Behavioral Medicine Rotation B: Obesity and Cardiopulmonary Rehabilitation - The Miriam Hospital
Faculty Supervisor(s): Anna Schierberl Scherr, PhD (primary), Maria Buckley, PhD, & Jeffrey Burock, MD
The Miriam Hospital's Behavioral Medicine Rotation B provides broad training in behavioral medicine by providing experience in assessment, individual and group treatment, and activities that promote chronic disease risk reduction and treatment. The clinical psychology resident functions on multidisciplinary teams that include psychologists, psychiatrists, physicians, clinical social workers, nurses, dietitians, pharmacists, respiratory and physical therapists and exercise physiologists.
Behavioral Medicine Clinical Services and Weight Management Program. Patients seen through the Behavioral Medicine Clinical Services are assessed and treated for problems such as chronic pain, obesity-related co-morbidities, smoking cessation, difficulty managing chronic medical conditions (e.g., arthritis, chronic fatigue, gastrointestinal disorders, endocrine disorders) and co-morbid sleep, anxiety and mood disorders. Patients are typically treated using cognitive-behavioral as well as acceptance based and self-compassion frameworks that can include lifestyle modification, skills training for management of medical symptoms and emotional distress, mindfulness-based self-regulation, and relapse prevention skills. Evaluations are done collaboratively between the clinical psychology resident and supervisor, and usually incorporate a comprehensive interview and data from self-report questionnaires. Clinical psychology resident participation in the Weight Management program includes evaluating potential participants for adherence risk factors and co-leading a psychoeducational group for weight management as part of a multidisciplinary team of physicians, dietitians, a nurse, and an exercise physiologist. Residents will also carry an individual caseload consisting of patients with weight management issues/eating disordered behaviors and other psychiatric conditions commonly occurring in medical settings.
Cardiac and Pulmonary Rehabilitation. The Cardiac and Pulmonary Rehabilitation Behavioral Medicine Service provides training in conducting brief, targeted interventions for issues such as adjustment to cardiac and pulmonary disease, weight management, smoking cessation, anxiety and mood management, adherence to exercise and treatment regimens and stress management. The clinical psychology resident will receive training in presenting brief psychoeducational classes to Cardiac and Pulmonary Rehabilitation patients. The resident also has the opportunity to co-facilitate a quarterly Heart Transplant/LVAD support group meeting. The Cardiac and Pulmonary Rehabilitation services are multidisciplinary and offer the opportunity to collaborate and consult with physicians, exercise physiologists, pharmacists, respiratory and physical therapists, dietitians and nurses and to assist them in their delivery of patient care.
The Miriam Hospital Inpatient Consultation-Liaison Clinic. On the inpatient Consultation-Liaison (C/L) service, the clinical psychology resident assesses and treats acute medical-surgical patients in the emergency room and during their inpatient stay at The Miriam Hospital. Consultations range from the assessment of more traditional psychiatric problems which may arise in medically ill patients (e.g., changes in mental status, depression, anxiety disorders, psychosis, suicidality) to the initiation of positive lifestyle modifications with the goal of long-term benefits. There is also an emphasis on treating psychiatric sequelae of neurological disorders and geriatric disorders, including dementia, Parkinson's disease, multiple sclerosis, and post-stroke sequelae. The trainee will also develop basic skills in the ability to read neuroimaging including Brain CTs and Brain MRIs. This experience includes both patient-centered and consultee-centered consultation, wherein the medical and nursing staff may be assisted in managing various behavioral difficulties in patients. The consultation-liaison service is multidisciplinary, consisting of psychiatrists, a psychiatric nurse, and trainees in each of these disciplines. This service treats a high number of patients each day and the pace of the service may be faster than other sites. There is also a special emphasis on identifying medical and neurological issues which may be playing a role in the psychiatric presentation.
The Pediatric Cardiology Rotation. The Pediatric Cardiology Rotation provides training with the Pediatric Psychology team providing integrated behavioral health services in Hasbro’s Pediatric Heart Center. Common referral questions include individual and familial adjustment to chronic illness, problems with adherence to medical regimens, preparation for medical procedures, transition to increased responsibility for their own medical care for children and adolescents with congenital heart disease, as well as complaints of cardiac symptoms often co-occurring with depression and anxiety. Trainees on the rotation participate as part of an interdisciplinary treatment team that includes representation from disciplines of cardiology, psychology, nursing, and social work. Treatment provided is typically CBT-based individual and family therapy. Opportunities may also exist for didactic presentations to families, as well as consultation with the medical team. In addition, trainees may participate in other interdisciplinary meetings (psychosocial team meeting, camp meetings, research meetings, echo conference) depending upon trainee availability and interest.