By Dr. Collins Hodges
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As a psychologist working within a bariatric surgery clinic, my job is to assess a patient’s psychological ‘readiness’ for surgery. In other words, based on the clinical interview and diagnostic testing, what psychological factors help a psychologist determine whether or not a patient is ready to move forward with surgery. There are a number of psychological factors to be considered, including psychological disorders, coping style, and stress.
Of course, any psychological disorder(s) with symptoms severe enough to cause hallucinations, delusions, suicidality, or an inability to function in one’s daily life would warrant further treatment prior to being re-considered for bariatric surgery. However, the ‘array’ of psychological issues associated with obesity is significant and complex. It just so happens that patients struggling with obesity and other serious medical conditions often also struggle with depression and anxiety, in its various forms and combinations. That is to say, there is no ‘right’ way to approach treating depression and anxiety. Each patient’s array of psychological issues will be different. Therefore, the roadmap to regaining mental health will be created individually for each patient. All roadmaps will utilize various psychological, emotional, and behavioral strategies. For example, some patients may struggle with impulse control and emotional eating.
These may or may not be a part of a clinical diagnosis of major depressive disorder and/or generalized anxiety disorder. What’s important is finding research-based strategies for each issue. Other more deep-seated issues such as trauma history would necessitate a more aggressive approach to treatment. For example, in such a case, all efforts would be made to ensure trauma-centered therapy was lined up (assuming it had not been already).
If the diagnostic testing shows a personality characteristic reflecting an oppositional coping style, it is a red flag. Such a finding warrants a discussion with the patient regarding the importance of cooperating with providers in a respectful and cooperative manner. Let’s face it, having a relationship with your surgeon that is based on trust and mutual respect lays the groundwork for success. Another way to think about coping style is in terms of the ways in which a patient approaches a problem. For example, she may show evidence of a problem focused, active, solution-oriented coping style. Such a patient would engage in things like securing social and emotional support from others prior to scheduling her bariatric procedure.
Or, someone may address her mild depression by setting up appointments with a mental health provider or speaking to her primary care doctor about antidepressant medication. Of course, patients with this coping style often prepare a great deal for postoperative recovery. It is not uncommon to see these patients with ready-to-go daily planners, to include information relative to nutrition, exercise, and cognitive and/or behavioral strategies to cope with stress and negative emotions.
The opposite of active coping would be emotion-focused coping. These patients become hyper-focused on the negative feelings and try to cope with them in an unhelpful way. For example, she may use alcohol and drugs in an effort to numb the emotional strain. Avoidance coping would simply mean a patient fails to acknowledge that there’s a problem to be solved.
Stress is a normal part of life. We have all struggled with stress at one point or another. With
respect to bariatric clearance, however, it is important to get a good idea of a patient’s stress
level. Health complications are the primary source of stress for our patient population. Patients
with serious underlying physical illness(es), for example, endure a great amount of daily stress.
The purpose, then, is to evaluate the patient’s psychological and behavioral approach to dealing
with stress. With the understanding that postoperative recovery is inherently stressful, the
strategy is to help the patient develop a ‘toolbox’ of effective, solution-focused coping skills.
Patients arrive at my office with a variety of stressors varying in intensity. Another common example would be hostility within a marriage. This may require a certain amount of marital counseling prior to and after bariatric surgery. More than anything, postoperative success requires the willingness on the part of the patient to do what is very uncomfortable: to ‘lean into’ her sources of stress and develop strategies to deal with them.
At the end of the day, my job is to make sure patients are psychologically and behaviorally prepared for bariatric surgery and the inevitable stress that follows during the postoperative recovery period. Using a variety of factors, including psychological vulnerabilities, coping style, and stress, the goal is to determine, as accurately as possible, whether or not a patient will become a postoperative success story.
