Behavioural Therapy

<中文版>

• Life style modification
• The BATHE technique
• Cognitive behavioural therapy

Life style modification

A musculoskeletal physician can provide a simple framework to encourage patients to adopt a healthy lifestyle whether or not they have a particular musculoskeletal disorder. Patients can receive advice, education, guidelines and support to achieve better basic lifestyle factors, namely nutrition (weight control, low fat/cholesterol diet, high fiber); to avoid or moderate potential harmful substances (tobacco, alcohol, caffeine, sugar, salt and social drugs); to initiate or maintain exercise and suitable physical activities, interesting hobbies, relaxation techniques.

Lifestyle habits that have developed over many years can be very difficult to change even when the patient is well motivated to change. A musculoskeletal physician can use a variety of instructional, motivational and behavioral techniques to motivate and support them with a lifestyle change program.

The BATHE technique¹

This is a psychotherapeutic interviewing technique that a musculoskeletal physician can use to manage patients who are depressed or emotionally distressed with the chronic pain or disability. The acronym BATHErefers to the components of the interview which consists of 4 specific questions about the patient’s background, affect, troubles and handling of the current situation followed by an empathic response.

The BATHE technique embodies many essential elements of successful psychotherapy, including establishment of a therapeutic alliance, empathy, identification of the central conflict, the development of insight and awareness, the discouragement of dependency and encouragement of adaptation and establishment of realistic coping strategies.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is the term for a number of therapies that are designed to help solving problems in people's lives, such as anxiety and depression. CBT was developed from two earlier types of psychotherapy:

• Cognitive therapy, designed to change people's thoughts, beliefs, attitudes and expectations.
• Behavioural therapy (also called behaviourism), designed to change how people act.

It is believed that the way we think about a situation affects how we act. In turn, our actions can affect how we feel and think. It is therefore necessary to change both the act of thinking (cognition) and behaviour at the same time. This is known as cognitive behavioural therapy.

CBT can help people to make sense from overwhelming problems by breaking them down into smaller parts: the situation, the thoughts, the emotions, the physical feelings and the actions. This makes it easier for the patient to see how these small parts are connected and how they are affecting him/her. CBT aims to get the patient to a point where they can "do it yourself", and work out their own ways of tackling these problems.

CBT is useful in breaking the pain-distress-pain vicious cycle that is commonly found among chronic pain patients. A musculoskeletal physician can use CBT to change these chronic pain patients’ mind-set and so change the way they feel and react to the chronic pain.

References:

1. Lieberman JA, Sturat MR. The BATHE method: Incorporating Counseling and Psychotherapy into the everyday management of patients. Primary Care Companion. J Clin Psychiartry 1999;1:35-38

行為治療

• 調整生活模式
• BATHE輔導技巧
• 認知行為治療

調整生活模式

不論病人是否有肌骼毛病，肌骼科醫生都會為他們提供一個簡單易明的指引，鼓勵他們採取一些健康的生活模式。病人可以得到一些建議、教育、指導和鼓勵支持，通過以下幾方面達到一個較健康的生活方式：

1. 飲食營養：即體重控制、低脂肪、低膽固醇及高纖維的飲食；
2. 預防接觸有害物質：即煙草、酒精、咖啡因、高糖份食品、高鹽份食品和毒品；
3. 開始及保持適當的體育運動，培養業餘興趣，學習放鬆技巧。

一些舊的生活模式因沿用多年，即使病人努力嘗試亦難以改變。肌骼科醫生可以運用各種指導性、激發性及行為科學的技巧，透過一些生活模式改變計劃去鼓勵和支持病人作出生活模式改變。

BATHE輔導技巧¹

這是肌骼科醫生常用的一種心理治療技巧，可以用來幫助情緒受困擾的慢性痛症患者或殘疾病人。BATHE是縮寫，包含了治療技巧中對病人發出的4個具體問題，包括病人的背景 (Background)、情緒 (Affect)、困擾 (Troubles)、對目前情況的處理 (Handling)，最後用同理心真誠回應病人(Empathy)。

BATHE輔導技巧涵蓋了心理治療中許多的成功重要元素，包括與病人建立一個有效的治療夥伴關係、找出問題及核心衝突、運用同理心、讓病人更了解自己、拒絕病人的依賴，並鼓勵病人建立適應現實處境的應對策略。

認知行為治療

認知行為治療（CBT）是一系列的治療方式，旨在幫助病人解決日常生活中出現的問題，例如焦慮和抑鬱。CBT是由兩種心理治療技巧發展而成的：

• 認知治療法，旨在改變人們在不同處境的思想、信念、態度和期望。
• 行為治療法（也稱為行為主義），旨在改變人們的應對行為。

人們對處境的想法與認知會影響他們如何以行為應對處境。反過來說，我們應對處境的行為與反應可以影響我們的感受和想法。因此，當我們需要改變行為的時候，亦需要同時改變我們對處境的認知與思維。這就是所謂的認知行為治療。

CBT可以幫助病人從棘手難題中抽絲剝繭，把問題分拆成較小的部分：現實形勢、對事情的看法、情緒反應、身體的相關生理反應和最終的行動。這樣可以讓病人更容易理解這些細小部分如何互相聯繫，以及如何影響病人。 CBT的最終目的是讓病人可以自助，合理制定自己的方式來處理生活上的種種問題。

慢性痛症的病人常常被困於"疼痛---困擾---疼痛"的惡性循環中。肌骼科醫生可以使用CBT幫助病人打破這些惡性循環，改變病人的思維方式，從而調節他們應對慢性疼痛的感受和反應。

參考文獻:

1. Lieberman JA, Sturat MR. The BATHE method: Incorporating Counseling and Psychotherapy into the everyday management of patients. Primary Care Companion. J Clin Psychiartry 1999;1:35-38