Help Therapy offers reference guides to partner therapists to assist them with psychological evaluations pertaining to bariatric surgery and spinal cord stimulator implants. However, therapists should always refer to the current standards and requirements of the pertinent State Board of Psychology before assessing patients.
The principal goals of psychological pre-surgical evaluation are to:
Determine a patient’s readiness for surgery
Identify any psychological factors, obstacles or contraindications for surgery
Screen candidates who may benefit from psychological treatment before surgery and to maximize the long term success of the surgery
Identify patients who may need further psychological support after surgery
Propose an alternative treatment when patients do not meet the criteria for bariatric surgery
The most widely accepted psychiatric contraindications to bariatric surgery include:
Active substance abuse
Psychosis
Mood disorders
Major life stressors
A history of problematic adherence to prior treatment plans and disagreement about binge eating disorder
When psychosocial issues are identified, moving forward with the surgery may or may not be advisable. A therapy and treatment plan can be developed to address the patient's particular mental health challenges. This treatment may improve the outcome of the surgery.
Types of tests for bariatric surgery readiness generally fall under one (or more) of the following categories:
Personality
Eating disorders
Mood disorders
Substance abuse
Cognitive Development
Physical Conditions
Quality of Life
Outcome measures
There are a multitude of test batteries under these categories to choose from, such as:
Alcohol Use Disorder Test-Core (AUDIT-C)
Drug Abuse Screening Test (DAST)
Millon Behavioral Medicine Diagnostic (MBMD)
Multidimensional Health Locus of Control (MHLC) Scales
Questionnaire on Weight and Eating Patterns-Revised (QEWP-R)
Beck Depression Inventory (BDI)
Eating Expectancy Questionnaire
Shipley Institute of Living Scale
Spielberger State-Trait Anger Expression Inventory (STAXI)
Spielberger State-Trait Anxiety Inventory (STAI)
Weight and Lifestyle Inventory (WALI)
Million Behavioral Medicine Diagnostic (MBMD)
Battery for Health Improvement 2 (BHI 2)
Minnesota Multiphasic Personality Inventory-2- Restructured Form (MMPI-2-RF)
Eating Inventory (EI)
Quality of Life Inventory (QOLI)
Personality Assessment Inventory (PAI)
Eating Disorder Inventory-2
The Treatment Self-Regulation Questionnaire (TSQR)
Perceived Competence Scale (PCS)
Health Care Climate Questionnaire (HCCQ)
General Causality Orientations Scale (GCOS)
Attitudes towards Behavior
Perceived Behavior Control (PBC)
Brief Pain Inventory (BPI)
Symptom Checklist-90-Revised (SCL-90-R)
Beck Anxiety Inventory (BAI)
As you can see, the options can become overwhelming. It’s important to include the necessary tests while keeping in mind the stress they may cause the patient and the length of time each of these tests take to complete.
Some evaluations may take 5 minutes, such as the Beck Anxiety Inventory (BAI), while others may take close to 2 hours, such as the Minnesota Multiphasic Personality Inventory-2- Restructured Form (MMPI-2-RF).
Before selecting your test battery, consider these questions:
1. Is the measure appropriate for this patient?
2. Does the test (or combination of tests) address the relevant issues, such as:
General psychopathology
Enduring personality traits or characterological problems
Emotional symptoms
Behavioral predispositions such as:
Detrimental eating attitudes and behaviors
Substance abuse
Suicidal thoughts
Impulsivity
Maladaptive coping style
Difficulty with attention
Motivation for procedure
The likelihood of complying with treatment and adherence to self-management guidelines
When the patient completes the selected test batteries and they are scored and all other assessments are finished, the psychological evaluation is then written.
This assessment generally includes the following sections:
Tests Administered
Brief History and Reason for Referral
Medical and Pain Interview
Behavioral Observation
Test Results
Recommendations
Psychological evaluation of patients before bariatric surgery is a critical step. This process can not only identify risk factors for surgery but also better understand the patient's motivation, readiness, behavioral challenges and emotional factors that may be detrimental to their ability to cope with and adjust to post-surgery lifestyle changes properly.
The psychologist's challenge is to collect data while simultaneously educating and motivating the patient in their pursuit of improved health and quality of life. For some patients, the initial evaluation is all they need to move forward. However, it’s just the beginning for many, as they will need additional psychological support to maintain the lifestyle changes essential for long-term post-operative success.
If you’re a Help Therapy provider partner, you can request a copy of the Psychological Evaluations Bariatric Surgery Manual and Reference Guide by emailing us at info@helptherapy.com.