- I'd like to welcome you to our talk
on creative coping with chronic illness.
It is my pleasure to introduce Dr. Heidi Beckman,
who is a clinical psychologist at UW Hospitals,
for today's talk, so...
(applause)
- Thank you, and thanks for inviting me here.
I want to talk a little bit first about what
department I'm in and explain what it is.
So I'm in the Department of Health Psychology
at the University Hospital.
And health psychologists are,
it's a specialty area of clinical psychology
where we work with people who have a wide variety
of medical conditions.
So it's sometimes people who are newly diagnosed
with a challenging medical condition.
Sometimes it's people who have been living
with chronic illness for a long, long time,
and maybe some new challenges come up that are
making it difficult to adjust to life
with a medical condition.
I see people with chronic illness and chronic pain
and people who are having some challenges
doing what their medical team asks them to do
in order to take good care of themselves.
So it's really a wide variety.
I'm currently running a group at the hospital
that's called Creative Coping with Chronic Illness.
I've been running the group for about eight years now,
and over the years, I've actually learned quite a bit.
I've had the pleasure of meeting a lot of
strong and courageous and insightful people
who have shared their stories with me
and have taught me quite a bit about what it means
to live well with a medical condition.
And so those are the insights that I'd like to share today.
Just a quick look at my agenda.
I'd like to start by talking about
some of the specific challenges of living with
a chronic medical condition.
And then, from there, talk about the phases
of the chronic illness journey.
Also, I want to talk about a concept
from a psychologist named Dr. Pauline Boss.
It's called ambiguous loss, and it fits quite nicely
in the context of this discussion of talking about
living with chronic illness.
And then, finally, I'd like to introduce some
ideas for coping.
So if we look first at the challenges
of living with chronic illness,
I think the first one on there is the most obvious one.
It's the one that we think of first.
It's the physical symptoms.
So pain and weakness and fatigue,
sometimes sensory disturbances,
sometimes changes to sleep or changes to appetite.
So very common in the context of chronic illness.
But you'll notice, even though that's the one we
think of first, there are six others on there.
And some of the others can be even more significant
or more problematic sometimes than the physical symptoms.
So the other six we'll look at one at a time.
Functional changes, emotional symptoms,
cognitive symptoms, negative thoughts,
relationship changes and changes in self-image.
When I say functional changes,
I mean changes to someone's participation in activities.
So sometimes, that's a reduction in participation,
and sometimes that's stopping participation all together
in things such as work or hobbies
or chores around the house, et cetera.
So if we pair the physical symptoms
with the functional changes, then it seems pretty obvious
that a byproduct of that can be emotional symptoms.
So probably, the first two on that list,
the anxiety and the depression,
are some of the most common symptom, emotional symptoms,
that occur with chronic medical conditions.
Also, people report changes in mood,
anger and frustration,
irritability, sometimes feelings of helplessness,
feelings of hopelessness,
like things are not going to get better,
or feelings of worthlessness, feeling down on oneself.
Another part of the picture of chronic medical conditions
would be cognitive symptoms in some cases.
By cognitive symptoms,
I mean changes to our thinking skills.
So that could be difficulty making decisions,
difficulty concentrating, changes to memory.
In certain medical conditions, you might see
changes to someone's personal insight,
their awareness of what's going on with themselves.
And sometimes changes to judgment.
Negative thoughts are very common
with chronic medical conditions.
When people become more stressed or depressed,
then a natural result of that is starting to think
more negative thoughts about the self,
about the world around us
and about the future.
So for example, negative thoughts about the self might be,
"I'm worthless," or "I'm a loser."
Negative thoughts about the world around us might be
"Life isn't fair,"
or "No one understands what I'm going through."
Negative thoughts about the future might be
"Things are just going to keep getting worse from here,"
or "My whole body is falling apart,
"and everything is going downhill."
So those are really common, especially in the early stages
of adjusting to a chronic medical condition.
A psychologist by the name of Dr. Aaron Beck
called those three areas the Negative Cognitive Triad.
So he said if you think about a triangle,
the three points on the triangle are
self, world, and future.
That as we get more stressed and depressed,
our thinking gets more negative in those three areas.
Relationship changes.
So we all live in an interpersonal context.
Very common when we're living with a chronic
medical condition to have changes to that
interpersonal context.
So in some cases, when we're not feeling a way,
we start to isolate ourselves.
We pull away from other people.
In other cases, the people around us
are somehow challenged by our chronic medical condition.
Maybe they're not sure how to be helpful to us
or they're not sure how to relate to someone
who has this new diagnosis.
And so they start pulling away.
So either way, the end result of all that
could be more isolation, more feelings of loneliness.
And then the unfortunate result of that
is often, at the very time when we need the most
social support and the most help from our friends
and family members that we're becoming more isolated.
And then, finally, changes in self-image.
So what I mean here is
people often find, when they begin having serious
medical symptoms, that they start feeling differently
about themselves, that they feel broken somehow
or like they're not a whole person
or not a complete person anymore.
Sometimes there are changes to self-esteem
or self-confidence.
And a very common reaction would be
a longing to have your old self back
and just wanting things to go back to the way
they were before.
So given that chronic illness can impact
so many aspects of our lives,
I always think that it takes so much courage and energy
to take on the task of managing a chronic illness better.
But many people do find that they do regain some control
over their existence, and they move through the phases
of the chronic illness journey,
and they get to a place where they're managing
their chronic illness better.
So you'll see the two circles on the screen.
I call those identity pies.
So if I gave you just a circle on a sheet of paper
and I said this circle represents your identity
or your sense of self,
and then I ask you to take a pen and just divide
the circle up into the different aspects of yourself,
people will often say, okay, well one piece
of my identity pie would be my family relationships.
Another piece would be my friendships.
Another piece would by my hobbies and interests.
Another piece might be my work, et cetera.
So it's kind of an interesting activity, you know,
to divide up your identity pie
and identify what is most important to your sense of self.
Now the circle that's on the left-hand side,
if you look at the red part of it,
I'm using the red color in this slide to represent
the chronic medical condition.
So when people are newly diagnosed
with a chronic medical condition,
their identity pie often looks like the one on the left.
The medical condition is in the center
of their sense of identity,
and it's bleeding over into every aspect of their life.
So it's kind of at the forefront of their consciousness.
When they're reflecting on themselves,
the chronic illness is dominant in their mind,
at the center of their sense of self.
The goal is to make your identity pie
look more like the one on the right-hand side
of the screen.
And So in that case, you can see the red shaded piece.
That's the chronic medical condition.
So in this case, the person would say,
okay, I've got my family relationships,
I have my friendships, I have my work,
I have my hobbies and interests, et cetera,
and, oh, by the way, one slice of my identity
is my chronic medical condition.
So it just happens to be one piece of who I am.
So you can see the difference there.
It's integrated into your sense of self,
but it's not bleeding over into every aspect
of who you are and every domain of your life.
So for many people that I meet within
the Health Psychology Department, that's the goal,
is to move from the identity pie on the left side
of the screen to the identity pie on the right side
of the screen.
There are many different theories about the stages
or the phases that people go through
as they cope with a chronic condition,
So I'd like to introduce one that I really like.
It's been designed by a medical social worker
by the name of Patricia Fennell.
And she summarizes it, she has a few different books
where she summarizes it.
The one that I like best is called
The Chronic Illness Workbook: Strategies and Solutions
for Taking Back Your Life.
And she talks a little bit about this journey
of integrating the chronic medical condition
into your sense of self.
She divides the process into four phases.
The first phase she calls the crisis phase.
So just as the name of the phase suggests,
it's a phase where there's a lot of crisis and chaos.
It's typically right after someone gets a new diagnosis
and they're simply trying to wrap their mind around
what this is.
What is this condition,
and what is this going to mean for me?
In the crisis phase, people are learning to observe
their body and how it reacts in different situations.
Very often, they're testing things out to find out
how they can preserve their energy
with this new medical condition.
The main task is to deal with the immediate hurts
and traumas of your new illness
to weather the crisis and regain some control
over your existence by simplifying your life
as much as possible.
After you've weathered the crisis,
then you move into phase two, which she calls
the stabilization phase.
I always think of phase two as the phase
where people are trying to sort out
what makes a good day and what makes a bad day.
Trying to learn what their patterns are.
You know, how much gardening can I handle
before my body doesn't want to cooperate with me anymore?
Or how many hours of sleep do I need
in order to optimize my functioning
with this medical condition?
In phase two, people have often reached a plateau
of their symptoms.
So their symptoms are starting to become
more familiar to them.
Perhaps the medical team has started
this person on a medication regimen that's helping
to manage the symptoms somewhat.
And so that allows you some space to start to define
the boundaries of your new life.
What is life going to look like for me now,
now that I'm living with this condition?
In this phase, people develop new norms for themselves,
and they clarify their values and their priorities
now that they understand that life is probably
not going to return to normal.
They're probably never going to be exactly the same person
they were before the onset of the medical condition.
People are also dealing with problems
that arise in their relationships.
So it's really common in phase one
that friends and family members rally around you.
You know, they see you're in chaos and crisis,
and they want to be there for you.
And so there tends to be good social support in phase one,
but by phase two that might fade a bit.
People are starting to realize that you're probably
not going to return to the person you were before.
That you're probably not going to return to normal,
whatever normal was.
And so sometimes, people begin to back away
or your relationships shuffle themselves a bit.
So in phase two, that could mean,
you know, finding who are the people who are there
for the long haul.
Who are the people who can be my social support structure
going forward, versus who are the people
who have backed away and what do I want to do
about those relationships?
So the main goal in phase two is to
stabilize and restructure your life patterns,
your relationships and your perceptions.
Phase three she calls the resolution phase.
I always like to call this one the meaning-making phase
because this is the phase where people start to ask
the larger questions, like why did this happen?
Or why did this happen to me?
Or now that this happened,
is there any way that I can use this in a positive way,
or is there any way I can make meaning out of this so that
I can live with the illness with more grace
or with more ease?
So in the resolution phase, people have learned
how their illness behaves
and how the world responds to it.
They've learned that they can't be the person
that they used to be before they became ill.
And so their task now is to try to maintain insight,
develop meaning into what's going on
and construct a new sense of self.
In this phase, people are often
coping with grief and loss.
So it's the realization that some of your functioning
may not return, and if you can't return
to some of you valued activities,
there's a sense of loss that comes with that.
Another task here is to just develop
a new authentic self
and begin to locate a personally meaningful philosophy
to live by.
You know, what's the philosophy, the life philosophy
that I can use that will help me live well
with this chronic medical condition?
And then, finally, phase four
she calls the integration phase.
So the way I think about that is
when you're walking through this chronic illness journey,
sometimes there are parts of yourself that get suppressed
for a while, or they get set aside for a while
because you're so busy with the task of coping
with these medical symptoms.
By the time someone gets to phase four,
they're often able to reintegrate those parts of themselves
back into their life again.
Maybe in a different way than before,
but nevertheless it becomes a part of their identity again.
So the task here is to integrate illness
into a whole and meaningful life.
Integrating parts of your old self from before the illness
with the person that you are now.
The task is also to continue to find ways
to express your new personal best.
To integrate your illness into your life
and arrive in a new whole complete life
of which illness is only one part.
In phase four and the social domain,
people are typically working on expanding
their social horizons as much as their medical condition
will permit them to do so.
In relationships with others,
when you're in phase four,
you're including the reality of your chronic disability
in your friendships and family relationships.
And also in phase four,
you're developing a strong network of new supporters,
people who acknowledge and accept the life
that you live now.
They understand your limitations,
and they want to be supportive for the long haul.
So those are the four phases.
Important to keep in mind that not everyone goes through
the phases in that exact order.
It's possible to skip stages.
It's possible to go forwards or backwards through them.
Sometimes people even revisit a stage
that they thought they were finished with
because perhaps there's a new flare up of their condition
or a new twist on their condition,
and they might find that they're redoing some of the work
of some of the earlier phases.
So that's normal and common
as a medical condition evolves
and as your physical status changes over time.
I guess what I hope you would take from these stages
is that you don't have to be psychologically stuck
in one place over the course of your illness experience,
and that there is hope to move forward
and work on some tasks of better integration.
Okay, so Pauline Boss.
Dr. Pauline Boss is a psychologist who
has worked quite extensively with people
who have chronic medical conditions.
And she has coined a term ambiguous loss
that I think makes a lot of sense here.
There's a recurrent theme in chronic illness,
and that's the theme of a mismatch.
So sometimes there's a mismatch between what you feel
on the inside and what people can see on the outside.
So people will sometimes say, well, I don't feel well
but my friends are coming up to me and saying,
well, you look fine, (chuckles)
or you look better, you must be feeling better.
So there's sometimes that mismatch.
Sometimes the mismatch shows up in a different way.
People in your life may come up to you and say,
gosh, you know, you're the same but you're different.
Or I can't put my finger on it,
but since you've had you medical condition,
you're the same but you're different.
So you're the same person,
but something about you has changed.
So that mismatch phenomenon can be unsettling.
Both versions of it can be unsettling.
And so Dr. Pauline Boss has said
this is called ambiguous loss,
where it's not clearly defined what the loss is
that you've had, but you've clearly had a loss.
So she says due to the ambiguity surrounding the loss,
individuals, couples and families remain confused.
Without comprehension, people can't find meaning.
Without meaning, they can't find hope to move forward
with their lives.
Both coping and grief processes are immobilized.
She goes on to describe some of the problems
that result from ambiguous loss.
So one would be immobilizing people
and their relationships.
So if you don't know how to make sense of the change
that's happened to you, then that can become paralyzing
and difficult to know what you should do next
in order to cope.
It often confuses the decision-making process.
It's hard to make informed and balanced decisions
about your medical care when you're not even quite sure
what this loss was.
It can freeze the grief process
and block the coping process.
It can prevent closure.
People often report feeling stuck somehow.
Psychologically stuck somehow.
It can lead to feelings of helplessness and hopelessness
and also exhaustion.
So psychologist Pauline Boss says it's not hopeless,
that there are ways to work through this,
and she summarizes her goals for intervention.
One is to find meaning.
So just as I mentioned before
when I was talking about the phases of chronic illness,
meaning making can be really important.
Naming the problem and acknowledging that
the ambiguity is the culprit not the patient.
Tempering your need for mastery.
So what she means there is we live in a culture
where being in charge and being in control are considered
very important.
But when you have chronic illness and you're uncertain
how your illness will react from day to day,
or how it's going to unfold over time,
then you can't control everything.
So tempering your need for mastery
means lowering your expectations,
going with the flow and letting things unfold
in their own time.
Easier said than done, right?
Reconstructing identity.
That's asking who am I now,
what roles do I play now,
and how do I redefine my role in my family
and in my friendships?
Normalizing ambivalence.
By this she means it's normal to feel like you're being
pulled in two different directions.
On the one hand, you might feel like you want to
resign yourself to your illness and retreat.
But on the other hand, there's a part of you that really
wants to be able to move forward with your life.
So being pulled in those two opposite directions
is common and expected.
Revising attachment.
This goes back to something I said earlier.
It's that relationships often reshuffle themselves
when you're living with a chronic medical condition.
And so there may be a task here
of having to build new human connections
or make sure you can surround yourself with people
who are supportive.
And discovering hope.
Here I mean imagining future possibilities,
imagining options,
recreating fun rituals and celebrations.
One of the things that Dr. Pauline Boss observed
was that when people are dealing
with a newly diagnosed condition,
they often stop celebrating the things
that had always been meaningful to them.
Or they often stop following through
with their old traditions.
And so she finds it really important for people
to recreate those fun rituals and celebrations.
She also encourages people to use spirituality
and resiliency to temper their need for mastery
when things don't go their way.
Okay?
So and now I'll move into some of the ideas for coping
And I call them the seven As.
I had to force them all to start with an A somehow.
(laughter)
But it worked out pretty well, I think.
The first one is accept,
and so that is working on acceptance.
Acceptance is not surrendering to a sense of defeat.
It's not passively resigning yourself to your illness
or taking a defeatist stance.
It just means allowing yourself to willingly engage
your illness.
It means making an active choice
to accept the aspects of your condition
that cannot be changed.
It's a positive embracing of your experience undertaking,
so that you can more fully live your life.
The more you fight the aspects of your illness
that cannot be changed, the more of your life
it takes away.
Some ideas for how to increase a sense of acceptance.
One is learning as much as you can about your condition.
So understanding your illness or disability
has to precede acceptance.
Another one is being open-minded.
Persisting in learning as much as you can
about how you've changed
and being open to creating a new identity pie.
Taking a self-growth perspective.
So remembering that this is a process,
or this is a work in progress.
You're not going to wake up one morning and say,
okay, I've arrived at 100% acceptance.
This is something that takes some time.
A very specific activity that often helps
to foster acceptance is making a list
of what you've lost forever, what you've gained,
and what you can still work on.
So people often find it helpful,
especially when it feels overwhelming
and it feels like everything outside of your control,
this list helps you to remember that sometimes
you actually gain some things
in coping with a chronic medical condition.
Maybe you realize some strength that you didn't realize
that you had before.
Or people sometimes discover a new purpose
in their medical condition.
They find ways to get involved in support groups
and support other people who have the same
medical condition.
And then the list of what you can work on, you know,
that is to remind you that there are always some aspects
of your health that remain under your control.
And so it's not all in the out-of-control category.
You know, some of it would be things that you can
continue to work on.
Another specific activity, spend some time
imagining what it would look like when you've achieved
an increase in self-acceptance.
So what would be different inside yourself?
How would you think differently about things?
How would you feel differently about things?
And then finally, see yourself as courageous and adaptable.
Believe if you nurture those qualities
that they will help to see you through the difficult times.
The second A is allow.
By allow, I mean allow yourself to feel
all of your emotions.
As human beings, we like to push away the negative emotions
and just try to focus on the positive ones,
but it's not a good long-term strategy.
So in order to remain emotionally healthy,
we have to allow ourselves to feel anger, sadness,
frustration, et cetera.
We also have to allow ourselves to experience
challenging emotions without letting those emotions
take over our life or our identity.
That's also easier said than done.
If you feel bogged down by negative emotions,
then often, it helps to consult
with a primary care physician or with a mental health
professional, psychiatrist, psychologist,
social worker, et cetera and get evaluated for depression
or other stress conditions.
Depression and stress are easily treatable,
sometimes with medication, sometimes with talk therapies,
and sometimes with both.
And so there are good treatments out there,
and it's not worth it to just try to live
with depressive symptoms and accept that as the norm.
The third A is assemble.
By assemble I mean assemble a strong support group.
Get support from your family, friends, your medical team.
If there is a support group that is specific
to the medical condition that you have,
those are often very helpful to talk with other people
who have the same medical condition.
Know that some people in your life
will believe in your illness and they're going to try
their best to help and support you,
but other people may not make the effort
to understand your illness at all.
Most people are somewhere in between the two extremes.
So realize that some of your old relationships
may not survive.
But you can seek out new people who will support you,
and you can integrate them into your life.
I think another piece of this too is to remember that
you can be ill and you can still be a friend to others.
So you can still talk and listen and care
even if your physical functioning has changed dramatically.
To maintain a friendship, you have to give equal time
to your friend's concerns.
So be careful not to overload any one friend
with too much about your illness.
The fourth A is actively cope.
So active coping means assuming responsibility
for your self-management.
Passive coping means withdrawal from activities
and becoming dependent upon other people
for physical relief.
So there's a lot of good research on active coping,
and it shows that active coping is related
to lower levels of pain, depression
and functional disability.
Passive coping, on the other hand,
is predictive of increased pain and depression.
So active coping means actively engaging
in your self-care, and it's kind of just the good,
basic self-care strategies that we've been hearing about
our whole lives.
Get good sleep, eat healthy foods,
get some form of physical activity.
Another good active coping strategy
is learning and practicing some type of relaxation
or stress reduction practice.
Very popular nowadays,
the mindfulness classes.
You probably read about mindfulness all over the news
and see it on TV.
There's a wide range of mindfulness programs
available both at the UW Hospital and throughout UW Health
and throughout the community as well.
Really a great self-care strategy
that allows people to remain active in their coping,
even when their functioning has changed dramatically.
Another one would be managing negative emotions.
And then, finally, being an active partner
in your healthcare.
So that means finding a healthcare team
that you really feel like you can work with.
So physicians and nurses and other providers
who really feel like they're a partner to you
or people who really feel like they're listening
to your concerns when you go to medical visits.
The fifth A is adhere to your treatment plan.
Individuals who are depressed or stressed
tend to have less energy, focus and motivation.
If we have less energy, focus and motivation,
it's harder to do all of the things that our medical team
asks us to do to take care of ourselves.
So when we're stressed and depressed,
we often begin to have problems with treatment adherence.
In chronic illness, treatment adherence
is a long-term undertaking.
Very often, what you do at home
and in your day to day life to manage your illness
has a much great impact on your health
than what happens in your doctor's office.
So a lot of managing chronic illness depends upon
what you do,
and I think that's good news because that means that
a lot of your management of your medical experiences
is under your control.
The sixth A is attitude check.
So your attitude and the content of your thoughts
can exert a strong influence on your emotions
and your behavior.
So you might ask yourself these questions:
what goes through my mind when I think of myself
having a chronic illness?
What do I find myself thinking
when my health is worse than expected?
What thoughts have led me to feel like giving up
my self-care efforts in the past?
Do I have any concerns, worries or fears
that come to mind when I think about managing my illness?
Once you answer these questions, challenge yourself
to replace the negative thoughts
with more balanced alternative thoughts.
So I'll give you an example of that.
If I go through my attitude check and I find that
the thought that's coming up for me is my whole body
is falling apart, well, I might replace that
with a balanced thought such as some days,
it feels like my whole body is falling apart,
but I know I have good days and bad days
and the best thing I can do on a bad day
is to figure out how to take good care of myself
until I feel better.
So you might notice, and this is actually quite typical,
you might notice that the negative thoughts
that pop into our head tend to pretty simple
and overgeneralized and sometimes pretty extremely
on the negative side.
The balanced thoughts tend to be longer and more complex,
and there are two components to the balanced thought.
Usually, there's an acknowledgment of the reality
of the situation,
and then there's a more positive piece.
So listen to my balanced thought again,
and see if you can identify those two things.
There's the acknowledgment of the reality
of the situation, and then there's the positive piece.
Some days it feels like my whole body is falling apart,
but I know I have good days and bad days
and the best thing I can do on a bad day is to figure out
how to take good care of myself until I feel better.
So there's actually more active coping
built into the balanced thought.
The original thought, remember,
was my whole body is falling apart.
If you're saying that to yourself repeatedly,
that doesn't lead you to take a problem-solving stance.
It doesn't lead to some kind of action.
And so that's why the balanced thoughts are often
more helpful because it leads you to some concrete steps
that you can take to manage the difficult situation.
And then the seventh A,
access joy, laughter and happiness.
So there's a famous happiness researcher
named Sonja Lyubomirsky.
She's a psychologist,
and she has done extensive studies of happiness
and has reviewed the research done by many other
research teams, and she's compiled it all
into one pretty interesting statement,
which is that 50% of your happiness
is determined by your genetics,
10% is determined by your life circumstances.
So for example, what state you happen to live in,
whether you have a chronic illness or not,
what your hobbies and interests are,
what your job is, et cetera.
So only 10% is determined by life circumstances.
I actually think that's good news for those of us
who live in Wisconsin. (laughter)
That living in Wisconsin,
even on the worst weather types of days,
is not going to significantly impact our happiness level.
The good news is that 40% of our happiness
is under our control.
So that's a large piece of the happiness pie
that is under our control.
She goes on to summarize all of the different factors
that contribute to happiness,
and she said that they can be things like optimism,
pursuing life goals,
nurturing meaningful relationships,
trying to maintain a positive outlook,
practicing gratitude on a regular basis,
practicing forgiveness when it's needed.
And she talks quite a bit about both self-forgiveness
and forgiveness of other people.
Savoring the present moment,
which actually goes along with the mindfulness stuff
that I mentioned before, that much of mindfulness has to do
with being present in the here and now
and being able to appreciate the present moment.
And then, finally, sitting quietly and thinking about
kindness and compassion.
So you don't even have to be out there practicing
kindness and compassion.
You can be sitting quietly and thinking about it,
and that has a significant impact on our overall
level of happiness.
So I just thought those were some fun ideas
that allow us to improve our coping
with chronic medical conditions.
I want to talk just a little bit more about resources
at the University Hospital.
So I mentioned earlier that I do run groups
that are called Creative Coping With Chronic Illness.
They are 12-week groups, run through the Department
of Health Psychology, designed to help people
improve their self-care and their confidence
in managing the distress that often comes along
with chronic illness.
People sometimes ask, ooh, if I see a health psychologist
at the hospital, do you have to assign
a psychiatric diagnosis?
And the answer to that is no,
that as a health psychologist, I'm actually able
to submit my billing using medical codes.
So whatever your medical diagnosis is,
as determined by your physician, is what I use
when I submit my billing, and that way I do not have to
make a psychiatric diagnosis.
The billing codes, just for your information,
the billing codes that allow us to do that
are called the Health and Behavior Assessment
and Intervention codes.
People sometimes ask me because they want to be sure
that those are covered by their insurance.
I can tell you for sure that they are covered
by Medicare and Unity.
And many of the people that we see at University Hospital
fall in those categories.
If you have a different insurance provider
and you're curious whether they would cover
health psychology visits, you would just need to know
that they're called Health and Behavior
Assessment and Intervention codes
when you call and ask your insurance provider.
So in addition to groups, we also do individual sessions.
My department has more inpatient providers
than outpatient providers.
So it is a bit of a wait
for individual sessions.
It's easier to get in the groups,
but we are working on that and working on kind of reducing
wait times, so if people want one-on-one sessions,
they don't have to wait as long.
Our department phone number is listed there.
It's 608-263-8060.
And, you know, if you're interested
in health psychology services, then anyone who answers
that number should be able to answer questions
about the groups and about the individual sessions.
So thank you for allowing me to spend time with you today,
and I hope you enjoy the rest of the afternoon.
(applause)