Dear Healthcare Provider,

 

As a former postdoctoral fellow at the Johns Hopkins University School of Medicine’s Behavioral Medicine Clinic, I have been trained to provide psychological evaluation and psychotherapy services to address a range of psychological problems, including depression and anxiety, that can affect a patient’s physical as well as emotional health.  Additionally, I specialize in working with individuals who have chronic pain. 

 

As you well know, the day-to-day experience of living with chronic pain takes both a physical and a psychological toll on a person.  Conversely, psychosocial factors affect the patient’s experience of pain and level of disability, over and above differences accounted for by objective physical pathology.  For example, depression may affect as many as 30-50% of individuals with severe, long-term chronic pain.  Depression and negative thinking are associated with higher pain severity ratings and more pain behaviors (e.g., nonverbal expressions of pain).  Even more importantly, depression and negative thinking correlate with a patient’s level of disability, and are associated with:

–   greater interference in daily activities due to pain

–   lower activity levels and more time spent lying down during the day

–   fewer adaptive coping efforts

–   poorer treatment outcomes

 

The presence of depression decreases the likelihood that the patient will report pain relief, or translate any pain relief provided into increased functioning.  Additionally, chronic pain patients who are depressed or prone to negative thinking may demonstrate greater analgesic use.  Depressive and anxiety disorders also significantly influence the outcome of a range of medical illnesses such as cardiac diseases, diabetes, cancer, and hypertension.

 

A psychological referral may be indicated if: you observe significant, prolonged depressed mood, anxiety, anger problems, or related symptoms (e.g., severe sleep disturbance); you are told by those close to the patient that such symptoms occur at home; you observe that the patient’s level of impairment is significantly greater than expected given his/her medical status; you observe that the patient is demonstrating escalating medication use; or you are considering the patient for chronic opioid therapy and have concerns about compliance issues. 

 

I employ a treatment model know as Cognitive Behavioral Therapy, or CBT.  CBT is considered by many psychologists in medical settings to be the most effective approach to psychological treatment with medical patients. CBT is a very here-and-now focused, problem-solving approach, which helps the patient develop strategies for coping with chronic pain (or other chronic stressors) on a day-to-day basis.  By using the techniques of CBT, and working collaboratively with the physician, I can help a patient:

·         Increase activity level, reduce pain behaviors, and reduce disability

·         Address problematic medication use

·         Decrease symptoms of depression or anxiety

·         Learn new stress management and coping skills that can be used in daily life

·         Learn specific skills for relaxation of the body and mind

·          Develop a realistic and more optimistic outlook

 

I would be happy to further discuss what services I can offer to you and your patients.  I look forward to the possibility of collaborating with you in the future. 

 

Sincerely,

Lisa M. Yacono Freeman, Ph.D.                        

Licensed Psychologist