PAST MEMBER SPOTLIGHTS

OCTOBER 2025: JJ ANDERSON-GUTIÉRREZ, AAPP MEMBER

What inspired you to pursue psychology as a career path?

I’ve always been fascinated by the mind–body connection and the ways people make meaning of their lives. Psychology felt like the perfect balance of science and compassion, allowing me to support people in moments of struggle and thriving.

How did you first become interested in pain psychology, and what experiences have shaped your training in this area so far?

It was during my pre-doctoral practicum rotation at St. Jude’s chronic pain program under the supervision of Dr. Allison Bicksler when the pain psychology journey began. I collaborated with a multidisciplinary team, providing therapy, group interventions, and pre-surgical evaluations.

These experiences not only ignited my interest in pain medicine but have solidified my passion for pain psychology.

What training experiences or projects have been most meaningful in your development as a developing pain psychology professional?

My work at St. Jude’s was especially impactful, along with assisting on projects for AAPP and now training in a pain clinic at the VA. I hope to conduct more experimental pain research as this will propel my development as a pain psychology professional even more!

What do you see as your biggest contributions or learning moments in pain psychology to this point?

I’ve contributed to expanding AAPP’s digital presence and by bringing neurodivergent-affirming, creative approaches into my clinical work in pain management. Although currently in its infancy, I’m excited to see how my clinical research contributes to the field of pain medicine.

In your view, what makes pain psychology unique and important within health care?

Pain psychology recognizes that pain is never just physical—it’s emotional, social, and existential. Psychologists bring tools to empower patients and help medical teams understand the broader biopsychosocial context of pain.

What advice would you give to other trainees or early-career professionals interested in pain psychology?

Stay curious and embrace the interdisciplinary nature of this work. Seek mentorship, get involved with organizations like AAPP, and don’t be afraid to bring creativity into your practice.

Looking ahead, how do you hope to grow within pain psychology, and how do you envision the field evolving in the future?

I hope to keep developing as a clinician and researcher, with a focus on accessible, affirming care for underserved and neurodivergent populations. I see the field expanding into general medical and community health settings and thoughtfully integrating digital tools into treatment.

JJ Anderson-Gutiérrez is currently a doctoral intern at the VA Puget Sound, Seattle-Tacoma, in Washington rotating in Primary Care Mental Health and the Pain Clinic. While completing his clinical training, he is also carrying out a research project focused on exploring the unique pain profile and experience of neurodivergent folk. He plans to educate pain medicine providers on more affirming, inclusive and effective approaches to managing chronic pain in the neurodivergent population. JJ hopes to continue specializing in pain psychology during his post-doctoral training following graduation in 2026.

July 2025: Christopher Gilbert, PhD, AAPP Member

What led you to become a psychologist?

My anthropology background made me curious about the mind-body connections that I saw everywhere. “Psychophysiology” contains both psyche and physiology, and I was drawn to the interaction between the two.

What got you interested in pain psychology and what was your experience with health and pain psychology?

I was fascinated by how pain triggers the brain’s search for physical threat but neglects the importance of attention and emotion. Also, Melzack & Wall’s gate control theory was very thought-provoking.

What were your most significant positions in pain psychology?

Central Bergen CMHC in Paramus, NJ, Kaiser Permanente’s Pain Management Program in San Francisco, and Osher Center for Integrative Medicine at UCSF.

What do you feel are your biggest contributions to the field of pain psychology so far?

I taught pain patients individually and in groups to detach from reflexive anxiety and depression, and then develop constructive coping strategies for pain management. Biofeedback and hypnosis were helpful tools.

What makes pain psychology unique in your opinion?

It teaches coping methods that go well beyond swallowing pills, and instead emphasizes active self-regulation.

What advice would you give to people interested in, or starting, pain psychology?

Experiment with pain management using any chronic pain you might have, or attach a bulldog clamp or clothespin on your fingertip and practice with that.

How do you see pain psychology developing in the future?

More appreciation of hypnosis, guided imagery, mindfulness, and biofeedback as adjunctive self-care techniques.

March 2025: Bayla Travis, PSYD, AAPP Member

What led you to become a psychologist?

I can’t remember a time when I wasn’t curious about why people did what they did and what made people different from each other. I was a question asker and a data gatherer. I read widely and found my way into the local university library before I graduated from high school. I was inspired to become a psychologist because I found Peter Levine’s trauma work on the mind-body connection so fascinating. But for many years I had no interest in working with people struggling to manage pain.

What got you interested in pain psychology and what was your experience with health and pain psychology?

My interest in pain psychology was the biggest surprise of my entire training trajectory! I reached out to the professor in my graduate program who taught the CBT class and asked to be his teaching assistant because I wanted to get more CBT skills under my belt before graduation. I wanted to be ready to work in hospital settings to broaden my employment options. It just so happened that this professor specialized in pain psychology. When I didn’t get the hospital internship training opportunity I wanted, he invited me to train with him at a spine surgery clinic. I learned to do pre-surgical evaluations and pre- and post-surgery pain management therapy. I was amazed how powerful CBT techniques were for pain management.

What were your most significant positions in pain psychology?

I have worked in three clinics where I primarily treated patients who had employment related injuries. I will always be inspired by these individuals for their willingness to engage in healing work while trying to navigate a system that makes the process very challenging. I also learned a tremendous amount about integrative treatment during my residency at the Highland Hospital’s pain clinic and the acute rehabilitation department at Fairmont Hospital. Collaborating with medical specialists and physical and occupational therapists was the pinnacle of mind—body medicine.

Now, in my private practice, I specialize in helping anxious people manage gut related pain. My history as a kid whose mom had Crohn’s Disease serves me quite well in understanding the reality of managing a chronic illness. I have served on the Crohn’s & Colitis Foundation’s Healthcare Professional Engagement Committee for over a decade. My work with the organization involves providing pain management education to patients, their families and gastroenterologists.

What do you feel are your biggest contributions to the field of pain psychology so far?

I think my biggest contribution to pain psychology is my interest in offering pain management that respects the reality of life’s ongoing myriad of hurdles. I was recently interviewed by a New York Times Magazine journalist about chronic pain and identity. I explained that patients with chronic pain often feel shame that they are not able to completely eliminate their pain. We live in a very driven culture that often doesn’t respect the limitations of the body and the need for acceptance and self-compassion. If you want to check out the article you can find it here: https://www.nytimes.com/2025/01/12/magazine/chronic-pain.html

What makes pain psychology unique in your opinion?

I’ve always appreciated the way that pain psychology provides direct evidence that the mind and body are connected. It’s not a hard sell to patients with pain that stressful thoughts and situations increase their pain. Once they recognize that thoughts and behaviors can turn up the pain signal, they are open to the possibility that pain signals can be turned down by the mind and altering behavior even if they can’t do it immediately.

What advice would you give to people interested in, or starting, pain psychology?

I would recommend training as early as possible in clinics where you can gain experience implementing an array of pain treatment modalities such as CBT, neurofeedback, psychometric assessment and hypnotherapy. Clinics that serve patients with workers compensation claims or hospitals will provide exposure to patients with a wide variety of clinical presentations and patients with diverse demographics. Having this breadth of experiences will be helpful in developing a niche specialization or confirm your interest in being a generalist. I also recommend interviewing pain psychologists who work in ways and locations that are appealing and getting a sense of the day-to-day experience. Each setting and population have their pros and cons, some of which may not be obvious. I always enjoy helping students contemplating their next training placement or early career psychologists sort out the options. Please feel free to reach out to me at drbaylatravis@gmail.com if I can be of assistance.

How do you see pain psychology developing in the future?

I’m really excite about providing ketamine-assisted psychotherapy for individuals with chronic pain, trauma and anxiety. This year I attended the Psychedelics & Pain Symposium. This gathering of researchers and clinicians was the perfect complement to the training I received while earning a Certificate in Psychedelic-Assisted Therapies & Research from the California Institute of Integral Studies. I would love to connect with pain psychology professionals in the Bay Area interested in using ketamine assisted psychotherapy to treat chronic pain. Please reach out to me at drbaylatravis@gmail.com if you would like to discuss.

January 2025: Deb Nelson, Psy.D., AAPP Member

What led you to become a psychologist?

Like many other therapists, I took a Psych 101 course and got hooked. I loved learning how the brain worked, what our emotions were about, and how humans connected — or not. I was so into it (dating myself here) that I hosted “rap sessions” in my college apartment as part of the psychology undergraduate program.

During my junior year, I was told by a professor that I wouldn’t make any money with a psych undergraduate degree — I would need a graduate degree to earn a living. Since I was tired of being broke and didn’t have the resources for graduate school, I switched to business and worked in marketing for 20 years.

After my run as a marketing executive, I decided to find a career that was more personally fulfilling. Returning to Psychology kept coming up, so I started graduate school, with two young kids at home. I’m forever thankful I was able to make this pivot.

What got you interested in pain psychology and what was your experience with health and pain psychology?

I attribute my interest in health psychology to my upbringing. My mother was raised as a quasi-Christian Scientist, and my father had a very indulgent mother who would let him skip school if he had the slightest discomfort. It was interesting to observe how their very disparate health beliefs shaped their lives. While their overall health states were similar, their beliefs about their health were opposed. Consequently, the challenges and disabilities they experienced were very different. Suffice it to say I learned that extreme beliefs are not helpful, and I came to appreciate the importance of working with an individual’s health and pain beliefs.

My interest in pain psychology specifically came from two key experiences:

Along my professional journey, I worked as a massage therapist and saw that occasionally, clients would cry during our work. I would always ask if they wanted me to stop, and they always wanted me to continue. The connection between the physical experience of the body and deep emotional content was clear, and it made me wonder if the somatic experiences were an expression of emotional content.

The second experience occurred in graduate school, where I worked with elders in an adult day health center. I was struck by their various beliefs in taking pain medications — some were crippled by pain and refused medications – the pain was just a part of life. Others, with minor injuries, believed they couldn’t survive without medication. Pain was a sign of something very wrong. I wanted to understand what influenced these perspectives and their decision processes – clearly, it was complex. Exploring this process became the basis of my dissertation – Older Adults’ Perceptions of Pain Medications.

What were your most significant positions in pain psychology?

Upon graduation, I went straight into private practice. I’ve not held any clinical positions.

What has been your most rewarding experience working in pain psychology?

Fortunately, I have had many rewarding individual experiences. Comments and letters from patients saying things like “I have hope again,” “I feel like I am armed with some great tools,” and “I’m back on the golf course” are so fulfilling to me.

Perhaps, though, even more rewarding than hearing patients share stories about recovery and re-engagement in life is the very real sense of mastery and accomplishment patients gain. Recovery from chronic pain is tough, and seeing the confidence gained and the courage to move forward is inspiring to me.

What do you feel are your biggest contributions to the field of pain psychology so far?

As a clinician, I believe my biggest contribution is the work I do with individuals. Helping someone improve the quality of their life, in a way that is meaningful to them, is the most important work I can do.

Beyond my individual work, I am fortunate to be able to promote the fact that recovery is possible through trainings and podcast interviews.

What makes pain psychology unique in your opinion?

Probably the most challenging aspect of working in the field of pain psychology is that the experience of pain is intricately linked to that person’s depression and anxiety. It is difficult to address the depression/anxiety without addressing the pain. And, it is difficult to address the pain without addressing the depression/anxiety. To exacerbate the problem, chronic pain changes the patient’s brain and nervous system, often disrupting normal brain communication and reward channels. Breaking this cycle is challenging.

Secondly, there are often more levels of complexity such as: the pain is related to a trauma event; or the patient has experienced pain for so long it has become part of their identity; or the pain is related to a life-threatening illness.

What advice would you give to people interested in, or starting, pain psychology?

First off, yes, please do consider a career in pain psychology —  we definitely need more skilled therapists!

As with all therapy training, we must check our belief systems. For therapists working in pain psychology, it’s important to check your own pain/healthbeliefs, as these beliefs can create unconscious biases, leading us to make inaccurate assumptions. A simple example is the belief that humans always express pain in a very particular manner (that belief is often rooted in how it was expressed in our family of origin).  The fact is that pain expression is highly individualized and can vary from day to day.

More specific training recommendations include understanding the fundamental physiology behind pain. This basic information is relatively easy to acquire through CEs, workshops, podcasts, online videos, and books.  Additionally, specific psychological therapy tools such as Acceptance and Commitment Therapy, Pain Reprocessing Therapy, Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and Mindfulness are cornerstones of the work. The greatest patient success arises when the patient understands physiologically what is happening in their bodies, and they have a handful of psychological tools to cope.

And last, but certainly not least, I highly recommend joining a professional organization – such as the American Association of Pain Psychology. Professional organizations such as AAPP are great resources for gathering additional education, training, and consultation to help advance professional development.

How do you see pain psychology developing in the future?

I am pleased to see the frame of using a biopsychosocial approach to treatment planning becoming more predominant and I will use this frame to answer the question.

The biological piece is a greater understanding of pain networks, how they communicate and how the brain detects and processes pain. This increased knowledge will help advance more targeted and thus improved surgeries as well as the development of better medications – including a more skillful use of psychedelics.

In the psychological realm, I am very excited about where the principle ideas of Pain Reprocessing Therapy can lead us. I believe we are just beginning to understand how to apply neuroplasticity in the management of chronic pain and the possibilities for implementing are still to be defined.

Social – since the pandemic we have learned (or been painfully reminded) of the importance of social connections. I am happy to see more research being conducted on the importance of social connections. Since we know there is a direct correlation between pain and social isolation, I do believe a greater collective appreciation of social connection will yield direct benefits to pain patients through more purposeful development of support systems and communities.

Outside of the biopsychosocial model, I think technology will play a greater role in chronic pain management. I am hopeful for improvements in devices and implants. We are also seeing greater use of phone apps that allow for tracking all sorts of variables that impact pain, and virtual reality has already shown some success and is implemented in rehab facilities. And then there is AI, which has the potential to help pain management professionals gather the most recent scientific and clinical information and create individualized treatment plans.

September 2024: Melissa Canter, PsyD, Co-Secretary AAPP

What led you to become a psychologist?

I decided in high school when another student stepped out of a classroom and bumped into me, and I asked her what class just ended. She said, psychology. I then asked her to explain further, Her response was so simple ,”it’s the study of understanding how the brain works.”  That was it for me.

What got you interested in pain psychology and what was your experience with health and pain psychology?

I did my pre and postdoctoral training in neuropsychology, including completing a two-year fellowship at UC Davis Medical Center in the Department of Physical Medicine and Rehabilitation.  I worked within an interdisciplinary team, alongside physiatrists. I enjoyed the team approach to patient care. As I started working in the field of neuropsychology, the work was a ‘glass half empty’ approach to psychology. While I included the patient’s cognitive strengths in reports, the general focus was finding cognitive deficits. Meanwhile, a colleague of mine reached out and asked if I wanted to work part-time in a pain clinic. The two days in the pain clinic were my favorite days of the week.  I had so much fun teaching patients to rewire their central nervous systems and discover the innate ability to heal and repair. I enjoyed working in a team environment.

What were your most significant positions in pain psychology?

As the Director of Psychology Services at the Spine Clinic of Monterey Bay. I developed and implemented the clinic’s functional restoration program and oversaw the program’s multidisciplinary team. I provided individual and group psychotherapy, specializing in chronic pain management, and administered psychological and neuropsychological assessments. I also completed pre-surgery assessments and developed and taught the clinic’s spine surgery education class

As Director of the Pain Management Clinic at San Mateo Medical Center (SMMC)–my current position. I assess the needs of patients and manage the pain clinic, oversee the program’s interdisciplinary team and the clinic’s functional restoration program. I also develop and implement the clinic’s medication-assisted treatment track for patients with substance use disorder, the development of training and represent pain services on SMMC health service committees.

What has been your most rewarding experience working in pain psychology?

I adore being a part of a team environment in support of our patients. It is extremely rewarding to see my colleagues work so hard in the service of others. I have almost weekly moments where a patient makes the slightest shift towards health and vitality. It is very rewarding to see patients graduate from a chronic pain program.

I enjoy being inspired by other colleagues in the field of pain psychology. I’ve been fortunate to be on the board of AAPP and I’m extremely inspired by colleagues.

What do you feel are your biggest contributions to the field of pain psychology thus far?

Being an educator in pain science and applies to chronic pain patients, the public, students, medical professionals, etc. Most people do not receive training in understanding chronic pain, including medical students. I think it’s vital that this field continues to progress so that the bio-psycho-social model of care is applied to all chronic pain patients moving forward.

What advice would you give to people interested in, or  starting, pain psychology?

Join a professional organization, such as AAPP, and continue to read and take courses in understanding chronic pain. Additionally, reach out to peers and colleagues in the field for support, be curious and continue to learn.

How do you anticipate the future development of pain psychology?

I hope every medical professional is educated in understanding the science and latest developments in chronic pain. Pain psychology principles should be offered to patients as mainstay treatments and students in doctorate. I would like to see preventative measures offering pain psychology and mindful movement treatments early during the onset of chronic pain.

June 2024:  Vika Gallich, PhD

What led you to become a psychologist?

I’ve always felt a pull between two contrasting forces: structure and intuition, rigidity and fluidity, business and psychology. My career journey began as a project accountant. With an AA degree in accounting as my foundation, I pursued an undergraduate degree in Integral Studies with a minor in psychology, deepening my interest in this field. While working as a project accountant, I earned my Master’s in Integral Psychology at the California Institute for Human Science (CIHS), where I gained insights into the holistic mind-body connection.

What is your educational background?

Following the completion of my master’s degree, which blended Eastern and Western therapies with modern therapeutic practices, I decided to transition careers. I then pursued my PhD in Clinical Psychology, with a specialization in Health Psychology, at CIHS.

What got you interested in pain psychology and what was your experience with, or training in, health and pain psychology?

To this day, my journey in pain and health psychology is deeply intertwined with my encounter with health challenges: uncertainty, chronic pain, stress, isolation, and despair. I’ve felt a spectrum of emotions after being diagnosed with Rheumatoid Arthritis (RA) while completing my master’s degree. Despite the psychological toll of living with this condition, I was surprised to never receive a referral to see a psychologist. This experience motivated me to pursue a doctorate in health psychology, with a focus on helping clients with pain and other health-related conditions. As part of my personal healing and professional development, I sought the guidance of both a pain psychologist and a health psychologist during my degree program.

My psychology practicum began with working with clients with substance use disorder and trauma, allowing me to start training in EMDR through EMDRIA. I furthered my training with Mark Grant, M.A., focusing on using EMDR to treat chronic pain and integrating hypnosis with EMDR for trauma and medically unexplained pain. I later completed advanced EMDR training and obtained consultation certification through EMDRIA. I completed a practicum at Alvarado Parkway Institute (API), Behavioral Health System, where I provided inpatient and outpatient therapy and conducted psychological testing for diagnosis and personality clarification to adults experiencing acute symptomology. During one of my rotations at API, I facilitated psychoeducation and process groups focusing on health and wellness, mindfulness-based stress reduction, self-care, and pain management. I then gained further experience working as a Clinical Support Counselor at Montecatini Eating Disorder Treatment Center (Acadia Healthcare). There, I facilitated weekly psychotherapy, process, and psychoeducation groups for patients dealing with bulimia, anorexia, binge eating disorder, and co-occurring disorders at both inpatient and outpatient centers for adolescents and adults.

I completed my predoctoral training at Mindhealth, Inc. (CAPIC), a chronic pain and trauma clinic. My focus was on treating workers’ compensation patients, chronic pain patients, elderly individuals, and first responders. I provided treatment for trauma, substance use disorders, brain injuries, chronic pain syndrome, migraines, autoimmune disease, and general mental health. Additionally, I performed psychological evaluations, pre-surgical assessments, chronic pain syndrome evaluations, neuropsychological screening consultations, and forensic assessments for adults. Under Dr. Parke’s supervision, I received further training in hypnosis and had opportunities to offer a range of interventions such as pain neuroscience education, cognitive behavioral therapy for pain, mindfulness, acceptance and commitment therapy, and biofeedback. Additionally, I also implement both hypnosis and EMDR in the treatment of chronic pain syndrome, allowing me to deepen my skills as a pain psychologist.

I am currently completing my post-doctoral training at Bellator Psychological and Consultants in San Diego under the supervision of Dr. Alan Acre, who specializes in PTSD, substance use, and general mental health, and Dr. George Dabdoub, who specializes in PTSD, chronic pain, and has served as a Regional Director for a pain management practice. At Bellator, I conduct fitness-for-duty psychological evaluations and provide individual and group therapy to both military personnel and the general population dealing with trauma-related issues, including PTSD, depression, anxiety, brain injuries, and chronic pain. Navigating my daily chronic pain has equipped me with wisdom and empathy, guiding my approach to helping others facing similar challenges. Recognizing the body-mind connection, I operate from the understanding that integrating nutritional interventions can help improve certain chronic pain and mental health conditions. To further my expertise, I have obtained certification in Nutrition and Mental Health through Harvard Medical School’s MGH Psychiatry Academy.

I regularly participate in ongoing training focused on chronic pain, trauma, occupational behavioral therapy, and eating disorders through various organizations, including the American Association of Pain Psychology (AAPP), Stanford Division of Pain Medicine, WorkComp Central, Western Occupational Environmental Medical Association, and the University of San Diego. I’m grateful for opportunities offered by AAPP for training in pain psychology and peer-to-peer consultation, where I can consult on cases and gain insights from other professionals in the field.

How did you select your pain-related dissertation project?

It took me eight months to receive a referral to a Rheumatologist, and by the time I saw one, I was diagnosed with severe RA. Unable to work, struggling to walk, and finding it difficult to take care of my basic needs, I felt overwhelmed by pain and despair. With a longstanding interest in nutrition, I desperately sought ways to help myself. Following my intuition, I began researching nutritional interventions for RA and integrated lifestyle changes. I saw how my pain and mental health began to improve with implementing an anti-inflammatory diet that focused on whole plant-based foods. My CRP levels started to decrease, and my overall functioning began to improve. This experience made me realize that healing involved addressing all lifestyle factors. It was this realization that sparked the inspiration for my dissertation.

My research explored the effects of an anti-inflammatory diet on chronic pain and mental health in individuals with RA, using Interpretative Phenomenological Analysis. It was the first study of its kind. The following group experiential themes were identified (a) Anti-inflammatory diet empowers and aids recovery; (b) Lifestyle adaptation for health management; and (c) The power of mental health in recovery. Additionally, seven subthemes were identified and explored (a) Diet as a significant tool in managing RA symptoms; (b) Medication a necessary, but not sole, solution; (c) Restoration of physical function and activity; (d) Diet as a way of regaining control; (e) Social life, dietary change a challenging but empowering lifestyle shift; (f) Meal planning and preparation are key; and (g) Positive mindset crucial for health recovery.

What are your professional goals in pain psychology?

My goals include pursuing ongoing training and positions in pain and health psychology. In the future, I hope to gain experience in oncology and further assist individuals with eating disorders. Ultimately, I aspire to establish my private practice specializing in treating individuals with chronic pain, PTSD, and health conditions.

What kinds of contributions do you hope to make in the field?

As part of my humanitarian efforts in the field of pain and nutritional psychology, I serve as a contributor to The Center of Nutritional Psychology where I curate the Diet and Chronic Pain Nutritional Psychology Research Library. Additionally, I contribute to the Nutritional Psychology course with the latest research findings. Currently, I am in the process of transforming my dissertation into an article, intending to submit it to a Health Psychology journal for publication. I hope to present my dissertation work as a poster at the APA conference next year. Moving forward, my objectives are to continue learning, expanding my knowledge, and conducting presentations on how nutritional interventions can positively impact mental health and pain management. I also have a keen interest in conducting further research and publishing articles related to chronic pain.

Who have been some of your biggest mentors or role models in pain psychology?

Dr. John Parke has been a significant mentor for me in the field of pain psychology. During my pre-doctoral internship at Mindhealth, working under his supervision provided me with a strong understanding of the neuroscience and biopsychosocial aspects of pain. Integrating Eriksonian principles with evidence-based practices, his mentorship laid a solid foundation for my professional growth. He also introduced me to Dr. Howard Schubine’s work on Mind Body Syndrome. I am grateful for the training opportunities with Mark Grant, MA, in implementing EMDR and hypnosis for chronic pain treatment. Mark’s trauma-informed approach, emphasizing the interconnectedness of somatic, neuro-affective, and functional aspects, deepened my understanding of medically unexplained pain and its developmental origins. His method aligns with Porges’ concept of ‘deep physiology,’ shedding light on the role of trauma and brain function in chronic pain maintenance. Additionally, I admire Dr. Stephen Porges’ work and have attended his seminars on the Polyvagal perspective on chronic pain and addictive treatment, as well as the integration of the Safe and Sound Protocol within EMDR.

How do you anticipate the future development of pain psychology? What is needed to accomplish that?

I think the convergence of nutritional psychiatry and gut microbiome research presents a promising frontier in the advancement of pain psychology. By understanding and leveraging the complex interactions between diet, gut health, and psychological well-being, pain psychologists can provide psychoeducation on the importance of diet in managing pain, mental health, and supporting gut health. Recent research underscores the importance of the gut-brain axis in influencing pain perception and mental health, particularly through inflammation modulation. Chronic inflammation is implicated in various pain conditions, and depression is increasingly recognized as an inflammatory disorder. A healthy gut microbiome can regulate the body’s inflammatory response, potentially alleviating pain and enhancing mental well-being. This insight paves the way for nutritional interventions aimed at promoting gut health as a strategy for pain management.

Pain psychologists play a vital role in addressing both the psychological factors contributing to pain maintenance and the brain’s changes. I envision psychologists collaborating with dietitians, functional medical doctors, and patients, translating dietary guidance into manageable steps, and psychologically preparing patients to make lasting changes to their dietary habits, which can be challenging for many. To achieve this, education and training in this area of focus are crucial for both pain psychologists and patients. Clinicians can enhance their practice by gaining insights into the role of the gut microbiome in pain and incorporating principles of Nutritional Psychiatry. As always, there is a continuous need to expand pain psychology training courses at universities and offer mentorship/internship opportunities to clinicians interested in this field.

April  2024:   Consuelo Flores, PsyD

What led you to become a psychologist?

From a very young age, I developed an ease for comforting people who were in pain or suffering. My name literally means to console or provide solace and from the time I was born, that was my role. I was exposed to a significant amount of trauma and pain in my upbringing and observed that the individuals who made the most difference for my loved ones were mental health providers. I believed that psychologists and psychiatrists were heroes and I wanted to be one. I was infinitely curious about the human body, brain, and behavior and wanted to learn as much as I could about healing suffering. I’ve always enjoyed talking with people and hearing their stories and wherever I went, people opened up to me. Other than the brief time in childhood when I wanted to be Shirley Temple and wore my tap shoes to school every day, as long as I can remember, I wanted to be a psychologist or psychiatrist.

What is your educational background?

My educational aspirations for college were beyond what was available for me at the time given that I was an unhoused teenager that barely graduated high school. Luckily, I found my way to my grandparents in Mexico who provided a stable environment and allowed me to pursue my educational dreams. In 1994, I enrolled in a Baccalaureate program at the Instituto de Estudios Tecnologicos y Superiores Matatipac to study Clinical Psychology. In my second year of study, I also enrolled in a second Baccalaureate program in Educational Psychology at the Universidad Autonoma de Nayarit. During these years, my practicum and internships included performing mental health assessments at the Nayarit State penitentiary, providing health education to adolescents through El Desarrollo Integral Familiar (DIF), and providing individual holistic treatment for patients with medical and physical injuries. I had the opportunity to learn alongside students from the school of medicine and anthropology immersing ourselves in the local indigenous medicine and traditions. Additionally, I was blessed with a holistic and alternative medicine mentor who trained me in traditional and alternative therapies. My education in Mexico came to a sudden and unexpected halt when I experienced a serious spinal injury that left me paralyzed for one year and was followed by years-long recovery and an introduction to a life of chronic pain.

The second part of my educational experience continued in California where I rebooted my education after learning that my studies from Mexico would not be validated. I began at a local community college and then transferred to California State University, Hayward (now East Bay) in 2000 to complete a Bachelor of Arts in Psychology. While there, I had the opportunity to work in a cognition research lab studying the effects of glucose on memory with Dr. Ward Rodriguez.

While completing my undergraduate studies, I worked as a physical therapy aide in a rehabilitation center that housed physical therapists, a muscle therapist, and chiropractor. I was immersed in learning about anatomy, physiology, and kinesiology and the therapists I worked with became my unofficial teachers and mentors. As the therapy center was located inside of a health and fitness club, I spent much of my time exercising and rehabilitating from my injury. Eventually, I became a certified exercise instructor (yoga, Pilates, aquatics) and began teaching groups and individuals at the health club and privately. I continued teaching yoga and Pilates for the next 20+ years.

For graduate school, I attended the California School of Professional Psychology at San Francisco to complete my doctorate in Clinical Psychology with a focus in Health Psychology. In my second-year practicum in 2003 at Medical Hill Rehabilitation Center in Oakland, CA, I completed training in an interdisciplinary neurobehavioral unit with inpatient dual diagnosis, geriatric, and palliative care patients in short- and long-term care. I learned how to perform neuropsychological assessments, participate as a psychologist in grand rounds, co-lead groups, and collaborate on a multidisciplinary team.

I went on to gain experience in child, adult, and family therapy with a diverse and underserved population at La Familia Counseling Center as part of my training practicum. After completing my practicum at La Familia, I began a psychological assistantship, performing psychodiagnostic assessments for children and continued to see individuals and couples in psychotherapy through a private practice with Dr. Valerie Dowla from 2004-2007.

In my predoctoral internship in 2006, I had the privilege of training at Santa Clara Valley Medical Center and completed two major rotations in the Psychology Division of Therapy Services in Physical Medicine and Rehabilitation. My exposure to multidisciplinary rehabilitation, pain, and trauma continued in the Traumatic Brain Injury unit, the Spinal Cord Injury unit, and the Burn unit. In addition to conducting initial assessments, creating treatment plans, and collaborating with family members and all disciplines involved, I also co-led groups for neurological disorders and spinal cord injury support groups.

I was introduced to the world of Functional Restoration Programs (FRP) in 2007 during my post-doctoral fellowship at the Bay Area Pain and Wellness Center where I was part of a multidisciplinary team that specialized in the care of individuals with chronic pain. During this time, I had the honor of being mentored by pain psychologist Dr. Kimeron Hardin. Little did I know, this would be my introduction to the beginning of my unexpected specialty of working with injured workers and chronic pain.

What got you interested in pain psychology and what was your experience with health and pain psychology?

I became interested in pain psychology before I knew it was a subspecialty or understood that was what I was practicing. When I experienced my injury, I was already studying psychology as well as holistic healing methods. Facing my pain and being informed that I would not walk again led me to seek every possible resource that I had available at the time to heal and rehabilitate. I believed very deeply in the mind-body connection and I understood that health was a multidimensional and dynamic process that required information, action, and support. You could say that I was my experiment with pain psychology and put myself through my functional restoration program before I knew they existed. I collaborated with multiple healers and therapists without any formal or prescribed treatment since I was not expected to walk again. I learned to manage my pain through cognitive behavioral methods, holistic and spiritual therapies, and restored my own function, and learned to walk again using what I had learned as an athlete and my yoga practice.

Since then, I have continued to adapt to my pain and functional limitations as well as continuously update my understanding of what it means to live with pain. I also have deeply explored the impact of medical trauma and processed the impact of going through the process of diagnosing and treating a life-changing injury. Through my own experience, I have become more passionate about helping others recover from their own painful and life altering circumstances.

What were your most significant positions in pain psychology?

My first significant position in pain psychology was in 2009 at IPM Medical Group where I began as a psychological assistant under the supervision of pain psychologist Dr. Howard Rome who directed the multidisciplinary East Bay Functional Restoration (EBFR) program. Under Dr. Rome’s mentorship, I developed my skills as a pain psychologist. I created and ran the first culturally sensitive Spanish-language functional restoration program (FRP) in the state of California, facilitated pain education and coping skills groups, conducted pain evaluations, and provided individual psychotherapy for catastrophic and traumatic cases. I also began training psychological assistants in pain psychology and multidisciplinary care.

My second most significant position in pain psychology is my current position at the Trauma and Stress Recovery Center where I am the Director of Clinical Operations. In my daily work, I have the opportunity to perform comprehensive psychological evaluations of individuals who have sustained catastrophic and traumatic work injuries and provide treatment plans for their rehabilitation.  Interdisciplinary collaboration is continued throughout the duration of treatment and I provide intensive trauma-based individual psychotherapy. I continue to facilitate pain and trauma groups with a combination of psychoeducation and trauma processing. I have the ongoing opportunity to train psychological associates and newly licensed clinical psychologists in pain psychology and work injury rehabilitation.

What has been your most rewarding experience working in pain psychology?

Looking back, I have enjoyed providing both group and individual psychotherapy for pain and trauma. For me, there is something very powerful about group energy and connection and to be able to facilitate that is such a blessing. At one point, I had the honor of being part of a special multidisciplinary team under great leadership that was integrated and caring and during that time I witnessed many individuals escaping the “tyranny of pain” (as Dr. Rome would say). In group settings, I have felt so much satisfaction in my work and through team collaboration, extreme joy in watching individuals learn and thrive, and significant pride when patients “got it” and transformed their health and lives.

I have also been a part of some very deep and intensive recovery processes in individual psychotherapy that have occurred over a longer course of time. In this work, there is a different type of satisfaction. For example, after the potential high of an intervention such as a procedure, rehabilitation program, or other treatment that provides some relief, the individual then goes through the reality of integrating their “tools” into real-life action. It is always amazing for me to observe an individual regain control of their life after unburdening their body and soul from pain and trauma and being a part of that journey is such a gift.

What do you feel are your biggest contributions to the field of pain psychology thus far?

My contributions to the field of pain psychology began with a Poster Session at the 2007 American Psychological Association Convention in San Francisco titled, Beliefs and Experiences of Mexican-American Women with Chronic Pain.

The second was an article that was published based on my dissertation, Flores, Consuelo; Zelman, Diane; Flores, Yvette. “I have not a want but a hunger to feel no pain” Mexican Immigrant Women with Chronic Pain: Narratives and Psychotherapeutic Implications. Journal of Women & Therapy. December 2011.

I have also had the honor of providing the following trainings and workshops:

NCAPP Workshop, San Francisco, 2013

Understanding Chronic Pain: Practical Knowledge and Current Updates

Chronic Pain and Special Populations: Working with Latinos

NCAPP Workshop, San Francisco, 2014

Psychotherapy with Pain Patients

Group Therapy for Chronic Pain

AAPP Training Video for Continuing Education, 2019

Culture and Pain Series

Working with Latino Patients with Chronic Pain

I had the grand opportunity to create and facilitate the first culturally sensitive Spanish-language functional restoration program at IPM Medical Group, Inc. from 2012-2017

And I continue to facilitate Spanish-language Pain and Trauma processing groups

What advice would you give to people interested in, or just starting out, in pain psychology?

Find a mentor or consultant (individual or group)

Be open to taking on pain cases with varying levels of complexity

Learn as much as you can about the physiology of pain and neurobiology of stress (due to the important relationship with the pain system and overall healing process)

Read medical reports when available and look up medical terminology. Learn about what your clients are going through.

Be open to collaborating with other disciplines and stay up to date with your client’s medical processes

Understand the relationship between pain and trauma and if possible, learn about trauma-informed approaches (many pain patients have trauma histories)

How do you anticipate the future development of pain psychology?  What is needed to accomplish that?

I often think about the influence of patient health literacy and provider expectations on how individuals respond to pain treatments and overall health outcomes. I believe that psychologists should be at the forefront of improving communication between patients and doctors, particularly when it comes to chronic and life-altering health events. So much can be “lost in translation” and medicine can be considered a different language. Although some advances have been made in certain pain management settings, I envision a more collaborative approach to include a psychological screening or assessment and psychoeducation or counseling/treatment earlier on in the illness or injury process. Counseling and information should also include the patient’s family and support system and take into consideration holistic approaches to their recovery. How wonderful it would be to have a psychologist on staff at every primary care or occupational medicine clinic.

Training opportunities for psychologists are needed at all levels, beginning from introductory courses in graduate training programs, to postdoctoral fellowships, to more specialized training for licensed clinicians. Providing opportunities to directly treat clients with pain, having supervision/mentorship, case consultation, and observation of others’ work (when possible) are some potential ideas for training the next generation of pain psychologists.

MARCH 2024:   HOWARD ROME, PHD

What led you to become a psychologist? What is your educational background?

After initially studying music and sociology, I found my way back to the “family business.” My father, uncle, and brother had careers in mental health, and it gradually dawned on me that I could avoid it for only so long. After relocating from Minnesota to California, I started graduate school at the California School of Professional Psychology. It was a good fit. I was fortunate to get a pre-doctoral internship at California Pacific Medical Center (CPMC) in San Francisco in 1981. The psychiatry/psychology training program at CPMC was superb and exposed me to a number of clinical settings: inpatient, outpatient, neuropsychology, and psychological assessment of chronic pain patients in the Workers’ Compensation system. The rotation that most interested me was the psychiatric consultation/liaison service on the medical wards. Under the supervision of George Becker, MD, an orthopedic surgeon who had trained as a psychiatrist, our team of psychiatric residents and psychology interns evaluated and treated medical inpatients with a wide variety of illnesses that required hospitalization. At this stage of my career, in the early 1980s, HIV/AIDS was just emerging and everyone in the hospital was struggling to understand this new and frightening illness.

What got you interested in pain psychology and what was your experience with health and pain psychology? What were your most significant positions in pain psychology?

On the medical wards, our team was frequently asked to participate in the treatment of patients with severe pain, often when the diagnosis was complicated, uncertain, or when there was concern about addiction. For the large number of AIDS patients referred to us, pain management and end-of-life issues were the focus of our interventions. We provided an array of treatments including medications and injections, psychological treatments including brief psychodynamic and cognitive behavioral therapy, and guided relaxation and hypnosis. Dr. Becker was an excellent teacher and mentor. He led an in-depth seminar on psychological factors in pain and illness and had us read and present articles and books on various topics. We regularly attended weekly orthopedic rounds at CPMC, and this was an invaluable education in medical/surgical issues. With Dr. Becker’s encouragement I chose chronic pain as the topic for my doctoral thesis. The Department of Orthopedics supported my research by referring patients into my MMPI based study on pain and abnormal illness behavior. I subsequently joined the staff at CPMC and remained there for twenty years. My practice focused primarily on medical patients with psychological complications, the majority were patients with chronic pain. For several years I consulted at the Facial Pain Research Center at University of Pacific Dental School. My neuropsychology practice was primarily with the liver transplant team and the geropsychiatry service at CPMC.

I also had the good fortune to work for many years with Elliot Krames, MD. His pioneering work in the neuroscience of pain and interventional pain treatments grounded me in the biopsychosocial model of understanding pain. We worked together to develop multidisciplinary treatments incorporating medical interventions, physical therapy, and cognitive behavioral therapy. My collaboration with Dr. Krames in the ‘80s and ’90s coincided with the emergence of the specialty of pain medicine and of pain psychology as a subspecialty within health psychology. Pain conferences were proliferating. New advances in the basic neuroscience of pain, along with psychological/behavioral research and treatment, were hot topics at these conferences and I learned a great deal. I also learned about the huge amounts of money spent by pharmaceutical and device manufacturers in marketing their pain-related products. OxyContin/Purdue Pharma is, of course, the poster child for what evolved into the most tragic episode in the history of pain treatment. But it follows on from a long history of misunderstanding and mistreatment of pain. Pain is the bane of humankind and chronic pain patients are particularly vulnerable to “misadventures” and exploitation. This is part of the history that we as pain psychologists are well-advised to understand and address.

What has been your most rewarding experience working in pain psychology?

In the late 1990s functional restoration programs for patients with work injuries became the exclusive focus of my practice. With Jacob Rosenberg MD and other pain physicians at IPM Medical Group, I developed and ran a multidisciplinary FRP, and I continue to work there currently on a part-time basis. I also developed practice as a Workers’ Compensation medical-legal evaluator. I’m most comfortable working in a multidisciplinary setting because it feels most in tune with my understanding of chronic pain as having a multifactorial etiology. Addressing all of the components of a complex problem simultaneously through integrated medical, physical therapy, and psychological treatments in a daily intensive outpatient program is, in my view, the gold standard for giving chronic pain patients the best chance to heal and improve, physically and psychologically. This view is supported by outcomes research. With some exceptions, such as Workers’ Compensation in California, and large medical institutions like Kaiser and the Mayo Clinic, intensive multidisciplinary treatment for pain is often not available. Nevertheless, it is still possible to provide integrated treatments in other settings and insurance environments. It requires teamwork and this is where pain psychologists can play a pivotal role in coordinating and communicating with patients, providers, insurance carriers, and families.

What do you feel are your biggest contributions to the field of pain psychology thus far?

The most pleasurable and interesting period in my career occurred when I collaborated with my brother, Jeffrey Rome, MD, a psychiatrist who directed the multidisciplinary pain program at the Mayo Clinic, in writing a paper describing a model for conceptualizing the neurobiologic linkage between pain, stress, and depression. We reviewed the literature on nociception-induced neuroplasticity at the corticolimbic level and proposed a biopsychosocial framework for understanding the sensory/affective/behavioral symptom complex seen in many patients with chronic pain. The paper was published in 2000 and is available online. The title is Limbically Augmented Pain Syndrome (LAPS): Kindling, Corticolimbic Sensitization, and the Convergence of Affective and Sensory Symptoms in Chronic Pain Disorders (search “Limbically Augmented Pain Syndrome” and click on Oxford Academic for full text).

Teaching pain management psychotherapy to psychology graduate students, and providing opportunities for interns to train in our FRP has also been a rewarding part of my career. There are relatively few psychology internships in pain. To grow the field of pain psychology we need more such training opportunities, as well as the leadership of American Association of Pain Psychology in providing continuing education, developing curricula, and gaining recognition for certification in pain psychology.

What advice would you give to people interested in, or just starting out, in pain psychology? How do you anticipate the future development of pain psychology? What is needed to accomplish that?

 Pain psychology is a truly fascinating field, at the forefront of patient care and research for those interested in understanding the mind/body connection. Among the satisfactions of choosing pain psychology as a subspecialty is the opportunity to facilitate and observe very substantial changes in pain severity, physical function, and emotional distress in your patients in a relatively short period of time. It is eye-opening to watch the synergism that occurs when prudent medical treatment is combined with carefully supervised progressive exercise, concurrent training in pain coping skills, and amelioration of comorbid depression/anxiety/anger. It can help even seemingly intractable cases. But please be aware that while we have our remarkable successes, we also have our remarkable failures. Humility is called for, especially in what we promise to our patients about our treatments. This is where the future of pain psychology and pain treatment as a whole lies: in better understanding the complex interactions between pain-induced changes in the CNS and how those changes interface with a person’s psyche, personality, social environment, and the medical/insurance industrial complex. Finally, there are abundant entrepreneurial opportunities for psychologists to link up with like-minded health providers across a variety of specialties to make multidisciplinary treatments available to more people, especially in underserved, underinsured communities.

FEBRUARY 2024:  FRAN STOTT, PHD