Rehabilitation psychology:
a key element in healing
(February 2008 Issue)

Sigmund Hough, Ph.D., ABPP, treats veterans of all ages within an interdisciplinary team system. He is a clinical neuropsychologist at Spinal Cord Injury Service for the VA Boston Healthcare System, an assistant professor at Harvard Medical School and adjunct professor at Boston University’s School of Medicine. (photo by Tom Croke)

By Phyllis Hanlon

While the word rehabilitation conjures visions of occupational, physical and speech therapists working to resolve physical injuries and disabilities, the importance of restoring emotional health as a vital part of the process should not be overlooked. Rehabilitation in the form of therapeutic psychological intervention could be a key element in comprehensive healing.

Sigmund Hough, Ph.D., ABPP, clinical neuropsychologist at Spinal Cord Injury Service for the VA Boston Healthcare System, assistant professor at Harvard Medical School and adjunct professor at Boston University's School of Medicine, treats veterans of all ages within an interdisciplinary team system. "This approach is a hallmark of our services," he says. Physicians, psychologists, social workers, occupational and physical therapists share goals and information in an effort to meet the objectives of the patient.

However, before a psychologist can begin to address emotional issues, medical professionals must tend to physical needs. "The fog has to clear, then the person can deal emotionally," says Hough. "Once he is more stable, he can think about his psychological health."

Additionally, many veterans present with multifaceted issues that preclude a definable timetable for effective treatment. Hough notes that sometimes old emotional wounds can be reopened "by new life events." He says, "Intervention is defined based on the complexity of what happened and on the individual. You want to start working on issues before they spiral out of control."

Interventions vary according to the person, but could include individual and/or family/significant other counseling, caregiver group support, psychosocial strategies, evidence-based, cognitive therapy and in some cases, peer support. Encouragement from an individual who has incurred similar injuries offers another avenue of support, Hough says. "Within the context of mental health support, this is a key element. Someone with the same injury can talk about the medical end and embarrassing issues. This can carry a lot of weight. It can buttress what other professionals are doing." He adds that the success of this approach depends on the patient's readiness for this type of therapy.

Robert A. Moverman, Ph.D., clinical psychologist from New England Neurological Associates, PC in Lawrence, Mass., works on-site at Northeast Rehabilitation Hospital in Salem, N.H. where he sees patients during hospitalization and post-discharge. He focuses on helping individuals cope with everyday challenges such as being wheelchair-bound and injury-related mood issues.

Stroke, head or spinal cord injury victims or those who have chronic illnesses such as lupus or multiple sclerosis often experience various fears related to their conditions, Moverman explains. Rehabilitation psychology attempts to allay anxiety that might inhibit the healing process through cognitive restructuring and sustains patients as they deal with uncertain futures. "A patient might be afraid of falling down in physical therapy or worrying about going home. [Rehabilitation psychology] helps with pain, insomnia and the stress of being in an unfamiliar setting and situation," Moverman says.

In addition to counseling, cognitive therapy and support, various types of testing offer supplemental tools for rehabilitation. Anita Remig, Ed.D., a biofeedback specialist and licensed psychologist in private practice in Portsmouth, N.H., utilizes biofeedback and neurofeedback to identify and track central nervous system deficits resulting from accidents and/or medical events. She says, "[This testing] captures brainwaves related to increases in brain and physical function."

Once Remig gathers data, she works together with her patients to reduce those deficits and increase functioning. "People look at a computer screen and see their autonomic reactivity. In their mind, they work with the body through relaxation, using imagery to bring the measures down," she says. "There is a definite connection between the physical and psychological."

Remig also combines talk therapy with the more technical aspect of treatment. She places sensors, which measure physiological response, externally on the brain. "I talk to the patient and get information while setting up the equipment," she says. By asking questions relating to sleep habits, health conditions and effectiveness of medication, she can compile a more comprehensive patient profile. "In any form of therapy, there is a psychotherapeutic alliance," she says.

Remig admits that improvement through biofeedback and neurofeedback takes time. "In mild to moderate situations, a patient may respond in 20 sessions," she says. In one case, she has been working with a severely impaired patient for one year.

Ronald L. Breazeale, Ph.D., clinical psychologist with a private practice in Portland and public education coordinator for the Maine Psychological Association (MePA), utilizes the principles of rehabilitation psychology as they relate to substance abuse and physical disability. He concentrates his efforts on "repositioning attitudes" towards individuals with disabilities and building resilience in those who face adversity of any ilk. "Psychologists should be playing a role across all diagnoses because of their information, research and knowledge," Breazeale says.

Breazeale believes that resilience combines "a lot of what we know about coping with loss" and has written a book that illustrates his philosophy. His novel "Reaching Home" addresses ways in which one person conquers fear in a world fraught with terrorist threats and personal challenges. A companion text, "Duct Tape Isn't Enough", offers guidelines for building survival skills.

In his private practice in Portland, Breazeale works with patients to develop skills to overcome and manage disabilities. He explains that flexibility, optimism and connection and empathy with others are key coping strategies. He attempts to reframe the way people view their diagnosis and emphasizes the importance of avoiding personal blame. "As psychologists, we focus on empowering people with disabilities. The medical model of pathology and diagnosis of rehab is not the greatest. We need to focus on strengths and build on them," says Breazeale.

While this discipline draws on the same principles as general psychology, Moverman reports the number of rehabilitation psychologists in New England is "relatively few and far between." He adds, "You just have to know a lot more about specific issues related to medical cases in order to help people."

The American Psychological Association's Division 22, Rehabilitation Psychology, concentrates on a message of hope for individuals with disabilities and chronic illness and aims to help them achieve health, independence, appropriate functioning abilities and social interaction with others.

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