1. The Practice of Clinical Health Psychology Robin Perkins, Ph.D. Clinical Psychologist Archbold 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 Medicine Medical Psychology Psychosomatic Medicine Health Psychology

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

5. Areas of Work: Academic Institutions Medical Centers / Hospitals Research Institutions Private Practice Primary Care Practices

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

7. Clinical Focus: Individual Psychotherapy Group Psychotherapy Psychological Testing Teaching Family Therapy

8. Specific Areas of Clinical Focus Cardiology Neurology Pain Management Smoking Cessation Stress Management Diabetes Cancer Pulmonary Diseases

9. Cardiac Psychology Prevalence: *** 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 Factors Modifiable Non-Modifiable Total Cholesterol Age and LDL Male Diabetes Family History Sedentary Personal History Lifestyle Smoking Obesity Stress Psychosocial 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. Charlie Issues 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. Charlie Rapport: *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