Center For Cognitive Therapy

Pre-Surgical Psychological Screening (PPS)

It is common that surgical outcomes have varied degrees of “success” even in those patients where the spinal surgery is perfectly performed. Fortunately, numerous scientific studies of surgical patients have isolated certain psychological and medical variables that if identified and addressed, can reduce the risk of unsuccessful surgical outcomes. Pre-surgical Psychological Screening (PPS) in those patients identified as being at risk can significantly reduce the risk of post-surgery complaints. A system for determining when to consider a referral for a Pre-Surgical Psychological Screening is outlined below:


  1. Exaggerated or inappropriate signs and symptoms of spine injury.
  2. Suspected clinical depression or high anxiety level.
  3. Severe sleep disturbance.
  4. Unrealistic expectations about surgical outcome.
  5. High level of Marital Distress or unexplained sexual difficulty.
  6. History of physical or sexual abuse (with women).
  7. Emotional lability or mood swings.
  8. Extended period of disability (> 3 months)
  9. Any substance abuse or large dosages of narcotics or anxiolytics.
  10. Evidence of financial gain or litigation related to spine injury.
  11. Poor work attitude (anger toward employer) or vague return to work plan.
  12. Previous “unsuccessful” surgeries.


0–1 items Not necessary to refer unless desired by patient
2–3 items Consider referral for PPS
4+ items Strongly consider referral for PPS


  • The PPS is a mental health (psychological) evaluation.
  • The PPS is a routine procedure, like any other medical test, to assist in developing the most effective treatment plan.
  • The PPS is a critical procedure, as important to surgical decision as any medical test.
  • The PPS will help determine if the patient is ready for surgery.
  • The PPS will help determine those patients who are likely to not report satisfactory improvement following a successful surgery.
  • Upon referral, the physician emphasizes that the patient has a legitimate injury and that the pain is real but that emotional factors influence how pain is processed by the body and ultimately experienced.
  • The PPS can identify factors that if treated, improve surgical outcome.


  • Pre-Surgical Psychological Screening (PPS) is a routine procedure that like other medical tests assists in the development of the most effective treatment plan. It is a critical procedure as important as any medical test to making surgical decisions.
  • Your physician recognizes that you have a legitimate injury and that the pain you experience is “real”.
  • The PPS is a psychological evaluation that identifies both psychological and medical variables that will determine if you are ready for surgery.
  • Although your pain is real and there is a medical basis for the pain you experience, certain psychological variables influence the intensity, frequency and duration of your pain. The PPS identifies these variables if they are present.
  • Identification and treatment of psychological factors increases the probability of a satisfactory surgical outcome.
  • The results of the PPS will be discussed in detail with you and your surgeon.


You are being referred to Mark E. Oakley, Ph.D. for a Pre-Surgical Psychological Screening. Dr. Oakley is a recognized expert in Cognitive-Behavior Therapy with extensive research and clinical experience with Chronic Pain. Dr. Oakley is a Full Clinical Professor at UCLA, Department of Psychology, where he trains advanced Clinical Psychology Graduate Students. He is also the founder of The Center For Cognitive Therapy in Beverly Hills, CA., where he continues to maintain his private practice helping individuals with a wide range of difficulties, including the management of chronic pain.

Feel free to contact Dr. Oakley at any time if you would like any further information or to schedule a PPS. Dr. Oakley would also be happy to meet with your staff for a free in-service training about the value of Pre-surgical Psychological Screening with your surgical candidates.

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