February 1st, 2013

Pre-surgery treatment and trauma among focuses of work

Most people do not take going under the knife lightly. Whether it’s a minor or major surgery, there are any number of fears that prey on the mind – from anxiety over being out of control to concern that the doctor will make a mistake to trepidation about the pain that will result.

There is evidence, however, that teaching patients coping skills to manage stress and anxiety have extremely positive results – both on the overall experience and on the physical outcomes of the surgery. It’s a professional niche where mental and medical health can, and should, overlap and one that Kathi Croce, Ph.D., a clinical psychologist with a private practice in Guilford, Conn., has set out to develop.

The first psychologist in the community to gain privileges at Yale-New Haven Hospital, Croce has spent the past several years developing an evidence-based treatment to reduce pre-surgery anxiety for patients.

Croce spoke with New England Psychologist’s Catherine Robertson Souter about her new endeavor and the importance of medical collaboration. A trauma specialist, Croce also talked about the help she was able to provide in Newtown, Conn., after the horrific killings in December and shared a message for psychologists who would like to get involved during disasters.


Q: With the pre-surgery treatment, you saw a need and, through research and interviewing people around the country, developed a new treatment modality. What was the impetus for developing this program?

A: I witnessed family and friends and talked with patients who had very difficult hospital or surgical experiences because they had few coping skills around their anxiety, fears, and pain. I think that medicine does its job but often doesn’t address some of the emotional or anxiety issues.

Research shows that these issues are often not addressed with patients prior to surgery. Sixty percent don’t read the patient education flyers, 30-50 percent don’t remember the surgical information.

This is where psychology or mental health can interface and collaborate with medicine to help patients.


Q: What does the pre-surgery program look like?

A: It is essentially around four sessions, depending on the nature of the individual and the level of anxiety. The first couple of sessions are in my office, teaching people a range of positive skills including imagery, self talk and positive outcome expectations. On the day of the surgery, I go to the surgical floor to go over any questions and to reinforce their control and relaxation. Then there is a follow up visit.


Q: Was it difficult to become part of the hospital system?

A: Since I was the first psychologist in the community in the history of the hospital to get staff privileges, there was a lot of scrutiny. That took a period of about nine months to a year.

I am still a private practitioner who has privileges at the hospital. The program is not integrated into the hospital, which is unfortunate. There are very few hospitals who have these services and I have not found any on the East Coast that have it in the formal way that I am doing it as a protocol, evidence-based treatment.

I am not saying that there are not people out there doing pre-surgery work. And I am not saying that others not doing this comprehensive model are not helping people. Sometimes CBT or the relaxation response would be enough.


Q: What are the steps you are taking to grow the business?

A: I am building my referral base. I have met with all the administrators but where you build the referral base is by meeting with surgeons and specialists, oncologists, etc. I have a brochure and I am working on a Web site and I am running a group with one wing of the cardiology department.


Q: What do you see as the future? Do you want to build a practice around this, expand to other hospitals, hire a staff?

A: Right now I am in the building stages, but that would certainly be a wish of mine in order to help patients. I would like to see this at other hospitals and maybe present at conventions and do trainings.

When I share my work with my peer group they say, “Oh my, you are going to have to hire people, this is going to be so fabulous.” The positive reaction to my work is huge. The logistics and what it takes to build this and to integrate with medicine is another issue. But I am hopeful.


Q: Is this a good niche to pursue?

A: On one hand, I think it is a really ethically responsible behavioral medicine niche. But, you have to work at it.

Yale does between 14,000 and 20,000 surgeries a year and that is one hospital. If you look at those numbers and you look at the average person’s response to surgery, the need is there.

It is disappointing that it is not more common, but with the biomedical model, physicians are trained very differently. Although they say that they are working with interns and medical students to learn how to talk to patients, it is really not integrated so that they are being supervised, having modules, role playing, etc.


Q: On another note, you recently volunteered as a trauma specialist after the Newtown tragedy. What was that experience like?

A: I am a mental health disaster volunteer. I got retrained after the storm Irene when there was so much devastation and I felt I could be doing more. I did some work after Sandy where I went out four times as a disaster volunteer.

When the Newtown tragedy happened, I saw it on the news and I felt really devastated. I went there that afternoon as a Red Cross mental health volunteer.

I worked that night, paired up with a colleague, and the next day I was assigned to the churches and to the school that was set up for family assistance. Then, later in that afternoon, I was assigned to a family who lost their daughter. We did good work with them that first night and continued to work with them during the week – to do a number of very difficult things around their daughter with the funeral home and other kinds of things. That was very trying.

This level of trauma work is very hard. But I am so glad to help this family. Otherwise, most of us feel helpless and just sad and overwhelmed. It was a horrendous assault on everyone involved.


Q: You have a message for other mental health professionals?

A: The town was inundated with help. Everyone was so upset by it. The FBI, the Red Cross reeled that in to make sure that qualified people were going out.

I think psychologists are probably better trained mental health people in general but that doesn’t mean that everybody has trauma training. If psychologists want to do this kind of work, disaster work, I suggest that they go through trauma protocols, go through Red Cross training. First, you are not going to be allowed on-site. We had to have badges, wrist bands, be okayed through the state police. Don’t just show up. Get the right training and get involved with the right group now so you can have access to be more helpful. 

By Catherine Robertson Souter

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