Stress Management Program Targets Healthy Mind and Body

Interlocking her hands, Heidi Allespach, Ph.D., assistant professor of family medicine and community health and director of behavioral medicine at the University of Miami Miller School of 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 Dr. Allespach. To alleviate this mental turbulence, she started the Stress Management Program 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, Dr. Allespach said, have been remarkable.

“In family medicine, we believe that people are much more than a medical diagnosis,” said Dr. 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.”

Patients come 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.

Dr. 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 often use the patient’s spiritual beliefs as a way to help them get in touch with more balanced, positive thinking. Cognitive restructuring, Dr. 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.

While stress management is widely practiced in mental health settings, Dr. Allespach designed this brief, four-step intervention specifically for a medical exam room. Since it was started in family medicine, 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.

“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 Dr. 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.”

Tags: community health, Department of Family Medicine and Community Health, Dr. Heidi Allespach, mental health, stress management