Friday Factoids Catch-Up: What Exactly Does Psychosomatic Mean?

When patients who are presenting to physicians for treatment hear the word “psychosomatic” they usually feel immediately discredited. This term is often followed by a referral to see a psychologist, which patients often do not choose to do.

 

First, the term psychosomatic means something different to physicians and most patients than it does to psychologists and mental health professionals. When physicians resort to telling patients they feel their condition is psychosomatic, it is often after much frustration and perceived treatment failures. Physicians note that these patients report very high levels of symptomatology, but testing and evaluations cannot identify concrete pathology. Physicians may also notice that patients seem to be reporting higher levels of symptoms than what seems to make sense in light of physical findings. The model that many physicians were trained in (Cartesian Model) creates a mindset that all medical conditions can be diagnosed with a methodical and logical approach. If this approach yields no solid support to reported symptoms, the problem is determined to be psychosomatic—or essentially not real. Laypeople (patients) typically identify the term psychosomatic in the same context. It can be a painful word for patients to hear and understand, and they often feel insulted by the resultant referral to see a psychologist.

 

Psychologists do not identify the term psychosomatic the same way as physicians and patients may define it. Many psychologists conceptualize health problems from a multi-faceted approach in which physical and biological conditions interact with their environment. “Somatic” research generally approaches physical conditions as inseparable from the mind. This under no circumstances means that psychologists think “every problem” is in the mind. In fact, it means that all systems in which a person functions interact with each other. Chronic pain is an example of a problem in which many systems interact. Emotions have been identified as one factor in decreasing pain tolerance, and biological changes can result from emotional state. So, feelings can make pain worse, and worsening pain increases emotional issues—and the problems can spiral.

 

Explaining to patients that seeing a psychologist is a part of treatment for medical conditions and not a result of practitioners deciding that patients are “faking” or “just emotional,” may help facilitate following up with recommendations. Patients who experience chronic illnesses often feel very misunderstood and disrespected, and more could be done to help patients understand that psychologists may be an instrumental part of their healthcare. This simple step could result in significant improvements in overall outcome for many conditions.

 

Rain Smith, MS
WKPIC Doctoral Intern

 

Article Review: The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury [Jones et. al. British Journal of Health Psychology(2012) 17, 798-811]

Jones et. al (2012) points out that traumatic injury can be linked with later development of PTSD. It does not seem surprising that PTSD is common after a major physical trauma resulting in orthopedic injuries (OI)  or acquired brain injury (ABI). Unknown variables included which factors might mitigate or limit the development of PTSD after traumatic injury.

 

Jones et.al. discussed the social identity model. The social identity approach looks at how one’s social group memberships contribute to health outcomes. Jones et. al. evaluated two injury groups (OI and ABI) at 2 weeks and again at three months after discharge. The participants were given The General Health Questionnaire (GHQ) to assess somatic symptoms. The Exeter Identity Transition Scales (EXITS) were utilized to assess sense of belonging, connection and support. Finally the Trauma Screening Questionnaire (TSQ) was given to assess post traumatic symptomatology.

 

The researchers found that group memberships seemed to effect OI and ABI differently. Injuries that caused long term life changes seemed to have reduced trauma symptoms when new group membership after the injury was developed. An example of “new group membership” would be joining an ABI support group. The authors theorized that membership in a group that facilitated the changes involved allowed patients to better adjust to their new life circumstances.

 

Jones et. al suggested that for injuries with higher levels of long term disabilities, trauma symptoms may be reduced by health care personnel making appropriate referrals to community services and groups.

 

References
Jones et. al (2012). The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury. British Journal of Health Psychology, 17, 798-811

 

Rain Smith, MS
WKPIC Doctoral Intern

 

Friday Factoids Catch-Up: The Cursed Dissertation Defense

 

 

I recently traveled back to California in order to complete my final dissertation defense. I decided that I would fly to California a day early so that I did not have to feel rushed. I was already nervous enough without having to worry about more travel logistics. I boarded my flight in Nashville on schedule and was on my way, or so I thought. One passenger started getting up and down using the bathroom. This isn’t necessarily unique, but after the fourth time myself and the passenger sitting next to me were curious. The flight attendants were opening and closing the lavatory door checking on the ill passenger. The Captain then announces that we will be making an emergency landing. The ill passenger apparently had some form of gastrointestinal illness and Norovirus was suspected. We landed in Kansas City to switch planes. I have never been in the Kansas City airport before but I can only describe it as a bunker. If there were a nuclear event while I was in Kansas City I knew I would survive.

 

Our new plane arrived, there were no nuclear events and we were underway again. As we were taking off another passenger started grabbing her chest and left arm. She was yelling at the flight attendant that she was “dying.” As a soon to be psychologist, I am usually very sympathetic to a person who is panicking but NOT today. Over the years in my previous work as a respiratory therapist I have seen many people actively having heart attacks. While you cannot necessarily tell if someone is actively having a heart attack without a proper evaluation, I was pretty convinced this lady was having a panic attack. The flight attendants were able to calm her for a bit and her distress decreased. As the flight proceeded she again started complaining of chest pain so we made emergency landing number two. Thankfully an ambulance was waiting on the runway and we were quickly up in the air again.

 

Several hours delayed, I arrived in Los Angeles at around 1 am and boarded my shuttle to the rental cars. Apparently circadian rhythm disorders are frequent in Los Angeles because the airport traffic was gridlocked. I doubled checked the time and wondered where all these people were going. A part of why I left Southern California was already quite evident. I did eventually make it to the rental car counter where I met the most dedicated rental car employee. Ever. She raised her voice when I declined the extra insurance, she told me (of course) about the “special” that would allow me to upgrade the car I was renting. I am normally quite patient but I stopped her and said, “I just want the car, nothing else.” She then proceeded to give me a lecture about how I had an out of state driver’s licence and needed the extra insurance and some other plan in case I got a flat tire. My response, “The car please.”

 

I traveled from Los Angeles to my room in Orange County near Disneyland. I was relieved to finally be at my destination and sorely in need of sleep. I checked in and the key to my room didn’t work. I returned to the desk, and the desk person tried to open the door and no luck. At this point I really would have slept in my hard won rental car. The front desk person informed me that there was only one room left, on the third floor, no elevator. I shrugged because after coming across the county three flights of stairs seemed a small obstacle. I quickly found out that there was a very good reason my first room was booked on the first floor. I managed to drag my suitcase up one flight of stairs and then proceeded to ask the front desk person to help me. I have some physical issues that limit my ability to gracefully carry a suitcase full of books up three flights of stairs. Finally, I was able to enter this room and collapse on the bed. It was around 4:30 am.

 

I spent the next day mostly sleeping. I was able to prepare a bit more that evening and I felt ready to make my final defense in the morning. I slept well and was going to leave an hour and a half early, again so that I didn’t have to feel pressured. I came out to the parking lot and did not see my rental car in the spot I was quite sure I parked it. I knew I had gotten in late and was generally disoriented after my flight so I proceeded to check the whole parking lot and no car. I started laughing like this situation was the most hilarious thing to ever happen. I’m not all together sure that it was a “good” laugh. One could argue that I had become out of touch with reality. I go into the hotel lobby and explain to the desk staff what is going on. I hear “Oh that was your car? The towing company accidentally towed it.” I took a deep breath in because we all need to breathe and count to ten sometimes. I explained that I was going to defend my dissertation and I needed to go now. The desk staff seemed to be able to read the angry, nervous state I was in. They called a cab for me and even had him wait for me. Good thing I started out early.

 

I made it to the classroom I was assigned to and began to attempt to set up my PowerPoint presentation. I had expected technical difficulties and that was why I allowed myself extra time but that time was cut in half by my missing car. I.T. was called because apparently I am putting off some form of energy into the universe that is not compatible with planes, cars, or computers. It is never good when I.T. says “wow, I’ve never seen this before,” when you are attempting to load your defense presentation. Thankfully my chair came into the room and was able to fix what was going wrong with the technology. I then successfully defended my dissertation. Now nothing else mattered, and my attitude about the travel glitches was cured by the statement: “My dissertation is defended.”

 

Little did I know that in my absence there was a plumbing problem that basically destroyed the kitchen and downstairs area of my house. My husband had wisely waited until after my dissertation was defended to tell me that we had no kitchen, laundry, downstairs bathroom. Nothing. He sent pictures and all I could say was, “My dissertation is defended.” I almost didn’t care that my house was in a state of demolition. I felt great! My car was returned and I was ready to go home (or whatever was left of home) victorious. I boarded my flight and we had a scheduled lay over in Kansas City, a.k.a the bunker port. All seemed to be going well, which at this point in the trip was a bit strange. It very well could have been that pandemonium was breaking out and I was just repeating, “My dissertation is done.”

 

I arrived at Nashville airport to be greeted by my family with flowers and balloons. I went to get my luggage while struggling to keep my very active 10 year old son from creating a public disturbance by riding on the luggage carousel. I was informed that the suitcases are “just like a horse,” meaning there is no good reason why one cannot ride on a suitcase spinning on the baggage carousel. I almost joined in until a security officer walked our way. I didn’t think he would buy my answer of “my dissertations done” as explanation for riding the baggage carousel. Well, as fun as the baggage claims area of the airport had become there was something crucial missing: my suitcases. Yep. Nothing like ending a trip with lost baggage, but you guessed it, I answered with, “My dissertation’s done!”

 

I was receiving supportive texts from my colleagues at WKPIC. Many times supporting one another involves continuing to point out the humor in almost any situation. I am now infamous among my colleagues for plane crashes (yep- see my interview story), emergency landings and other travel mishaps.

 

Rain Smith, MS
WKPIC Doctoral Intern

 

(Director’s Note: We offer these stories so interns will know they are not alone. Cursed times appear to include internship interviews, Match Day, Dissertation Defense, and Licensing Exams/Orals. YOU ARE NOT ALONE.)

 

Friday Factoids Catch-Up: You Aren’t “One of Them”: Stories and Themes of People Who Felt Treatment Wasn’t Effective

Mental health treatment “failure” is a subject, which is overlooked by many. I have been approached by acquaintances who have asked some interesting, and at times difficult questions about mental health treatment. I listened to some of their stories, views, and opinions regarding their treatment experiences. They consider me a friend or family member more than a psychologist, so I feel that some of this more candid insight could be helpful.

 

The statement “you aren’t one of them,” meaning that I am not like the mental health providers with whom the person had interacted, has been said to me frequently at the beginning of one of these discussions.  My first thought was that I am not a treating psychologist during these conversations, so I am glad I am not “one of them” to my family and friends. However, there were other considerations when I thought about the “not one of them” statement. I began asking more questions about what “one of them” meant. Mental health treatment providers were then described to me in an adversarial manner. The individuals sharing their stories were essentially impoverished and residing in rural and critically underserved areas of the U.S. In the view of these service-seekers, clinicians were seen as “rich people” who could never understand what life was like for people who had fewer resources. Treatment providers were identified as holding such a high position that they had the ability to “remove all the rights a person has.”

 

Most of these folks, understandably, did not seek treatment until they were in a state of utter despair. They discussed feeling judged by the clinicians they saw. While my own experience is that treatment providers are non-judgmental, it was concerning that the perception of many of the people in most need, those seeking treatment in crisis in areas where services are marginally available, was the opposite. Many disclosed that they were not truthful with clinicians because they feared what the clinicians’ responses might be. Often times, people seeking psychotropic medications indicated that waiting lists were unbearably long, which in turn contributed to their perceptions that providers did not understand the suffering they experienced. Much of their perception of the mental health service system as adversarial seemed to be rooted in misunderstandings and miscommunication. Mental health treatment for those I spoke with was relegated for those who “hear and see things.”

 

As a clinician I feel there is sometimes a lack of time to develop a deep understanding of the patient for whom you want to provide care. It may be that in the precious time we have with a patient, our mannerisms, clothing, or signs of status like jewelry communicate the divide–immediately, at first sight. The person presenting for treatment in some areas of the country has been suffering for a long time, possibly left on a waiting list, and then they must face a person they think cannot relate to their suffering (or any suffering). While this may or may not be true, it is an important variable in how supported some rural, low-income service-seekers feel.  Those sharing their stories had a lack of education about many facets of mental health treatment, and more importantly, they were afraid to ask questions.

 

In my opinion, treatment providers could do more to be attuned to the challenges their patients face, and we could listen more closely to those who are telling us we failed to help them.

 

Rain Smith, MS
WKPIC Doctoral Intern

Friday Factoids: Mental Health Benefits to Pokémon GO

The new social craze is the phone app Pokémon GO. This game lets players travel between the real world and the virtual world by using real locations to search for Pokémon to catch. Players step outside their homes to find interesting places such as historical landmarks, monuments, and public art installations. Users have been flocking to social media to share how playing this game has improved their mental health. This game has the added benefit to help a person not even think of it as helping their mood because it’s not targeted towards improving mental health. It’s simply a game.

 

When you get an egg in the game, usually at a Pokéstop, you can place it in an incubator to wait for it to hatch. But the time it takes to hatch is up to you. The first eggs you get require you to walk 2 km or 5 km for incubation to complete. For many players, partaking in this game involves a lot of walking, running, and cycling. This helps to elevate mood, boost coordination and balance, maintain a healthy body weight and even strengthen bones. What’s more, walking through scenic natural areas can provide further mental health benefits. Research from a Stanford University graduate found that walking through green areas actually had a significant effect on positivity.

 

There are stories on social media about Pokémon GO’s impact on players’ anxiety and depression. People have praised the game for getting them outside of the house and making it easier to interact with friends and strangers. The challenge with depression is having low motivation or energy to get up and stay active. Similarly, if a person is anxious they may be less likely to interact with other people in social situations. If a person struggling with mental illness is not accessing outpatient treatment then this game can have positive effects by adding exercise to their daily routine. Be careful not to mistake this information and believe that substituting Pokémon GO as an opportunity to treat a mood disorder solely with a game. If some day the game does not load, that can be a devastating setback for someone who does not have additional coping skills established to help them. Similarly, someone who already feels isolated won’t receive help because the game does not extend to some remote regions across the country. Pokémon GO could be used as an adjunct to psychotherapy and medications, but it should not be the sole treatment.

 

The game can be educational as well. Many videogame players tend to stay indoors and may be relatively unaware of significant locations in their local communities. Additionally, conventional online multiplayer games are still limited to purely digital interactions. Many of the Pokéstops that players visit are landmarks and historical markers. While players are out catching Pokémon there could be at least twenty other people in the same location. Many players report that while hunting for Pokémon they regularly notice, interact and make friends with others out playing the game. Pokémon GO gives gamers a great incentive to socialize and meet others who would usually recluse while playing video games. Again, most individuals believed that technology is driving people apart and making our society more anti-social. Pokémon GO brings people together and provides a break in the day from work or studying. It’s preventing some people from becoming bored and improving social connections.

 

This app demonstrated the unintentional benefits of gaming and produced a game that encourages healthy exercise. There are hundreds of app developers that have tried to develop mood-altering apps by encouraging people to track their mood or providing them with encouraging affirmations. Unfortunately, these apps rarely catch on, and few people continue using them past the first week, Research has long shown the benefits of simple exercise and socializing on improving mood. The developers behind Pokémon GO didn’t mean to create a mental health gaming app. The effects seem to be largely positive.

 

References:
Grohol, J. (2016, July 11). Pokémon GO Reportedly Helping People’s Mental Health, Depression. Psych Central. Retrieved from: http://psychcentral.com/blog/archives/2016/07/11/pokemon-go-reportedly-helping-peoples-mental-health-depression/

 

Saifi, R. (2016, July 26). Pokémon GO’s Mental Health Benefits Are Real. The Huffington Post. Retreived from: http://www.huffingtonpost.com/rahis-saifi/pokemon-gos-mental-health_b_11204184.html

 

Jonathan Torres, M.S.
WKPIC Doctoral Intern