2020 Ep 9. Cognitive Behavior Therapy & Hearing Health

Dale Johnson: It’s the Conversation Starts Here on KFOR FM 103.3 1240 AM with Dr. Sandra Miller from Complete Hearing. Go to Complete-Hearing.com for a lot of information way beyond what we have time to talk about here on the show every Saturday morning on KFOR.

Dale Johnson: Dr. Miller, thank you-

Dr. Sandra Miller Au.D.: Good morning.

Dale Johnson: … very much for coming in. Interesting subject today, a link between mental health and hearing, and we have an expert in addition to yourself as well.

Dr. Sandra Miller Au.D.: We do have an expert. I’m so grateful to have Doctor Zlomke with us today. He is a clinical psychologist here in Lincoln, Nebraska, and I’m just going to introduce him and let him tell you a little bit about himself. We’ve had exposure to having him in our office and talking with our staff and was so appreciative of his expertise, and I thought we could share that with you today.

Dale Johnson: Dr. Z, thank you very much for being on our show.

Dr. Lee C. Zlomke, PH.D.: You’re welcome Dale.

Dr. Sandra Miller Au.D.: Tell us a little about who you are and what you do and what your background is and what your focus is?

Dr. Lee C. Zlomke, PH.D.: Okay. I’d be glad to. I’m the clinical director for Nebraska Mental Health Centers, which is a large mental health practice that has offices in Lincoln, Beatrice and Fremont, and we have five doctoral level psychologists. We have three doctoral level psychological interns that come in from all over the country, and we have five mental health providers that give services across those three clinics.

Dr. Lee C. Zlomke, PH.D.: One of the things we’re most excited about recently is we have for the next year been nationally approved by the American Psychological Association as a internship provider site. We have been providing internship training for doctoral level psychologists for around 13 years, but had not been seeking American Psychological Association accreditation until recently. Finally after a two year period of working on that, we finally achieved that.

Dr. Sandra Miller Au.D.: That is so wonderful that you are taking on new future doctors and giving them that training. That is so wonderful. We collaborate with that too in terms of having students from the university at our office doing practical offsite with us as well, so it’s nice to be able to bring those new graduates into the fold. It’s wonderful.

Dr. Sandra Miller Au.D.: Can you address a little bit about the difference between doctoral level versus a mental health provider? Can you give you our listeners just an idea of what that means?

Dr. Lee C. Zlomke, PH.D.: A mental health practitioner has a master’s degree in mental health practice and has done an internship and has practice under supervision for a few years, and that can often see patients independently with some doctoral level oversights from time to time as needed. A doctoral level person has a master’s degree and then four more years of graduate school and an internship and a post-doctoral year, and then practices under another supervision for a short period of time and then can practice completely independently.

Dr. Lee C. Zlomke, PH.D.: In Nebraska, they talk about supervising practitioners of the healing arts, and those would be physicians and other medical practitioners that can practice completely independently, and psychologists are in that considered group as well.

Dr. Sandra Miller Au.D.: That’s very interesting because I don’t think our listeners probably know that there’s so many differentiations, and I think that’s important when we talk about… We’ve talked about before, that there are certain insurances that will cover services, and other insurances may not because of the level of education based on what you have. When we have patients who have maybe some depression isolation, we talked about that they may be currently on some medications, but also can you tell me what cognitive behavior therapy is?

Dr. Lee C. Zlomke, PH.D.: Well, it’s one of many kinds of therapy that addresses a person’s problems and challenges in slightly different ways that may meet weaknesses and strengths of the individual patient, and cognitive behavioral is where we want to work with the person’s emotions and thinking process as well as behavioral processes, which will change that thinking and feeling into actually behaving and living differently.

Dr. Sandra Miller Au.D.: That’s interesting.

Dr. Sandra Miller Au.D.: When you came to visit with us, you talked about that cognitive behavior therapy is one of the more common type of treatment that you maybe work with a geriatric population. Is that true?

Dr. Lee C. Zlomke, PH.D.: That’s very true. Cognitive behavioral is important in that we can change thinking and feelings, but if you can’t make a change into behavior where people see that that’s the difference and people start to feel their life improving, then what have you really achieved-

Dr. Sandra Miller Au.D.: Exactly.

Dr. Lee C. Zlomke, PH.D.: … if you don’t see it and you realize?

Dr. Sandra Miller Au.D.: Can you give us some examples of what that would look like? Because I’m really curious as to… As the population that we deal with most at Complete Hearing being this age 60 to 90, I’m wondering what that looks like. Made me think of this. What does that mean? How do you change that process? If you can give us an example of what that means.

Dr. Lee C. Zlomke, PH.D.: Sure. We’ll try to look at it in a hearing example. If you don’t hear well, if the background noise makes it almost impossible for you to carry on a conversation in restaurants and large group activities, you may start to withdraw from those and just say, “I don’t like to go to those. I don’t choose to go to those anymore.” And it might not be that you don’t like the activity or don’t appreciate the stimulation and the camaraderie, but you just can’t hear it, and so you just don’t go. Well you may understand then once you go to Complete Hearing, that now if I have my hearing aids in, then I can hear better, but I’m not used to that and for a long time I haven’t been going, so while I understand that I should wear my hearing aids and I should go, I just don’t do it.

Dr. Lee C. Zlomke, PH.D.: So cognitively, you know, behaviorally, you haven’t changed. And so sometimes you need the behavioral treatments to help make that change to experience it, to develop it, to learn how to change the hearing aid so that it maximizes your pleasure from that. As you can see, knowing it and doing it are two different things.

Dr. Sandra Miller Au.D.: Oh my goodness, that’s such a great example. I think about that so much when we talk about our patients have a little bit of fear. “I didn’t come to see you because I didn’t think this was going to work, and well, I’m 85 years old and I can just get by.” And we just talk about them not being socially engaged and how important that is for brain function and brain health, and I think it’s so interesting because we also talk to them about, we don’t want it to be overwhelming. So we give them the expectation of when you go back home and you enter that dining room situation where it could be with five tables and 25 people, or you’re in a dining room with five people at your table and a hundred people in that dining room, what does that look like for you and where should you sit and what should your expectation be and how should I have my hearing aid set?

Dr. Sandra Miller Au.D.: We talk a lot about those things because it’s easing them back into those environments that they weren’t going to because… Or they were transitioning out of or they were not enjoying, and there’s fear behind that a little bit. They’re not sure what to expect when they put devices on and they can hear again. I always tell my patients I wished hearing aids were like glasses, because you put your glasses on and instantaneously for most people, vision comes back to normal and you are on your way. The brain needs to be retrained for sound and it can be very still overwhelming when they walk back into that environment.

Dr. Sandra Miller Au.D.: We talk a lot about that with our patients with dementia, in terms of it can be overstimulation, and so we want to make sure we ease them into that process as well. That this isn’t something where they can just walk out the door and everything’s going to be wonderful. That we talk about the true expectations of what this means when we give them that sense of hearing back. It takes some people five minutes and it takes some people five months. If they have the right expectation and we ease them into the process correctly, that their success is so much higher.

Dale Johnson: You’ve set them up with a greater chance of success by having conversations before the device is even applied about, “Here’s what you can expect,”

Dr. Sandra Miller Au.D.: Exactly.

Dale Johnson: … with this individual, because you’re right, some people can just apply the device and their hearing is instantaneously improved and they’ve accepted them, while others have this expectation of a miracle almost, and then they’re disappointed, and the result is they don’t wear them.

Dr. Sandra Miller Au.D.: Yeah. Dr. Z, do you see that in terms of therapy too, that they may be coming in with an expectation? Do you have to set that up in any way? Do people know what to expect when they’re going through any type of therapy? Did you lay that out?

Dr. Lee C. Zlomke, PH.D.: I would say most patients don’t really understand how the process will work. We see patients all the way from two years old to 102 years old, and every kind of disability in between. Especially with children or adolescents, may come in and say, “Well, just fix me.” And the parents will say, “Just fix them. Make them better.” One of things I’ll try to say is, “I can’t get in their head and dig around with a stick, it’s just not the how that works. It’s got to be friendship. It’s got to be a work in progress together.”

Dr. Lee C. Zlomke, PH.D.: There’s things that the parents know that I’ll never know. There’s a relationship between parent and child that we’ll never be completely in tune with, but we have ideas that the whole family system can understand and may try new ways of thinking and doing. And that’s a team effort that how things will improve and get better.

Dale Johnson: You brought up before Dr. Miller, that you always welcome a member of the family or someone who knows this individual very well, to accompany them in for an appointment.

Dr. Sandra Miller Au.D.: Yes. I think there’s a huge trust factor obviously, that goes into this, and I often tell my patients, “I’m not here to sell you a widget, I’m here to provide you better quality of care and better quality of life. I can put a hearing aid on you, and that’s just the very beginning. And developing a trust factor that I want what’s best for you and if I have a solution to help you in your quality of life, I want to provide that to you.”

Dr. Sandra Miller Au.D.: So I love the side of it where Dr. Z says, “You have to develop a relationship with this patient and get to know them because it’s not a one and done.” And that’s definitely in our practice as well, is that we want a longterm relationship with our patients so that we have their best interests at heart. I think we very much match professions in that way, that it’s caring what the heart is what we definitely do.

Dale Johnson: Dr. Z, I do a lot of interviewing, and in reading some of those supplemental information today I see motivational interviewing. Could you explain what motivational interviewing is?

Dr. Lee C. Zlomke, PH.D.: It’s another technique in mental health practice, but similar in some ways to cognitive behavioral therapy, but it looks at providing more support to improve people’s buy in. Improves their understanding that they need help. Improves their understanding to engage in the process. It works at helping them understand why is it that you’ve gotten here and what’s holding you back from moving forward? So it really focuses on the person’s desire and buy in to make changes. Sometimes you really need to do that early on, start the engagement of the patient in their own care, and then you can move forward with more change oriented treatment.

Dr. Sandra Miller Au.D.: I would tell you that we very much use that same technique when we are going through a health history and case history with our patients. We have something called a communication questionnaire, where we try to dig into the fact of where are people struggling and how does that impact them? Because sometimes people are at different stages of accepting that they have hearing loss and wanting to do something about it. When we go through motivational interviewing in our practice, we just very much talk about, “You’re struggling hearing at a restaurant, tell me about that? How does that make you feel? Let’s talk to the loved one and see what happens in that situation.” Sometimes people aren’t aware how it has the impact not only on themselves but those around them. And it has a very big impact when we come to a fact, “Oh, I didn’t know you were feeling that way when we’re in that environment.”

Dr. Sandra Miller Au.D.: It helps them understand that this may have a bigger impact on them then they really realize.

Dale Johnson: Dr. Z, for more information to how can listeners reach out to you?

Dr. Lee C. Zlomke, PH.D.: We can be reached at our Lincoln office, which does the scheduling for all three satellite clinics, and that would be at a (402) 483-6990, or nmhc-clinic.com

Dr. Sandra Miller Au.D.: We’re going to provide a link, so if you want to reach out in regards to getting more information. Of course our podcast is always on our website, and we will also be providing a link to Dr. Zlomke’s clinic as well.

Dale Johnson: Dr. Z, there is so much more information than there is time. Would you be able to stay with us for another show?

Dr. Lee C. Zlomke, PH.D.: Yes, I could.

Dale Johnson: Excellent. Dr. Miller, let’s continue this next week-

Dr. Sandra Miller Au.D.: Sounds great.

Dale Johnson: … shall we? Dr. Z, thank you very much, we appreciate your time.

Dr. Lee C. Zlomke, PH.D.: Thanks very much for having me.

Dr. Sandra Miller Au.D.: Thanks Dr. Z. Safe travels back home.

Dr. Lee C. Zlomke, PH.D.: Thank you.

Dale Johnson: Much more information Complete-Hearing.com, and listen every Saturday morning for The Conversation Starts Here.