Adapting To A Changing Landscape

Greg Thorkelson, MD with Ryan Reagan, PhD(c), LPC

The Nexus Group offers a range of services to help patients manage stress, improve mental health, and achieve greater wellbeing. The care that we provide is integrative and compassionate. We aim to transform lives. The healthcare landscape is in a time of change. The covid pandemic was a singularly disruptive event that accelerated some of the changes in healthcare. This event proved disruptive across industries. It had an impact on our jobs and lives, and the full cost will probably not register for some time.

While our clinic has offered telepsychiatry as an option to patients for well over six years, we were all required to adapt. Nexus began expanding telepsychiatry services throughout Pennsylvania to accommodate for the growing stresses and restrictions that came with the pandemic. Telepsychiatry services can be delivered in as little as 30 minutes and has proved to be a valuable lifeline in this environment. This service permitted providers and patients continue medication management and maintain therapeutic relationships. Telepsychiatry provided services to underserved regions strained by the pandemic.

As we transition out of the pandemic, we continue to offer telepsychiatry services here in Pittsburgh and the state. Telepsychiatry services have been popular for working adults and families and will continue to be offered. In-person visits are also offered for those who prefer this service. We also now offer for more extensive psychotherapy sessions to those patients who might feel the need for additional counseling services.

The psychotherapy services that we offer are predominately Cognitive Behavioral Therapy (CBT). CBT is one of the most heavily researched and evidence supported treatments for a range of mental health concerns that include depression, generalized anxiety, and obsessive-compulsive disorder. Cognitive behavioral therapy is a highly structured psychotherapy that aims to transform how we think about the problems that confront us. CBT includes structured exercises and sometimes homework and readings to help patients better understand how to work through stressful situations.  

A helpful analogy for CBT is physical therapy. You come to a weekly or biweekly session, learn some new exercises, and you go home to practice.  Over time you notice that your range of motion has improved. After several week, patients commonly report “aha moments” or “insights,” with a line like “I realized that I handled that better than the old me would have.” This is the transformative nature of psychotherapy. It can create lasting change in our lives.

It would be worth clarifying a few things about CBT. Over the past fifty years CBT emerged as the predominant approach to counseling in outpatient settings. In the last 30 years it has been formatted and tailored to fit specific diagnoses, as in Trauma-Focused CBT. Another popular therapy (DBT) emerged from this framework to provide more extensive focus on emotion regulation and responses to stress. Newer therapies have also emerged in the past 20 years, with an argument now being made that CBT is a family of therapies that aim to help improve cognition.

You maybe inclined to ask—what is cognition? This is a fair question. We tend to conflate the idea with thinking. Unfortunately, the human brain and mind are far more complicated than just thinking. We also feel. We have emotions, memories, goals, etc. Sometimes our memories are painful. Sometimes we have two goals that are in conflict—essentially what it means when we say “I feel torn.” Cognition is far more complicated that we often appreciate. The cognitive behavioral therapies aim to facilitate clearer thinking. It is using the mind to deliver physical therapy to the brain.

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