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, Barbara Jandesek, PhD
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.
Patients seen through the Behavioral Medicine Clinical Services are assessed and treated for problems such as chronic pain, obesity-related conditions, 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 patients for entry into a medically supervised weight management program. The clinical psychology residents will conduct a thorough evaluation of weight and lifestyle behaviors and assess program candidates for potential adherence risk factors, including mood disorders, eating disorders, or other psychosocial risk factors prior to entry into the program. The clinical psychology resident will also co-lead a psychoeducational group for participants in the weight management program, and will function as part of an interprofessional team of physicians, dieticians, a nurse, and an exercise physiologist.
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 clinical psychology 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.
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. The service treats a wide range of patients from the Spanish and Portuguese community as well as a wide range in socioeconomic status. Approximately 1/3 of the patients are consults in the emergency room setting and 2/3 of the patients are consults on the medical-surgical floors. The service works closely with physicians from all other disciplines of medicine.
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. Clinical psychology residents 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.