Medical illnesses often have a stress component. Illnesses will flare up at times of emotional stress. Psychological stress impacts the physical body. Psychological stress uses up different nutrients, it alters our habits, it changes appetite and sleep patterns, it changes the immune system.
There are ways to evaluate the impact of stress on the body. By evaluating the stress someone is exposed to, it's possible to develop a plan to manage the stress better and to reduce the medical symptoms. Tracking when symptoms occur can clearly document for someone the link between the stressful experience and the physical manifestations of stress.
A number of medical conditions have a stress link. These are as common as neck and back pain, difficulty sleeping, or headaches, to less common problems of gout, hypertension, irritable bowel syndrome, asthma, and increased susceptibility to colds or flu. Working with a health and medical psychologist can help to document the links between stress and physical symptoms, devise a treatment plan to manage the symptoms better, devise a plan to manage the stress better, and to decrease the actual illness in the process.
Monday, May 24, 2010
Friday, May 21, 2010
Rewiring the brain
The brain rewires itself in relation to environmental experience and things it must attend to. The brain adds neuro-linkages to those areas. The areas expand and develop in relationship to how often they are used. This is extremely important and valuable information in relation to things like learning new tasks, recovering ability following injury or accident, or dealing with psychological conditions like depression and anxiety.
People develop habits. Those habits become wired through neural networks in the brain. As the habits are practiced, the wiring is strengthened. Other nearby areas of wiring don't get as much practice and eventually fall into disuse and are taken over by areas that are used. If we want to change habits it's important to practice and pay attention to the new habits that are developing.
If I want to learn a new software program and I practice it, eventually it will become easier to use. My brain will develop wiring attached to finger motions, eye movements, sounds in the environment, and will allow me to both smooth out the movements and make them effortless. If I want to become less depressed or anxious I can apply the same strategy to change the focus of my thinking, relabel my thoughts, and rewire the previously laid down wiring and learn new ways to mange what is happening. If I want to improve a skill, like memory, music, math, or general knowledge, then I have to practice it daily for a period of about an hour or so. After somewhere between 5 weeks and 6 months I should be able to see substantial improvement in that area. That means that I'm likely to need to track what I'm doing to be able to notice the changes. Getting baseline data and noticing incremental improvement will help me to stay with the process and keep on task. If I'm trying to change to something new from something I used to be able to do, I'm going to have to practice and also avoid doing all the old behaviors. The more I practice, the easier and smoother the transition.
Part of my current work involves setting up sequences, tracking systems, and reinforcement systems for people who want to learn new behaviors, rewire after something has happened, or change to something different.
Feel free to contact me for more information.
DonohueMA@aol.com
People develop habits. Those habits become wired through neural networks in the brain. As the habits are practiced, the wiring is strengthened. Other nearby areas of wiring don't get as much practice and eventually fall into disuse and are taken over by areas that are used. If we want to change habits it's important to practice and pay attention to the new habits that are developing.
If I want to learn a new software program and I practice it, eventually it will become easier to use. My brain will develop wiring attached to finger motions, eye movements, sounds in the environment, and will allow me to both smooth out the movements and make them effortless. If I want to become less depressed or anxious I can apply the same strategy to change the focus of my thinking, relabel my thoughts, and rewire the previously laid down wiring and learn new ways to mange what is happening. If I want to improve a skill, like memory, music, math, or general knowledge, then I have to practice it daily for a period of about an hour or so. After somewhere between 5 weeks and 6 months I should be able to see substantial improvement in that area. That means that I'm likely to need to track what I'm doing to be able to notice the changes. Getting baseline data and noticing incremental improvement will help me to stay with the process and keep on task. If I'm trying to change to something new from something I used to be able to do, I'm going to have to practice and also avoid doing all the old behaviors. The more I practice, the easier and smoother the transition.
Part of my current work involves setting up sequences, tracking systems, and reinforcement systems for people who want to learn new behaviors, rewire after something has happened, or change to something different.
Feel free to contact me for more information.
DonohueMA@aol.com
Wednesday, May 12, 2010
Distance Therapy
I've been working with a former client of mine online for the past two weeks. Instead of seeing this person at my office (which is exceptionally far for them), I'm seeing this person online, via email, or cell phone. Like Distance Learning, the computer has come to therapy. So this person and I have to figure out how this treatment will work. Here is what we've decided. First, this is going to be formal therapy. There are arranged times, homework assignments, readings, and substantial information being provided, including daily assessments. We've agreed on a specific type of treatment. There are a lot of security issues. The internet isn't secure. We use minimally identifying information back and forth online. The phone isn't secure. The information can be overheard.
So in two weeks what's been accomplished? The client has a new job, an improved relationship, and (I can document with the questionnaires that have been completed) a 50% reduction in depression and anxiety. Not bad for two weeks. Not bad for online and no face-to-face interactions.
So what are the clinical and ethical issues in this new world of computers? Security is certainly an issue. I don't know about how confidential anything is. I assume everything on the internet is pretty much public information, but I don't think everyone else thinks that way. I have to remind the client about this. I certainly get more detailed records this way since everything is written out. The client gets access to data that is tracked and trended, color coded and on an excel spreadsheet. Daily. I'm interacting on a daily basis instead of once a week or once every two weeks. But the interactions are extremely brief. High touch and high tech certainly. The client has a workbook they are using in conjunction with treatment. The type of treatment uses homework assignments and is readily available in workbook format by a number of authors. I can explain concepts in general in email. The rating scales can be readily downloaded from the internet and the results sent back over email. Could I do more formal assessments remotely with say a web cam or remote server? Maybe. And the results are fast. Same day, or next day. But this is traditional treatment it's just the format that's different. What about seeing someone online I don't know? Is it ethical to provide online only treatment? What if I'm seeing someone in another State? I'm licensed in California and Nevada. If my client were to move to say Idaho or Arizona would I need to be licensed in the State they are in to provide services online from California or Nevada or do my current licenses cover that treatment? I don't know off hand. I would have to check with the State licensing agency involved if that were to happen. What about less traditional treatment? What about assessments that are only normally done face-to-face? Does a computer based assessment system change the results? Does insurance cover this type of treatment? How does it get priced out? Lots of new questions to be determined.
So far so good with this person. As I add people in this format I'll keep updating.
So in two weeks what's been accomplished? The client has a new job, an improved relationship, and (I can document with the questionnaires that have been completed) a 50% reduction in depression and anxiety. Not bad for two weeks. Not bad for online and no face-to-face interactions.
So what are the clinical and ethical issues in this new world of computers? Security is certainly an issue. I don't know about how confidential anything is. I assume everything on the internet is pretty much public information, but I don't think everyone else thinks that way. I have to remind the client about this. I certainly get more detailed records this way since everything is written out. The client gets access to data that is tracked and trended, color coded and on an excel spreadsheet. Daily. I'm interacting on a daily basis instead of once a week or once every two weeks. But the interactions are extremely brief. High touch and high tech certainly. The client has a workbook they are using in conjunction with treatment. The type of treatment uses homework assignments and is readily available in workbook format by a number of authors. I can explain concepts in general in email. The rating scales can be readily downloaded from the internet and the results sent back over email. Could I do more formal assessments remotely with say a web cam or remote server? Maybe. And the results are fast. Same day, or next day. But this is traditional treatment it's just the format that's different. What about seeing someone online I don't know? Is it ethical to provide online only treatment? What if I'm seeing someone in another State? I'm licensed in California and Nevada. If my client were to move to say Idaho or Arizona would I need to be licensed in the State they are in to provide services online from California or Nevada or do my current licenses cover that treatment? I don't know off hand. I would have to check with the State licensing agency involved if that were to happen. What about less traditional treatment? What about assessments that are only normally done face-to-face? Does a computer based assessment system change the results? Does insurance cover this type of treatment? How does it get priced out? Lots of new questions to be determined.
So far so good with this person. As I add people in this format I'll keep updating.
Saturday, May 1, 2010
Undiagnosed conditions
Most people expect their doctor to determine what's wrong with them at the first or second visit. Just answer some simple questions maybe get a lab test or two and poof there you have it.
Not exactly. In many cases it can take months or even years to get a diagnosis. In some cases you just learn to live with not knowing and wait for science to catch up. The difficulty between expectation on the part of both physician and patient makes for very strained relationships. Doctors become surly and outright hostile. Patient's become stressed and exasperated. Litigation happens or patients seek services elsewhere. Doctor's tell patients not to return. Or imply the medical problems really don't exist.
Some patients recover from being told not to return or being told the doctor doesn't know what's wrong. Some stop getting any medical care. Some seek treatment from multiple physicians and then branch out to complementary or alternative treatments, mental health specialists or look to spiritual guidance or psychics. Some physicians get overly cautious ordering countless tests and procedures. Some refer out to specialists as soon as it gets ambiguous. Some move into administrative services and limit direct patient care.
Complaints about medical symptoms which don't resolve within 6 office visits would benefit from treatment by a medical psychologist. Either the physician or the patient could seek the treatment to help with the medical collaborative process. A medical psychologist is knowledgeable about medical conditions, diagnostic decision trees, medical research, and how patients talk about symptoms.
Several years ago I was in a risk management meeting with a major health management organization. I was seated at a table with a group of physicians which included an internist, cardiologist, orthopedist, psychiatrist, gynecologist, and general practitioner. We were discussing a case which came to the attention of the company attorneys. All the identifying information had been stripped out of the case. We were to discuss work flow, diagnosis and next steps in a step wise manner as the case unfolded. A female patient presented with neck and back pain after exertion. She was seen by the physician on-call at the clinic for a same day appointment. She was seen for 20 minutes. A full history was not taken. She was given a prescription for anti-inflammatory medication and told to return if needed. So I raised the issue of cardiovascular disease with the physician colleagues at the table. The cardiologist disagreed strongly. "It's neck and back pain, not chest pain." "But" I countered "women experience heart problems differently then men, often complaining of neck and back pain with exertion." I mentioned these findings were noted in medical journals of Cardiology and JAMA, as well as studies from the American Heart Association. As we went through the documented scenarios of the next four treatment visits for the same problems which were worsening over time, the physicians came to agree that having a single physician in charge of her care would be useful. Having a full history would be useful. Up until the last visit where the patient collapsed, the cardiologist and orthopedist were convinced this was not a cardiac event but some problem with her neck or back. In the final scenario the autopsy proved the woman died of a heart attack and the family sued the physicians involved. The point was it could all have been avoided with collaborative treatment.
Over the next several years at the company the physicians who had been at that table for the risk management seminar referred to me anyone they were not able to diagnose after the second meeting for the same symptoms. Sometimes they just stopped me in the hallway to discuss a case. These discussions benefited the company, the clinical practices of the physicians, and the patients. I was able to help people cope with not having a diagnosis. I was able to help physicians run through branches of medical decision trees or alternative branches, get information and clarify symptom presentation. Together we saved lives and helped people improve their health. The physicians involved in those discussions didn't limit referrals to psychology to just people with mental symptoms. The company went on to provide more medical psychology services and to integrate medical psychology into the medical services they provide. The company remains innovative in treatment and use of psychological services.
If you are a patient or a physician dealing with someone who complains of medical symptoms which are not diagnosed you may want to seek a consultation with a health or medical psychologist.
Not exactly. In many cases it can take months or even years to get a diagnosis. In some cases you just learn to live with not knowing and wait for science to catch up. The difficulty between expectation on the part of both physician and patient makes for very strained relationships. Doctors become surly and outright hostile. Patient's become stressed and exasperated. Litigation happens or patients seek services elsewhere. Doctor's tell patients not to return. Or imply the medical problems really don't exist.
Some patients recover from being told not to return or being told the doctor doesn't know what's wrong. Some stop getting any medical care. Some seek treatment from multiple physicians and then branch out to complementary or alternative treatments, mental health specialists or look to spiritual guidance or psychics. Some physicians get overly cautious ordering countless tests and procedures. Some refer out to specialists as soon as it gets ambiguous. Some move into administrative services and limit direct patient care.
Complaints about medical symptoms which don't resolve within 6 office visits would benefit from treatment by a medical psychologist. Either the physician or the patient could seek the treatment to help with the medical collaborative process. A medical psychologist is knowledgeable about medical conditions, diagnostic decision trees, medical research, and how patients talk about symptoms.
Several years ago I was in a risk management meeting with a major health management organization. I was seated at a table with a group of physicians which included an internist, cardiologist, orthopedist, psychiatrist, gynecologist, and general practitioner. We were discussing a case which came to the attention of the company attorneys. All the identifying information had been stripped out of the case. We were to discuss work flow, diagnosis and next steps in a step wise manner as the case unfolded. A female patient presented with neck and back pain after exertion. She was seen by the physician on-call at the clinic for a same day appointment. She was seen for 20 minutes. A full history was not taken. She was given a prescription for anti-inflammatory medication and told to return if needed. So I raised the issue of cardiovascular disease with the physician colleagues at the table. The cardiologist disagreed strongly. "It's neck and back pain, not chest pain." "But" I countered "women experience heart problems differently then men, often complaining of neck and back pain with exertion." I mentioned these findings were noted in medical journals of Cardiology and JAMA, as well as studies from the American Heart Association. As we went through the documented scenarios of the next four treatment visits for the same problems which were worsening over time, the physicians came to agree that having a single physician in charge of her care would be useful. Having a full history would be useful. Up until the last visit where the patient collapsed, the cardiologist and orthopedist were convinced this was not a cardiac event but some problem with her neck or back. In the final scenario the autopsy proved the woman died of a heart attack and the family sued the physicians involved. The point was it could all have been avoided with collaborative treatment.
Over the next several years at the company the physicians who had been at that table for the risk management seminar referred to me anyone they were not able to diagnose after the second meeting for the same symptoms. Sometimes they just stopped me in the hallway to discuss a case. These discussions benefited the company, the clinical practices of the physicians, and the patients. I was able to help people cope with not having a diagnosis. I was able to help physicians run through branches of medical decision trees or alternative branches, get information and clarify symptom presentation. Together we saved lives and helped people improve their health. The physicians involved in those discussions didn't limit referrals to psychology to just people with mental symptoms. The company went on to provide more medical psychology services and to integrate medical psychology into the medical services they provide. The company remains innovative in treatment and use of psychological services.
If you are a patient or a physician dealing with someone who complains of medical symptoms which are not diagnosed you may want to seek a consultation with a health or medical psychologist.
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