Mind-Body Medicine in Inpatient Psychiatry. David Låg Tomasi
and Movement Science
Erin Curtis, MD, Psychiatrist, UVMMC Inpatient Psychiatry
Anjali Varigonda, MD, Psychiatrist, UVMMC Inpatient Psychiatry
James Goldsmith, Project Manager
Alex Krupp
Culli Pringle
To discuss Mind-Body Medicine strategies to improve clinical outcomes in inpatient psychiatry settings, we shall start with a thorough examination of the psychotherapy and group therapy-based interventions offered on the Inpatient psychiatry units Shepardson 3 and Shepardson 6. As “psychotherapy” is a very broad term, we also need to identify the specific characteristics of such practice in this context, starting from needs and objectives: a) individual and group therapy sessions, b) exercise sessions, and c) Attendance and session standardization. Each category is described in detail below.
Needs and Objectives:
a) Individual and Group Therapy Sessions:
The following terms are the descriptors used throughout this research study, as well as the exact terms utilized on the University of Vermont Inpatient Psychiatry Electronic Health Record (EHR) Epic/Prism software system.
Group Goals:
Developing Coping Skills; Identify Grief/Loss; Identify Feelings; Identify Stressors/Problems; Increase Activity Level; Increase Affective Range; Increase Attention Span; Increase Awareness of self in relation to others; Increase Education about Mental Illness; Increase Emotional Expression; Increase Expression of Needs; Increase Motivation; Increase Organization; Increase Relaxation; Increase Responsibility of Behavior; Increase Self-Control; Increase Self-Esteem; Increase Socialization.
Patient Communication:
Answered Questions; Circumstantial/Tangential; Delusional Speech; Latent; Logical; Loose; Pressured; Silent; Spontaneous verbalization.
Patient Behavior:
Ability to Complete Task; Angry behavior; Anxious Behavior; Appropriate; Attentive; Depressed Affect; Disorganized; Disoriented; Disruptive; Dozing off; Engaged; Inattentive; Initiation without Prompts; Intrusive; Labile affect; manic; Organized; Social Interactive; Withdrawn.
The extended list of groups offered on the Inpatient Psychiatry Psychotherapists/Group Therapists offered on the Inpatient psychiatry units Shepardson 3 and Shepardson 6 by the Psychotherapists/group therapists is as follows:
Affirmations & Gratitudes/Positive Affirmations
Anger Management
Art Therapy
Body Awareness
Coffee Talk
CBT—Cognitive Behavioral Therapy & Cognitive Processes
CFT—Compassion Focused Therapy
Coffee Talk
Communication Skills
Crossword Puzzle
DMT—Dance Movement Therapy
DBT—Dialectic Behavioral Therapy
Discharge & Post Crisis Plan
Daily Goals/Check-in
Distress Tolerance
Drumming/Relaxation
Effective Questions
Exercise/Gentle Movement
Eurhythmics
Focus
Games, including Board Games, Video vs. Computer Games
Garden
Gentle Yoga
Grief and Anger
Group Therapy
Journaling
Karaoke
Leisure Skills
Life Skills
Magnetic Expression
Meditation/Mindfulness/Relaxation
Mind and Body Connection
Morning Check-In
Movie Nights
Music & Movement
Narrative Medicine
Nutrition
Open Art/Arts & Crafts
REBT—Rational Emotive Behavior Therapy
Recovery Group (volunteer-based, discussed separately in Chapter 5)
Pathways (volunteer-based)
Personality Type
Pet Therapy (volunteer-based)
Poetry
Positive Affirmations
Relapse Prevention
Seeking Safety
Self-esteem
Self-image
Self-reflection
Solve That Problem
Spiritual Care
Stress Management
Supportive Relationships
T’ai Chi Chuan
VR-based therapeutic and leisure activities
b) Exercise Sessions:
Primary need: developing strategies and healthier coping skills for mania, angry outburst and generalized disruptive behavior—Department understaffed for specific exercise-based therapeutic intervention/funding needed beyond existing operating budget.
Secondary need: providing patients with useful resources for self-improvement in outpatient settings upon discharge.
Primary Objective: promote exercise/fitness/physical health in inpatient psychiatry patients on Shepardson 3 and 6.
Secondary Objective: Therapeutic management of anger, anxiety, and depression; promoting self-esteem, healthier sleep, and anxiety reduction, as well as enhancing mood and emotional regulation.
Tertiary Objective: Promoting research in the psychophysiological effectors of exercise in combination with psychotherapy.
c) Group Attendance and Session Standardization:
This research area focuses on therapy groups’ attendance in relation to unit structure and scheduling and therapeutic strategies, including length, types and typologies of groups as well as patient behavior during therapeutic sessions. It is aimed at verifying the positive outcomes, in terms of statistically relevant data, of the changes to the unit in terms of patients’ attendance to Therapeutic-Process, Task, and Leisure Groups over a 12-month period (May 2015–May 2016). Each of the therapeutic groups offered on the units Shepardson 3 South and Shepardson 6 is led by a Psychotherapist/Group Therapist. The Psychotherapist provides psycho-educational, skills-based, psychotherapeutic, and social groups to individuals receiving care on Inpatient Psychiatry. In addition to facilitating group sessions, clinical duties include collaboration and consultation with other members of the multidisciplinary team (attending psychiatrists, resident psychiatrists, nurses, social workers, and other group therapists, as shown in Fig. 1), assessment of new patients, and providing individual support to patients on an as-needed basis. Outside of direct patient care, the Psychotherapist is also responsible for administrative and organizational tasks, including but not limited to timely and satisfactory documentation, participation