Outpatient Psychological Services

Outpatient Psychology at Wellstar

Psychology is the science that seeks to understand, explain, and when necessary, change human behavior. Behavior is influenced by thoughts, needs, values, motivations, emotions, and even physiology. Clinical psychology is the synthesis of the science of psychology with clinical practice and experience. Clinical psychologists understand and treat psychological problems, and promote personal adjustment and development.

Wellstar Psychological Services is a group of doctoral-trained clinicians who provide psychological evaluations and consultations, as well as individual and group counseling, behavioral modification services, and interventions to enhance the management of various medical problems. Although we treat patients with various problems, our psychologists concentrate primarily on:

Evaluating patients with complex psychiatric conditions.
Treating patients with medical or health-related conditions.
Helping individuals change clearly-identified and problematic behaviors.
Providing treatment to persons whose psychiatric symptoms can be mitigated via evidence-based and empirically-supported treatments.

Philosophically, our psychologists are, first and foremost, scientist-practitioners, meaning that we seek to integrate the latest scientific research into our treatment approaches—a commitment that we believe distinguishes us and ensures that our patients are receiving the most helpful and sound interventions.

Services

Common Therapies

While each patient is unique, and their circumstances different, individuals do exhibit symptom patterns that help us decide which treatments are likely to be most effective. Diagnoses—broad classifications of symptoms and behaviors—are expressed in terms of these patterns. Psychologists use models to describe and understand human behavior, but many of these theories are not approachable by the average patient. An alternate framework is called Descriptive Psychology, in which problems are understood as a function of three aspects of personality: Actor, Observer, and Critic (AOC). All three components of the personality are essential, but an over-emphasis or under-emphasis of any of these three roles can result in dysfunction.

Actor

Problems of Acting refer to a person's engaging in behaviors without full consideration of consequences. Thus, problems of the Actor might manifest in a number of different ways, such as addictive behavior, problems with impulsivity, overeating, smoking, or difficulty regulating or managing one's emotions.

Observer

The Observer is the part of our personality that pays attention, describes situations in objective terms, and regulates our behavior. While the Observer role is critical to living an adaptive life, it too can become problematic when out of proportion. Problems such as having obsessive thoughts could be conceptualized as a problem of Observing.

Critic

Finally, some problems can be attributed to the Critic function of our personality. The Critic serves as a judge—either towards self or others. When out of proportion, this often leads to problems commonly referred to as depression. When directed externally towards others, the Critic role often also contributes to problems and dissatisfaction in relationships.

After conceptualizing a patient's problem as one of Acting, Observing, or Criticizing, or via traditional diagnostic classifications, psychologists can understand which therapeutic paradigms will be most helpful to the patient.

When possible, at Wellstar we use evidence-based and empirically supported psychological therapies whose efficacy has been identified and thoroughly demonstrated through scientific study. While staying at the cutting edge of psychological research and evaluation, we avoid faddish, unproven psychotherapies, which may be ineffective or even dangerous to patients. Although some problems require ongoing or longer-term therapy, others can be resolved via these brief, evidence-based and empirically-supported treatments. Patients should have confidence that treatment duration hinges on medical necessity, and that the frequency and duration of sessions are determined on the basis of individualized need. Many problems can be resolved in six or fewer sessions. Others, however, require more extensive work.

Treatment Approaches

Acceptance and Commitment Therapy (ACT) teaches patients to observe, accept, and embrace events in their lives, even those that are unpleasant. Inherent in ACT is the concept that pain avoidance is normal, but also problematic. Via ACT, patients learn to increase their psychological flexibility – their ability to manage unforeseen events—by strengthening their values and acting in accordance with them. Rather than relying on "willpower" to change behavior, when a person tethers their daily actions to their core values, behavioral change becomes more probable.

Unlike some traditional psychological models, which assume that people are naturally psychologically healthy, ACT assumes that a “normal” mind can sometimes be self-destructive. Its central insight is that habit, comfort, and risk-aversion lead to a rigidity that leads to discord between values and behavior. ACT is well-suited to treat problems of Acting, Observing, and Criticizing, such as addictive behaviors depression, phobia, and post-traumatic stress disorder. In many cases, ACT is effective by bringing to light the patient's behavioral avoidance, which further intensifies the patient's problem.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) assumes that, during times of mental distress, people's minds begin working differently, producing extreme and destructive thoughts and emotions. Extreme thoughts can elicit unpleasant emotions, which may then contribute to maladaptive and unhealthy behaviors. This process can result in a vicious cycle, as an individual’s behavioral choices may prolong and deepen his/her distress.

CBT involves a process of patient and therapist engagement, which includes collaborative development of a shared view of the patient's problem, and identification and achievement of personalized therapy goals. The strategies employed vary according to the problems being addressed, but they include evaluation and questioning beliefs and assumptions that may be unrealistic, facing unpleasant activities and obligations, and consciously adjusting behavior.

Compared to many other treatment approaches, CBT is typically brief and time-limited. It has been shown to be highly effective in treating anxiety disorders (for example, phobias), mood disorders, insomnia, stress-related problems, and various other conditions. It has been shown to be effective with children and adolescents as well as adults.

Interpersonal Psychotherapy

Interpersonal Psychotherapy (IPT) emphasizes personal relationships as they contribute to psychological problems, and attempts to alleviate these issues by adjusting the ways in which individuals relate to other people. It is often helpful to adolescents as well as adults.

IPT begins with diagnosis and development of a treatment plan for the problems identified. Interpersonal problems that are often identified and treated via an IPT approach include:

Grief—a distorted reaction to a lost relationship. The patient is helped to accept his/her grief, and move on to replacement of the loss.
Role Dispute—expecting something from a relationship that the other person is unwilling or unable to provide. Usually treated by analyzing the dispute and fostering communication.
Role Transition—difficulties in moving from one role in life to another (for example, retirement). The patient's loss is explored, and he/she is equipped with tools and skills to succeed in the new role.
Interpersonal Deficits—problems establishing and cultivating relationships. Communication problems are identified and corrected, often through role-playing exercises with the therapist.

Outpatient Behavior Modification

Many people engage in behaviors that contribute to less healthy, enjoyable, or productive lives. Examples include overeating, smoking, and substance abuse. Despite the negative consequences of such behaviors, changing them can be more difficult than simply willing oneself to change. Behavior Modification is the application of demonstrably effective techniques to reduce or eliminate undesirable behaviors.

Weight Management

Obesity is one of the nation’s most serious and fastest-growing health problems. Obese people are at increased risk of many physical diseases, like heart attack, stroke, diabetes, some cancers, and many other chronic diseases. It is believed to be (after smoking) the second leading preventable cause of death in the United States.

While there are clear physical causes and genetic predispositions that contribute to obesity, these are often accompanied by emotional and behavioral factors that make it exceedingly difficult to manage weight effectively. Sadness, anxiety, boredom, and stress often contribute to overeating. Learning to manage these emotions can be key to preventing obesity, and to treating it effectively.

Conquering obesity requires cultivating behaviors that comprise a healthier lifestyle, like exercise and an improved diet. While these general concepts are inherent in most all effective weight loss plans, lifestyle changes that are too radical can sometimes worsen an already precarious physical and/or psychological situation. In cases where individuals are dealing with substantial medical or psychiatric problems, it is often prudent to receive consultation from a healthcare provider.

Wellstar suggests a team approach, including a physician and/or dietician to help you develop a healthy diet and exercise plan; and a psychologist to help you discern and control the emotional factors that led to your weight gain, leading to long-lasting and enduring health-focused behaviors.

While many people worry sometimes about weighing too much, eating disorders can result when these concerns become out of control, and begin threatening health and life. Common eating disorders include:

Anorexia Nervosa: the belief that you're overweight even when you're dangerously thin, which contributes to excessive food restriction and extreme methods of weight control. Family therapy has been shown to be effective in overcoming anorexia.
Bulimia Nervosa: eating extreme portions of food, this is then followed by purging by vomiting or through the use of laxatives. Two types of psychotherapy have been shown to be particularly effective in treating bulimia—cognitive-behavioral, in which patients are helped to attain a realistic view of their appearance; and interpersonal psychotherapy, where quality of relationships are improved.
Binge Eating Disorder: intermittent episodes involving extreme overeating, but without the purging behaviors that accompany bulimia. A common treatment approach of Wellstar psychologists to the treatment of binge eating disorder involves explanation of the functions of Actor, Observer, and Critic, and subsequent use of cognitive and behavioral interventions to elicit change.

Case Example: An obese patient learns the concepts of Descriptive Psychology and Acceptance and Commitment Therapy. Observing his core values, and realizing that his current health trajectory is likely to compromise his health, and ultimately his ability to participate in activities with his family, he commits to a treatment regimen. After four months, he has lost 85 pounds and reports improved health and relationships with his family members.

Substance Abuse

Addiction refers to the need to use a substance in order to avoid physical and psychological withdrawal symptoms. Addiction typically begins with the abuse of a substance, whereby an individual's use is accompanied by negative consequences, such as interpersonal, academic, work-related, or legal problems. Eventually, an individual might become substance dependent. When this occurs, an individual has developed tolerance, having to consume more and more of the substance to get the same effect. When a person becomes dependent, the substance of choice often becomes the dominant and motivating force in a person's life.

Most people drink alcoholic beverages safely; for many, moderate consumption of alcohol (one drink a day for women, two for men) is enjoyable and may even have health benefits. For some people, however, including individuals with a disposition to problematic drinking behavior, abstinence is recommended. Heavy alcohol intake increases risk of accidents, liver and heart disease, cancer, and pancreatitis, and has the potential to endanger personal and professional relationships and success.

About one in 12 adults in the United States is alcohol dependent or abuses alcohol; people with other psychiatric disorders are approximately four times more likely to abuse alcohol as are individuals with no mental illness.

Drug abuse results in about 40 million serious illnesses and injuries and about 40,000 deaths per year in the United States. It has the potential to cause family disintegration, child abuse, academic failure, and loss of productivity and employment. In recent years, abuse of legal, prescription drugs (often painkillers) has become increasingly prevalent and responsible for many of the same problems as illegal drugs have been.

Treatment of addictive behavior necessitates a thorough assessment of a patient's behavior, including the type of substance(s) used, the frequency of use, the duration of use, the presence of other underlying psychiatric problems, and the extent to which a person's life is endangered in light of their addiction. There is not a one-size-fits-all approach with regards to treatment, but there are conceptual similarities. Wellstar's Clinical Psychologists are careful to ensure that treatment is provided appropriately to individuals who are dealing with addictive behaviors, such as drug or alcohol dependence. If a patient's drug or alcohol abuse is severe, it often warrants treatment via inpatient, intensive outpatient, or residential treatment programs. In such cases, our psychologists will assist in connecting the patient with the appropriate treatment structure. In other situations, substance abuse can be managed effectively via traditional outpatient treatment approaches. The framework offered by ACT is often effective, and combined with adjunct recommendations such as regular 12-step meetings, and medication management.

Smoking Cessation

Smoking is the leading preventable cause of death in the United States, killing more than 435,000 people annually. It contributes to myriad diseases, most prominently heart disease, stroke, and many cancers. More than 70% of smokers say they would like to quit, and health improves immediately upon quitting. However, quitting can be difficult, and may require repeated attempts.

A combination of counseling and medication is more effective than either counseling or medication alone. Your Wellstar physician can prescribe medications that help reduce tobacco dependence, and your psychologist will help you set a quit date, anticipate and face the challenges you will face as you withdraw from nicotine, and help you procure an environment in which quitting is as painless as possible.

In the process of becoming a tobacco-free environment, Wellstar has embarked on the development of a smoking cessation program, which involves several, parallel treatments. In addition to using adjunct nicotinic and non-nicotinic medications, we offer a menu of treatment interventions including, telephone assessment and reassessment, individualized CBT, and biofeedback. Wellstar psychologists work in collaboration with the Pulmonary and Oncology (cancer treatment) service lines to provide these comprehensive treatment options to patients and Wellstar team members.

Case Example: An older adult male who is very close to his granddaughter states that he wants to quit smoking. It is suggested that he write his granddaughter’s name on each cigarette in the pack he has with him. Surprised, he asks why his psychologist would make such this suggestion. He realizes that his cigarettes have the potential to compromise his health, and thus his relationship with his granddaughter. The patient establishes a quit date—his granddaughter’s birthday. He announces to his family that he has decided to quit smoking and tells his granddaughter of his decision. Committed to his core values, he remains smoke free.

Psychological Medical Management

Psychological Medical Management is the application of clinical psychology to disorders manifested with physical symptoms, like headaches, insomnia, and chronic pain. In some cases, the disorders involve a significant emotional or stress-related component, which has contributed to the onset of the problem; in many other cases, emotional distress is a consequence of a primary medical problem. Whatever the case might be, we seek to manage symptoms using psychological tools, often in concert with other medical practitioners.

Managing Chronic Pain

The causes of chronic pain range from musculoskeletal disorders (like lower back pain), to malignancy (cancer), injury, severe burns, and arthritis. At times, there may be no apparent cause at all. While acute pain is an indispensable alert that something is wrong and needs your attention, chronic pain continues for weeks, months, or even years. In time, the nervous system itself can change, complicating the original problem. Furthermore, the anxiety and depression resulting from the original problem, and/or the pain that is a symptom of it, have been shown to heighten pain perception.

According to the National Centers for Health Statistics, chronic pain affects over 75 million people in the United States. Back pain is the leading disability in Americans under age 45.

Prescription drugs are often used to treat chronic pain. While offering relief, these painkillers can be addictive; in 2007, 12,000 people died in the United States from unintentional overdose of pain relievers. These drugs also may lose efficacy over time.

Psychological techniques to manage chronic pain include biofeedback. Since pain is a complex sensation, and not purely sensory, biofeedback is used as one of many tools, including Cognitive Behavioral Therapy (CBT), paradoxical relaxation approaches, and Acceptance and Commitment Therapy (ACT).

Managing Migraines

Migraine is characterized by debilitating headaches, lasting from a few hours to a few days, often resulting in nausea, vomiting, and other secondary symptoms. It is about three times as common in women as in men; its causes are unknown, but there is likely a genetic as well as psychosocial component. Tension headaches are much more common than migraines, accounting for nearly 90% of all headaches. They are often described as a feeling of constant pressure. Causes are uncertain; theories include muscle tension and chemical errors by the brain's pain filter.

Although the causes of these headaches are unclear, triggers include stress, hunger, lack of sleep, eyestrain, and dehydration. Psychologically managing these triggers can provide significant relief.

Biofeedback, which seeks to enhance control of bodily function through managing indicators like blood pressure, heart rate, and brain activity, helps some people with chronic headaches. It may be coupled with relaxation therapy, which teaches other stress-reduction methods. Studies have shown that biofeedback relieves migraines about as effectively as migraine medications, and that the two treatments together may provide greater relief. A formal biofeedback session usually lasts a half an hour to an hour, and should be repeated over the course of weeks or months. Often, Wellstar psychologists incorporate elements of biofeedback into evaluations and other forms of psychotherapy.

Thermal Biofeedback is training to raise hand temperature consciously. Patients are not told how to raise their hand temperatures, but are instructed to imagine that their hands feel warm; their actual hand temperature is displayed on a monitor. Those who succeed sometimes experience a decrease in occurrence and severity of headaches.

Similarly, electromyographic (EMG) training provides a direct measurement of muscle tension in the face, neck, and shoulders, to teach patients to control this tension and reduce their headaches.

Case Example: A recently-divorced woman with chronic migraines learns to track the onset and intensity of her headaches, as well as her daily stress level. After two sessions, she has identified a relationship between her stress and her headaches. By session four, she has learned to decrease her migraine occurrence and intensity by implementing new coping strategies and incorporating thermal biofeedback techniques into her symptom management.

Managing Sleep Problems

Insomnia is difficulty falling or staying asleep that impairs daytime functioning. In a 2002 poll, 35% of adults in America reported nightly insomnia, and 58% said they had insomnia at least a few nights per week.

The most common treatments for insomnia are pharmacological. There are dozens of over-the-counter and sleep aids, and they do often work, at least in the short term. However, the long-term use of such drugs entails adverse effects like habituation and dependence, reduced motor and cognitive performance while awake, and sleep disturbance.

Fortunately, insomnia is usually quite responsive to psychological treatments; research has demonstrated that behavioral and cognitive-behavioral psychological interventions are just as or more effective than medications at reducing insomnia over the long haul.

The standard course of insomnia therapy generally entails six to eight weekly sessions to unlearn behaviors that prevent sound, restful sleep. These sessions may include:

Sleep education—regular sleep schedules, and controlling napping, exercise, nicotine, caffeine, and alcohol.
Cognitive therapy—addressing unrealistic expectations about sleep and the effects of insomnia.
Stimulus control—reducing anxiety about sleeping. If you can't fall asleep, get up and do something.
Sleep restriction—curtailing the amount of sleep, causing fatigue and easier and deeper sleep.
Relaxation—muscle relaxation and breathing techniques that simulate the onset of sleep.