Costos del servicio de la Planta Turística de Salaverry

An overview of the therapeutic components in the 70-page pilot manual is as follows: using the biopsychosocial framework, sessions one and two focused on psychological interventions, sessions three and four focused on physical interventions,

and sessions five and six focused on social interventions. These were presented in a sequence designed to encourage logical sequential engagement by group participants.

7.7.1.1 Session one: acknowledging distress and increasing an awareness of strengths.

The purpose of session one was to help participants to identify their presenting problems and reinforce their existing personal strengths. Furthermore, it was the aim that at the end of the first session, participants should feel that attending further sessions would be helpful for their particular situation and circumstances. Also, the group setting should provide a place where they would experience an empathic understanding of their CHC.

Session one’s therapeutic content explored finding solutions to current problems based on past successes. This began with the identification of current issues and difficulties. Next, participants identified past difficulties they had faced effectively including the approaches used to successfully manage their situation. The next part of the activity explored participants’ values and beliefs which they may have abandoned or neglected in their current circumstances, possibly due to their health issues.

Towards the end of the session, the biopsychosocial model was introduced with an explanation as to how this is linked to health. An explanation of how health is impacted in a complex and dynamic way rather than considering CHC in a strictly biomedical framework was highlighted for participants.

The Development of the Treatment Manuals 67 7.7.1.2 Session two: Psychological and physical stress. Strategies to

assist building strength and resilience.

Session two had multiple aims. Firstly, it was designed to reinforce an awareness of personal strengths that was discussed in the previous session. Next, it attempts to further aid participants to view or construct a future that focused on the positive aspects of their lives. Also, participants would have observed others living with a long term illness and recognised their choices, despite the limitations of living with a CHC. Another aim of session two was to introduce concepts that linked psychological well-being to physical health. Further, the session was intended to facilitate positive behaviour change through promoting an increased awareness of the reciprocal

relationship between the mind and body, as explained by the biopsychosocial model. The therapeutic content of session two began with the Magic or Miracle question (de Shazer, 1988). In particular, the Miracle question explored existing strengths and resources, and applied these to current difficulties faced by the participants. The next therapeutic tools used in the session consisted of psycho-education using the

biopsychosocial model; learning the relationship between chronic stress, anxiety and depression; and the situations or events that exacerbate stress and impact on CHCs. Finally, diaphragmatic breathing, the first physical therapy component of the biopsychosocial framework, was introduced.

7.7.1.3 Session three: strategies for managing stress and distress.

Session three reinforced the physical component of the biopsychosocial model. This session aimed to increase the ability to attend to relaxation activities. Thus, participants experienced first-hand, the concept and physical benefits of relaxation, and

learned how to activate a relaxation response. Although it would not make the issue of living with a long term illness go away, reducing stress would help make a CHC more tolerable, as well as assisting participants to develop a sense of control in increasing their sense of well-being.

Session three’s therapeutic content was solely based on learning the relaxation techniques of progressive muscle relaxation and visual imagery relaxation. These include the Sunlight Meditation (Bourne, 2005 ) and A Walk in the Country (Lorig et al., 2006).

Being able to maximise one’s potential and gain a sense of self control, despite a health condition, is a dynamic and continuing process. The aim was that relaxation techniques would demonstrate the relationship between mind and body. In addition, it gave a practical demonstration of physiological changes which occur when people intentionally attempt to relax.

7.7.1.4 Session four: biofeedback.

The therapy content of session four focused entirely on a practical demonstration of using a biofeedback machine to illustrate powerfully, an individual’s ability to have some control over physical aspects of their health and body.

7.7.1.5 Session five: communication with health professionals and identifying barriers to implementing change.

Under the biopsychosocial framework, sessions five and six focused on social support. The focus in session five was on acquiring knowledge and social skills which would reinforce a participant’s ability to be responsible for their self-care and well-

The Development of the Treatment Manuals 69 being. Another aim was to empower participants to access required health information and to use this to make informed decisions. Thus, participants would actively manage their care, and persist in obtaining quality services from health providers by

strengthening their sense of participation during interactions with health care providers. Part of session five’s therapy components was learning the acronym P.A.R.T. (Prepare, Ask, Repeat and Take Action) (Lorig et al., 2006). The next therapeutic intervention brainstormed health care system hints, and shared thoughts and ideas to assist in managing appointments and health care services. The final therapeutic intervention of the session was an introduction to the Stages of Change Model (Prochaska, Di Clemente, & Norcross, 1992).

7.7.1.6 Session six: building support.

The aim of session six was to consider the social support that participants gained in the group context, and to facilitate discussion about increasing positive social support in their personal lives following group completion. The session also focused on

reviewing topics, ideas and skills that had been discussed and implemented throughout all the sessions.

The therapeutic content of this session focused on further developing existing social support. Participants considered a range of enjoyable leisure and recreational activities they could pursue to create opportunities to increase contact with others, and develop opportunities to improve their social support. Participants role-played scenarios and practiced using social skills. Finally, to end the session, a discussion was held on the positive changes that had occurred as a result of living with a chronic illness. The

session and group therapy closed with a discussion of highlights and a certificate (Appendix C) presentation.