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Am Fam Physician. 2002;65(9):1934

As persons live longer, the prevalence of chronic medical diseases is increasing. Patients who have chronic medical problems have to cope with uncertainty, periods of debilitation, and demanding treatments. Adjusting to chronic illness can be difficult and can lead to dysfunctional psychologic symptoms that may be associated with physical morbidity. White reviewed cognitive therapy principles that can help family physicians better manage patients with chronic illnesses.

Cognitive therapy is defined as “a focused, structured, collaborative, and usually short-term psychological therapy that aims to facilitate problem solving and to modify dysfunctional thinking and behavior.” This type of therapy has documented success in dealing with mood disorder and fatigue. Self-management and collaboration are important principles of therapy and emphasize building skills with which the patient can manage psychologic problems. A key principle of cognitive therapy is recognizing the interrelationship of behavior, mood, thoughts, beliefs, and physical feelings.

Cognitive therapy sessions usually include homework that involves cognitive and behavioral strategies designed to diminish factors that cause symptoms and help the patient control both physical and psychologic feelings.

Four techniques can be used by primary care physicians to care for patients with chronic diseases: agenda setting, self-monitoring, experimentation, and changing distressing thoughts. Agenda setting involves a collaborative determination between the physician and the patient of the priority of the patient's chronic problems. This helps the physician identify a starting point and assures that the patient's most pressing needs are addressed. Another technique is self-monitoring, which involves having the patient keep a diary to record activities, physical symptoms, or psychologic symptoms that are important to the patient. Patients can also keep a log of subjective feelings and responses to symptoms. This type of homework assignment compiles information that helps the physician learn ways to improve the patient's self-management with education or specific interventions.

Experimentation is a therapeutic intervention that monitors a patient's feelings that they may not have recognized. The final technique is changing distressing thoughts, which involves offering simple techniques to relieve some distress by helping patients question distressing thoughts and challenging them with alternative thoughts. Self-help cognitive therapy manuals are available that assist patients with this strategy.

Referral for cognitive therapy is most useful for patients who have someone who can identify and differentiate their emotions and behaviors, and recognize that they can have a positive impact on their own problems. The Academy of Cognitive Therapy ( offers information about certified cognitive therapists.

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