SFBT – Solution Focussed Brief Therapy

I’ve recently been on a course on SFBT – Solution Focussed Brief Therapy. It was interesting. It makes initial construct sense to me… So some of my patients, family, colleagues and friends have already been practiced on … and they don’t even know it! It’s a different way for me to ask questions. A different bias to how I understand others. I already knew that not many people like being told what to do – even if they’ve asked for my opinion! True.

The main thing I got from the course is the re-phrasing of key questions so that whoever I’m talking to starts to come up with their own solutions. Less “I tell you what to do”… more “you tell me how you know when it changes.” I ask questions that facilitate you to come up with some of your own answers and strategies.

SFBT is not going to change any of the core physiotherapy diagnostic or treatments that I provide, but it’s already assisting me to understand people even better, so that I know how my skill my be of help or assistance.

Whenever I’m learning something new, it always seems to throw up more questions than answers. I have only found one research study(1) that specifically examines SFBT in musculo-skeletal physiotherapy (back & neck pain). It compares it to one exercise-based treatment intervention. The study shows that the exercise-based intervention (McKenzie) is more costly (due to increased number of appointments), but is also more cost effective. Although it is impossible to generalise results from one limited study, it says to me that there is no evidence to replace exercise-based physiotherapy with SFBT. I can find no information on combined treatment effects of both, as yet.

An article by Reiter(2) discusses how SFBT builds hope & expectancy. He cites Lambert (1992): Hope and expectancy has been reported associated with 15% variability of outcome from psychotherapy.  I would now know like to know how SFBT can affect placebo (percieved or actual improvement response) and nocebo (percieved or actual harmful or undesirable reponse) in physiotherapy.

So initial construct validity means I will try SFBT. I will suck-it-and-see in relation to musculo-skeletal physiotherapy, and in home/ family life. However, lack of robust evidence means I will also proceed with empirical caution and enquiry.

Further information on SFBT can be found on the internet – wikipedia gives a good overview.

1. Manca et al (2007) Randomised trial of two physiotherapy interventions for primary care back and neck pain patients: cost effectiveness analysis. Rheumatology 46(9): 1495-1501

2. Reiter (2010) Hope and expectancy in solution-focused breif therapy. Journal of Family Psychotherapy. 21(2): 132-148

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Writer’s cramp?

Lots of writing Christmas cards giving you a sore hand  and arm?

Are you pressing too hard when you write?

Some people find it really helps to use a felt tip pen instead … so that you can’t press hard (don’t smush the pen tip in either!!)

 

Breathing & Neck Pain

Some neck pains worsen by the type of breath you take. Shallow breaths overuse upper chest & neck muscles. Diaphragmatic breathing is gentle but deep “fill your belly” breathing.

“Diaphragmatic breathing” orabdominal breathing” or “tummy breathing” is the act of breathing deep into your lungs so that your abdominal area gently swells in a relaxed and smooth manner. Your diaphragm is a muscle. It is a flat disc-like structure that causes you to breath-in when it contracts. Gentle, relaxed, yet deep, breathing using your diaphragm is generally accepted to be the normal and natural way to breathe for a healthy person.

Diaphragmatic breathing is used as a therapy for many conditions and symptoms including chest conditions such as asthma, for hyperventilation, anxiety, stress & relaxation and for stuttering. I use diaphragmatic breathing to treat many musculo-skeletal pains – including neck pains and back pains. Many movement control classes also use diaphragmatic breathing e.g. yoga, tai chi, chi gung, and more.

Although the diaphragm is accepted to be your primary/foremost breathing muscle, many people have never been aware of how they breathe. I teach many, many people how to relax their upper chest and neck muscles when breathing and use their diaphragm instead. I have seen this make a big difference to their pain and symptoms.

Some people have just got themselves into a habit of breathing with their upper chest and neck muscles – possibly after a nasty chest infection, or after a period of stress, or because they often sit slumped and slouched. Other people have been tensing their abdominal area and this tension limits or stops them fully using their diaphragm to breathe. If this is the case, the abdominal tension may well need to be relaxed and released to allow diaphragmatic breathing.

Either way, if you’re not using your diaphragm in a gentle, full relaxed manner you may well be over-using other muscles. This can cause you pain, or this can increase the pain you feel from a different condition.

Is it worth thinking about and considering how you breathe?

Mindfulness

For me, mindfulness is a real-time meta-cognition.
It is the process of me thinking about and being quietly aware of my tension, emotions, positions, postures, movements, opinions and my actions. Quietly aware of them all, whilst they are taking place. Real-time thinking & awareness.

When I “remember” 🙂 to practice mindfulness I find that I am genuinely able to make a different choice e.g. choose to drink a glass of water, choose to sit upright but relaxed, choose to uncross my legs, choose to prioritise, choose to plan, choose to wait, choose to change posture…

There are many ways to learn mindfulness. I am not aware that one method of learning is any more powerful/ beneficial than another.
I have been listening to the podcasts “Zencast” – they have taught me a lot about mindfulness from one of the Buddhist perspectives. There are others.
Mindfulness also exists within mainstream healthcare, without using the Buddhist teachings.

Mindfulness seems to be one method that may help reduce pain (e.g. Zeidan et al (2010) Journal of Pain 11(3); Cusens et al (2010) Clinical Psychology & Psychotherapy. 17(1); ). Mindfulness may be a useful method to reintroduce physical-postural-movement balance during physiotherapy.

Low levels of mindfulness have been linked to traits within those that have chronic, on-going pain (e.g. Schutze (2010) Pain. 148(1)).

I am a more physical-postural-movement balanced person when I remember to use mindfulness.

It is a process and a challenge, not a habit as yet 🙂

Busy…

I’ve done it again. I get so busy rushing from place to place, different deadlines. I forget ‘me’. Time is my nemesis! I’ve only just realised, as I’m typing this, that my jaw is so tense. My teeth are clamped shut… I’m going to do the opposite … big wide silent-scream here I come. And another. And a third – this time with ‘surprise’ eyebrows. Laughing at myself now, but by-crikey I’m a heap more relaxed in those muscles.