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CBT Frontline Action for Long-Term Conditions and Palliative Care
A Guide for Care Professionals
Nigel Sage (Author), Andrea Edeleanu (Author), Michelle Sowden (Contributions by), Elizabeth Chorlton (Contributions by)
9781118769270, Wiley
Paperback / softback, published 13 May 2026
448 pages
24.4 x 16.5 x 3.3 cm, 0.658 kg
Apply CBT techniques to emotional challenges of long-term illness CBT Frontline Action for Long-Term Conditions and Palliative Care is a guide to the sensitive application of CBT to promote psychological well-being in people with life-changing physical illnesses such as cancer, diabetes, heart problems and multiple sclerosis. Living with a long-term condition or life-limiting illness brings challenges that extend far beyond the physical. For many people, emotional distress, unhelpful habits, anxieties, dilemmas, and setbacks become part of the landscape of daily life. Those providing care—whether in hospitals, community teams, social care, or specialist palliative services—encounter these difficulties every day, often without the psychological tools they wish they had. This book is written for those practitioners. CBT Frontline Action offers a practical, respectful way of bringing psychological understanding into routine clinical work. It is designed for busy professionals who want to respond more confidently and sensitively when distress gets in the way of treatment, recovery, or quality of life. Its aim is not to turn readers into therapists, but to help them use proven cognitive behavioural ideas in straightforward, timely ways that fit naturally into their established roles. Drawing on many years of practice in physical health, mental health, and palliative care, the authors describe a clear pathway for using CBT Frontline Action (CFA): how to spot when it may help, how to understand what is happening for the person in front of the practitioner, and how to choose small, focused interventions that can make a meaningful difference. The book is arranged in three parts: Throughout the book, collaboration, empathy, and the importance of working with, not on, the people being supported are emphasised. The authors also highlight the value of self-awareness and self-care for practitioners, recognising that emotionally demanding work requires attention to personal wellbeing. Whether working in health care, social care, or community settings, readers are encouraged to feel more equipped to respond to distress, more attuned to the psychological dimensions of illness, and more confident in the small actions that often make the biggest difference. Written by practitioners for practitioners, this book aims to support the shared endeavour of helping people live as fully as possible in the face of long-term and life-changing conditions.
List of Figures xi List of Tables xiii About the Authors xiv About the Contributors xv Acknowledgements and Foreword xvi Introduction 1 a. The Structure of the book 1 b. Defining terms 3 Part 1: The Practitioner Briefings for CBT Frontline Action Book structure 8 A. CFA in Your Work 9 More About Our Practitioner Characters 10 B. Is Using CFA in My Work for Me? 19 C. Preparing to Use CFA 25 D. Deciding to Use CFA 30 E. Action 1 – Identifying the Problem 33 Explaining the Model 34 F. Action 2 – Understanding the Problem Better 38 Five Areas Mapping 40 G. Action 3 – Agreeing a Goal and Action Plan 45 H. Action 4 – Session Structure 50 I. Action 5 – Applying CFA to the Plan 55 A Practicable Plan 55 Achieving Steps and Overcoming Obstacles 56 J. Maintaining Skills and Personal Wellbeing 60 Reflective Practice 61 Feedback 61 Clinical Supervision 62 Backup Support Promptly Available 62 Applying CFA to Teamwork 62 Skill Maintenance and Self- Care Checklist 63 Part 2: The CFA Manual Chapter 1: CBT and Long- Term Conditions 69 ‘It’s Not All in My Mind: It’s Real!’ 69 The Cognitive Behavioural Approach 71 The Relevance of CBT for People with Long- Term Conditions 75 Chapter 2: Does Cognitive Behaviour Therapy Work? – Researching the Evidence 82 Researching Your Patient 82 Do Psychological Therapies Work? 82 Assessing the Research Data 84 Applying Research Findings to Clinical Practice 87 The Effectiveness of CBT for Specific Conditions 88 Experimental Design in Clinical Practice 88 Some Clinical Examples 89 Ethical Issues in Psychological Research Interventions 92 In Conclusion 92 Chapter 3: Core Skills in CBT Frontline Action 97 Determining a Role for CBT Frontline Action 97 Communication Skills in Health Care 101 Specific Features of the CBT Communication Style 110 Guided Discovery: Using the Socratic Method 117 Chapter 4: Deciding to Use CBT Frontline Action 128 Assessment 128 Formulations 143 Putting the Assessment and Formulation to Work 178 Chapter 5: Goals, Purpose, Values and Hope 182 Goals and Action Planning 183 Purpose and Hope: Values and Wellbeing 194 Conclusion 201 Chapter 6: Bringing About Change and Sustaining It 202 Change, the Five Areas Model and Formulation 205 Methods of Behaviour Change 209 Methods of Cognitive Change 213 Dealing with Unpleasant Emotional and Physical Experiences 218 The Physical and Emotional Aspects of Living with an LTC 228 Resilience and Sustaining Change 236 Chapter 7: Supervision and Self- care 241 The Nature of Supervision 241 Setting Up Clinical Supervision 245 Self- Care 252 Part 3: The Toolkit: CBT Methods in Practice Section 1: Guide to Problem Identification and Decision- Making 257 How to Use This Part of the Book 257 Deciding on a Course of Action Decision Tree and 5 Step Assessment 258 5 Step CFA Assessment 258 The CFA Decision Tree 260 Problem Identification 261 Adjustment Difficulties 263 Altered Body Image 265 Altered Body Functioning 267 Anger 269 Anxiety and Stress 271 Avoidance 273 Breathing Difficulties 274 Concentration and Memory Difficulties 275 Denial 277 Dilemmas 279 Existential Distress 280 Fatigue 282 Fear of the Future 284 Inactivity 286 Indecisiveness 288 Intrusive/Distressing Thoughts 289 Lack of Motivation 291 Loss of Pleasure or Ability to Enjoy Things 293 Low Mood 295 Low Self Esteem 297 Negative Outlook 299 Pain 300 Panic Attacks 302 Physical Tension 304 Problem Solving Difficulties 305 Safety Behaviours 307 Setbacks and Illness Progression 308 Sleep Difficulties 310 Unassertiveness 312 Uncertainty 314 Worrying 315 Section 2: Techniques 317 Acceptance: Promoting Constructive Use 317 Activity Monitoring 319 Activity Planning 320 Assessing Psychological Distress 321 Attention Strategies 322 Behavioural Activation 324 Behavioural Experiments 325 Behavioural Rehearsal 326 Breathing Regulation 327 Challenging Unhelpful Thoughts 328 Consultation Skills 329 Continuum Thinking 330 Distraction 331 Drop Anchor 333 Effective Communication Skills 335 Emotional Expression 336 Environmental and Stimulus Control 337 Expressive Writing 338 Graded Activities 339 Health Condition: Enhancing Understanding 340 Imagery: Creating a Helpful Image 341 Mindfulness 342 Motivation Enhancement 343 Pacing 344 Problem Solving 345 Psychoeducation 346 Responsibility Pie 347 Socratic Questioning 348 Weighing the Pros and Cons 349 Section 3: Information Sheets 351 Antidotes to bad days 351 The Assertiveness Model 352 Assertiveness Rights 353 Bad old habits: avoiding relapsing into them 354 Behavioural Activation and depression 355 Body image changes 357 Breathing: learning self- help regulation 358 Change: motivation 359 Change: the desire for it 360 Change: the transition curve 361 Choice points: notes and an example 362 Coping with setbacks 1: Physical Health Setbacks 363 Coping with setbacks 2: mental attitude setbacks 364 Denial: advantages and disadvantages 365 Experiential learning cycle 366 Goal setting and the step- by- step approach 367 Goal setting: step ladder and stepping stones 369 Goal setting questions 370 Living in the here and now 372 Mental traps: 7 ways to escape them 374 Mental traps: examining the evidence 375 Mental traps: examples of how to get out of them 376 Mindfulness attitudes 378 Mindfulness exercises 379 Mindfulness: learning to be in the present moment 380 Mindfulness practice 381 Motivational enhancement 382 Pacing 383 Pacing examples 385 Personal development planner 386 The reactions of other people 388 Relaxation: mental exercise 389 Muscle relaxation exercise 390 Relaxed breathing exercise 391 The serenity prayer 392 Sharing and mixing with other people 393 SMART guidelines 394 Socratic questioning: examples 395 Values, valued direction and goal setting 396 A vicious cycle model of anxious avoidance 399 A vicious cycle model of anxious preoccupation 400 A vicious cycle model of hopelessness- helplessness 401 Wellbeing 402 Section 4: Record Forms 403 Thought Record 403 Pacing Record Form 404 Goal Planning: Step- By- Step Action Plan 405 CBT Diary 406 Activity Schedule 407 Choice Points 408 “Clean” Versus “Dirty” Discomfort 409 Maintenance cycle 410 Vicious Flower: Issue and Petals that maintain it 411 Illness coping strategies formulation 412 Motivation and Commitment Formulation 413 ABC Record Form 414 Personal Development Planner 415 Willingness- and- Action Plan 416 Daily Mood Record 417 Index 418
Subject Areas: Psychology [JM]
