Moorey, S. (2013). “I know they are distressed. What do I do now?” Psycho-Oncology,22, 1946-1952.
Journal Website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611
Author Website: http://www.national.slam.nhs.uk/stirlingmoorey/
Stirling Moorey has been at the forefront of psychotherapy research in palliative cancer care, and he is particularly known for his work in cognitive behaviour therapy (CBT). In this personal perspective, Moorey describes the evolution of psychotherapy research in oncology as a movement through three phases. The first consisted of identifying the prevalence of psychosocial problems and the corresponding need for interventions. The second, which is still in early stages but is making great strides, has tested treatment protocols derived from mental health research, as well as those developed specifically within cancer care. The third phase has to do with the dissemination of effective interventions, which in a Canadian context would be known as knowledge translation. Like other guidelines for screening and intervening with distress, including CAPO’s own depression guideline, Moorey proposes a stepped-care approach for people who have psychological problems of differing severity. Some basic communication skills should be part of the training of all professionals, but brief psychotherapy, internet, and telephone counselling have a place for providers with additional expertise. Patients with the most serious difficulties should be seen by team members with some specialization in mental health.
Importantly, Moorey introduces the concept of “first aid CBT,” which comprises a core set of therapeutic techniques for defining and explaining problems, devising simple behavioural experiments, and applying time-limited problem-solving. In Moorey’s opinion, this type of approach can be implemented by various members of the treatment team, and is even applicable in palliative care. Moorey, a psychiatrist, then describes the success of his own recent research in training nurses in the model.
Why I like this article: The tone of this paper is one of thoughtful reflection as it provides a personal overview of the literature; it is not intended to be a rigorously scientific systematic review. However, it outlines a sensible and practical way to conceptualize how to intervene with distressed patients. Since CBT is currently the predominant form of psychotherapy in the community generally, there is a place for more clinicians in cancer care to have a basic sense of how it works and how it can be applied to their patients. First aid CBT is probably a concept whose time has come.
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