Date of Award

2024

Document Type

Dissertation

Degree Name

Philosophy (Ph.D)

Department

Psychology

First Advisor

Wilson McDermut

Second Advisor

Raymond DiGiuseppe

Third Advisor

William Chaplin

Abstract

This cross-sectional study involving 156 clinicians explores the influence of personal factors on psychotherapy interventions and clinicians’ decisions to engage with individuals at the end-of-life (EOL) in psychotherapy. Extending qualitative research on perceived barriers to applying CBT in cancer care, this quantitative investigation delves into death anxiety, attitudes toward Cognitive Behavioral Therapy (CBT), and clinician distress tolerance in predicting the use, comfort, and confidence in applying cognitive restructuring (CR) with individuals at the EOL. Clinicians read a vignette of a terminally ill patient who is presenting as distressed and reporting several different irrational beliefs. Clinicians were then asked about their likelihood of using cognitive restructuring, comfort levels, and confidence in using these techniques with the hypothetical patient. Contrary to what was expected, death anxiety did not predict the use of cognitive restructuring at the EOL. However, death anxiety did negatively affect clinician comfort and self-efficacy using cognitive restructuring. Death anxiety also predicted clinicians’ likelihood of avoiding terminally ill patients seeking psychotherapy. Specialized experience with EOL patients predicted clinician comfort using cognitive restructuring but did not predict cognitive restructuring likelihood or confidence, highlighting the impact of exposure and practice on comfort while raising questions about practicing EOL clinicians’ preferred techniques and concerns about CR. Theoretical orientation (CBT) emerged as a predictor of cognitive restructuring outcomes. Older clinicians exhibited lower death anxiety and positive associations with cognitive restructuring outcomes. Clinicians reported concerns about using cognitive restructuring with EOL patients, including fears of committing empathic failures. The study emphasizes the need for nuanced training programs fostering the empathic application of cognitive restructuring and teaching diverse versions of this technique for those who want to build their skills and comfort in this domain. The author calls for further research on best practices in psychotherapy with EOL populations and advocates for developing core competencies in CBT and EOL care. Limitations included a focus on cognitive restructuring, a hypothetical clinical encounter, and potential sample bias. Practical implications underscore the potential for improved education and training to enhance the quality of EOL care and address existing gaps in clinicians’ understanding and application of psychotherapeutic techniques.

Download

Share

COinS