Welcome to the webinar! My name is Dr. Joe Tatta and I’ll be joined by Dr. Jeremy Fletcher. We’re both physical therapists who are helping people access kind of really a greater scope of practice as a mental health physical therapy, helping serve individuals and communities and populations with their mental health and their mental well-being. We’re going to talk probably for about, oh, 15 minutes or so, give or take today. I know this is a global community, so I welcome people from all over the globe of all professions. Thank you for joining us today in this webinar. A replay will go out later, so we’ll send you the link, and we hope that you share that link with your friends and colleagues. to discuss what we’re doing here in the mental health physical therapy space. With that, I’m going to get started with the webinar. We will have a Q&A at the end, so you can write questions down. We’d love for you to speak to us one-on-one, so there’ll be an opportunity to unmute so we can meet you and hear all about the work you’re doing in this area and what brings you here to the webinar. That Q&A will be toward the end.

Treating Mind and Body: Mental Health Physical Therapy

Today’s webinar is Treating Mind and Body in Mental Health Physical Therapy. And we’ll be discussing ways to expand your role, meet a growing need in health and mental health care, and how you can bring and build this into your practice as a physical therapist. So the objectives for the webinar are to describe interventions to address mental health challenges that lead to resilience and whole person health, understand your scope and role as a mental health physical therapist, describe areas of growth as the demand skyrockets for mental health physical therapy, and how to make alliances with health and or mental health providers to enhance your patient outcomes and your professional trajectory. So as I mentioned before, we’re really a global community here at this point. I receive lots of emails from really PTs in Australia, the UK and Canada saying, hey, what are you doing in this space? I see people with mental health conditions every day as a physical therapist and orthopedics and neurology and women’s health really in all areas. So this really is just an over, you know, kind of a global overview. of where we are with the adult prevalence of mental illness. And I think what’s happening in the U.S. is very similar to what’s happening in other, quote-unquote, Western countries. Now the stats you see here on the screen are kind of for the general population, right? There are studies out there that look at mental health challenges or conditions in physical therapy practice specifically. And anywhere between 50 to 75% of patients that are coming into an outpatient physical therapy clinic present with one or potentially even more mental health conditions. So this is something that we’re all seeing, right? We’re all acutely aware that mental health is a challenge in our healthcare system. that people need resources and help, and how can we start to fill this gap as a physical therapist? I will turn attention to the United States of America because that’s where Jeremy and I work.

When we look at the mental health workforce availability in the US, right, so we’re talking about mental health professionals here, about 150 million people live in a mental health workforce shortage area. So approximately 150 million people do not have access to mental health care in one form or another. There’s a deficit of about 300,000 mental health providers in the United States of America. That includes things like psychiatrists, psychiatric nurse practitioners, psychologists, mental health counselors, licensed clinical social workers, addiction counselors, etc., etc. And the data you see here on the screen doesn’t account for whether these providers accept insurance, In New York City, you would be hard-pressed to find a psychologist that is in-network and accepts insurance, so it’s equally difficult to connect our clients and patients sometimes with the much-needed services in the mental health area. So, we know there’s a shortage in the United States, and this, of course, maps globally to other countries and jurisdictions. In 2022, so the data is kind of still building here, but about half of adults with a mental illness in the United States did not receive treatment. So we know that obviously the mental health need is increasing. There’s a gap in the amount of providers that are able to serve that need. And because of that, many patients or many individuals with mental health conditions are not receiving the care that they need, right? And it varies state to state. Jeremy will talk about the state he lives in a little bit. But if you see those kind of darker blue, very dark blue states, those are the states typically where the need is the greatest. And the states with a little bit of lighter blue are doing a little bit better, although the entire country really could use a boost to its mental health. When I’ve talked about adults, I really wanna make sure we talk about adolescent and children’s mental health, because oftentimes this is where mental health begins, or poor mental health begins. So approximately 20% of children and adolescents in the United States experience a mental health disorder in any given year. However, out of that 20%, only about 20% receive appropriate care. So these conditions are starting young, but children and adolescents are not receiving the care that they need. So we’re kind of priming the brain and the body for poor physical and mental health in some way that’s going unaddressed. Now, when I’ve already mentioned to you that both adult and children’s mental health is going unaddressed.

Unaddressed Mental Health

When mental health goes unaddressed it has the potential to lead to is prolonged psychological distress over many months or many years. And this can become traumatizing for people, right? So I’m not necessarily saying that people develop acute PTSD. That is a very specific syndrome with a very specific set of clinical symptoms. But people do present with different types of signs and symptoms of trauma. So things like problems with emotional regulation, adverse experiences or re-traumatization in the healthcare system because they’re being met with poor or inadequate care. And with that, the isolation and stigma that goes along with that, right? And that isolation and stigma becomes embodied and it affects our physiologic systems, right? This regulates our autonomic nervous system, this regulates our immune system, has an impact on our cardiovascular system. Of course, our musculoskeletal system, many of you that work in chronic pain knows the bi-directional relationship at times between pain and trauma and even affects our gastrointestinal system. That’s why when you start to look at these communities where mental health is poorly treated or maybe not treated at all, you almost see a bidirectional or increased rates of things like diabetes, cardiovascular disease, autoimmune conditions, chronic musculoskeletal pain, IBS or IBD. There’s an aspect of learned helplessness and a loss of agency with this. And of course, of course, this has an impact on our interpersonal relationships. And there’s even data that this can change through epigenetic changes, change our DNA and that trauma or the trauma genes can be passed down from one generation to the next.

Physical Therapists Treating Trauma

What I want to do if you’re a physical therapist or a physiotherapist, I want to take you kind of in a journey through time in the United States and America. And I want to go back in time, really quite way back in time to about 1914, which was World War I. Now, when World War I broke out, physical therapists were called reconstruction aides. and they were sent overseas and around the United States to help soldiers recover from obviously physical wounds and something that at the time was termed battle neurosis. Now battle neurosis is what we know today as PTSD, right? So both physical therapists and occupational therapists as well We’re already working with mental health care at the beginning, really, of our profession, if you will. And this is true. World War I affected not only US, but of course, many countries across the globe. But really, our profession actually started treating comorbid mental health conditions in some way.

Physical Therapy in Mental Health

Now fast forwarding that to modern day, right? So now we have the evidence and we have the data to support physical therapists and physiotherapists work in these types of roles. So that first box you see there was a systematic review looking at physiotherapists in Canada who use mental health interventions in physiotherapist practice. And of course, the data is strong that physiotherapists can use this once they’re obviously empowered with the knowledge, skills, and some practice to use those interventions. This was a scoping review that was recently published in PTJ that looked at the role of the physical therapist in mental health. How can we play a positive role in working with either comorbid mental health conditions or mental health conditions by themselves? This is a colleague, Ryan McGrath, who is a physiotherapist in Australia, that wrote really a great systematic review looking at the recommended approaches that we can use for physiotherapists working in mental health. I wrote a paper in 2023, it was kind of a small paper, but really me kind of urging our profession that as physical therapists, we have this wonderful tool called exercise and physical activity. That when we look at things like mild to moderate depression, actually it’s kind of shaping up that exercise is just as good as psychotherapy. and or antidepressant medication when we have mild to moderate depression. And when people have more severe cases of depression, this should be part of an integrative or multidisciplinary approach to people with depression specifically. And then I wrote another paper. This is kind of geared toward pain. I wrote an integrative systems model for a chronic pain called PRISM. But at the end of that paper, we recommended that this model should be adopted for mental health physical therapy as well.

Evidence Supporting the Role of Physical Therapy in Mental Health

We have a lot of research now supporting our role in mental health as physical therapists or physiotherapists. Now with that, as the research has built, the International Organization of Physical Therapy and Mental Health was created probably about 15 years ago. There are now 15 countries that are members of this organization. It’s a wonderful organization. You can look for it online. And with that, it really started kind of this movement. where small organizations or moderate organizations have now started in many countries within the physical therapy associations of many different countries. So in the United States, ours is housed under the Academy of Leadership and Innovation. And we’re what’s called a physical therapy and mental health catalyst group. So this is primarily a group of educators working to change policy both in the DPT program and in clinical practice and research so that we can play a greater role in this area. And this has obviously been mapped to many physical therapy associations throughout the globe. We’ve also had a scope of practice change in early 2020, where the American Physical Therapy Association released a House of Delegates statement, this is a policy statement, that demonstrated or said it is within the professional scope of physical therapist practice to screen for and address behavioral and mental health conditions in patients, clients, and communities and populations. right? So obviously you can address these things individually. You can also consult, refer, or co-manage these conditions with licensed health and or mental health professionals that are working in these areas, and we encourage that. There has been kind of more global guidance in this area from the World Health Organization that demonstrates that when healthcare workers, non-mental healthcare workers like a PT or an OT or a nurse, receive adequate training in this area, that it improves your knowledge, skills, and confidence to deliver these interventions. for a variety of conditions, most of them center around stress, depression, anxiety, and PTSD. And that when you deliver these interventions, it improves obviously health and mental health outcomes and quality of life. And when you learn these interventions, that it is one way to increase the global provision and capacity, right, to ease the mental health shortage that we see happening in various countries. So what is a mental health physical therapist, right? What is mental health physical therapy? So Jeremy and I have been working on this for some time. And really it’s not just one thing. There’s lots of different types of approaches or scopes that you can kind of move in and out of as a physical therapist in this space. And this is what makes it really interesting. So one is just a physical health approach, right? Many of you are doing that now. You’re, let’s say, treating pain, and in treating pain effectively or relieving someone’s physical impairments, in some way you are improving their mental health. There is a psychosocial approach, and there’s also a specific psychotherapeutic approach. So I’m going to go through those slides now, one, two, and three. So one, under the physical health approach, right? I really like this pyramid that was developed. We as physical therapists, of course, are resolving physical impairments and we’re using exercise prescription and physical activity, right? But we’re also working at the level of lifestyle interventions. So things like sleep, healthy nutrition, helping people manage stress, promoting social connection, and helping people with substance use and support. So that entails motivational interviewing, which is squarely in our scope of practice. It’s actually in the guide for PT practice. Now, as you move forward from this lifestyle approach, right, then we move up to the next level, which are psychological interventions. And there’s really two levels of that. So there’s a psychosocial approach. So this is the prevention of a mental health condition. So this is considering the influence of psychosocial factors in our practice to prevent a mental health condition. Then we go to the psychotherapeutic approach. So with the psychotherapeutic approach, a physical therapist utilizes low to moderate intense psychological techniques to specifically target mental health symptoms. What are those techniques? Well, those techniques fall under cognitive techniques, behavioral techniques, emotional techniques, and somatic techniques. Those can be used alone, but we really recommend they should be used in combination with other physical therapy interventions, one that many traditional physical therapists are using in practice. Okay, so I’ve been kind of chatting away here and moving through. I’ve kind of moved through this really fast. I really want to make sure we have enough time for questions. And I of course want to make sure we have enough time where you can meet my good friend and colleague Jeremy Fletcher. Jeremy is obviously a doctor of physical therapy. He currently works within the VA medical system. working as a primary care physical therapist, but he has a long history of both personal and professional work in this area. I think some of his most interesting work is working as the CEO of a organization that serve veterans in the community. He’ll mention that just briefly. And without further ado, I’m going to turn it over to Jeremy. Okay, Jeremy, I’m going to stop sharing here so you can take over.

Thanks, Joe. Appreciate that. It’s really As I’m sitting here watching this information roll across the screen and thinking about where we are as a profession, it’s, man, it’s so exciting. I also sit here and say, well, I think I need to implement one of those somatic techniques right now because I’m getting so excited and I hope I’m able to deliver what it is I should be delivering today. So, Joe, I’m gonna, let’s see, I’m gonna go back to Zoom here. and share my screen as soon as I can get to it. Let’s go in there and share. Jay did a fantastic job, by the way. Let’s see. Joe, I can’t see on my end. Are you looking at the slides or the presentation view? Oh, you’re muted.

I think you’re you’re in presenter mode. Just come out of presenter mode there. That way people can see the whole slide itself.

One of my screens here. Hey, what, Joe, I’m having a problem toggling through a couple of these things. Would you mind going back and sharing yours and then I’ll just tell you when the slide advance?

Yeah, I can do that. Sure. No worries. Okay.

So here we go. Um, so yeah, so I, I’m really excited to share what Joe alluded to, which was, um, one, my personal experience, uh, having difficulties managing and navigating mental, mental distress and what subsequently led to a diagnosis of post-traumatic stress disorder for myself and the journey that I was on and to many to really the same degree I’m still on and how I really was able to take some of my life experiences and be able to transform those into positive change for myself as well as other lives. So I’m sharing this story with you primarily just to give you an understanding of where mental health physical therapists may come from. Hopefully you find something in my story today that’s a little bit relatable as a physical therapist, but just also as another human being who’s likely been through some difficult life experiences as well. So that’s what I hope to share today. Joe, you can go ahead and advance the slide. Thank you. So many of you that work in pain probably listen to people’s pain stories. And what I want to do today is share my personal pain story. So this image here for me renders a lot of thoughts around my mom and a lot of the dysfunction that she had in her life. My mom did the very best she could as a person who suffered with depression and anxiety and ended up taking her own life by the time that I was 21 years old. She did the best job that she could to care for my brother and my half sister and I, given the skills and the tools and the abilities that she had. Regardless of that, she also had a lot of challenges raising us and it created a pretty unstable environment for myself and my brother and my half sister to live in. And so for those of you that may be familiar with some elements of trauma and what are considered adverse childhood experiences, My score ended up being around a 7 out of 10. And what that really means is that someone who has around a 4 or above goes on to develop some difficult health conditions, or the probability of those things happening is much higher. And so, you know, where I was, I had a significant amount of emotional abuse, emotional neglect, and physical neglect. And that really created a nervous system for me that really became very overly protective. And so I think that’s sort of the impetus in the beginning of my personal pain story was growing up in a difficult childhood experience. And so that’s what brought me to sort of my adulthood. And Joe, would you mind advancing the slide? Thank you. So in 2001, I was blessed to meet my wife, Cherish, and she really became the person that provided me with some sense of stability. And it was really my desire and passion to want to raise a family to be able to move away from the difficult life experiences that I had and create a new life with my wife together. That drove the motivation for me to Want to move out of this athletic endeavor that i was a part of i was a baseball player in college and really had found out at that point that. Many of the successes that i like had been in my particular life up to that point and really been a way for me to. find meaning, also find purpose, and also to be able to heal from some of the past wounds that I’d had. I developed some good positive coping mechanisms, but there were also some that were not so positive. But I will say that through this relationship with my wife that was loving and caring, and then also the combination of the motivation that I had to continue to persist, it allowed me to overcome a lot of those difficult life experiences that I’ve had. Okay, move forward. Sort of a next step in this journey that I’ve had led me to become a physical therapist on active duty. I began actually as an enlisted medic and then became a physical therapist assistant. Finally, they go through physical therapy school and become a physical therapist. I was in 2013 when I deployed to Afghanistan as a part of a brigade combat team that some of the past really began to become more present for me. And that was while I was in Afghanistan serving in a combat environment. I was really at the height and pinnacle of what I felt like was my professional career. But emotionally and mentally, it was extremely difficult. I was watching and experiencing people in front of me, their countenance change, everything about their body, everything about their mind was slowly eroding toward a state of suffering. And that took a significant emotional toll on me. In the middle of this deployment, also my grandfather passed away, and he was really about the only person that I could ever really trust in life. He was the only stable person I really had. And so he passed away, tremendous amounts of grief, loss, took an amazing amount of toll on me. And so that was kind of a next step in my journey. So I went back home, and Joe, would you advance to the next slide? Uh, and this was, this was actually around September. It’s a good looking picture there. I was really suffering at that point. Uh, I had about. Maybe two hours of sleep, uh, that I was, um, living with for probably about three to four months. Um, and I was really struggling mentally and emotionally, and, uh, I was doing the best I could to survive. Um, I was literally getting up at 12 o’clock at night and I would go run uh, four to five miles at night, just exhaust my nervous system. And finally to come home, uh, and just fall asleep on the floor and then get up and go to work the next day. Um, and yeah, I was ended up being prescribed all sorts of medications. My immune system was shot and realized like at this, this was pretty much the low of the low point. Um, and yeah, I guess I knew that I needed to document this in some way, uh, as a, as a memory and as a reminder, um, that this can, this can be life at times. Um, so now I’m hoping to share that with you, uh, as a, as a meaning of hope and inspiration. Um, And so, yes, from this point forward, I ended up seeking help. So I got help for, really, I called my boss that morning. He came and he brought me into behavioral health. And that’s really where my journey of recovery began. So you can advance to the next slide, Joe. And, you know, I think through the help of counselors, the help of friends, the help of mentors and colleagues, my life has transformed since that moment. And I’m getting pretty emotional thinking about it, even in this moment, how grateful I am for the amount of people that cared for me, poured into me, and supported me through that particular journey. And fortunately, I was able to take those experiences and bring those into another organization and another team. And through some funding through the Robert Wood Johnson Foundation, we were able to help build an organization that helped people that were really just like me. And I was able to become the chief operations officer of that organization. We had an amazing founder with a tremendous vision who wanted to transform lives of people along the Gulf Coast to address those problems that Joe was talking about. And you saw the map of the Gulf Coast, it’s as deep blue as it can get. So we had a significant problem and with the help of an amazing team that was interdisciplinary, we were able to address some of those things and really move my painful experiences to a wonderful experience. So I’m really excited that I was able to make it through that difficult period of time. So Joe, you can advance to the next slide. This is something that I feel like is a really great summary for me, and that’s trauma creates change you don’t choose, but healing is about creating change you do choose. And so ultimately, we have a choice to move forward. And I’m so thankful for the choice that I’ve had. And more importantly, now that I have that choice and had that experience, I really want to move to the next level for me is to make a bigger impact in the lives of other people. And really excited to be able to bring this to you. Also, I want to share a little bit about some of the work that I do day to day, how that plays out. So let me tell you about Michael. Michael had persistent low back pain. He developed that back pain actually on a rescue mission as a Coast Guard member. And for those of you who may not be familiar with the Coast Guard, sometimes they refer to people in his position as the hands of God. They literally reach down and try to pull people out of the depths of dying. And so he was on a rescue mission, felt a sharp pain down his leg. He was in helicopter pilot. He came back off a mission. They order imaging, prescribe medications, limited his duty. And ultimately he never really recovered from that particular instance. He had had three failed attempts at what we might call a traditional physical therapy. Some of the things that we might traditionally do. And Joe, next slide. So, as you may be aware, there are great tools to help us identify some of the cognitions and emotions and behavioral issues that people do present with in clinical practice. One of those is the OSPRO Yellow Flag tool. And this particular gentleman had screen positive for depression and anxiety, fear avoidance, kinesiophobia. He had very low chronic pain acceptance and low self-efficacy for rehabilitation. Some of the therapeutic intervention strategies and processes that we used, or I used rather, in clinical practice was to build a therapeutic alliance. I also use the therapeutic use of self, which essentially is a disclosure of some of the difficulties that I’ve had experience in order to help build therapeutic alliance. We use some mindful movement strategies and helped him address some nutritional difficulties he was having and was curious about. And then we kind of work toward his values and aligning some of the activities that were important to him with his movement behavior. kind of a broad overview, session-by-session overview of what it might look like to implement a psychotherapeutic approach in this particular case. So, you can kind of take a look and see what approaches were used here. Joe and I have had a lot of discussions around what does it mean to implement a process-based And Joe’s work that he’s done in Prism, I think does an excellent job of painting a pathway for us to follow here. And that’s essentially what this looks like, is a process-based approach. So we went through these different processes to ultimately bolster his self-efficacy and improve his ability to move. And Joe, would you move to the next slide? So the outcomes were after six sessions, and these six sessions were delivered really over about, I think it ended up being four months. So it wasn’t high intensity, but he did a lot of work in between, in between sessions. And we re-screened using the Osprey yellow flag again, and he no longer screened positive for depression, anxiety, fear avoidance, kinesiophobia. He had improvements in his chronic pain acceptance and had high levels of pain self-efficacy. So, you know, it’s just one illustration of a positive outcome using this psychotherapeutic approach. And so that’s what I wanted to be able to share with you today. So next slide. This was a comment he made that I felt really made a profound impact and also really spoke to the power of this psychotherapeutic approach. So before this therapy, I always felt like my body and mind were disconnected, but this helped me to see how deeply connected they really are. And now I can deal with my stress better and I feel physically and emotionally stronger. And what was most important to me as a physical therapist who’s trying to help people manage these things better and live life more fully is that he said, I can take care of myself. That was pretty impactful for me. Next slide. And I think Joe, this is where you take back over.

Thanks, Jeremy. So if you have questions for Jeremy, please make sure to either write them down or we can talk about them. We have a couple more slides here before we get to Q&A. I’m just going to move through these. So I want to talk about scope of practice, because obviously some of the things that I’m talking about and Jeremy’s talking about are, of course, within your scope of practice, but they’re skills that we’ve built over, you know, I mean, between Jeremy and I, we probably have 50 years of education, training, and clinical experience that we’re kind of rolling in here. So the physical therapist scope of practice has three parts to it. There’s your professional scope, there’s a jurisdictional scope, and there’s a personal scope. So the professional scope I already went through. So the professional scope is released by the American Physical Therapy Association and really sets the tone for the entire nation. And as I mentioned before, we do have this policy statement that says it is within the professional scope of physical therapist practice to screen for and address behavioral and mental health conditions in patients and clients, right? So that’s there. Your jurisdictional scope really in the United States is your state, right? And in the United States, we have kind of this overarching jurisdictional scope in each state. And if you kind of go into that jurisdictional scope and look at it, it talks about the term disability and or health. Now, for most of us as physical therapists, we think of disabilities as physical disabilities. But if you look at the Center for Disease Control definition, a disability is any condition of the body or mind, right? So the title of this webinar was Treating Body and Mind. So body and mind, treating the body and the mind, is embedded in our scope of practice, both on a national level and on a state level. And we’re looking at treating obviously body and mind when it comes to activity limitations and participation restrictions, right? Those things make perfect sense to us as physical therapists and other healthcare providers. Finally, the third scope that you have to consider is your personal scope. So the personal scope consists of the activities for which you are educated, trained, and competent to perform. And I really think this is the most important place that you need to kind of think about and reflect on with regard to working with these individuals and this population. Because we know most of us didn’t receive this type of training in the DPT program or in a physical therapy program necessarily. Now, how do you assess your skill level here? Well, a couple of really simple questions. Have you completed any specific mental health training for physical therapists? Now, there’s a lot of mental health training out there, but when you take it, it’s really geared more for psychologist practice. You have a very specific practice as a physical therapist. You have to take something that’s specific for PT practice. Do you have proof of competency in this type of area as a mental health physical therapist? And of course, we’re not talking about a three hour CEU credit that you just took because it seemed really easy, right? You need sufficient training in this area before you start to really interact with people on the deep level that Jeremy and I are talking about. And then finally, what skills do you need to improve in this specialty area? So maybe you do have some foundational knowledge, but there may be gaps in your education or your training. And just to be kind of aware, both Jeremy and I are lifelong learners. We continue to learn more and more as we go along. I’ve learned a tremendous amount from Jeremy. I’ve learned a tremendous amount from doing research, from collaborating with other mental health providers, and of course, the patients who have trusted me with their care and well-being.\

Mental Health Physical Therapy Certification

I’d like to introduce you to a certification program that Jeremy and I have created. We have brought one cohort halfway through the program, so to speak, and we’re kind of on to our second cohort here of training physical therapists and mental health to expand their skill set, to address a growing need, and obviously to improve both mental and physical health outcomes. When you join the program, you’ll learn both the physical, cognitive, behavioral, emotional, and somatic techniques that optimize mental health. It is where 32 CEUs approve for physical therapists and physical therapist assistants. The program is divided into three components. So the first component are mental health foundations. That’s where you learn to screen, identify, and differentially diagnose conditions like depression, anxiety, and PTSD and substance use. The second component of the training are the essential mental health skills. That’s where we’ll go through that psychotherapeutic approach that we’ve been talking about through this webinar. And the third component of the training is what we call mental health mastery. So that’s working with your colleagues in the program and working with us on trying out these skills and testing these skills on each other first before you go and use them with patients. So Jeremy and I have tested this process both in clinical practice, in trainings on national levels, through our research, and of course working with the therapists who have been with us in this program so far. And I’d like to tell you about some of the professionals that we’ve had really the honor of working with. So the first is Dr. Sarah Case-Morris. Sarah is a clinical assistant professor in the physical therapy department at the University of Flint, Michigan. Sarah is a DPT, she’s an educator, right? So she realized that a year or two ago CAPTI released standards for implementing mental health content into the DPT program. Now CAPTI provides guidelines, however they don’t provide a whole lot of guidance for exactly how to do that. So Jeremy, the one thing Jeremy didn’t mention was that he worked as a full-time professor in a DPT program for I believe about six or seven years, if I’m getting that right Jeremy, And I’ve been an adjunct professor probably now for about five years. So we’re familiar with working with students in the program. We’re familiar with the challenges that our colleagues have with this type of content in the program. And the certification that we have really can easily be kind of ported over to the DPT program. So you can use what you’re learning here in the content of the DPT program. Second is Sarah Conover who is a physical therapist. She has a really fantastic website. I really recommend you visit it. Her website is called dizzycoach.com. I think it’s a really great way to brand vestibular therapy, right? So, Sarah is a vestibular physical therapist. She’d been practicing for a number of decades, obviously has a degree in physical therapy, went on to get specialized in vestibular therapy. Somewhere in there, I got some essential skills in health coaching and realized that, wow, a lot of my patients with vestibular disorders also struggle with anxiety. and how I can’t really treat them fully as a whole person unless I start to address their anxiety and symptoms of anxiety. So, Sarah joined our program. Sarah’s got a great website. Please make sure that you check it out. Sarah’s also taken a couple other courses with me. She’s taken the acrochronic pain course and she took my functional nutrition course before she joined the mental health certification. So, she has a really wonderful breadth and depth of knowledge as a mental health physical therapist building. And then finally is my good buddy Chase Belote. So Chase is a physical therapist who works in San Diego at the Family Health Centers of San Diego, and he serves adult pediatric and women’s pelvic health patients in an outpatient capacity. It’s an outpatient multidisciplinary clinic. They’re actually building an integrative chronic pain model for that clinic, and Chase wanted to kind of bolster some of his mental health skills so he can really support, obviously, his patients. and work in an interdisciplinary capacity within that program. Chase and I have met through the Pilates and yoga community. I’ve done a lot of work in that community. And as you know, people who kind of find their way into Pilates and yoga really have already kind of bought into this idea of developing a holistic mind, body and spirit approach to working with individuals and communities of people. So just a sample of the really incredible physical therapists who I think are really tackling some really difficult challenges in healthcare. And I really think they’re setting the tone for what’s to come in the next one to five years in physical therapy. We’re already seeing a lot of this happening with our colleagues in the program. So let me tell you a little bit more about the program. So we will begin on January 12th with the second cohort, so that’s just about in six days. The first part, the mental health foundations, I mentioned before, you focus on screening, identifying, and differentially diagnosing mental health conditions. That’s about six hours of self-paced work online. And at the end of that module, there’ll be a two-hour live integration session where Jeremy and I will help you integrate that work into, obviously, your clinical practice. After that is the second part, which is the mental health essential skills. So this is where we go through specific cognitive, behavioral, emotional, and somatic techniques for various mental health conditions. That’s about 14 hours of self-paced content. And then again, at the end of that, there is a two hour live integration session. That’s about 16 hours in total. And then about a week or two later. we have a one day online live training where it’s really all experiential practice. So this is where you get to practice with us and you get to practice with your colleagues. That way we can really help you develop mastery in this area. Um, so you go and work with, uh, obviously these populations, it’s about eight hours total. It’s a one day live online, um, zoom call. The total program is 32 hours approved for physical therapist and physical therapist assistance. Included in the program are case-based learning, discussion forums, patient simulations, we have a community forum, and of course, support and mentorship from Jeremy and I, as well as your colleagues. The benefits for you, obviously, you’re going to expand your scope of practice. You’ll have a broader kind of box of treatment strategies to use. You’ll be building yourself up to have a competitive advantage in the healthcare system that’s really rapidly changing, right? It’s really difficult to help people with their health if we’re leaving the mental health component out of it. With that, it should open up some new doors and opportunities for you if you’re looking to work in this area further. That may lead to increased earning potential. And of course, the thing that we haven’t spoke about, but I really want to shed a light on, is that when you learn these types of skills, not only does it improve your patient’s mental health, but it has an impact on your mental health. Things like reducing burnout, reducing secondary traumatic stress, and reducing compassion fatigue that I’ve dealt with at multiple times throughout my career. And once I learned these skills, it really eased that burden on me and really made my life better, right? There is a high demand for mental health physical therapists, of course, in PT clinics. In the DPT program, we need this information in addiction care and mental health clinics, and of course, primary care and primary behavioral health, and potentially even in consulting. If you look at what’s happening in technology, in the technology space, things like apps and online programs, working with employers, they’re looking for professionals that have a broad skill set that they can, obviously you can go into employers, an insurance company, maybe a digital health venture capitalist and say, hey, I have these skills and I can work with these types of patients or develop programs. Now, I think, you know, To be honest, both Jeremy and I thought about going back to school. And a lot of people in the program said, oh, at one point I thought about going back to school. Now, if you go back to school for a degree in mental health or psychology, that will cost you anywhere between $75,000 to $250,000. It’ll take you anywhere between two to seven, eight, nine years, depending on how you do it. Plus there’s supervision after that. Jeremy and I actually realized through our own journey that we actually love being physical therapists. We don’t want to be mental health providers, but we want to have some of those skills to help our patients, right? We want to be mind-body practitioners. We want to be psychologically informed. We want to be mental health informed, right? So we really have taken the combined experience that Jeremy and I have and really have rolled it into a program so that you don’t have to expend so much time, effort and energy to access those skills. As I’ve kind of gone through some of these already, I’ll just kind of put them on the screen here for you. This is really, really deep training at just a fraction of the time and costs that will empower you to work as a mental health physical therapist. We do have payment plans. So if you need a payment plan, we have three and six month payment plans. Um, I do offer student discounts. If you are a student, please email me. Um, and I will, uh, happily connect you with a student discount. If there’s someone in another country where that’s kind of a differential with the U S dollar, send me an email as well. And I’ll help you out there as well. Okay. Let’s open it to question and answers.

Joe, I was monitoring the chat and there are two questions. One’s from Rashna Mehta, and it’s, is the program approved for CEUs in all states in the United States?

Many, and if we’re not approved in your state, we will submit it for you and it’ll be approved. We’re approved I think now in 45 of the states. So if that’s not one of your states, New Jersey does have their own approval process. If you join the program, I will submit to New Jersey personally and that will be approved. We have never been denied for any CEUs by any state at the Integrative Pain Science Institute.

And Tracy Matthews also asked, where did you learn your somatic techniques?

Where did I learn my somatic techniques? How much time do we have? Really, first for me, I was a competitive gymnast. So I really learned about the mind-body connection being a gymnast. And that’s really why I wanted to be a physical therapist. I didn’t wind up working with gymnasts because in Midtown Manhattan, there’s not too many Olympic gymnasts here. But what we do have here are dancers and lots of dancers, modern dancers, performing artists of all types, ballet dancers. So I worked in the performing arts for about three to five years, just working with performing artists one-on-one. And I really learned a lot about the mind-body approach there. And that took me to becoming certified in Pilates and yoga. And then from there, you know, a lot of these things you kind of develop on your own. I’ve developed my own techniques. I have something called pain resilience therapy now, which I’ve published in a peer review journal, the Journal of Physiotherapy and Mental Health. And you’ll see some of the techniques I’ve used and developed in that peer review literature there. I think, you know, when it comes to somatic, I think a lot of us as physical therapists are doing this kind of innately. Um, but we want some support and how we can do it more intentionally with different types of conditions.

Yeah. Um, let’s say, uh, Kyle asked about what about Canada? I’m assuming that’s for the CEUs.

We’re American-based PTs. We’re happy to help you out if you want to submit to Canadian boards. I’m not sure if that happens nationally or if that happens to reach Providence, but I’m happy to provide you with course objectives, learning objectives, outlines, whatever you need to submit to the board there. I can help facilitate that.

Great. Let’s see. Lauren Parker asked, could you discuss differences in pain reprocessing therapy course versus the mental health physical therapy certification training?

Sure, that’s an easy one. Pain reprocess therapy is a short eight-session intervention that was developed specifically for chronic pain, only addressing chronic pain through psychological means. Our certification is to train physical therapists to work with people who have mental health conditions. So this is not a program for treating chronic pain. This is a program that helps you as a physical therapist work with people who have either mental health conditions alone and or a comorbid mental health condition. So it’s completely different from anything like that. The other thing I would say is, as interesting as pain reprocessing therapy looks, everything we do here at the Integrated Pain Science Institute looks at someone as a whole person. And that is just a purely psychological intervention. And I have some challenges with that because, for example, metabolic syndrome is comorbid with depression and anxiety. Um, so we have to really look at the whole person and it also leaves out social factors. And I know Jeremy, that’s something you can talk about cause you’ve worked in directly in communities and the social aspect aspect is a big part of whole person care that we can go over in the program.

Yeah. Um, and I, I want to go ahead and, uh, just bring out that if for the, I know there’s a lot of, um, questions that are being populated in the chat. If there’s anybody that wants to unmute and ask a question directly, please feel free to do so as well.

Yeah, so there’s one thing that Tina just mentioned. She said the ICF model encourages us to consider contextual and environmental factors. And we actually go through that in the program. And we really spend just not a lot of time, but a little bit of time on that model. And in that model, it talks about body structure and function. Now, when you hear that as a traditionally trained physical therapist, you think, well, of course, they’re talking about physical impairments. But if you look at the definition of that model, body structures and functions include mental functions. So again, embedded in the models that we learn in physical therapy school are these kind of mind-body models addressing both mind and body. Who wants to chat with us? I’ve been ready to chat with people, Jeremy. How about you?

Yeah. Hi, I’m Tracy Matthews. I am not a physical therapist. I’m a somatic practitioner and Pilates instructor. And I work with a lot of injured clients with the psychosocial model of dealing with injuries and behavior and emotions. My somatic training really comes in handy with that. So I’m interested in what you have to offer about what your program you’re offering is for PTs, and I would not be eligible for that. So my question is, do you have any plans of creating something more for the movement community that are not licensed in a physical therapy way?

So lots of questions there. I guess I’m happy to kind of help you out with those. So first, what we can offer for you is I love your background in somatic therapy. I think it’s it’s desperately needed in the mental health. So much of mental health is just focusing on cognitive and they’re, you know, not addressing anything really chin down. And most of the conditions, especially depression, anxiety, and PTSD, have a body-based component to it. So that work is needed, and thank you for doing that. What our program would afford for you are the cognitive, emotional, and behavioral aspects that you may not have learned in somatic training, as well as some of the whole health lifestyle interventions that you may or may not have learned in somatic training.

So are you saying I could take the training that you’re offering, that you’re advertising today, even though I’m not a physical therapist?

So Jeremy and I have designed this specifically for physical therapy, just because the need is so great in the physical therapy community. We do recognize that occupational therapists, nurses, really a broad array of allied health and health professionals may benefit from this information. We welcome you into the program. We think you would benefit from it. Just realize that we do kind of house it under the scope of physical therapist practice. So, for example, in the first section of the training, we’re going to go through how to screen and identify various mental health conditions within the physical therapist scope of practice. But a lot of this really is easily probably adapted by many other professionals. Yep. And we welcome, you know, we welcome Jeremy and I’ve talked about this a lot. We welcome other professionals into the program. We want to learn from you as well.

Okay, and I was interested. So you’ve the somatic techniques that you have, you didn’t study with, like the Blanc, Le Bon Institute, or BMC, or any of those established somatic practices out there.

I have no formal certification in somatic therapies. I have a doctorate degree in physical therapy, working in this field for a long time and conducting research in this field.

Right. Well, I’m excited to learn more about it. Thank you.

I’ll jump in. Hi, Joe. Hi, you guys again. Sorry, it’s been a two year delay since our last conversation. You know, some things have happened in between. I am signed up. I’m thrilled, beyond thrilled, beyond excited. I do think this is critical for us to get into DPT programs. And we are creating a new curriculum at New York Medical College. And this is actually in a course I’m creating and starting to deliver next Thursday. So I’m really excited. I’ve got some student research groups that have been doing work on this as well. So I’m just, I’m really excited to see how you guys put this together and compare it to what I’ve created and just really get this out there. And I think, you know, one of the things that struck me at CSM in San Diego, when I met you guys and we talked about this, you know, the closing session that day was a debate between those who believe in psychologically informed care and those who don’t. I found it fascinating to watch my mentors, my former chair of our program, people I went to school and learned from at Columbia, mentors I’ve had in the New York City area, who were assigned to this debate of yes or no, whether or not they truly believed in it. And I think that um, you know when I started teaching 20 years ago One of my colleagues was a PT who had actually gone to Columbia when it was a certificate before it was a bachelor’s or a master’s or a doctorate and he had gone back and gotten a PhD in psychology and he taught that until he retired in his 90s and then passed the mantle to me and When I said, why are you passing it to me? And he said because from your first research project you were always about what does the patient think, feel, and how does that influence what they choose to do and the fear that limits them. And I look back at my career and I’m like, holy crap, that’s always been part of who I am. And I think that, you know, we say if I think good PTs do this, they just include it, right? It’s like, I have to understand that why you’re not getting out of that chair might be because you have a fear of falling or you have a fear of pain or you don’t have faith in yourself and your self-efficacy is lacking. And, you know, bad PTs or so-so PTs, you know, are good enough. They’re still getting the patient up and out and supporting them physically and encouraging them and giving them those inactive experiences. But I think what you said about if we can truly be more intentional about this and understand why we’re choosing to say this, do this, add this first, create that therapeutic relationship, really build upon that, I think our patients can just go so much further, so much faster. And I think it’ll improve our effectiveness and efficacy as PTs. So I’m just like, I don’t know. I can’t even tell you how happy I am to be sitting in this seat right now with you guys and to start this program. So thank you. I have a question.

Yeah, Karen.

Yes. Um, sort of several problems. Um, one is I noticed in a lot of PT practices, people are, um, in the most big, huge multi-site practices, people are pushed to see three patients an hour. and in open space. So I’m wondering about the architecture of the office. I used to work in an office where we had private rooms as well as an open gym. And people will reveal more about their lives in a private room, I find, than in an open gym. So have you guys thought about that or think about that? And two is, I’ve done all this in an informal way,

No, no, no, no. Thank you for. What CPT code do you use when you’re doing this work?

I’ll take the first question, Joe. Yes, absolutely. Creating a safe place for people to express, express who they are, express what’s happened to them. Creating a safety is essential within this you know, within this particular psychotherapeutic approach, we have to create a sense of safety. And sometimes that means we need to be in a safe space. I’ll give you an example, just clinically what I do. I do have a closed office space. I work with a lot of veterans who have experienced PTSD. And so as I invite them into my particular room, I always ask for permission in order to close the door. And, you know, I asked permission so that they have some sense of control and they have a say so in how we create a shared space together. I think I’ve also worked in an outpatient clinic where we did not have that kind of closed off space. And it was sort of in this open environment. And when I was moving in toward a conversation that was more emotional in context or some other types of experiences were coming up, then I might invite that person to a room that we did have that was that we could close and we could talk about those things. So I think it’s more about the invitation and allowing that person to lead the conversation that creates safety. And then y’all let you handle the

Yeah, the billing question. So Karen, behavioral health and health behavior changes is a big topic in practice. I guess to answer your question effectively, what self-report measure are you using to demonstrate that the patient has a need for a cognitive behavioral intervention?

I do it informally. So I don’t use any one thing.

Yeah, so, so Jeremy, Jeremy and I are kind of big on assessing and not guessing. And the data really demonstrates that as well, that when we just kind of guess, like, does this person have depression? Does this person have anxiety? That oftentimes we’re actually incorrect in our guesstimate. And the reason why that is is because many of these signs and symptoms are kind of invisible. So it’s very difficult. So the first thing I would highly recommend you do is use some type of validated self-report measure to start looking at the psychosocial variables that may be impacting your patient’s care. Once you use that in practice and you find that let’s say someone has moderate depression, maybe they’re scoring a nine on a PHQ-9 score, right? Then you can document that in your initial evaluation. And you can say in addition to the physical impairments that my patient is presenting with, decreased range of motion, decreased strength, decreased balance, inability to ambulate more than, you know, 10 city blocks, whatever it is, that my patient also exhibits signs and symptoms of mild to moderate depression, so to speak. And then from there, you can start to build out your plan of care. what treatment you’re going to use at each session, and then we can talk about what code you’re going to be using for behavioral health. So I think the take-home message here, and I love this question, Karen, it’s always what code should I use? And my answer to you is How are you demonstrating the need for the code first? Because insurance companies, especially nowadays in the United States of America, want to see that you’re demonstrating a need. If you can demonstrate a need, then you’re more likely to get reimbursed for the code that you’re going to use. And also keep in mind, we have a big country, 50 states, and every insurance company has a little bit of a different coding system. So I highly recommend you take some of these questions to your medical biller and say, hey, I’m using a cognitive intervention, or I’m helping someone with emotion regulation, or I’m using this. Somatic practice more or less can fit under therapeutic exercise or neuromuscular re-education. But if it’s anything else, go to your biller and say, hey, with this particular insurance, Blue Horse Blue Shield of Iowa, what code do they recommend I use? Can you call the insurance company and ask them? That’s what medical billers are for. They’re trained to do that. That’s what they go to school for or certified to do.

I had a quick question.

Yeah, so Dr. Tatta, first of all, thank you so much and Jeremy for doing this. I heard your lecture last year at CSM in Boston. Our physical therapist qualified for mental health. And again, you had an amazing array of people who spoke about this and the speakers were amazing. So I’m an orthopedic and public health physical therapist. I’ve incorporated a lot of holistic you know, modalities into what I do, and I’m excited to take your certification. So I teach acupressure. I’ve kind of gone more into holistic healing methods. I’m also a yoga therapist practitioner. So my question to you is, do you teach any energy healing methods that are more physical practices as compared to mental practices as well in your certification? I know you teach somatic practices, and I’m excited to learn more about that. But do you have any energy healing methods that you teach as well.

We do not teach any specific energy healing methods, I think, as you’re describing them, although we would welcome to have you give us some insight into that in the program. I think therapists would be interested in it. You know, when I think of when, so when you mentioned the word energy to me, right, all of these states, I call them states, we talk about things, you know, humans moving in and out of these states, right? So many of the mental health conditions, people move into these states where they’re very depleting. And I think there are lots of different ways to help people with their energy who have mental health or comorbid mental health conditions. For example, nutrition is a wonderful way to optimize someone’s energy production. Your mitochondria needs B vitamins. And when you don’t have those B vitamins in sufficient amounts, it’s very difficult for your mitochondria to produce energy. Now your mitochondria is most dense where? Well, nerve tissue and muscle tissue. So when we look at like a whole health approach to things, there’s lots of different ways that we probably are indirectly improving someone’s energy capacity, either through optimizing nutrition, through movement, right? Helping those connections, neuroplasticity, or helping people reduce or alleviate, release the stress and or traumatic stress that they’ve been experiencing.

Absolutely. Absolutely. And I could not say enough. I’m a Columbia alumni. I was in the first Columbia deputy program. And it’s interesting at the poster presentation, I ran into my professor, Dr. Martha Lewinsky. And the topic of her poster was, how are we dealing with the mental stress of DPT students in the PT program? And that is amazing that it’s coming out and being talked about more now, because even as a student going through the three-year program and being the first cohort of DPT students, it was so much stress that we went into and came through with that program. And again, you know, as Tina said, we bring this into our work. You know, I think we’re tuned into this work with our patients, especially for public health. Again, I work in a closed room and what stays in the room, I am conscious of what my patients tell me and how I address them and how I speak to them when I come out of that room. So even for somebody coming with an incontinence, I will never ask a question out in the open. about how are your symptoms or something like that. So I’m more aware of what happens behind closed doors that it just stays with me and I can address that with the patient. So I’m very excited to sign up for your certification and thank you today for everything you’ve presented.

You’re welcome. It’s good to see you again. I can’t wait to work with you and learn more about the way you’re integrating this work together. And this is really what our program is about. It’s we realize that all of you have unique skills and you’re going to learn some new skills here and you’re going to weave them together so you can become the best version of a physical therapist that you envision in treating people with health and mental health conditions.

Thank you so much. I also wanted to mention that after that lecture at CSM, I partnered up with another physical therapist here who works at Kessler, Preeti Jha. And through the American Physical Therapy Association of New Jersey, we’ve started a new integrated physical therapy special interest group. So we are welcoming therapists. We have a small cohort of therapists and we share practices that we are all using in our own realm to learn more from each other. So thank you for that inspiration.

Thank you so much for that. I think we’ll see more of that. We’re going to see lots of different special interest group pop. We already have them at the national level, but like we’ll see different, you know, kind of groups pop up at the state level. And we have our own community here that we’ve been building for a long time, um, who have been using a really integrated physical therapy. And that’s why it’s called the integrative pain science Institute, right? Speaking my language. I appreciate you being here. Thank you so much. Anyone else? as we kind of start to move.

Yeah, Joe, I’ve just got a question if that’s OK.

My name’s Andy. I’m a physio from Liverpool, UK. Apologies, we can’t understand my accent. A lot of people can’t, to be honest. So if people can’t understand, I’ll slow down. But firstly, thanks for the presentation and thanks to Jeremy as well. I think it takes a lot of courage if you’ve been through trauma to actually talk about it. I live with my mom and dad who are narcissists, so probably about 30 years. So I think it takes a lot of courage. I’m actually going through a healing journey myself at the moment. So I’ve got a lot of respect for that. The question I was going to ask, I work in the NHS and do private as well. So if someone’s got MSK problems like lower back pain or a shoulder problem, but they’ve also got mental health issues like anxiety, depression, PTSD, where do you start first? Because sometimes where I’ve tried to go down the physical route, there’s been a rejection there, but there’s been other times when I’ve gone down the mental health and trying to deal with sleep, nutrition, mindset, and then you feel like you’re hitting a brick wall and become resistant to it. So where would you go? Would you go the mental health side of it first and deal with that, and then the physical, or would you actually run both alongside each other?

I’ll share a little bit about my, I guess my insights there are that I don’t see them as separate routes. Personally, I don’t see them as a mental health route or a physical health route. I see it as a route to improving their overall well being. And so for me, that means that I need to better understand who that individual is. and what it is they really care about and what means something to them. And so from there, I try to meet them at that point. So someone comes into my clinic, they sit down, and my question is, how can I help you today? And then we start from there. Okay. And really, if we were using this sort of process, you know, kind of thinking, it would be number one to be able to, you know, build a therapeutic alliance that creates a sense of safety, because that’s the first and most important step in this process is to be able to create a sense of safety for that person. And, you know, through the interview process, that’s whenever I begin to understand where that person is today, because that may be different tomorrow. And so, you know, I know Joe was talking about, for example, implementing valid and reliable screening tools. There are days when that is something I might do on the initial evaluation. There are some days when that might be done on the second session for me, because sometimes people just need to be heard, listened to, and felt valued for who they are as a human being. And I tend to make that a higher priority than identifying which route I’m going to go down. And when I finally make it to that point where the other human being sit across from me is at a point where they’re ready to decide which route they want to go down, that’s the route I’ll go down with them. That might be physical, that might be mental, that might be social, honestly. I’ve had people where I’ve tried to say, hey, what is it you need? What do you feel like you need in this moment? And it’s literally a lawyer because they’re in a lawsuit. And that reduces their immediate distress. So I think that’s how my mind conceptualized this psychotherapeutic approach.

That’s been really helpful. Thank you. 

So the program starts next Sunday, officially. You can join now and today, but the cohort registration period will be open between now and next Sunday. We start next Sunday. And I believe in total, when you add up all the weeks, I think there was a question in there somewhere. You’re looking at approximately four months of education and training. So you can start to set aside some time in your schedule. We start out nice and easy. You probably have about maybe about an hour a week. The middle part of the program is a little bit more dense. You probably need about an hour and a half or so per week, depending on how fast you move through content, read papers, engage with community, chat threads, and things like that. Time has not really been a factor in this program. Everyone who’s come into this program has just been like, I just want the information. I don’t care how much time it takes. I just want to learn these skills so I can help people in a more effective way. We do start next Sunday. So next Sunday is the official start for this cohort. After that, we’re not running this again for six months. So you don’t have access to this for another six months. And we probably will raise the price, just because we know that there’s tremendous value in this. And every time we go through this, it gets kind of better and better. So there is value for everyone in this program. If you have any questions, you can, of course, email my assistant. Email address is easy. Support. at integrativepainscienceinstitute.com. That’s support at integrativepainscienceinstitute.com. I know that I speak on behalf of Jeremy when I say that we’re really excited to be leading this work and to be talking with you today and sharing everything. We’re excited for the work that you’re all doing. and to see how you grow and flourish once you complete the certification. If you have any questions, just reach out. All of you know where to find me. It’s been a pleasure. Have a great weekend and we’ll see you soon. Take care.