan is worked on actively. It sounds like this is where your T is. If a client is moved into action when they are still contemplating or preparing, it can be quite frustrating and seen as resistance by the client. When, IMO, it is a failure on the part of the T to accurately assess what stage the client is in.

5. Maintenance: This is when the behavior has changed, and the goal is to maintain the gains made.

6. Relapse prevention: This stage is important in that it acknowledges the power of the old behavior, and plans for how to handle relapse and prevent it if possible. What I like about it is that it doesn't view relapse as a failure but rather as a stage. If it occurs, you just move back through the stages...maybe back to action, maybe further back, depending on the severity.

I hope this is helpful and that you are not now asleep at your screen. :) But I find it very helpful to use this model to assess with clients where they are before jumping into action. Just because someone comes to therapy doesn't mean they are ready to jump into behavior change. There is sometimes motivation work or mourning of a past lifestyle or behavior that needs to occur first.

Good luck to you. I applaud your work on this, as it is not easy.





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