Family Medicine’s Stress Management Program Targets Healthy Mind and Body

Using interlocked hands, Heidi Allespach, Ph.D., assistant professor of family medicine and community health and director of behavioral medicine, illustrates the powerful connection between the mind and the body. When stress enters the equation, she says, “it takes an emotional and physical toll.”

In fact, countless ailments are caused or exacerbated by stress and negative thoughts, explains Allespach, a University of Miami psychologist who set out to treat patients holistically when she began her career with the Miller School and the nearby Jefferson Reaves Sr. Health Center in 1999. Last year Allespach started the Stress Management Program, which doctors at Jefferson Reaves use to guide patients through a series of brief calming exercises in the exam room.

The aim is to reduce emotional stressors and instill healthier thought patterns, which in turn helps improve a patient’s physical condition. The results, Allespach said, “have been remarkable.”

“In family medicine, we believe that people are much more than a medical diagnosis,” said Allespach, who specializes in behavioral medicine, addiction, physician wellness and chronic pain. “We talk to our patients about their thoughts, feelings, relationships, sexuality and spirituality and we see significant decreases in their blood pressure and pain, as well as other positive physiologic and emotional changes.”

Robert Schwartz, M.D., professor and Chair of Family Medicine and Community Health, practices stress management techniques with his patients — many of whom come to the clinic with stress-related disorders as well as organic illnesses. “Stress management and behavioral medicine are an important part of what family doctors offer,” he says. “It is certainly an integral piece of the education for our medical students and residents in family medicine.”

Physicians, he adds, are often a patient’s first advocate. Treating patients holistically makes them feel more cared for. “From my perspective, this is a mandate for family medicine,” he says.

Patients come to the Jefferson Reaves with complaints of pain, shortness of breath and chronic conditions such as heart disease or diabetes, and leave feeling better physically and emotionally. The program has also given many residents and longtime doctors a newer approach to patient care that does not require prescription drugs.

Allespach’s four stress management exercises include cognitive restructuring, mindfulness, diaphragmatic breathing and a six-minute relaxation session with guided imagery — all of which are tailored to meet an individual’s needs. The process takes about 20 minutes at the beginning of each appointment for three consecutive visits.

In cognitive restructuring, physicians use the patient’s spiritual beliefs as a way to help them get in touch with more balanced, positive thinking. Cognitive restructuring, Allespach says, also helps people identify negative or distorted thoughts which create distress.

“Typically, negative thoughts about the future — the “what ifs” — create feelings of overwhelming anxiety in the same manner that ruminating about past mistakes and loss contribute to feelings of depression, guilt, regret and resentment,” she said.

Mindfulness, or the “awareness exercise,” helps patients stay centered in the present by becoming acutely aware of sensory information. Diaphragmatic breathing focuses on inhaling and exhaling from the abdomen. In the relaxation component, doctors ask patients to systematically focus on areas of their body and help guide them to a peaceful place that has positive meaning.

The Jefferson Reaves Sr. Health Center is a community clinic with the Jackson Health System. It is located in Miami’s historic Overtown community and sees patients from diverse socio-economic and cultural backgrounds.

Translators sometimes help facilitate the exercises and patients are encouraged to continue the exercises, or “homework,” after their visits. When necessary, they’re referred to the clinic’s psychologist, Mary Reyes, Ph.D.

While stress management is widely practiced in mental health settings, Allespach designed this brief, four-step intervention specifically for a medical exam room. Since it was started in family medicine a year ago, it has branched off into other divisions including surgery, the ICU, internal medicine and in-patient hospital care. Residents and seasoned physicians throughout the health system see the benefits.

“Stress management has completely changed how my patients view coming to clinic,” said Norine Rosado, M.D., a third year family medicine resident. “The results have just astounded me. Patients are more compliant with medications and are more willing to come see me. Their overall outlook is just more positive.”

Resident Dorothy Contiguglia-Akcan, M.D., remembers administering the exercises to a hospitalized woman who was HIV-positive and abusing drugs. “While her situation hadn’t changed, she left the hospital more hopeful.”

Sometimes just opening up about their personal lives has helped patients alleviate tension. Lilian Sarfati, M.D., a third year family medicine resident who is worked closely with Allespach, says they have had patients who chronically complain about something, only to learn that they have financial or family stressors.

“Once we are able to identify them and have them realize that psychological stress is causing the physical manifestations,” she says, “they’re able to deal with their problems a lot easier and their physical manifestations somehow mitigate.”

Given the program’s success, Allespach says she plans to collect follow-up data on patient health outcomes, such as blood pressure levels, inflammatory markers, perceptions of pain, substance use, levels of depression and anxiety, as well as adherence to follow-up visits.

She also encourages the next generation of physicians to use the techniques for their own wellness.

“I teach the residents and medical students they need to take care of themselves first and foremost; otherwise, they will not be able to provide high-quality and compassionate care for their patients,” said Allespach. “Everyone needs to slow down and stop once in a while…. It is a critical habit to start developing now at this early point in their careers. Everyone can benefit from ongoing stress management.”

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