If you're living with a chronic illness, you're in the right place.

Monday, October 29, 2012

Sunday, October 28, 2012

The What-If's

11:36 AM Posted by Stephanie Horgan , , ,

I recently was talking to a good friend of mine who also has a chronic illness, and she expressed to me something that I think many people go though. She talked about the idea of growing up too fast, since her diagnosis was at 18. Typically, when a teenager is diagnosed with a chronic illness, it can really alter their social/emotional growth, as not only do they have to face significant health challenges, which their peers are not facing, but they also have to learn to fit in despite these issues, all while taking care of themselves and managing their illness. Many adolescents we see at our practice are struggling with the concept of identity and fitting in. Will they be able to live a "normal" college life? Will they be able to hold down a job? Will their peers really "get it"? Developmentally, teens and college students are sorting through all sorts of identity issues, but chronic illness can throw a wrench in things. 

Often times, illnesses prevent young adults from participating in things. Whether its having to miss classes for a flare or doctor's appointments or surgeries, or having to cut back on extracurricular activities due to fatigue or symptoms, there are limits that their peers aren't dealing with. Limits are no fun. Especially when those limits are from your own body, and you are a teenager who is trying to establish independence from your family. Chronic illness is like a step forward from your peers, one where you have to grow up all too fast and be aware of your body's every signal. It is also like a step back, where you have to continue to depend on your parents or family members to take care of you when you are sick, instead of functioning like a typical independent adult. All these steps forward and backward can leave patients dizzy.

While friends may have been able to study abroad, patients with a chronic illness may have to stay close to their doctors and hospitals where they receive treatment. While friends may have been able to enjoy a beer and play sports, patients may have had to avoid alcohol due to medications they are on. While friends may be able to travel after graduation or take time off after graduation, patients need to find a job with health insurance and never want to have a lapse in coverage to avoid a future denial. Since the "typical" age to be diagnosed with Inflammatory Bowel Disease is age 15-25, we hear from patients the feeling that they have missed out on these crucial developmental years. 

When adult patients look back on when they were diagnosed, they may be faced with a long list of "what ifs", such as "What if I had been able to do everything I had wanted to do physically, like my peers?" College is a prime season for making friends, trying on a new identity, exploring new interests, taking road trips, backpacking the world, etc. All of these things can be severely impacted by someone who is dealing with a chronic illness diagnosis. There is a significant grief to process about the losses from chronic illness. And this grief is not a one-time thing, it can resurface at various times throughout the life cycle (throughout the week for that matter!) The important thing about addressing these losses, is having a safe place to process them, as well as to find ways to move forward. If you ever feel stuck in your grief, that is the time to reach out! Although it can feel very safe to isolate and not talk about your negative feelings towards your illness, grief is a funny thing in that you can't go around it, you have to go through it. From personal experience, my journey of grieving my losses is ongoing, non-linear, and ever-changing. One week I may be very in touch with the blessings from my illness, and feel the support of those around me. Another week, I may feel devastated and angry by yet another unpredictable loss of having to miss out on an activity I was looking forward to. The good news is that there are therapists who are trained to help with this, and there are many other patients out there who experience similar losses. Sometimes having a support network that includes others with your illness can provide an outlet to vent, as well as understanding from other people who are dealing with the same issues.

As for the what if's...those are not so easy to make disappear. They are part of the journey of being real about your illness, and something we may never get answers to. But in the meantime, there is help available, and the hope that flares don't last forever. There will be times of remission, and times where you can do more of the things you love. I saw a quote the other day that said "don't let a bad day make you feel like you have a bad life." I found this to be a great reminder on days when my illness is the worst, and it provides a bigger perspective on life. After all, we all have limited time here on the earth, we may as well enjoy it as much as we possible can! 

Saturday, October 27, 2012

The Slow Road to Parity

5:54 AM Posted by Tiffany Taft , , , ,
If you've ever tried to use your health insurance for mental health services, you may have experienced some challenges.  Things like need for prior authorization to see a therapist, limits on the number of sessions you can have, or limits on the amount of coverage your plan allows (to name a few).  Starting in 1996, congress passed a law that aimed to create "parity," or equality, between coverage for mental health and physical health conditions.  This law stated that insurance companies cannot have different lifetime benefit limits for mental health care. It was a start; unfortunately it took 12 years for the issue to be revisited.

In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed, adding to the 1996 law that health insurance issuers cannot require higher co-pays or deductibles, or restrict the number of treatment visits for mental health conditions.  So why are people still experiencing hurdles when it comes to using insurance for mental health services?  A rather long and convoluted 2012 report to congress on enforcement of the law is available.  It seems that regulators and agencies have had issues with enacting the law as its written, allowing coverage for mental health to remain unequal under many insurance plans.  "More studies are needed" to determine how to make these changes.

The Affordable Care Act aims to push the 1996 and 2008 laws even further by removing the pre-existing condition clauses that prevent many people with a mental illness diagnosis from using their benefits.  This move has been lauded by mental health organizations such as the American Psychiatric Association as a way to ensure proper treatments for the millions of people living with a mental illness. I'm also hopeful, but am also a bit of a cynic and just hope that loopholes aren't found and exploited, and implementation isn't tied up for years in committees of regulators who aren't sure how to make the necessary changes that are fair to all parties involved.

Depression is considered by the World Health Organization to be the world's leading cause of disability.  We know that up to half of people living with a chronic physical illness will experience some sort of anxiety or depression because of their illness.  Having access to quality medical and mental health care so the whole person, not just the diseased body part, is treated is essential.  We also know that mental health is directly correlated with physical health outcomes - people who feel better mentally are more likely to follow their treatment regimen, use the healthcare system less, experience less physical pain, and are more engaged in their pre-illness social and work roles.  It seems like a no-brainer to integrate (and pay for) mental health services as part of a comprehensive treatment of physical illness.

We will be watching how these laws play out, and remain hopeful that one day our mental well-being will be considered and appreciated equally.

Friday, October 26, 2012

Treatments & Adolescents

12:33 PM Posted by Tiffany Taft , , ,
The Lupus Foundation of America reports a new study on the effects of lupus and its treatments on teenage girls.  The researchers evaluated how both the illness and a common treatment, oral steroids, can affect the teens' mood and feelings about their appearance.  They found that feelings of depression were present in most of the teens they studied, and over 90% felt unattractive because of their condition.

A little side note on the effects of oral steroids.  These are powerful medications that are used in a wide variety of conditions to reduce inflammation.  They have been around a long time and are considered safe, but come with a host of side effects that patients often struggle with.  These include increased blood pressure, weight gain, acne, swelling of the cheeks (patients sometime call these "chipmunk cheeks") or the back of the neck, mood swings, increased appetite, weakening of the immune system, and general swelling or fluid retention.  Many of our clients have said they have a love-hate relationship with steroids because they work so well to control their illness symptoms, but the side effects can sometimes be really difficult to deal with.

Adolescence is already a challenging time in life where teens are more aware of their physical appearances, so it makes sense that having lupus and dealing with steroid side effects increases the risks of depression.  The authors note the importance of having psychological assessment and help available for teens living with lupus, and we could not agree more.  As medicine integrates psychology more into everyday practice, we hope that therapists like Steph and I are better able to serve teens living with chronic medical illness.  

If you're in the Chicago area and have a teen who is struggling with depression because of lupus, or any other medical diagnosis, we are here to help.

Appearance concern and depression in adolescent girls with systemic lupus erythematosus
Ji L, Lili S, Jing W, Yanyan H, Min W, Juan X, and Hongmei S. Appearance concern and depression in adolescent girls with systemic lupus erythematosus. Clinical Rheumatology 2012 Sept 9. doi: 10.1007/s10067-012-2071-8. [Epub ahead of print]

Wednesday, October 24, 2012

EGIDs, Kids, & Psychology

3:07 PM Posted by Stephanie Horgan , ,

Recently when doing some research, I came across a journal article in Children's Health Care, which talked about Psychological Functioning of Children and Adolescents With Eosinophil-Associated Gastrointestinal Disorders. EGIDs are growing in numbers, but there has not been a lot of literature on the psychosocial aspects of these disorders. The article was written by various clinicians and psychologists (Cortina et al) at the Cincinnati Children's Hospital and examined the health-related quality of life and adjustment among children with EGIDs compared to their healthy peers. (To note, my colleague Tiffany Taft has written multiple articles in the field of EGID's since 2004!) 

Similar to Inflammatory Bowel Diseases, EGIDs are an inflammatory condition of the digestive tract, but only since 2004 have they been described in medical literature. Some of the frustrations revolve around eating and children's food hypersensitivity, so mealtimes can pose significant challenges for families.  Here are some of the findings from this 2010 study.

Children and adolescents with EGIDs...

  • Their parents reported higher frequencies of internalizing and externalizing symptoms
  • Parents rated them with less developed social skills
  • Parents reported more missed school days for their kids
  • Had greater overall depressive symptoms
  • Had lower quality of life scores
So what can we do with these findings? Is there hope? 

The good news is YES! We are here to help, and encourage those with EGIDs to reach out. Whether you are a child or adult, there are unique challenges to this diagnosis, and just like any other chronic illness, it requires a period of adjustment and acceptance. It is not easy to rearrange your life, or your child's life, to a new set of eating habits or medical appointment schedule. There will be ups and downs, and that is something a therapist can help a patient adjust to. We can also help with behavioral interventions around eating, to try and reduce anxiety for the patient and family. As Tiffany and I head to the first Cured Foundation Research Symposium on November 2-4, 2012, we will excitedly learn more about how to best serve this population and their psychosocial needs. 

Citation: Psychological Functioning of Children and Adolescents With Eosinophil-Associated Gastrointestinal Disorders. Cortina S, McGraw K, Dealarcon A, Ahrens A, Rothenberg ME, Drotar D. Child Health Care. 2010 Oct; 39(4):266-278.

Tuesday, October 23, 2012

Guest Post: Massage Therapy & Chronic Illness

10:08 AM Posted by Tiffany Taft , ,
This week we have a guest blogger, Melanie Bowen, of the Mesothelioma Cancer Alliance who writes about the benefits of massage therapy for people living with a chronic illness.  Melanie is an awareness advocate for natural health and cancer treatment alternatives.  She highlights the great benefits of alternative nutritional, emotional, and physical treatments on those diagnosed with cancer and other serious illness.  She also assists in social media outreach efforts to spread awareness.  Thank you, Melanie, for contributing!  Visit her blog.

Benefits of Massage Therapy for Cancer Patients

Numerous cancer treatment facilities are now offering massage therapy to patients suffering from cancer as a complementary treatment to radiation or chemotherapy. While massage isn't meant to be a treatment for cancer on its own, it can go a long way toward helping these people relieve many of their cancer symptoms and the side effects of the treatments.

What is Massage Therapy?

Massage is the kneading, rubbing and manipulation of the skin and muscles in order to promote health and encourage feelings of relaxation and well-being. The types of massage that people are most familiar with are back or foot rubs, but professional massage therapy is quite similar.

There are many different methods used in massage therapy. Some of the most popular techniques used for people with cancer include Swedish and aromatherapy massage. Deep tissue massage is also commonly used and is good for helping patients deal with limited motion, scar tissue and chronic pain after treatment is finished. However, it is never used or recommended for people who are actively undergoing treatment as this technique can exacerbate discomfort or pain in such cases.

Massage Therapy Benefits

Researchers who have studied the effects of massage on health believe that it provides great psychological and physical benefits. Here are some of the things it can do:
  • Reduce inflammation and edema
  • Improve the flow of blood throughout the body
  • Relieve muscle soreness and stiffness
  • Reduce blood levels of cortisol, the stress hormone
  • Promote relaxation
  • Trigger the release of endorphins to aid pain relief
  • Distract patients from their pain and illness
  • Break up mucus in the lungs and promote expectoration, which is especially helpful for patients with mesothelioma.
It just seems to make sense that massage therapy should help people living with cancer. It feels good and there's a certain serenity to be gained when being pampered by someone who knows what they're doing and wants to help. In fact, researchers are finding that massage can help cancer patients with numerous emotional and lifestyle aspects such as:
  • Reduced feelings of depression
  • Less anxiety and stress
  • Better sleep quality
  • Reduced fatigue
  • Pain management
  • Better quality of life
According to one study, massage is an excellent way for people with cancer to manage their pain. The effects don't last a long time, but massage is considered to be a safe and reliable method of pain relief. Although such therapy might not completely negate the need for painkillers, it may still help patients rely less on these expensive and potentially addictive drugs. Yet another study had found that massage therapy even offered pain relief for patients suffering from bone cancer.

Warnings and Contraindications

It is recommended to speak with a doctor before beginning massage therapy, especially in cases of recent surgery or treatments with radiation or chemotherapy. Consult your doctor and find a therapy that works best for you and your treat and give your body, mind and spirit the vacation it deserves!

Monday, October 22, 2012

Monday Metacognition #6

9:09 AM Posted by Tiffany Taft ,
I'm taking a detour this week from the topic I was going to post about to share some interesting findings from Dennis Charney, MD who is a leading expert at Mount Sinai Medical Center on mood disorders and "resilience" - or our ability to overcome stress brought on by adversity.  Resilience is a bit of a buzz word in psychology these days, but there are some important topics that Dr. Charney covered in a recent interview on the Shrink Rap podcast on 10/19/2012.  You can hear the whole interview here.  Dr. Charney discussed 7 elements that are key to being a resilient person:

Realistic versus Blind or "Polly Anna" Optimism:
Realistic optimism is when we stop and realistically evaluate our situation, compare the resources we have on hand to face the adversity, and conclude that we can, in fact, prevail.  Blind optimism does not involve this assessment, and is what I like to call the "sunshine, puppies, and roses perspective."  Optimism is somewhat genetic, but the good news is everyone can learn how to be more optimistic by changing their thinking patterns.  Cognitive Behavioral Therapy (CBT) can help.

Embrace A Personal Moral Compass
This means having a set of core beliefs that very few things can change.  This could be spirituality, faith, doing good deeds for others without expecting things in return (altruism), or other things that bring meaning to your life.

Find A Resilient Role Model
Reach out and connect with others who have been where you are today and learn from them on how to move forward.  There are many patient advocacy groups run by incredible people who understand, who've "been there" and can teach you.  Ideally, find several role models so you can gain multiple perspectives and decide which strategies might work best for you.

Face Your Fears
"Fear is normal and can be used as a guide." The root of chronic anxiety is avoiding the things that we're afraid of.  The only way to break that cycle is to face the feared event and see if what we think might happen (remember catastrophizing?) actually does.  We also increase our self-esteem and self-confidence when we face our fears because we learn that we can, in fact, handle things better than we may believe when our thinking is clouded by fear and anxiety.

Keep a Social Safety Net
What is your social support network like?  The type of people that you're surrounded by in life play a key role in how resilient you are.  Even having 1 person who "gets it" improves your mental well-being, and having close relationships with others who have gone through similar challenges is important.

Physical exercise improves your mood, brain function, ability to learn and remember, and to regulate your emotions in a positive way.  All of these things are critical to resiliency.

Embrace Cognitive Flexibility
After you've been through a challenging or traumatizing event, try to work through the meaning of what happened to you.  In people with Post Traumatic Stress Disorder (PTSD) the urge is to avoid thinking about the traumatic event at all costs because it is so upsetting.  Unfortunately this doesn't allow our brains to process the information in a meaningful way, and it ends up being stored differently than other memories.  You don't have to have PTSD to benefit from cognitive flexibility.  Thinking about your situation in more depth helps you accept what happened and move forward.

What do you think?  How have you embraced, or struggled with, resiliency in your life?

Sunday, October 21, 2012

Insurance- to take or not to take?

12:10 PM Posted by Stephanie Horgan , , ,
Since Tiffany recently mentioned insurance in her post on October 14th, I figured I would chime in with my perspective as well. Insurance is a tricky topic. Why do so many therapists refuse to take insurance? Well, as you may know from being a patient, insurance companies are not always the easiest to deal with. When a therapist accepts insurance, they are basically saying they are willing to take a large pay-cut (because of the current rates the insurance companies pay), as well as also deal with the details that come along with submitting the billing and advocating for their patients. This is extra time that therapists are not paid for, and something that can be quite time-consuming.

As I was researching this, I found a great explanation in a blog stating that "different insurance policies by the same company can have different payment rates, so someone has to call for each patient, verify the insurance, find out the terms, co-pays, deductibles, and this involves sitting on hold and dealing with assorted prompting menus. And if the insurance company finds a reason not to pay, the doc (or therapist) is stuck- he/she can't bill the patient, he/she's just out the money." So instead of taking insurance and getting paid less, many therapists decide to leave that burden to the client. It is up to the client to pay out of pocket for each session, and then submit their sessions to their insurance company to see what kind of out-of-network benefits they will reimburse.

And that is how many therapists choose to operate. Makes sense, right? Well, not really. This means that the only people getting to go to therapy are the ones that are able to pay up front, and ones that have the follow-through to fight with their insurance company about reimbursement. Not only this, but since the patient's therapist is out-of-network, he/she is likely to have a higher copay and higher deductible, making this even more expensive for the patient. Here is where the ethical dilemma comes in- there are many, many patients that cannot afford to pay out of pocket, and would only be able to afford therapy if they use their insurance.

And it is for that reason, why we at Oak Park Behavioral Medicine, LLC are getting on insurance panels so that more and more people will have access to our services. We want as many patients as possible to have the opportunity to come to our practice and get help with their illness, leaving with tools to live a full life, instead of large bills on top of their potentially already large medical bills. In the case that patients want to skip the insurance process and pay out of pocket, we gladly welcome them! It allows greater freedom to not have to put a diagnosis label on them, or be confined to a certain number of sessions. But we realize this is a rarity, and we want to make sure we are reaching out to all who are needing help, not just a privileged few. So there is my Sunday soapbox. I'll kindly step down now.

Last but not least, I want to encourage you to sign up for our November 14th Patient Education talk in Oak Park, as it is filling up fast! Hope to see you all there!

Friday, October 19, 2012

Counseling Obese Moms-To-Be

9:15 AM Posted by Tiffany Taft , ,
A new Belgian study published in the International Journal of Obesity  found that "motivational counseling" helped reduce the amount of weight gained in obese moms-to-be from an average of 30lbs in those getting standard care to 23lbs in those participating in the treatment.  Not only did the counseling, which occurred in a group format, keep moms-to-be from gaining excessive amounts of weight, but it also helped reduce feelings of anxiety and depression.

I should emphasize that this study was for moms-to-be who were already obese prior to getting pregnant, as the recommended weight gain during pregnancy for an average weight woman is between 25 and 30 lbs.  As a relatively new first time mom, I learned a few things about pregnancy and the downright contradictory social expectations that pregnant women often encounter.  I won't get into them all here but I want to highlight a few.

"Go ahead, you're eating for 2 now!" ...."My God, you're HUGE!  Are you having twins?"

Pregnant women historically have been given carte blanche to eat what they want during pregnancy, and as much of it as they want.  You know, containers of ice cream with a side of pickles.  My thing was cheeseburgers (there went my decade of vegetarianism in one fell swoop!). We now know that gaining over 30lbs during pregnancy in a healthy weight woman can increase the risks for a variety of pregnancy complications, including gestational diabetes.  But you hear it all the time - eat!  Then if you do and put on too much weight, you begin receiving comments about how many babies exactly are residing in your belly.  Think about what these conflicting messages can do to a woman's psyche.  You're not eating enough, feed your baby!  Whoa, slow down heifer!  Nobody told you to eat that much!  We know that people who struggle with their weight often report "emotional eating" habits, so how are we helping women who may already be struggling with keeping their pregnancy weight down with these messages?

The Perfect Baby Bump

You've seen it on the covers of magazines in the grocery store checkout line.  Look at [insert starlet's name here]'s perfect baby bump!  There are websites and magazine articles dedicated to how to make sure your pregnancy is as cute as possible.  The fact is, at least in my experience, pregnancy is hard for a lot of women.  You're fighting incessant nausea, swollen sinuses, swollen ankles, back pain, hip pain, heartburn, and sleep issues to name a few.  So the pressure to have the body of Gisele Bundchen with a perfectly round bump while pregnant may be laughable on the surface, but beneath is a pressure to remain attractive over the next 9 months.  Women who don't achieve this status may feel depressed and unattractive, which adds stress to their pregnancies and may set them up for post-partum depression.

When are you going to lose that baby weight?

Ok, so you've had your baby and you're adjusting to an entirely new way of living your life.  You're up every few hours to feed and soothe your baby.  Why haven't you been hitting the gym 2 hours a day to lose those 50lbs you put on?  I mean come on, it's been at least 2 months.  Just look at Jessica Simpson and the heat she caught for not only the weight she gained but how slowly she was losing it.  There were 109 headlines about her baby weight alone.  For women who don't have millions of dollars or access to personal trainers and nannies, these expectations are ridiculous.  Yet this attitude isn't reserved for Jessica and many women who already struggled with their weight are facing the same struggle plus 40 pounds.

This is just a snippet of the social stigma of obesity as it relates to pregnancy.  The good news is programs like that in the Belgian study, run by midwives not psychologists, can be readily accessible.  Medical providers should acknowledge that moms-to-be, especially those who are at the most risk of significant weight gain, can benefit from support and counseling which ultimately leads to healthier and happier moms and babies.

Tuesday, October 16, 2012

We're rePresenting!

11:49 AM Posted by Tiffany Taft , , ,
On November 2nd, the CURED Foundation - a patient advocacy group dedicated to people living with Eosinophilic GI Diseases such as Eosinophilic Esophagitis or Eosinophilic Gastroenteritis - is hosting its first annual Patient Education Symposium at Cincinnati Children's Hospital.  And we've been asked to speak!

Stephanie and I are giving 2 talks on Saturday.  The first is on health related quality of life for adults living with these conditions, including some of the main concerns that patients have, the effects of the treatments (especially restricted diets), and how these concerns are related to other things like mental health and illness symptom activity.  The second will be for parents of kids with EGIDs and what we understand about caregiver stress, including how it's related to the child's illness, treatments, and behavior.  Both of these talks are from research studies that I did at Northwestern University Feinberg School of Medicine in the Center for Psychosocial Research in GI.

We couldn't be more honored to be part of this inaugural conference and speaking with some of the world's leading experts on EGIDs.  We look forward to learning from our colleagues and hopefully sharing some of our knowledge with the people most affected by these conditions.

Want more information about CURED and the Conference? Go>>>

Monday, October 15, 2012

Monday Metacognition #5

11:42 AM Posted by Tiffany Taft ,
Today's Topic:  Probability Overestimation.  The tendency to believe that whatever prediction you may be making about a certain situation that it's at or near 100% likely to be true.  This thinking trap is often paired with others I've talked about the past few weeks, especially catastrophizing and mind reading.

It's only nature to believe that what you think is correct and that there's only a very small chance that something else may be true.  This serves as a protective quality, but can really turn up the stress dial when combined with negative expectations.

Back to our friend Shannon with UC:

Last week, Shannon was certain that a polyp that was removed in her colon meant that eventually she was going to develop colon cancer and die (catastrophizing).  Not only did she think this was her fate, she was 99% sure that it would happen (probability overestimation).  Needless to say, her worry was off the charts, she had trouble sleeping and couldn't concentrate very well at work.

Like catastrophizing, the key to overcoming probability overestimation is to examine the evidence.  I like to call it giving it the "will your argument stand up in court" method.  Sometimes I reference Judge Wapner, but depending on the age of my client that can backfire on me.  "Judge who?"

The People's Court 1980-1991

If Shannon were to present her case to a judge, does she have enough evidence for a "guilty!" verdict or would her case be thrown out for lack of evidence beyond a reasonable doubt?  When we're keyed up by distressing news or events, our minds tend to filter out more logical or rational thinking.  Our "Emotional Mind" can take over, making these thoughts seem to be accurate and likely.  Taking time to step back and evaluate your thinking can help shed light on what might otherwise feel like a catastrophic inevitability.

Next Week:  Discounting the Positive

Sunday, October 14, 2012

There's A Pill For That...

5:52 AM Posted by Tiffany Taft , , ,
Take 12 of these and call me in a month
There's an article out via the New York Times about a physician in Georgia who's prescribing ADHD meds to children who live in poor neighborhoods, and don't have ADHD, to help them concentrate and boost school performance.  His rationale is because we, as a nation, aren't investing in changing these kids' environments, the only other option is to "change the kid."  This story bothers me immensely for several reasons, but it got me thinking about my role as a clinical psychologist; or specifically psychologists as a collective, especially those in private practice.

I did a poll with my friends at the Great Bowel Movement about mental health care and living with IBD.  One of the questions I asked was "If you've considered seeing a therapist, what are some of the barriers that you've encountered." People could check off as many items as they wanted - things such as "not enough time," "finding a therapist who specializes in IBD," "bad experience with a past therapist," etc.  27% endorsed "many therapists don't accept insurance" as a barrier.  

There's a debate among psychologists in private practice about accepting insurance that I first learned about while in graduate school.  There are some compelling (and not so compelling) arguments out there as to why psychologists shouldn't accept insurance.  I read on one practitioner's website that a psychologist who accepts insurance isn't nearly as experienced or maybe not as competent because they accept insurance because they can't generate referrals elsewhere.  Needless to say, as someone early in their career and who believes in accepting insurance, I was slightly offended.  With attitudes like this floating around, it's not surprising that many psychologists either accept 1 plan or none at all.  Personally, I've always felt that it was a professional responsibility to allow clients to use their insurance for psychological care.  

Back to the original article, which is about low-income children.  Although I don't doubt that there are kids in middle through upper classes who are getting these meds for the same reasons.  Depending on the state, Medicaid will not pay for seeing a psychologist - Illinois is one of them.  There is also variability in what private insurance companies will cover for mental health, although recent laws have been put in place to remove these limitations.  Unfortunately, their enactment has been painfully slow.

So why is it even shocking that parents are turning to these pills to help their children?  We can blame our "quick fix" society, I suppose.  But how much of the above has contributed to this attitude?  Maybe parents and kids don't want to take powerful psychiatric medications and would prefer to learn skills or work through issues to make lasting changes in their behavior.  But it's just not easily accessible, making the prescription that is cheaper and convenient to fill (can there be any more Walgreen's in the greater Chicago area?) the more attractive option.  I realize I'm ignoring many other factors at play in this incredibly complex issue.  But I do believe that we, as psychologists, need to do more.

Friday, October 12, 2012

8 Questions to Ask Your Potential Therapist

5:19 AM Posted by Tiffany Taft , ,

You've decided to seek help from a therapist and you've found a few in your area that you're considering. Before setting up your first appointment, any good therapist will take time to answer your questions on the phone to make sure that you and him/her are likely to be a good fit.  Research shows that the "fit" between you and your therapist is as important as the type of treatment they provide.  Since we're dedicated to people living with chronic illness, our list is specific to this.

Here are 8 questions that everyone should ask:

  1. What is your approach to treatment?
    As we'll talk about in a future blog post, there are MANY approaches to psychological treatment out there.  Your experience will be different depending on this, so it's important to know what theory the therapist works under. Common answers include Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, Psychodynamic or Psychoanalytic, Humanistic/Existential, Family Systems, Acceptance and Commitment Therapy (ACT), Mindfulness Therapy, and Client-Centered Therapy.  Some therapists might say they're "eclectic" or they use multiple approaches.  While this is relatively common, you want to know what their primary approach is.  For example, my approach is CBT and I understand the client's experience and develop my treatment based on this theory.  I may borrow from ACT or Family Systems depending on the person, but my overall approach is from the CBT model.

  2. How many clients have you seen with (insert your condition here)?
    The therapist should be able to give you a ballpark estimate, not just "several."  Ask for some specific examples about how they worked with someone with your condition.  If they don't have experience with your illness, that may not be a deal breaker if the person has extensive experience with other illnesses (see next question).

  3. Do you have any specialty training in chronic illnesses?
    If a therapist is advertising that they work with people with chronic illness, they should have some specialty training in this area.  This may have happened in graduate school in during their post-graduate work.  For example, I have a degree in clinical psychology and my graduate school offered a specialization in "health psychology."  This means I took extra classes on physical illnesses, working in medical settings, and specific treatments for chronic conditions.  The therapist may have experience working in medical settings, such as hospitals or outpatient clinics, or have attended professional conferences.  Ask about all of this.

  4. How long does your typical client work with you?
    There is no way we can predict how long treatment will take for each person, but we can give a range of how long most clients work with us.  This will also depend on the treatment approach of the therapist.  For example, CBT is generally designed to last up to 6 months where Psychoanalysis is designed to last several years.  Any experienced therapist should be able to give a general statement about how long they work with most of their clients.

  5. Do you accept insurance?
    There's a bit of a debate in the mental health world about accepting insurance.  Some do, some don't. This has a lot to do with the red tape often associated with working with managed care companies as a mental health provider, as well as sometimes-severely discounted fees that we're paid by the insurance companies.  If the therapist does not accept insurance, ask how they work as an out-of-network provider and will work with you to obtain reimbursement for fees you'll be paying out of pocket.

  6. How will you work with my physician?
    A good therapist working with people with chronic physical illnesses will want to be part of the treatment team and not work in a bubble.  If it is important to you that they work with your regular physician, ask how they typically do this.  Most will, with your permission, contact your doctor and discuss your treatment without going into great detail about your problems.  Rather, will discuss what brings you in (anxiety about having a relapse in cancer symptoms, for example) and what the treatment plan is.  They will send an update if anything major changes and then send a treatment summary when you are finished.

  7. What are your fees? Fees that therapists charge vary, and will differ depending on what part of the country you live in.  Ask if they charge for the first visit/consultation or if this is provided free of charge.  This will also vary by therapist.  If you have limited finances, ask the therapist if they offer a sliding fee scale or reduced fees based on your income and family size.

  8. Do you have any references?
    Ask to speak to some of their other professional colleagues.  They can't give patient references because of confidentiality rules.

Thursday, October 11, 2012

Exciting Times!

8:03 AM Posted by Tiffany Taft
We have 2 really exciting pieces of news to share today....

First, we've been nominated for the Silver Stethoscope Award in this year's WEGO Health Activist Awards!  We're really honored by this, especially since we've just gotten started.  So thank you for this great recognition! If you'd like to endorse us, please use the badge on the right side of our page ---->

Second, Steph and I are putting on our first of hopefully many patient education groups on November 14th from 6:30-8:00 p.m. at the Buzz Cafe in Oak Park, IL.  This session is devoted to people living life with Inflammatory Bowel Disease (IBD).  We'll be talking about some of the common issues people with IBD face in their social and emotional lives, and giving some tips on how to manage these.  Space is limited, so please RSVP by November 9th at info@opbmed.com or 312-725-6175.

Tuesday, October 9, 2012

Stress Reduction toolbox

1:04 PM Posted by Stephanie Horgan , , , ,

I work with a variety of patients who are undergoing medical treatments, and recently one of my adult oncology patients mentioned an article in the Chicago Tribune about meditation and its benefits. I found this interesting as my monthly cancer support group I lead addressed this topic as well. Meditation and mindfulness is becoming more and more mainstream, and something that doctors are pausing to consider as its popularity and research base grows. There are many studies that have recently documented the benefits of meditation and mindfulness for patients of all types. Even though the article above is pertaining to breast cancer patients, I wanted to share the importance of exploring this realm and developing your own "relaxation toolbox" that works for you. Everyone encounters stress in their life, some good, some bad, but patients with chronic illness need to be especially aware of where they carry their stress and how to manage it. Whether its tai chi, massage, visualization, guided imagery, meditation, deep breathing, yoga, chi gong, progressive muscle relaxation...there are many tools that I encourage patients to "try on" and incorporate into their life, in order to improve their mental health. A key idea from these techniques is the importance of staying in the present moment and gaining control over your thoughts. Often when a patient is dealing with a chronic illness, they feel that this defines them and they spend much time worrying about what the future may hold. When will the next flare-up come? What will I have to cancel? How will it affect those around me? When you find yourself mentally drowning in the "what ifs?", coming back to mindfulness and the present moment is a great tool. The biggest barrier to patients doing this is time. But the most encouraging thing about stress reduction techniques is that they can be done throughout the day, a few minutes here and there. Similar to exercise, something is better than nothing. So give one a try. Google a few and see if anything resonates with you or peaks your interest. Or come in for a session and let Tiffany and I lead you through exercises. Honestly, what do you have to lose, besides some stress? 

Best of The Web #1

11:13 AM Posted by Tiffany Taft
We fully admit that we're not the only awesome resource on the web for information about living with a chronic illness.  Here are some other sites that we think are worth checking out:

An Itchy Little World:  Blog about allergies, asthma and eczema by Jennifer dedicated to parents of kids affected by these conditions.

Thriving:  Pediatric Health Blog run by the staff at Children's Hospital in Boston

Inflamed & Untamed - A personal blog by Sara Ringer, Crohn's patient, advocate, and overall cool-person

Dr. Jen 4 Kids:  A fantastic pediatrician located in Franklin, WI.

The Great Bowel Movement - Patient advocacy organization started by a couple of our friends, Andrea Meyer and Megan Starshak.  Their mission is to get people talking about IBD to increase awareness
and decrease stigma.

Know of some great sites that should be on our list?  Drop us a line and let us know.

Monday, October 8, 2012

Monday Metacognition #4

8:34 AM Posted by Tiffany Taft ,
This week:  Catastrophizing

This week's thinking trap is one of my favorites - Catastrophizing.  By looking at it you can probably guess what it is by its root word, catastrophe.  To catastrophize is to expect the worst case scenario to be the only possible outcome to a situation, or what I like to call "blowing-things-out-of-proportion-itis."  Catastrophizing usually takes place with another trap we'll cover next week, probability overestimation.  Together, these traps make for some pretty tense times.

Like all thinking traps, we all experience catastrophizing from time to time.  If you tend to be a "glass half empty" type of thinker, it may happen to you more often.  But catastrophic thinking can happen to even the most optimistic person.  Let's go back to our friend Shannon for an example.

Shannon has been feeling pretty well the past year or so, but her gastroenterologist decides that she would like to do a colonoscopy to check Shannon's colon for any problems and make sure no dysplasia, or pre-cancerous cells, are present.  Shannon has been through this many times in the past so she's not really worried about the procedure.  A few days later she gets a phone call from her doctor saying that she found some polyps and had them removed to be tested for signs of cancer.  One of them did come back with some dysplasia and she assures Shannon that by removing the polyp any chances of it progressing to colon cancer were removed.  However, because of this, Shannon should have a colonoscopy again in 6 months to make sure nothing has changed. 

Shannon goes into catastrophizing mode with the following thoughts:

"I'm sure I'm going to get colon cancer."
"What if she didn't get it all and it spreads not just in my colon but to my other organs?"
"What if when I have my scope in 6 months there are more polyps and because I waited so long they've turned into cancer?"

All 3 of these thoughts are predicting the worst case scenario in Shannon's mind - developing colon cancer.  Is colon cancer a real risk for her?  Absolutely.  But by assuming that this is her destiny, and that her doctor isn't going to do everything she can to keep it from happening, Shannon is setting herself up for a lot of worry and stress.  Catastrophic thinking can be a real drain on our ability to problem solve and focus on what actions we need to take to change a negative situation we find ourselves in.  Some people can become almost paralyzed by the anxiety catastrophizing can cause.

Are there situations in your life where you're predicting the worst case scenario?  How accurate do you think you are?  What are the alternatives and what can you do to make sure the "catastrophe" doesn't occur?

Next week:  Probability Overestimation

Thursday, October 4, 2012

Parent-Caregivers and "Chronic Sorrow"

12:51 PM Posted by Tiffany Taft , , ,
Today I want to discuss the experiences of parents of kids affected by a chronic illness.  Recently I did a research study on parent-caregiver stress in parents of children diagnosed with eosinophilic GI diseases that was published in the Journal of Pediatric Psychology.  Lo and behold I found that these parents (moms, really) are stressed, and this stress is related to other things like the parent's mental-health and their child's behavior.  I'll be presenting these findings at the first annual CURED patient education symposium in Cincinnati in November.

There's an interesting article on PsychCentral discussing how parents often find a lot of support during the initial stages of a diagnosis or illness, but then they find themselves feeling isolated as friends may drift away.  In this article, the term "Chronic Sorrow," first coined by Simon Olshansky in 1967 is discussed as:

"...however much a family embraces the child they have, they are nonetheless repeatedly confronted with the 'loss' of the child, and the life, they thought they would get....Watching friends’ children progress normally through the ages and stages makes the struggles and deficiencies of their own children painfully obvious and real.  For such parents, the pain from realizing their child is out of step with peers is interspersed with longer periods of feeling okay but stretched to periods of low-grade sorrow. Even while we love our children and celebrate whatever successes they may accomplish, the knowledge of their problems and the worries for their future linger in the background. The process rarely stops."

If you're a parent, do you agree with this?  Have you experienced chronic sorrow or something similar in caring for your child?

As a relatively new parent, I think about what it would be like if my daughter had a chronic illness and what the experiences of other parents who find themselves in this situation must be like.  The article goes on to say it's important for families to not take it personally when friends distance themselves after a chronic illness appears.  I'm not sure I agree with that statement, because it is personal.  However, I agree not to slip into the Personalization thinking trap that I blogged about earlier this week.  These times in our lives can help weed out people who maybe aren't who we thought they were and not quality friends.  But this still comes with loss, and that loss is added on top of the other losses that come with having a child with an illness.  It's a challenge to say the least.  We'll be dedicating more space here to parent-caregivers and how chronic illness touches many more lives than the "identified patient."

Tuesday, October 2, 2012

The Emotions of Chronic Illness

7:13 PM Posted by Stephanie Horgan ,
This may be an over share, but a few months ago, I was reading AARP. Not sure why I had it in my possession, but there was an article on chronic illness which struck my eye. It featured the NBC newscaster, Meredith Vieira, and her husband Richard Cohen who openly shared how his multiple sclerosis, which he has been dealing with since age 25. This degenerative disease has now taken his eyesight and Meredith spoke of the balance of realism and denial they have shared as she figures out how to balance their time together and her news career. She and her husband offer an honest and unique perspective as a couple is thriving despite this hard illness. One quote I found particularly inspiring.
"In some ways, the course of a chronic illness parallels the indignities of aging. Most of us, if we live long enough, will realize that we've driven our last car or scaled our last fence. But with chronic disease, the process is accelerated and tinged with cruelty. As we get older things are happening in the right time. We tend to be dealing with them with our peers. For a younger person with a chronic illness, it feels like a robbery, and its unfair. Anger is a natural reaction. Adapting to a chronic illness doesn't happen once though. It must happen over and over." 

This is a great way of acknowledging the anger and grief of dealing with a chronic illness. Unlike an acute illness like a broken bone or a short bout with mono, a chronic illness provides episode after episode throughout the lifespan in order to learn about the anger and emotions behind the illness. Often when we work with those who are younger facing a chronic illness diagnosis, we see a variety of responses, including denial, resilience, sadness, activism, or anger. All of these are natural reactions and will fluctuate from time to time. When you find yourself overwhelmed by any of the emotions of chronic illness, that is the perfect time to see a therapist who specializes in these issues. You are not alone, and can life a full and satisfying life despite your illness. 

Getting Help: Shrinks 101

12:11 PM Posted by Tiffany Taft , ,
Tell me about your mother
So you've decided that you  might want to get help from a professional about depression, anxiety, stress, or other issues that are weighing on your mind.  But how do you decide who to see, how do you find them, and what can you expect from your visits?  In our "Getting Help" series, we're going to hopefully break this down for you to make navigating the mental health field a little less daunting, and make sure you're connected with the right resource.  

This week:  Shrinks 101

There are many people who provide mental health services.  These include:  psychiatrists, psychologists, licensed clinical social workers, licensed clinical counselors, marriage and family therapists, hypnotherapists, life coaches, psychoanalysts, and I'm sure I'm missing a few.  Here's a few in more detail:

Psychiatrists:  These are medical doctors (MDs) who attended medical school then did advanced training in psychiatry. Therefore they can prescribe psychiatric medications, such as anti-depressants, anti-anxiety meds, and other medications for more severe mental illnesses like schizophrenia or bipolar disorder.  In general, psychiatrists don't usually do talk therapy - but some do.  Most will meet with you once a month or less, depending on how you're doing, and check in with you about how your medications are working.  Appointment times can be short (15 minutes or so for a med check) to longer if the physician is also providing therapy services.  If you are interested in getting a prescription for a psych medication, a psychiatrist is who you should see.  Note:  Primary care doctors also prescribe these medications, and many are comfortable with doing so.  

Psychologists:  These are people who hold a doctoral degree, either a PhD (Doctor of Philosophy) or PsyD (Doctor of Psychology) in clinical or counseling psychology.  They completed 4-5 years of graduate school, which includes a 1-year internship, and then 1-2 years of post-doctoral work before they get their license in the state they practice.  There are other types of psychologists, but only those who studied clinical or counseling psychology can get a license to practice and see people for therapy. Psychologists specialize in talk therapy and cannot prescribe medications except in a few states where this is now legal, like New Mexico and Louisiana, or in the military.  While there are some differences in training, both PhD and PsyD psychologists are well-qualified to see clients for therapy.  Psychologists work in a variety of roles including private practice, medical centers, veteran's centers, academic positions, consultants, and corporations to name a few.

Licensed Clinical Social Workers:  LCSWs have a Master's degree in clinical social work, which includes a 1-year internship.  They also cannot prescribe medication and specialize in psychotherapy.  Other types of Social Workers may work in public service roles such as in schools or government agencies.

Licensed Clinical Counselors:  These are people who hold a Master's degree in clinical or counseling psychology and have taken a state licensing exam.  They may work in private practice, in college counseling centers, or other public service roles.

Psychoanalysts:  These practitioners specialize in a certain type of therapy that was created by Sigmund Freud (or others in this area), and may be a psychologist, psychiatrist, or social worker.  Psychoanalysis is meant to be long term therapy that explores issues from childhood and other defenses that may be causing you issues today.  It can often take years to complete this type of treatment, meeting with your therapist multiple times per week.

Life Coaches:  Caution should be taken when looking to work with a life coach.  I'm sure there are many very qualified people who are in this line of work, but they typically do not hold the advanced training of the other clinicians I discussed.  

Next week I will cover some of the different approaches to therapy that are out there, such as CBT (what we use at OP Behavioral Medicine).  Picking the right therapist AND the right treatment approach is really important to getting the most out of your visits.

Monday, October 1, 2012

Monday Metacognition #3

12:07 PM Posted by Tiffany Taft ,
Atari's Pitfall, circa 1982
This week:  Personalization.  The tendency to see negative events as some indication of a negative trait or quality in yourself.  Or, taking personal responsibility for events that were beyond your doing or control.

We've all been told "Don't take it personally!"  But, c'mon, it can be really hard sometimes to not think that we had a hand in some negative event, or that some subtle negative comment was directed at us.  And sometimes we do take things personally because it's appropriate, so that's not what we're getting at when we talk about Personalization as a thinking trap.  Rather, it's the tendency to place too much responsibility on ourselves and ignore other information that offers alternative explanations.  Take this example with our friend "Shannon":

Shannon goes to see her doctor for a routine follow up visit, someone she's been seeing for years and feels like she has a really good relationship with.  Normally she takes time to talk with Shannon, asks how everything is going, and even asks about her family from time to time.  At this appointment, the doctor is less chatty and hurries through the visit, keeping a much more formal tone with Shannon.  She finishes quickly and is "all business."

Possible "Personalization" thoughts:

  • "She must be mad at me."  (a little mind-reading, too)
  • "What did I do wrong?"  
  • "Maybe she doesn't like me like I thought she did."
If we step back and look at the situation, there are many other possible explanations as to why she was abrupt that have nothing to do with Shannon.  She could be behind schedule; she may have just gotten some bad news about a patient or someone in her personal life; she could be sleep deprived; she could have been reprimanded by the practice administrator 5 minutes before the appointment with Shannon.  This list could go on and on.  How Shannon feels emotionally will be very different if she falls into the Personalization trap versus thinks of these other possible reasons why her doctor behaved the way she did.  She may also behave differently and her relationship with her doctor may deteriorate.  

So when you find yourself taking something personally, step back and look at the situation objectively and the evidence you have to support your claim.  Did you do something to contribute to the negative situation or are there alternative explanations that hold as much, or more, water?

Next week:  Catastrophizing