In January, Amy Wachholtz, PhD, associate professor and program director of Clinical Health Psychology at CU Denver, published the textbook Clinical Health Psychology: Integrating Medical Information for Improved Treatment Outcomes ($85, Cognella, 2020). The 400-page textbook is the first to blend health psychology, physiology, neurology, neuropsychology, and pharmacology research—a 360-degree, integrative approach to therapy—and it’s already become required reading in some primary care rotations.
Why was it important to write this book?
“This was the book I was looking for throughout my entire training: grad school, internship, and in my post-doctoral program. When I couldn’t find the book, I wrote it. Everyone becomes so siloed in our profession. It’s rare for a researcher to bring together the five disciplines of physiology, neurology, neuropsychology, pharmacology, and health psychology. But together, they explain why the brain functions the way it does in order for clinicians to provide better psychotherapy to patients in the midst of a disease process. For example, how do you best provide therapy to someone on beta blockers after a cardiac event?”
How could beta blockers affect therapy?
“It’s common for people to go on beta blockers after a cardiac event and beta blockers come with side effects that mimic depression. Then there’s the psychological genesis of depression after an event like that which may cause existential distress and fear around dying. If a therapist approaches the patient with a strictly cognitive behavioral therapy standard depression protocol, while ignoring the pharmacological and physiological influences of beta blockers, the psychotherapy sessions will be much less effective in treating that depression. Beta blockers can slow cognitive processing, too. In a fast-paced therapy session, that patient may smile and nod because they want to be a good patient, but the therapy isn’t sticking with them.
“We need to figure out how to adjust therapy for each patient. For example, a patient with diabetes who has had a consistently high hemoglobin A1c may have cognitive side effects, possible retinal neuropathy that affects eyesight, or difficulty with fine motor skills (such as holding a pen) because of the neuropathy. As a therapist, that knowledge would help you to assess for potential issues before giving a patient homework tasks such as daily journals that would require them to read and write. This book allows mental and physical health providers to see the big picture in order to be effective as possible.”
How can family doctors use the same skills?
“Most of us have had the experience of being in school and studying for a test with a cold or flu. You end up reading the same paragraph over and over and over and you can’t seem to get it to stick in your memory. Now imagine going to your physician’s office and getting a complex regimen of pills and behavioral changes while you are feeling like that. The physician would be giving the proper information, but because of the effects of fever on memory consolidation, it wouldn’t ‘stick.’ That would mean it was an ineffective communication interaction. This book also helps physicians to address common issues such as that to become more effective communicators about complex health issues.
“In a 15-minute session with a patient, doctors don’t have a lot of time to follow up. They need to target how they communicate with patients for critical information. Simply asking “do you remember what I said?” and asking patients to teach it back is a good start. If the doctor asks their patient to go to pharmacy, take a medication a certain number of times a day, doctors need to know whether it’s better to give their patients written or oral instructions based on their illness, injury, and pharmacological profile.”
Tell us about your writing process
“CU Denver PhD students co-authored 11 of the 13 chapters with me. This was important. Clinical Health Psychology students became comfortable reading medical and pharmacological literature and applying it to clinical health psychotherapy. They began to think integratively. They not only learned this process, but they developed the skills to communicate this information to other students. This is a lifelong professional skill. With every patient they see in the future, they will be comfortable diving into the medical, pharmacological, and neuropsychological literature and applying that information to improve patient care. That’s the goal of the book.”