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Bluegrass Health Psychology

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LEXINGTON Since high school, Jonathan Cole, PhD, ABPP, knew he wanted a career in psychiatry or psychology. His father David worked in mental health and his mother Becky was a nurse and became a nurse practitioner. Now as founder and president of Bluegrass Health Psychology (BHP) in Lexington, Coles dreams of working in his chosen field in his hometown are realized.

After taking his undergraduate degree at UK, Cole mastered in clinical psychology at Eastern Kentucky University (EKU) and received his PhD in clinical psychology at the Illinois Institute of Technology in Chicago. He then completed a fellowship in health psychology and pain management at Sun Coast Pain Management Center in Biloxi, Miss. Cole is married to Melody Cole, who is also from Lexington, so the decision to open his practice in the Bluegrass was easy.

Added to that happy circumstance is the satisfaction of seeing patients who need the special skills that Cole and his fellow health psychologists offer to patients dealing with chronic pain, headaches, migraines, gastro-intestinal issues, insomnia, sleep apnea, dermatology problems, and bariatric surgery, to name the most common.

Medical health psychology, according to Cole, uses psychological techniques and training to treat people with medical conditions with the goal of improving their health. “Bluegrass Health Psychology is the only fulltime health psychology private practice in Central Kentucky offering the full range of psychological treatment options for patients,” says Cole. BHP also is the only medical health psychology practice that is board certified in pain treatment and pre-bariatric surgery evaluation, states Cole.

Bluegrass Health Psychology usually does not treat patients with purely mental health illnesses such as bipolar disorder, schizophrenia, or PTSD, among others. “We rarely see the patient with only mental illness,” says Cole. “The vast majority of our patients have a medical health condition that a physician believes has a psychological component such as migraines, chronic pain, irritable bowel syndrome, sleep issues, insomnia, plus diet and weight loss concerns related to bariatric surgery, diabetes, and even dermatological or cardiovascular disease.”

“The brain and the body are connected,” Cole continues. “We treat patients with medical conditions that are sensitive to stress and have a stress trigger. We’re impacting their medical health by treating their brain.”

As an example, Cole cites his success in treating insomnia. Treating patients with chronic pain and headaches often involved individuals with sleep problems, so he trained in sleep, helping people adjust to CPAP sensation. “I am most successful in treating insomnia using a procedure called ‘cognitive behavioral treatment for insomnia’ which has over a 90 percent success rate after four sessions. Basically, it’s sleep rehabilitation, addressing many aspects of sleep, going for quality versus quantity. Sleep heals the body. A good night’s sleep can help with many medical conditions.”

Referral Patterns: Success Breeds Success

Since opening Bluegrass Health Psychology in 2006, with himself as the sole provider, Cole has seen the practice grow steadily to the point where it now has four PhD psychologists and a licensed clinical social worker plus administrative staff. The reason for the growth, Cole believes, is the successful outcomes that referring physicians see. “Once a doctor sends a patient to us and the patient improves in their medical conditions, we typically see more referrals from that doctor’s office.”

Currently on staff at Bluegrass Health Psychology with Cole are: Amanda Merchant, PhD, ABPP; Erica Adams, PhD; Donald Crowe, PhD; and Susan Snyder, LCSW. The breadth of staff allows BHP to expand treatment beyond chronic pain patients.

Merchant is a board certified clinical health psychologist. She received her undergraduate degree in psychology from Boston University and her master’s and PhD in clinical psychology from Chicago Medical School. She completed a clinical and health psychology internship at the Cincinnati VA Medical Center and a postdoctoral fellowship in primary care psychology at the University of Massachusetts Medical Center. In addition to chronic pain patients, Merchant specializes in patients presenting with GI, sleep, cardiology, diabetes, anxiety, and dermatological disorders, pre-surgical spinal cord stimulators, intrathecal pain pumps, and bariatric surgery evaluations.

Merchant joined BHP shortly after it opened. She describes the work of the health psychologist as “working in the bio-psycho-social model, understanding a person’s health in the context of their medical issues, their social interactions, and their psychological conditions. We intervene at certain points to positively affect their health.”

Not a new specialty, health psychology is becoming more widely known and de-stigmatized as “chronic illnesses such as pain, psoriasis, cardiac disease, and diabetes are negatively affecting people’s quality of life,” says Merchant. “We don’t only treat depression. We provide coping strategies for people in their daily lives.”

Erica Adams, PhD, a licensed counseling and health psychologist took her undergraduate degree in psychology at UK, her master’s in clinical psychology from EKU and her PhD in counseling psychology from U of L. She completed an internship in clinical and health psychology at the Dayton VA Medical Center and a postdoctoral fellowship in pain at Tampa VA Medical Center.

In addition to chronic pain patients, Adams specializes in pelvic pain, gastro-intestinal disorders, headache, sleep, cardiac rehab, bariatric, and pre-surgical spinal cord stimulator and intrathecal pain pump evaluations. Adams has been with BGH since 2013.

Adams herself was diagnosed with Crohn’s Disease at 18 years old, and she believes that influenced her career decision. “I did my dissertation on coping techniques for chronic GI disorders, which led me to chronic pelvic pain because they often overlap,” she says. She treats patients who have dysfunctional GI systems but with no organic disease pathology to explain it. “Treatment for chronic pelvic pain is complex, and treatment can last for months or years. What I try to accomplish is to instill hope in my patients. Hope that something can be done to get them feeling better.”

Donald Crowe, PhD, is a licensed clinical psychologist, having received his PhD from UK. He specializes in chronic pain and trauma issues related to health conditions.

Susan Snyder, MA, LCSW, specializes in treating depression and anxiety with both children and adults in addition to chronic pain, bariatric and sleep patients.

It’s Not All in Your Head … Just Some of It

Ironically, says Cole, the biggest misconception about medical health psychology comes not from physicians, but from the patients. “I tell my patients, ‘If your doctor thought your problems were all in your head, you wouldn’t be here. You’re here because your doctor thinks your physical health issues are legitimate and can be helped with behavioral strategies.’”

Common contributing factors to a lack of progress in medical health are “behavioral compliance and risk assessment,” says Cole. Before prescribing opioids, some of BHP’s referring physicians ask for a risk assessment for addictive personality traits. Other issues involve the behavioral compliance of patients, such as diet control and blood sugar monitoring for diabetics, performing relaxation exercises for migraines and sleep problems, and even something as simple as not overdoing it for chronic pain patients.

“I’ve had patients with chronic pain, who’ve had a good day, so they went out the next day and overdid it,” says Cole. “And then they’re laid up for three days. We use cognitive behavioral therapy to get our patients to see the cause and effect of their behavior on their medical health.”

Pain has two parts, says Cole, “There’s the physical aspect, and then there’s the mental suffering that goes along with it. Pain management is not pain cessation.” Physicians and physical therapists reduce as much of the physical pain as they can. The psychologists at Bluegrass Health Psychology deal with whatever pain is left over. They help the patients accept the situation and move on.

“You can either hurt and be miserable, or you can hurt and be happy,” says Cole.

The brain and the body are connected. We treat patients with medical conditions that are sensitive to stress and have a stress trigger. – Jonathan Cole, PhD