Dr. Stein's Psychology Blog
My thoughts on mental health counseling, therapy, neuropsychology, collaborative divorce and more.
Here's my article on anger:
Obtaining psychological clearance before you begin a trial period of spinal cord stimulation is routine, but many people are unsure about why this is such an important step.
Spinal cord stimulation uses electrical current to minimize the feeling of pain reaching the brain. It involves insertion of small devices in the area around the spinal canal, which send the current when activated.
Following are a few common questions people ask about the required screening session with a neuropsychologist and how the results can be used to help meet your needs.
Q: Does a referral to a neuropsychologist mean my surgeon thinks I’m crazy or will go crazy after the stimulator placement?A: No, but not everyone responds well psychologically when a foreign device is implanted into their body. For some, the stimulator can cause an increase in worry and anxiety. Unfortunately, this stress can reduce the effectiveness of the simulator placement. In part, the pre-surgical clearance examination helps your physician prepare you for the procedure and make recommendations to help you adjust to this new part of your body.
Q: What happens during the pre-surgical psychological examination?A: Sometimes patients who have never met with a psychologist before get anxious about the initial visit. Knowing what to expect can help decrease worry.
Typically, the examination consists of a conversation between you and the psychologist about your medical history, including your chronic pain struggles. It also involves a social history, family history, information about previous alcohol or substance use, and what kind of psychological treatment you may have had in the past.
Q: What if I am depressed or anxious? Will that stop me from having the stimulator placement?A: No. In fact, chronic pain patients are much more likely to suffer from depression and anxiety than the general public. It is typical and expected that people living with chronic pain will have high levels of irritability, anxiety, and depression.Also, pain relief often helps decrease depression and anxiety. If you are struggling with depression and/or anxiety, the pre-surgical clearance evaluation will offer recommendations to help diminish these feelings.
Q: Can the psychologist make other recommendations besides the stimulator?A: Yes. The psychologist can be a valuable member of your pain management team. Many people find that alternative or complementary treatments, such as biofeedback and mindfulness approaches, can be helpful in helping manage chronic pain. Psychologists can guide people in these therapies as well as provide traditional psychological counseling.
Q: How long is the appointment and can the screening usually be done in a single appointment?A: Typically, an evaluation takes two hours and—depending on your insurance—can be done in one appointment. Following the evaluation, the results are shared with you and your physician.
Q: Are most people cleared to proceed with spinal cord stimulation?:A: While most people are cleared to have the trial placement of the stimulator, a small number of people are not. Those who are experiencing hallucinations, delusions, and cannot understand and follow post-operational directions should not have a stimulator. Instead, complementary and holistic interventions such as mindfulness, cognitive-behavioral therapy, or biofeedback may be a more effective option for pain management.
If you have any questions, feel free to call me in my Red Bank, NJ office at 732-747-8818.
(Initially published at: http://www.sports-health.com/blog/3-ways-stay-sane-when-injury-puts-running-hold)
If you're an elite runner, a weekend warrior, or somewhere in-between, it's generally not a question of if an injury will happen, but when. See Common Running Injuries
Half of runners will be hurt more than once in a given two-year period, according to Stephen Messier, the director of the J.B. Snow Biomechanics Laboratory at Wake Forest University in Winston-Salem, N.C. Women runners are somewhat more likely to be injured than men.
Running injuries can be caused by a traumatic event, but are most often happen over time due to repetitive movement. See Running InjuriesApplying repeated force over a extended period of time or suddenly boosting a training level causes conditions such as runner's knee, Achilles tendinitis, plantar fasciitis, shin splints, iliotibial band syndrome, patellar tendinitis (also spelled tendonitis), ankle sprain, pulled muscles, blisters, chafing, and side stitches.
In fact, the late runner-philosopher Dr. George Sheehan called running injuries “diseases of excellence.” While heart disease, type 2 diabetes, and hypertension are often seen as maladies of the sedentary, athletic individuals are not immune to health issues such as shin splints, stress fractures, and pulled groins. See Stress Fracture Causes
But let’s face it, most runners—myself included—aren't comforted by that badge of honor and don’t tolerate injuries well. Instead, we bemoan the fact that we can’t participate in something that keeps us physically and mentally healthy.
When injured, we fret over the loss of fitness, the possibility of weight gain, and the anxiety that we won't return to our previous level of physical intensity. Runners who are injured can become depressed. Their friends and family can find them difficult to deal with.See All About Ankle Sprains and Strains
Here are three coping skills runners can use to manage being sidelined:
1. HAVE A SECOND PHYSICAL ACTIVITY: Christy Victor, an ultra-marathoner, advises having an auxiliary physical activity already in place before an injury occurs.
“When I broke my ankle last fall, I threw all my energy into the strength training that had just been a secondary activity," explains the busy veterinarian, wife, and mother. "It helped in so many ways. It gave me a physical outlet, helped keep me from falling into the self-pity trap, and I worked really hard to correct some chronic imbalances that needed to be remedied.” See Exercises to Lessen Back Pain While Running
Having a physical outlet independent of running can ease concerns about losing fitness and helps you continue to enjoy many of the mental benefits seen from running. A secondary physical activity also helps individuals keep structure and routine in their lives, two things that help prevent or reduce depression. Additionally, a secondary physical activity helps maintain fitness, something that eases the emotional burden of being injured.
2. STAY CONNECTED: Team athletes can remain involved in athletics even when injured, but running tends to be a solitary activity. Social media, though, can help runners who do not belong to their local clubs or teams boost feelings of connectedness and reassurance. Facebook, message boards, and running apps allow runners to forge friendships, share milestones, and most importantly, offer encouragement and support when injured. Social media also helps runners remain accountable for getting back to running when healed from their injury. See Treating Acute Sports and Exercise Injuries in the First 24 to 72 Hours
Greg Medwid, a master-class runner who has a personal best of 79 minutes in the half marathon, knows what it's like.“When you are injured, you suddenly feel like an outsider. You watch your friends speed off, chatting and laughing while you wallow in a collection of pity and resentment. However, staying in touch can make all the difference. We need to at least be able to talk about running, and running friends provide that opportunity. Friends can give you that chance to keep up to date, to think about goals when you do come back. Good friends will even lie about how bad their runs were so you don’t feel too jealous.”
3. CHALLENGE CATASTROPHIC THINKING: It’s no secret that runners pride themselves on their passion and spend a lot of time thinking about the sport. When injured, it's easy for thoughts to turn dark and catastrophic.Psychologist Albert Ellis, the pioneer of Rational Emotive Behavioral Therapy, would suggest that when injured, a runner employ his “ABC method.” For Ellis, the Activating Event (A) would be the external fact of being injured, something that for the time being cannot be changed. This event in itself is not the cause of suffering. Rather, the Belief (B), that follows is what leads to a negative emotion or, in other words, a Consequence (C). Ellis argued that, over time, as you alter your aberrant beliefs (B), your negative emotions diminish.For example, a recent patient of mine effectively managed depression with running and was excitedly preparing for her first marathon. She was fit mentally and physically. As the marathon approached, though, a severe case of plantar fasciitis compelled her to withdraw from the race.See Plantar Fasciitis Risk Factors
The injury (A) triggered a series of catastrophic thoughts (B) that at first she was hardly aware of, including ideas that she would never finish a marathon. She also believed that the running she did was diminished by her injury. Even worse, she thought her depression would return at a level more severe than before. Lastly, this patient was very concerned about being embarrassed and humiliated because she spoke often to her family and friends about participating in her first marathon. At her core, she believed that she was a “loser” for getting injured.
When she was able to identify her dysfunctional thoughts and look at them more closely, she was able to make small, positive changes in her beliefs. Her mood did not improve overnight, and she later observed that she was still not happy about being injured. After all, who would be? But when she put her negative thinking to the test, she was able to view her injury as part of the marathon challenge.In time, she felt less helpless. Overall, she changed the mind-movie in her head of not achieving her goal and the sadness went away.
No runner likes the idea of getting injured while exercising. But having a variety of coping skills including a backup physical activity, staying connected with social media, and thinking clearly about the issue will be of benefit until you can literally and figuratively get back on your feet.
I'm a clinical psychologist and neuropsychologist with a private practice in Red Bank, NJ.