Titles: Behavioral Medicine Medical Psychology Psychosomatic Medicine Health Psychology

1. The Practiceof Clinical HealthPsychologyRobin Perkins, Ph.D.Clinical PsychologistArchbold Integrative Medicine Center

2. Health Psychology:Utilizes the contributions of the science of psychology to promote and maintain health, prevent illness, and identify causes related to health, illness, and wellbeing.

3. Titles: Behavioral MedicineMedical PsychologyPsychosomatic MedicineHealth Psychology

4. Requirements: Ph.D. in PsychologyPrefer Specific graduate training and graduate internship in Clinical Health PsychologyState License in Psychology

5. Areas of Work:Academic InstitutionsMedical Centers / HospitalsResearch InstitutionsPrivate PracticePrimary Care Practices

6. Top Three Professional Activities:Clinical Practice 65%Research 55%Teaching / Supervision 50%

7. Clinical Focus:Individual PsychotherapyGroup PsychotherapyPsychological TestingTeaching Family Therapy

8. Specific Areas of Clinical FocusCardiologyNeurology Pain ManagementSmoking CessationStress ManagementDiabetesCancerPulmonary Diseases

9. Cardiac PsychologyPrevalence:*** 4,000 People in the U.S. suffer from myocardial Infarction (MI) each day****** 1 out of 5 Americans have an MI before the age of 60***

10. Cardiac Risk FactorsModifiableNon-ModifiableTotal Cholesterol Age and LDL MaleDiabetes Family HistorySedentary Personal History LifestyleSmokingObesityStressPsychosocial Factors

11. Major Psychosocial Variables***Type A Behavior***Anger and Hostility***Chronic Stress***Job Strain***Exhaustion***Social Isolation***Depression

12. Charlie*Charlie is referred to you by his cardiologist.*The referral reads: “Stress Management.”*Charlie’s wife calls and makes the first appointment.*Charlie cancels the first appointment but attends the second with his wife.

13. Charlie*Assessment: Diagnostic Interview Psychosocial Mental Status Medical history Psych Hx / Sx Psychological Testing ?

14. Charlie* 48 years old white male* Family history of heart disease*Father died of a heart attack at age 50 years*Older brother Fred is a “cardiac cripple”.

15. Charlie*Married (second time) for 25 years.*Oldest son (22 years) is in college.*Has one daughter still living at home (16 years).

16. Charlie*Completed 4 years of college*Degree in Criminal Justice*Works as a prison guard in a low security federal prison for men.

17. Charlie*Smokes 1.5 to 2 packs of cigarettes per day.*Does not exercise and really struggles to meet physical demands of job.*Drinks 1 to 2 beers per night, usually after work.* Diet: SAD

18. Charlie*Has no friends outside of a few co-workers that he occasionally has a beer with after work.*Does not attend church with his wife and daughter.*Does not have much contact with other family.

19. Charlie*No significant past medical history.*No significant past mental health history.*No family history of mental health issues.

20. Charlie*Charlie presents as alert and oriented in all spheres. *Walks with a cane, poor posture.*Does not make good eye contact.*Speech is normal.

21. Charlie*Mood seems depressed.*Affect is flattened.*Range is restricted.*He reports not knowing why he is here and denies any problems.

22. Charlie *Talk with wife? *Important Issues to address?*Build rapport?

23. Charlie*Wife presents as very supportive of Charlie.*She reports that she is worried about him: *He tends to work too hard.*Is not sleeping at night.*He is normally controlling with a temper – now worse.

24. CharlieIssues to address?

25. Issues to address?*Personality factors*General stress*Work stress*Smoking*Alcohol?*Exercise*Diet

26. Issues to address? *Mood: depression?- Anxiety?*Sleep*Social Isolation

27. CharlieRapport:*How can I help?*What does Charlie want?*Depression / Anxiety / Fear /Denial?*Start with medical and work to psychological

28. Other thoughts about Charlie?

29. Questions?Thank You