By Dr Marc Mooney, PhD, LP
Many of us will need surgery at some point. Sometimes medical or mental-health challenges can affect our ability to give informed consent or to follow through with post-surgical instructions. Some people have had difficult past procedures or have seen family members struggle. A brief pre-surgical psychological assessment can reduce these barriers and set you up for a smoother recovery.
Why Would I Need to See a Psychologist Before Getting Surgery?
To be cleared for surgery, you need to be medically and psychologically ready. This does not mean perfect health.
- Medical clearance means you can tolerate the stress of surgery and recovery and can follow basic aftercare. For example, an infection may need treatment before the procedure.
- Psychological readiness means you can understand the procedure, its risks and benefits, reasonable alternatives, and what you will need to do afterward to make it successful.
Short-term issues like significant anxiety, depressed mood, trauma reactions, or substance use can temporarily affect decision-making and follow-through. With brief support, most people can be restored to readiness and proceed with confidence.
What Does a Pre-Surgical Psychological Evaluation Involve?
- Interview with a psychologist, psychiatrist, or other licensed mental-health professional
- Brief questionnaires and standardized tests
- Total time commitment of about 1.5 to 3.0 hours
- Questions about current and past mental-health symptoms and coping
- Review of your understanding of:
- the risks and benefits of the surgery
- the rationale for the procedure
- alternatives to surgery
- what you can do to maximize success during recovery
- Same-day feedback when possible and a written summary you can share with your care team
Risk Versus Reward
Every medical decision includes potential risks and potential benefits.
- Risk: The chance of a negative outcome. For example, a surgery could temporarily result in more pain or reduced mobility.
- Reward: The potential benefit, such as healing an injury, reducing pain, or improving function or appearance.
No treatment is completely risk-free, and doing nothing also carries risks. The key is weighing the likelihood and severity of risks against the expected benefits and your personal goals. If a feared risk is treatable or recoverable, the overall proposition becomes more favorable. Example: a knee surgery may carry a small infection risk that can be treated, while potentially allowing you to walk farther with less pain.
Capacity and Informed Consent
These are closely related but distinct concepts:
- Capacity is your ability to understand information about a treatment and make a reasoned choice.
- Informed consent is the process of providing you with clear information about the procedure, including risks, benefits, and alternatives, so you can decide.
What If I Have Psychological Barriers to Surgery?
Most patients have no significant barriers. When barriers are identified, many can be addressed quickly; some may require a brief delay to optimize safety and aftercare. Conditions like depression, anxiety, trauma-related stress, or substance use are common and treatable. In practice, psychological assessment rarely delays surgery and often helps the team coordinate care more efficiently.
Surgery Scares Me
Surgery can be life-changing by improving mobility, strength, appearance, or comfort. It also includes elements that commonly trigger anxiety:
- Needles and injections: Fear of needles can lead people to avoid medical care entirely.
- Blood and incisions: Most surgeries involve some bleeding. Seeing blood or thinking about tissue injury can be uncomfortable for many people.
- Bodily injury phobia: Fear related to cuts, broken bones, or surgical wounds can be intense.
- Anesthesia: Concerns about “going to sleep” and waking up are common. Your anesthesia plan is individualized, and your team will review your specific risks.
Treatments for Surgery Fear
A phobia is an anxiety disorder marked by excessive, persistent fear and active avoidance of a specific situation or trigger. Not every dislike is a phobia. Hallmarks include:
- Fear out of proportion to the actual danger
- Avoidance that disrupts life, work, school, or health care
- Significant distress or impairment
The good news: these fears respond well to brief, skills-based treatments. The most effective is exposure therapy with response prevention, which helps you face fears gradually while learning to manage the body’s alarm system.
Additional tools may include:
- Education about what to expect
- Coping skills for anxiety and for vasovagal symptoms (hydration, applied muscle tension, paced breathing, light aerobic warm-ups when appropriate)
- Coordination with your surgical team
Case Example
A patient with severe needle and blood fear needed pre-op labs and injections. Working through a graded plan, she began with short video clips, progressed to observing blood draws in clinic, and practiced applied muscle tension to prevent fainting. After several sessions she completed labs and injections and moved forward with surgery. Her recovery was uneventful.
In Vivo vs. Imaginal Exposure
There are two broad ways to conduct exposure therapy:
- In vivo: Directly and safely practicing with real-world cues. For needle fear, this might include sitting in a phlebotomy chair, handling sterile supplies, and rehearsing the steps. No real blood is used.
- Imaginal (including Virtual Reality): Rehearsing feared situations in imagination or with guided media. Virtual Reality headsets can present graded, realistic scenes for needles, blood, or injury in a controlled environment.
Conclusions
Sometimes surgery is a straightforward decision. Other times, anxiety, past experiences, or mood symptoms make it harder to consent confidently and follow through on aftercare. A brief psychological evaluation can identify barriers, offer practical strategies, and improve outcomes. If you are considering surgery but feel hesitant, help is available.
Note to Clinicians and Surgeons
Dr. Mooney offers a variety of services.
- I am credentialed through 11 major payers (or provide a superbill).
- I can complete evaluations online or in-person.
- I can complete an evaluation in as little as one week if required.
- I offer evening or weekend hours if desired.
- I will tailor my evaluation to include any domains or tests required.
- I can successfully and quickly treat phobias that can prevent surgery, such as blood, injuries, anesthesia, needles, and injections.
To schedule, please have your staff or the patient call (763) 205-4843 or encrypted email me at mmooney@expansemn.com.