What are the top three things that therapists could do in cognitive behavioral therapy?

Question:

Shelly Massingale, PT, MPT: “So there was another question about a lot of us on here are therapists and we may not have access to neuropsychology or psychologists. So, what would be your top three things that therapists could do to help these patients? Is there really basic CBT training is one question that was asked.”

Answer:

Jamie Pardini, PhD: “So when somebody asked that question, I actually did a little quick search and there are conferences that are PT/OT based that do have speakers that come in and talk about basic CBT principles. There are also online webinars that talk about it a little bit. And even the Beck Institute offers a course for other disciplines to understand the basics of cognitive behavioral therapy. So I think you don’t want to be that kind of therapist, but understanding the importance of how and you already do this. So it’s kind of like rephrasing it.

So understanding how to explain to people that emotion affects behavior affects how you think. So when I have a headache, I think, “I’ll never get over this concussion, I’ll never be back to normal, this is terrible.” And then the minute I think that, I go eat a bag of potato chips, and then I feel horrible about myself, because I don’t have any self-control and well, now, I’m going to be overweight and I can’t control this. And it’s just this spiral of no matter where you start, the behavior or the emotion or the thought, we get wrapped up in that. And the goal of CBT is to find multiple places and multiple ways to address that. So I think just having some basic training and just looking for those opportunities in a general therapeutic way.”

Stanley Herring, MD: “Yeah, Shelly, I have an analogous situation with most of physical therapists. I’m not a mental health provider, but I find it my responsibility to try to set the patients up for success. So I think for physical therapists, the first thing to do is you have to know the material. This is not a topic for dilettantes. So understand, know all the material about recovery for mild traumatic brain injury and the timeline in which it happened. Second thing is I think physical therapists and physicians can be helpful in the unlearning process. So ask the patient in their own words to explain to you what the matter with him is, and then help them understand which parts of that may be grounded in fact and which may be belief systems that they can work upon. You do that while continually validating their suffering.

And then the third thing you do is know your business, that it is safe to do early activation. It is safe for them to go outside, to do some scores. They’re not going to damage their brain more if they read a book. If you want to delve into the world of Jamie and Donna and they’ve spent a lot of time getting good at it, I’m careful not to overstep my boundaries. You also have to understand it changes your role. You cannot be a healthcare provider and a therapist. It’s two different roles. If you want to start exploring those questions, I know everybody says they don’t have access to mental health providers. Go find one that knows this, go find your Jamie or Donna, and sit down with them and ask them what you can do to help the patient. They’re the experts. So what questions can I ask, what part of CBT would you be comfortable with me doing, and then I know everybody says it’s hard to find a mental health provider, but look harder. If your practice is full of these patients, you’re not going to get them better by yourself.”

RESOURCES & LINKS:

  • This Q&A is an excerpt from the Concussion Health Summit Sessions
  • The Concussion Health Summit Sessions are included with 360NeuroGO Enterprise

FACULTY:

Donna Broshek, PhD, ABPP-CN

Donna Broshek, PhD, ABPP-CN, is the John Edward Fowler Professor of Psychology. She directs the Neurocognitive Assessment Lab and co-directs the UVA Acute Concussion Evaluation Clinic. Although she sees patients with multiple medical and neurologic issues, her clinical and research interests focus primarily on epilepsy and sports concussion. She is on the professional advisory board for the Epilepsy Foundation, is past-president and board member of the Sports Neuropsychology Society, and is a member of the NBA Concussion Committee. Dr. Broshek is also a founding member of the executive committee of the International Congress for Athlete Brain Health. 

Stanley Herring, MD

Stanley A. Herring, MD, is senior medical advisor and co-founder of The Sports Institute at UW Medicine, Co-medical director for Orthopedic Health and Sports Medicine for UW Medicine, and co-medical director of the UW Medicine Sports Concussion Program. Dr. Herring is one of the team physicians for the Seattle Seahawks and the Seattle Mariners. His clinical practice focuses on the diagnosis and non-operative management of neurological and musculoskeletal injuries, particularly focusing on spinal disorders in active people and athletes as well as sports-related concussions. Dr. Herring is a clinical professor in the Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery at the University of Washington, Seattle and holds the Zachery Lystedt  Sports Concussion Endowed Chair. His philosophy is to provide kind and compassionate care that focuses not only on the relief of pain and suffering, but also helps patients return to activities that give them quality of life.

Jamie Pardini, PhD

Dr. Jamie Pardini is a Neuropsychologist and Clinical Associate Professor at the Sports Medicine and Concussion Specialists division of Banner University Medical Center-Phoenix. Prior to arriving at Banner, Dr. Pardini was Assistant Professor and Neuropsychologist for the Department of Neurological Surgery at the University of Pittsburgh Medical Center. She began her post-doctoral fellowship and academic career at the University of Pittsburgh Medical Center Sports Medicine Concussion Program, where she spent more than 9 years working solely with sport-related concussion and mild traumatic brain injury, managing the care and return-to-play of thousands of athletes.

Shelly Massingale, PT, MPT

Shelly Massingale is the Service Line Administrative Director for Sports Medicine at Banner in Arizona. She is a specialist in vestibular and balance therapy. Shelly has been practicing physical therapy in the outpatient neurological setting for 22 years and has specialized primarily in mild traumatic brain injury since 2013. Since opening the Banner Sports Medicine and Concussion Center in 2013, she has focused her treatment and research solely on concussion. She is a co-developer of the Concussion Balance Test (COBALT) and has published articles that explored the utility of COBALT as an objective measurement of balance for the healthy and injured athletic population. 

Bridgett Wallace, PT, DPT

Bridgett Wallace, PT, DPT, has a doctorate of physical therapy and holds competency-based certifications in vestibular rehabilitation and concussion management. Dr. Wallace has been treating patients with dizziness and balance disorders for more than 20 years and is the founder and President of 360 Balance & Dizziness – a specialty clinic for the evaluation and treatment of dizziness and balance disorders that includes both audiology and therapy services. She is also the co-founder and Director of Clinical Education for 360 Neuro Health Institute, which provides online, mobile, and live educational offerings for healthcare providers.