Quality Stress Management Course

The Well Being Way Stress Management Program

What you'll learn in the book is as follows: The Secret Formula I use every day to gain maximum happiness. Over 101 Ways To Reduce Stress. How To Use Your Body to Maximise Your Happiness. The one thing I did in 2010 which made a huge difference to my life which I didn't use for the 2 previous years. How To Deal With Challenging Emotions. The key to building a Joyful Life that if you implement will make huge changes. How To Turn Stressful Situations Around When Things Arent Going Your Way. Revealed. The best Spiritual Advice I've Ever Received. Affirmations. How To Make Affirmations Work For You. The Cornerstone of Maintaining Joy In Your Life. The One Technique To Cope With Huge Workloads in An American Fortune 500 Company. The 2 things that you need to start doing to overcome modern day stress in your life. More here...

The Well Being Way Stress Management Program Summary

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Stressful Life Events

Stressful life events, including childhood trauma, have been associated with the development of som-atization later in life (Campo and Fritsch 1994). Chronic stressors can have an effect on the body's stress response systems, such as the hypothalamic-pituitary-adrenal (HPA) axis. Although elevations of cortisol may be associated with acute stress, prolonged exposure to stress can suppress the HPA axis, resulting in the lowered cortisol levels that are associated with somatic complaints (Lackner et al. 2004). Somatoform symptoms have been linked to traumatic events experienced in both childhood and adulthood (Binzer et al. 1997 Roelofs et al. 2002). Roelofs et al. (2005) have found that the number of traumatic events an individual has experienced is associated with the number of conversion disorder symptoms exhibited. Of traumatic events experienced, those pertaining to relationship and occupational problems are most likely to trigger immediate somatic symptoms in adults (Roelofs et...

Domestication how did the wild animal become a pet

The advances that have been made in veterinary medicine, the increase in the number of pet insurers, the growth in the pet food industry and the demand for animal behaviourists, personal trainers and alternative therapists suggest how greatly humans value their pets in the present day (Blacker 2004). Domestic animals still have a variety of roles (Table 1.1) but the modern world dictates a greater need for animals to be kept solely as companions. The contributory factors to this requirement are the breakdown of the family unit, a more stressful lifestyle and the fact that more people live alone. For many years pet owners have eulogized the virtues of their animals but it is only recently that scientists have been able to prove that companion animals are beneficial to human health and wellbeing.

Companion animals in prisons

Have in reducing stress has since been recognised as passive animal-assisted activity. The activity of birds and fish, their colours and the sounds they create have been found to have a calming influence and are now used to great effect in many veterinary, dental and medical surgery waiting rooms. Since the success of introducing small pets into prisons, other pet-related schemes have been devised, giving prisoners an opportunity to take a more active role in caring for animals, thus enabling them to learn new skills. A programme initiated at a women's prison in Washington has taught prisoners how to train dogs to assist the physically handicapped. The dogs used are frequently strays provided by the local humane centre. Once the prisoners have become accomplished dog trainers, they work with a disabled person to find out exactly what their specific needs are and train the dogs accordingly (CSS 1988). Clearly, this is a programme that benefits everyone.

The Creative Persons Contact with the Inner Child

It would seem that a child with both high sensitivity and high curiosity could be the parent of a creative veteran, so to speak. Early stressful life experiences are often harder to bear for a sensitive child but serve at the same time as fuel for his or her motivation. Difficult life events, given the proper environmental support and resources, can be the necessary fuel for the first creative accomplishments which from thereafter enforce and encourage further efforts in the same vein.

Balancing Treatment of Disease and Promotion of Health

Behaviors that have the greatest impact on preventing chronic disease and its progression are (1) reducing exposure to toxic substances (tobacco, alcohol, drugs, pollution), (2) movement and exercise, (3) healthy diet, (4) psychosocial integration and stress management, and (5) early disease

Stress Appraisal and Coping

Coping refers to how individuals manage the real or imagined discrepancy between environmental demands and their resources for addressing the stressful situation. According to Lazarus and Folkman (1984), adaptation to stress is mediated by appraisal (i.e., personal meaning of a stressor and one's sense of resources for dealing with it) and coping (i.e., thoughts and behaviors used to manage stress). With emotion-focused coping, a person directs energy to regulating internal feeling states, whereas with problem-focused coping, a person directs attention to reducing the stressor or expanding resources for dealing with it (Sarafino, 1990). The effect of stressful life events on health is determined by many factors related to coping, such as cognitive style, personality characteristics, and social and behavioral tendencies.

Important Times for Psychosocial Interventions

A dramatic change in patient symptoms also indicates consideration of psychosocial factors. A psychosocial crisis can provoke an exacerbation of a chronic condition (e.g., rheumatoid arthritis), a new manifestation of illness (e.g., myocardial infarction), or emotional-psychiatric symptoms (e.g., anxiety, trouble sleeping) best treated through stress reduction and symptomatic care.

Takeoff Induction of General Anesthesia

Induction of anesthesia can be a stressful time for both the patient and the anesthesiologist. Anesthesiologists know that induction of general anesthesia is a time when a disproportionate numbers of accidents occur. Monitors have been attached to healthy anesthesiologists during induction of general anesthesia and have revealed a high incidence of cardiac rhythm abnormalities in the anesthesiologist during this time associated with surges of fight-or-flight hormone release.

Understanding patients explanations

To understand patients' explanations it may first be necessary to allow them to lead and explore the models of their mental health problems. It is often helpful to normalise, but this is not to minimise or be dismissive of their symptoms. A vulnerability stress model is useful in explaining the illness, and is credible scientifically. Some patients have vulnerabilities that may have been inherited or caused by some physical effects on the brain, and the presence of stressful events (which might include chemical interaction, e.g. illicit drugs or viral illness) which may have precipitated the illness. For some people their vulnerability is very low, but the stress they have experienced has been high and overwhelming. Others seem very vulnerable to stress, and illness precipitates readily.

The Patient with Posttraumatic Stress Disorder

Brief reactive psychosis any one or more events that would be stressful to anyone Multiple personality disorder abuse or other childhood emotional trauma Dissociative fugue severe psychologically stressful event such as marital quarrels, military conflict, natural disaster, or personal rejection Dissociative amnesia severe psychologically stressful event such as the tragic death of a loved one, abandonment, or a threat of personal injury Conversion disorder extreme psychologically stressful event such as warfare or a recent tragic death of a loved one Depersonalization disorder severe stressful event such as military combat or an automobile accident

Sociology of Mental Health

Considerable research also indicates that social integration not only directly predicts individual well-being but also helps people cope with the stressors that they experience (e.g. House, Landis, & Umberson 1988 Turner, 1999). One of the strongest relationships in the sociology of mental health is between the presence of social support and positive mental health. This relationship stems less from the direct impact of support on well-being than from the way that people with much support are better able to cope with the impact of stressful life events (Kessler & McLeod, 1985). As Durkheim realized, however, social support brings costs along with its strong benefits. People involved in supportive relationships reap emotional and instrumental gains but also accrue obligations to provide support to others. Social obligations can produce stressful demands such as caregiv-ing responsibilities, role captivity, and worry over the well-being of others that strain mental health (Pearlin et...

Diathesisstress Models

Exposure to stressful life events has been recognized as an important promoter of major psychiatric illness for many years (i.e., the classic diathesis-stress model). This belief stems from observations that episodes of psychiatric illness are more frequently observed shortly after major life stressors and that clinical symptoms of many psychiatric illnesses worsen during times of stress (Mazure and Druss, 1995). Indeed, the role of life stressors as determinants for the onset and severity of many major psychiatric conditions has been common parlance in psychiatric settings for decades. Stress has been reported to promote symptomology in diverse psychiatric conditions ranging from personality disorders, to affective disorders, to dissociative disorders, and to somatic disorders. With such a wide range of conditions affected by exposure to stressors, it is clearly of interest to understand the organization and function of stress responsive systems in the brain that might serve as...

What It Can Do for You

Advocates suggest that the variety of flower remedies available today can help some people improve their sleep, reduce stress, calm fears, ease childbirth, reduce alcoholic tremors, and lessen skeletal and muscular aches. There are no scientific studies to support these claims, but flower remedies may evoke a placebo response. Flower remedies do not cure disease. As long as they are not used in place of needed professional care, they cause no harm and may provide a pleasant antidote to emotional stress.

What Are The Other Elements Of Treatment Besides Medical Therapy

The psychosocial aspects of epilepsy are an important component of the disorder. Patients often have major concerns about health, independence, personal growth, relationships, well-being, and security. These issues are discussed more fully in Chapter 5 and can be appreciated and addressed only if the physician attempts to uncover the psychologic and social problems that adversely affect the patient's quality of life. This process begins with taking a complete psychosocial history, including information about any previous psychiatric illnesses or treatments, education, employment, driving, insurance, interpersonal relationships, and attitude toward having epilepsy. A number of questionnaires developed for this purpose supplement the psychosocial history and provide a quantifiable means of assessing and following patients as pharmacotherapeutic and psychosocial interventions are implemented.3 Uncovering a source of psychosocial stress may lead to an effective strategy for reducing the...

The Nature of Mental Health and Distress

The major implication of these critical perspectives for defining mental health and illness distress is that mental distress, regardless of its intensity or duration, cannot necessarily be viewed as poor mental health. On the one hand, this point is consistent with the sociological emphasis on the importance of distinguishing normal responses to stressful life experiences from mental disorders, a point also articulated in the introductory pages of the DSM manuals, if not fully considered by practicing psychiatrists (Horwitz, 2002). On the other hand, however, the critical theorists suggest that the psychic damage inflicted in advanced capitalist societies is so thorough and insidious that distinctive stressful life circumstances need not be apparent, and that even those individuals who suffer intense psychic distress in the absence of readily identifiable stressors should not be pathologized. For the critical theorists, as we have seen, mental distress is an appropriate response to...

Model of Pediatric Somatization

The process of somatization may be reinforced by attention from caregivers and physicians and or avoidance of stressful situations (e.g., attending school, participating in competitive athletics) as a consequence of the illness behavior. These feedback loops may help establish a pattern of the illness behavior that persists beyond the original reason for the symptom, whether it was physiological or psychological in nature. Psychological trauma may play an important role in amplifying and fostering so-matoform symptoms.

What Is The Spectrum Of Epilepsy

Epilepsy can also be described along a spectrum of categories ranging from the uncomplicated to compromised or devastated. 3,6 The person with epilepsy may move from one category to another at different times throughout life because of changes in seizures, medications, developmental levels, or because of psychosocial factors. For example, the person may have, at one point in life, an uncomplicated course with well-controlled seizures, no medication side effects, and no significant psychosocial issues. The person may then switch jobs, a change that leads to sleep deprivation and more frequent seizures. Or the person may need to stop driving, a change that creates stress because of inaccessible transportation and financial hardship. The frequency and severity of the person's seizures may still be considered mild medically the person's life, however, may still be compromised by the consequences of their seizures. Care should be directed at suggesting lifestyle modifications to decrease...

Existing Approaches to Assessing the Work Mental Health Relationship

From the micro analytic perspective, there is an extensive literature on the relationship between the characteristics or attributes of jobs and the mental, and physical, health of individual workers. This research has examined the potentially stressful characteristics of the physical work environment, organizational properties of work and social relationships with co-workers and supervisors (e.g., House, 1980 Kahn, 1974 Karasek, 1979 1989a Kasl, 1978). Two models of the etiology of job stress have developed out of this research. (1) The person-environment fit model argues that stress develops out of a discrepancy between characteristics of the work environment and individual characteristics (French, Caplan, & Harrison, 1982). (2) The job demands-control model argues that stress arises when there is inadequate structural capacity (control) to meet job demands (Karasek, 1979 Karasek & Theorell, 1990). However, neither of these models has been concerned with the structural origins and...

Who Can Be Hypnotized

Hypnosis self-hypnosis is a state of focused attention or altered consciousness, a restful alertness in which distractions are blocked, allowing a person to concentrate intently on a particular subject, memory, sensation or problem. Hypnosis may be used instead of or as assist to anesthetic agents during surgical and dental procedures. It is especially helpful when allergy or some other circumstance prohibits anesthesia. It is also used to reduce stress, pain and anxiety, and to assist in removing undesired habits such as bed-wetting in children or smoking.

What Practitioners Say It Does

For those who can, or who wish to learn self-hypnosis, it has important benefits. To achieve control over various problems, for example, hypnosis can be self-induced by patients whenever they feel the need for pain or stress relief. This can help them avoid narcotic dependency and the long-term expense and physical complications of narcotic medication, and control their own pain or stress whenever the individual wishes.

Individual Psychotherapy

Psychotherapy approaches are used to reduce somatic and psychological symptoms, improve coping and functioning, improve communication and problem solving, and reduce stress load. Cognitive-behavioral therapy is focused on achieving these goals by modifying unhelpful cognitions, assumptions, beliefs, and behaviors. Techniques might include developing a biopsychosocial view of symp

Nonpharmacologic Therapy

Nonpharmacologic therapy includes psychoeducation, exercise, stress management, and psychotherapy. Psychoeducation should include instructing patients to avoid stimulating agents such as caffeine, decongestants, diet pills, and excessive alcohol use. Regular exercise is also recommended. Cognitive-behavioral therapy (CBT), the most effective psychological therapy for GAD patients, helps patients to recognize and alter patterns of distorted thinking and dysfunctional behavior. Some trials suggest that treatment gains with CBT may be maintained for up to 1 year.21 The combination of CBT and an antidepressant may be more effective than either treatment alone. In a recent study, 80.7 of children were much improved on the combination of CBT and an

Diurnal species eg falcons

Bird's eyes but leaving its beak exposed. This calms the bird and helps to reduce stress. These birds also have a very good sense of hearing, so reducing the noise in the room reduces the stress. Most falcons will also be presented wearing leather straps or jesses around their ankles, which enable them to be restrained while on their owner's arm (Fig. 15.10). When restraining these birds, wear a leather gauntlet because it is extremely painful if they grip your arm without one.

Research Design Considerations

Health consequences, from anxiety and depression to cardiovascular illnesses. These jobs are also more likely to be dead end jobs with few chances of upward mobility, and their occupants are more likely to experience employment disruptions - layoffs and permanent unemployment - stressful events that proliferate over time (Pearlin et al., 2005).

Research Evidence to Date

Many studies have documented the correlation between meditation and the reduction of stress, anxiety, and panic states. Research documents the relaxation response produced by meditation and prayer, a response involving decreased heart and respiration rates and eased muscle tension. Meditation has been shown also to help control negative thinking and assist people in managing potentially stressful situations in a calm fashion.

Cognitive Behavioral Therapy

CBT has been tested in numerous controlled adult studies and has been found to be the most effective psychotherapeutic approach to bulimia nervosa. CBT has been found more effective than other interventions, including no therapy, nondirective therapy, pill placebo, manualized psychodynamic therapy (supportive-expressive), stress management, and antidepressant treatment (Agras et al. 1989, 1992, 1994, 1997, 2000 Barlow et al. 1988 P.J. Cooper and Steere 1995 Fairburn et al. 1993 Leitenberg et al. 1994 Mitchell 1991 Pope et al. 1983 Walsh and Devlin 1995 Wilfley et al. 1993). Among adults with bulimia nervosa completing CBT, between 30 and 40 were abstinent, and another 20 were much improved (Fairburn et al. 2000). Fairburn et al. (1995) followed patients with bulimia nervosa treated with CBT for 5 years posttreatment. After 5 years, nearly 60 had no eating disorder, and another 20 had a subclinical disorder the remainder were unrecovered, with a small percentage diagnosed as having...

Session 6 Relapse prevention

As a way of reinforcing the relapse prevention plan we extended Kathy's time-line into the future and she tried to predict stressful events that may occur in the next few years. The most anxiety-provoking event that Kathy could envisage was that she was moving house in three months' time to be nearer her parents and was able to predict that her symptoms would probably worsen at that time. Kathy was encouraged to make a list of all of the things that could go wrong and developed a set of strategies that she would employ if those things happened. This included such possibilities as What if the delivery men don't show up and What if I have a bad attack the night before She concluded that having such a plan would probably help her to worry less and help to minimise the effect of such a stressful event in her life.

Baseline Fetal Heart Rate

Normal baseline FHR ranges from 110 to 160 beats min. A baseline change is interpreted as one that persists for 10 minutes or more and occurs between or in the absence of contractions. An FHR of less than 110 beats min is considered bradycardia. FHR is a function of the autonomic nervous system. The vagus nerve provides an inhibitory affect, whereas the sympathetic nervous system provides an excitatory influence. As the gestation advances, the vagal system gains dominance, resulting in a gradual decrease in the baseline. Stressful events such as hypoxia, uterine contractions, and head compression evoke a baroreceptor reflex, with resulting peripheral vasoconstriction and hypertension causing bradycardia. Stimulation of peripheral nerve receptors can cause acceleration of FHR (Fig. 21-10). An FHR baseline greater than 160 beats min is defined as tachycardia. This is

Clinical Skills and Resources

Part IV gives an overview of clinical skills and resources. After reviewing the clinical approaches of key clinical theorists, it describes basic counseling techniques and clinical microskills. Client homework assignments and exercises to enhance client health and stress management are also included. CLIENT HEALTH AND STRESS MANAGEMENT Affect-Regulation Coping Skills Counseling Stress-Management Training

The beastly boss game

In this exercise, from Epstein's The Big Book of Stress Relief Games, people learn the value of performing relaxation exercises when they're under stress. People divide into pairs and role play situations in which a Beastly Boss makes unreasonable demands of an Exemplary Employee. In some role plays, the employee subtly performs simple breathing exercises in order to stay relaxed. Without such exercises, the conversations often escalate with the exercises, they do not. Exercises of this sort can be used to teach both managers and employees the value of stress-management training.

The Persisting Effects of Early Traumas and Adversities

Health problems for some, but not all, who experience such adversities. Much has been learned about the pathways by which childhood traumas increase vulnerability to mental health problems decades later. Childhood traumas and adversities substantially reduce individuals' socioeconomic achievements and ability to develop and sustain high-quality social relationships (e.g., Harris et al., 1990 McLeod, 1991 O'Connor et al., 1999 Ross & Mirowsky, 1999 Shaw & Krause, 2002) which, in turn, increase vulnerability to mental health problems. Another pathway is between childhood adversities and higher exposure to stressful life events during adulthood (e.g., Horwitz et al., 2001 O'Connor et al., 1999). The mechanisms by which early stress produces high levels of stress decades later remain unidentified, but the relationship is a strong one. Stress Accumulation. Recently, the conceptualization and measurement of stress has broadened beyond stressful life events and chronic stressors to...

The Role of Stress in Recovery and Recurrence

Research evidence concerning the role of stress in recovery from and recurrence of MDD is inconsistent. I am aware of only two studies in which stressful life events were observed to delay recovery from MDD. Bosworth and colleagues followed patients with coronary artery disease for a year. They report that stressful life events over that interval predicted both the onset of MDD and decreased rates of recovery among those with MDD (Bosworth, Steffens, Kuchibhatla, Jiang, Arias, O'Connor, & Krishnan, 2000). Similarly, Pevalin and Goldberg (2003) reported that, over 8 years, stressful life events reduced the odds of recovery from MDD in their British community-based study. In contrast, George and colleagues (1989) report that negative life events were unrelated to the odds of recovery in their clinical sample. Clearly this issue merits additional research. Research on the role of stressors (typically stressful life events) in recurrence of MDD has sparked considerable controversy. First,...

Shaffer Coping Models2

. . . let us now examine a range of options when dealing with stressful situations and your reactions to them, keeping in mind that this is a complex, dynamic, interactional process. 2 From Stress Management for Wellness (2nd ed., pp. 227-231), by W. Schafer, 1992, Fort Worth, TX Harcourt Brace Jovanovich College Publishers. Reprinted with permission.

Loss of Arousal Regulation

Subjects who did not develop PTSD exhibited significant autonomic responses to a reminder of their trauma, while PTSD patients showed almost no autonomic response to the recounting of the triggering stressful event. Interestingly, the PTSD patients demonstrated a comparable degree of autonomic dysregulation at rest as the control subjects' reaction to a personal stressor They reacted to ordinary stimuli the way others reacted to reminders of traumatic incidents. One possible explanation for this phenomenon is that PTSD patients experience so great a degree of autonomic hyper-activation at rest that they are unable to marshal a further stress response to reminders of their trauma (Cohen et al., 1998). A recent study found that the HRV parameters that indicate autonomic dysregulation, which characterize PTSD patients at rest, are normalized in responding patients by use of selective serotonin reuptake inhibitors (SSRIs) (Cohen et al., 2000a).

Therapeutic Interventions

Practice stress management skills, to reduce overall stress levels and craving. (22) 22. Teach the client stress management skills (e.g., relaxation exercises, physical exercise, talking about problems, going to meetings, getting a sponsor) to reduce the level of anxiety and increase a sense of mastery over the environment.

Lifetime Accumulation of Stress and Disadvantage

Our second focus concerns the study of cumulative advantage disadvantage, which Dannefer defines as the systematic tendency for interindividual divergence in a given characteristic (e.g., money, health, or status) with the passage of time (Dannefer, 2003 S324). Although closely associated with the study of individual and cohort aging, an important point of departure within our field is the sociological conceptualization of the structural origins of mental health problems (Aneshensel, Rutter & Lachenbruch, 1991). This has been modeled in terms of the stresses that are embedded in the contexts of daily life, as emphasized in the Pearlin formulation of social stress theory (Pearlin, Lieberman, Menaghan, & Mullan, 1981) or through restricted access to economic, interpersonal and political resources that might alter exposure to stress and broader sociogenesis of ill health (Link & Phelan, 1995). Research in the field of social stress, for example, has addressed mental health disparities...

Cervical Strains and Sprains

Cervical strains and sprains are characterized by pain in the neck because of irritation and spasm of muscles at the back of the neck. Common related factors are poor posture (e.g., while working or studying), carrying heavy bags on one shoulder, emotional or physical stress, and trauma. The patient has a history of pain in the lower neck and upper back stiffness in the neck, back, and shoulders and perhaps a new work environment, working in a certain posture (e.g., at computer), and trauma. Clinical findings include tenderness posterior to neck, with or without ROM limitation. Diagnosis may be apparent from the history and physical examination. Uncomplicated pain is managed by conservative treatment and correction of causative factors, such as changes in associated environmental factors (e.g., adjustment of height of desk or chair, avoiding straps on shoulders). Stress reduction is beneficial to aid reduction of muscle tension. Warmth applied to the neck is helpful, as are ROM...

Training and Development

Note that self-paced learning, allowing plenty of time, having plenty of help available, and reducing stress associated with training will all enhance the learning of older employees in a training and development context. A recent meta-analysis supports these contentions, showing training performance was particularly enhanced for older learners when self-pacing was used (Scully, Kiker, & Cross, in press).

Neck Back and Myofascial Pain

Trolled trial.150 Too often, physical therapy is limited to ultrasound, hot packs, and a little massage, which are unlikely to help the patient with chronic neck pain or tension headache. Tricyclic antidepressants and stress management with cognitive coping and relaxation techniques improve the control of tension headaches and the combination is better than placebo or either treatment alone.151

Social Psychology and Stress Research

The stress process is a microcosm of the society-individual interface, where structural and cultural constraints are manifest in human thought and action. Macro-level constraints become visible in population patterns of stress exposures as well as in the strategies that individuals use to avoid and respond to potentially stressful circumstances. Proximal social interactions that are embedded in this broader set of constraints serve as the sites at which the meanings of stressful life experiences are constructed, thereby acting as conduits for macro-level influences. The selves that engage stressful experiences participate in, and are shaped by, this process of meaning construction, closing the circle between society and individual. If we accept all this to be true, research on the stress process must invoke the full range of sociological theories regarding the nature of the society-individual interface. In turn, stress research has potential to inform the development of those theories...

Meaning in the Stress Process

In response to these concerns, some researchers have developed elaborate coding systems designed to yield objective ratings of event characteristics. For example, Brown and Harris's (1978) Life Events and Difficulties Schedule elicits a narrative about each reported event or difficulty which is then evaluated by a panel that rates the event for its long-term contextual threat, severity, as well as several other characteristics (see Wethington, Brown, & Kessler, 1995 for a review). Event difficulty ratings are made without reference to the respondent's subjective reactions or emotional responses to ensure that the ratings are independent of the effects of the stressors on mental health outcomes. Dohrenwend and colleagues (1993) developed the Standardized Event Rating system which follows a similar format, but which deletes all information pertaining to social vulnerability from the narratives in order to permit analysis of how social vulnerabilities modify the effects of stressful...

Psychosomatic Illness

Neurohumoral or end-organ imbalances and dysreg-ulation (i.e., allostatic load). These changes may render the organism susceptible to disease or physical disorder. Current scientific advances substantiate these systems as potential pathways by which highly emotional or stressful life events or interpersonal relations may influence physical well-being and illness. Many diseases have been associated with negative alterations in these pathways however, in this chapter, we focus on the psychosomatic aspects of respiratory disease.

Social Roles in the Stress Process

Role-using offers additional insight into the process of meaning construction, one that is particularly attentive to macro-level constraints and which is, therefore, consistent with stress researchers' traditional interests in inequality. Analyses of role-using would direct our attention to individuals' abilities to assert role-based identity claims in order to cope with potentially stressful circumstances. To continue our substantive example, we could analyze the ability of men and women in different structural locations to assert their identities as parents or workers in order to manage the stress of conflicting work-family roles. Consider, for instance, the contrast between welfare mothers' inabilities to collectively assert the priority of their roles as mothers over their roles as workers as compared to middle and upper-class women's abilities to collectively negotiate flexibility in work contracts to allow for maternal leave, flexible hours, and even stopped tenure clocks. In...

Asthma Etiology An Epigenetic Framework

Problematic parenting appears to increase risk of asthma onset in children at genetic risk (Klinnert et al. 1994, 2001). Developmentally relevant stressful events and or the quality of caregiving may alter the emotional and physiological regulation of the infant in the direction of increased allergic response. Klinnert et al. (2007) reported that the development and onset of asthma may be affected by genetic risk, environmental exposure, and psychological factors such as parent-child interactions. This suggestion is consistent with early observations of association between family dysfunction and childhood asthma (Minuchin et al. 1975 Purcell et al. 1969).

Beliefs on Which It Is Based

Another belief on which art therapy is based is that the beauty of creative works is intrinsically uplifting and refreshing. The timeless nature of great works of art that continue to elicit powerful feelings from people all over the world in all walks of life is testament to the power of art. Part of that power is distraction, the ability of art as we view it to remove us mentally from the constraints and problems of our physical or emotional pain. This, too, can contribute to healing by reducing stress and enhancing well-being.

The Correspondence Bias in Person Perception

Research in social cognition shows evidence of a correspondence bias in perceptions of targets. More specifically, on the basis of their observations of targets, observers will infer that targets have traits or dispositions, even when the behavior of the targets was a function of or was constrained by situational factors (Hamilton & Sherman, 1994). For example, observers are likely to attribute signs of stress or strain that are observed in targets to underlying dispositions, as opposed to the effects of environmental stressors. To the degree that dispositional inferences are made about targets, they are likely to suffer both access and treatment discrimination. Thus, not only will targets suffer harm from a host of other environmental factors (e.g., stressful jobs, poor housing), but also they will further be harmed by the correspondence biases of observers.

Unfair Discrimination on the Basis of Strain Confounded Measures

Because of the above-noted relations among race, SES, exposure to stressors, and strain, to the extent that measures of psychological strain (e.g., neuroticism, NA, emotional stability) are used in personnel selection, individuals who have elevated scores on such measures may suffer both access and treatment discrimination. More specifically, the use of such measures for selection purposes may lead to indirect race-based discrimination against members of several minority groups (eg., African Americans, Mexican Americans, American Indians). In addition, if such measures are applied to existing employees, those who have elevated scores on them may suffer various types of treatment discrimination. Overall, therefore, it appears highly inappropriate to use measures of psychological strain (e.g., many popular measures of NA) for most personnel decision-making purposes. However, there is one important exception to this. More specifically, it is acceptable to use information from such...

Acu Points for Bothersome Bowels

I've helped many patients return to a more normal life through Oriental Medicine. In addition to working out an acupressure and acupuncture plan, I also help my patients address lifestyle habits, such as diet and stress management. Typical treatment lasts for several months, with acupuncture sessions spreading farther apart as your condition stabilizes and your own self-care becomes more effective. I also recommend that my patients begin taking acidophilus and bifidus supplements. These are the naturally occurring bacteria that are supposed to be

Day 3 Coping and identification of harder emotions

Several small and large group activities focused on stress during day 3. During art therapy, the campers' most stressful days were discussed. Then, artworks of a safe haven during times of stress were drawn and discussed with the group. Small group leaders also taught stress management and relaxation techniques. The large group challenge activity was impromptu skits. Here the children were placed in a stressful situation, but it was enveloped in a spirit of fun. This challenge activity reinforced a sense of mastery over stress and encouraged their resiliency skills.

Rescue or Acute Medications

Start with a combination of anti-emetics (if needed), sedation, and analgesics. If in 2 h the patient is no better, the sedation is repeated and acetaminophen is substituted for the NSAID. If these medicines are unsuccessful after 2-3 migraine attacks, a triptan is added. In most episodic migraine attacks, these measures combined with stress management, lifestyle change, and diet restrictions are effective. However, if the diagnosis is not clear and the patient has CDH with superimposed acute worsening, rescue medications are less effective.

Preventive Medications

When the patient presents with more than three attacks of migraine per week or more than three to four headache days per week and has failed to respond to lifestyle changes, diet, stress management, and rescue measures, daily preventive measures should be considered. This decision must be made together with the patient and parents. Other considerations for the use of preventive medications include excessive school absences and analgesic medication overuse. If the attacks are few but extremely severe and or prolonged, consideration can also be given to the use of preventive medications.

Course And Duration Of Episodes

We have already discussed the nosological issue of mania most likely being best seen in the context of a broader, bipolar affective syndrome that has sometimes yet to unfold. In this context, it is the manic-depressive cycle that is often the subject of investigation. However, manic episodes themselves have a definable course. Most patients experience more than one episode of mania and the interval from one episode to the next tends to decrease during the first five episodes (Cookson, 1998). However, the length between episodes shows an appreciable amount of individual variation, tending to cluster around stressful life events (Cutler and Post, 1982). The duration of manic episodes before the availability of effective treatments was on average six months, something that is, thankfully, amenable to treatment.

The Need for an Integrating Framework

Relationships, including emotional support, instrumental support, informational support, companionship, and social validation (Argyle, 1992 House, 1981). Different forms of social support can also be distinguished based on who provides the support - informal support provided by family, friends, coworkers, and neighbors or formal support provided by bureaucratic organizations and professional help-givers. Each of these different dimensions of support are likely to be more useful in dealing with particular kinds of problems than with others - for example, one would hypothesize that emotional support would be particularly useful in buffering individuals against interpersonal stress, while informational support would be less helpful in this regard. Similarly, one would expect different types of social support to be related to adjustment through differing mechanisms such as altering appraisal of the stressful event, enhancing mastery and self-esteem, improving problem-solving ability, and...

Psychological Factors Affecting Onset and Course

Although it is unclear what may temporally precede the onset of JRA in youth, current theories implicate a diathesis-stress model with a genetic predisposition toward the disease triggered by multiple pathways such as infection, psychosocial stressors, and mood resulting in the same disease (i.e., equifinal-ity Schanberg et al. 2000). Although psychosocial stressors and their impact on disease onset, course, and severity have been studied in adults, a systemic investigation has not been undertaken in the pedi-atric population with JRA. Stress has been examined as an outcome variable in this literature rather than as a predictive factor of onset, course, and severity of disease (Schanberg et al. 2000). One study employed a daily diary method for 7 days to observe daily mood, daily stressors, and daily symptoms in 12 youth with JRA. Results indicated that JRA symptoms, mood, and stressful events fluctuated daily. The most interesting and compelling finding was that daily mood and daily...

Subcortical FEAR System and Feelings of Anxiety

Until demonstrated otherwise, a reasonable working hypothesis is that the whole FEAR circuit is necessary for a fully elaborated anxiety response. It is important to reemphasize that such core emotional circuits can be sensitized by repeated activation with ESB or stressful life experiences (Adamec and Young, 2000). Once such limbic permeabilities are established (Maren, 1999), as may occur most dramatically in PTSD (van der Kolk, 1987), there are no robust ways to reverse them (Davidson, 1997), even though certain experimental agents (e.g., cholecystokinin receptor blockade) can provide prophylaxis against trauma effects in an animal model (Adamec and Young, 2000). We can also anticipate that rich social contact and sincere support after trauma might do the same (Ruis et al., 1999).

Had Enough Let Go of Stress

Ears the window to your soul As you read in Chapter 9, Pain Below the Belt, your ear acupoints lead to your whole body. An acu-ear treatment will strike out at your stress. Close your eyes and hold both ear lobes between your thumbs and index fingers. Gently squeeze while breathing slowly and deeply. Move up and over your ear, lightly pinching as you go. Gently cup your ears in your hand and slowly stretch them by moving forward and backward. Cover them with cupped hands and breathe slowly in and out for 30 seconds. Closing your eyes also shuts out distractions and helps you relax.

Helping the Patient Cope

Coping involves efforts to reduce stress in the face of adversity. Some coping mechanisms, such as prayer or seeking knowledge, are healthy. Alternatively, patients may erect psychological walls, or defense mechanisms, to avoid or deny the seriousness of their situation. Although less healthy, these responses can still help patients get through the difficult process of gradually accepting their illness as a result, such responses are mainly a concern if they persist.

Pollution Emotional and Cognitive Responses

Aresearch team led by Stephen Jacobs looked specifically at the relationship between air pollution and depression.14 They surveyed English-speaking and Spanish-speaking residents of the Los Angeles metropolitan area and obtained measures of depressive symptomatology and exposure to air pollution. The results showed that perceived air pollution was a significant predictor of depression when combined with one or more other stressful life events. This study controlled for other factors (e.g., socioeconomic status, prior psychiatric status) that could have contributed to depression scores.

Stress State and Creativity Possible Relationships

A stress state is a psychological state which accompanies stressful situations and stimuli. It can be identified by subjective, contextual, and physiological indicators, and it is multidimensional as it has several underlying factors. In general, states are influenced by appraisals of environmental threats, opportunities, and personal capability. These states will in turn influence the individual's situational response - actions, coping strategies, or avoidance. The overall process is a transaction between individual and environment, and states play a part in that process. The association between stress state and creativity can have implications for different contexts (e.g., education, organizations). Many researchers have realized this and studied the topic but a number of aspects remain ambiguous. Stress reduction through relaxation techniques has been found to increase creative performance in experimental and nonexperimental settings. However, not all studies have found a definite...

Bring out the best in the Whiner

W hile some complaining can be therapeutic for the complainer, and some can even be helpful to the listener, lots of complaining is simply wallowing. This is the Whiner's specialty. The Whiner's complaints have little to do with stress relief and are rarely helpful. Whiners are cousins to the No People, in the sense that their actions also emerge from the intent to get it right. But while they have a sense that things should be different, they have no idea how this should happen. So instead of taking action, they whine.

The Role of the Domain Specificity of Creativity Correlates

In general, differences in personality traits across domains have been repeatedly evidenced in previous research. Specifically, artists have shown higher levels of emotional expressiveness and have shown to be more sensitive to their feelings than scientists. Also, artists tend to experience more negative affect, be more impulsive, and have shown lower levels of emotional control than scientists. In terms also of the relationship between affect and creativity, the results from the study by Sanchez-Ruiz et al. show that, when considering domain in the analyses, the negative relationship between divergent thinking performance and the trait emotional intelligence factor of self-control (which includes the stress management facet) is only true for artists but not for technical and natural scientists, and social scientists.

Choose foods that help maintain a healthful weight

Continued their usual diet and lifestyle. Those in the other group went on a vegan diet with soy, fish oil, selenium, vitamins C and E, exercise, stress management techniques, and a weekly group meeting. At the end of one year, the men on the vegan diet had a 4 percent decrease in their PSA (from an average of 6.23 to 5.98), whereas the diet-as-usual group had a 6 percent increase (from an average of 6.36 to 6.74).16

Interference Control and Intrusive Memories

(Verwoerd, Wessel, & de Jong, 2009), nonselected undergraduates completed indices of the executive abilities of resistance to PI and response inhibition. The proactive interference task consisted of studying two lists of paired associates (i.e., AB - AC). The lists were construed such that for each pair, the cue (A) was strongly related to the target (B) in the first list, but weakly related to the target (C) in the second list (e.g., Sheep-Wool list1 Sheep-Grass list 2 ). The idea was that List 2 learning would require effort to override a strong tendency to respond with the List 1 target and that a relatively weak executive control would be reflected by more difficulty with List 2 learning. As an index of response inhibition, the color-name Stroop task was administered. In addition, participants reported how often they had experienced intrusive memories of a highly stressful event from their personal past in the week before the test session. The results showed a unique relationship...

Unclassified Interventions

Come scores by group were not provided. In yet another study, Hewson-Bower and Drummond (2001) compared two active treatments (stress management versus guided imagery focused on the immune system) with a wait-list control condition in 35 children with upper respiratory tract infections. No differences between the three conditions were found in terms of the number of symptomatic episodes however, the two active treatments had shorter episodes and elevated salivatory sIgA levels. Collectively, these studies suggest that psychological interventions may alter immune functioning, and larger-scale studies are warranted to elucidate the effects on disease progression.

Coping Skills and Adaptive Problem Solving

Fortunately, most people will find new ways to handle or cope with a crisis. Coping styles are the unique ways that patients deal with stress. For example, some cope with a stressful crisis by analyzing it, asking others for help, or gathering additional information. Some coping styles work better in certain situations than others. Box 45-2 lists some typical adaptive coping styles that can be suggested to patients, as well as pathologic coping styles that should be avoided whenever possible. Crisis resolution can be promoted by evaluating a patient's coping style and, when necessary, suggesting an alternative or more adaptive coping style. These new skills facilitate a patient's adaptation to the stressful life circumstances. In general, those who can flexibly use many coping styles are the most successful at crisis resolution and problem solving. Often, patients in crisis rely too heavily on one coping style, which may not be the most adaptive for a particular situation. Those...

Other Trauma Treatments

No acute psychiatric treatment is often the best course of action if symptoms and non-life-threatening problems are resolving and if social and occupational functioning have remained intact over the first 6 weeks. Evidence indicates that mandatory crisis intervention in non-life-threatening circumstances, often called critical incident stress management (CISM), or debriefing (Mitchell et al., 1983), is not helpful (Rose et al., 2004). Patients who have experienced a mass trauma or disaster may benefit from psychological first aid (Bisson et al., 2007). This approach fosters safety, calmness, self and community efficacy, social connectedness, and optimism. The best personnel to deliver this treatment remains controversial (clinician responder or emergency responder with community leader ) (Watson, 2007).

About Anger

Friedman et al., Alteration of Type A Behavior and Its Effect on Cardiac Recurrences in Post Myocardial Infarction Patients Summary Results of the Recurrent Coronary Prevention Project, American Heart Journal 112, no. 4 (1986) 653-65. Also see J. A. Blumenthal et al., Stress Management and Exercise Training in Cardiac Patients with Myocardial Ischemia Effects on Prognosis and Evaluation of Mechanisms, Archives of Internal Medicine 157, no. 19 (October 27, 1997) 2213-23. The former showed that Type A behavior could be reduced, and so doing significantly reduced the risk of a second heart attack. The latter study showed that stress management (relaxation, reducing hostility and depression) was more effective in reducing second heart attacks than even exercise or medication.

Education of patients Behavioral and Emotional Support

Utilization of nurses in the gatekeeper role of the patient's plan of care allows other members of the medical team (e.g., the physicians) to do what they do best, diagnose and treat. Leaving the role of education and support to the nursing staff is an effective and efficient way to provide patients with stress-reduction techniques, emotional support, continuity of care, and ongoing assistance. Teaching patients relaxation techniques can play a role in stress reduction. It can decrease the severity of headaches, and help reduce the need for multiple preventive medications and overly frequent use of acute medications. Some of the more common relaxation techniques used include rhythmic breathing, deep breathing, visualized breathing, progressive muscle relaxation exercises, guided imagery, and autogenics. Providing patients with material to facilitate these practices gives patients a means of self-control over their headaches.

Aspects of the Transforming Illness

Use creativity as a coping mechanism during illness as a way to manage stress. Our minds can generally focus on only one thing at a time, which makes creativity an excellent coping mechanism during illness because it can distract a sick person from physical discomfort by redirecting attention toward a creative activity. The folk artist Maud Lewis (Canadian, 1903-70), who had a lifetime of pain from severe juvenile rheumatoid arthritis, spoke about this distraction saying, As long as I've got a brush in front of me, I'm all right. Arthritis became a transforming illness in Lewis' childhood because she turned to art as a way to pass the time when poor health kept her home from school. Despite severely limited use of her hands, Lewis became a professional artist. Preferring to use her right hand to paint even though her left hand was less affected by arthritis, Lewis propped up her right hand with her left one in order to keep working.

Empirical Investigations of Intrusive Trauma Memories

Butler, Wells, and Dewick (1995) explored the effect of worry and imagery on intrusive images from a trauma film after film viewing. Participants were instructed to either worry about the film in verbal form (worry group), imagine the film in mental pictures (imagery group), or take some time to settle down (control group) after the film. Participants reported any intrusive images from the film in a diary during one week after film viewing. There were no significant differences between the three groups in intrusion frequency after a 7-day period, but the authors noted that most intrusive images were reported in the first three days in the diary. After three days, participants in the worry group reported significantly more intrusive images from the film compared to both the imagery group and the control group. Although the study by Butler et al. (1995) does not explicitly test an information processing account of PTSD, their results do have implications on the level of posttrauma...

Temperament and Personality

The major impediment to evaluation of the causal role of life events in anxiety (or depression), is the retrospective nature of most research addressing this issue. For example, Lteif and Mavissakalian (1996) found that patients with panic or agoraphobia exhibited an increased tendency to report life events in general this suggests that studies that limit assessment of life events to those preceding onset of a disorder may be misleading because they fail to provide comparison for the time period of onset. Moreover, stressful life events may interact with other risk factors such as family history of depression in precipitating episodes of panic (Manfro et al., 1996).

Overlap Between Mood And Anxiety Disorders

Ge X, Lorenz FO, Conger RD, Elder GH, Simons RL (1994) Trajectories of stressful life events and depressive symptoms during adolescence. Developmental Psychology 30 467-483. Last C, Barlow D, O'Brien G (1984) Precipitants of agoraphobia Role of stressful life events. Psychological Reports 54 567-570. Manfro GG, Otto MW, McArdle ET, et al. (1996) Relationship of antecedent stressful life events to childhood and family history of anxiety and the course of panic disorder. Journal of Affective Disorders 41 135-139.

Pregnancy and Migraine

Natural supplements such as magnesium oxide and vitamin B2 have demonstrated benefit in double-blind studies for migraine prophylaxis, and can be used when needed (see Chap. 9). Other non-medication options include biofeedback and other pain and stress management techniques. Yoga may also be of benefit in some women.

Indications for Splinting

Degree Wrist Extension Splint

Alexander,1 Feinberg,910 Gault,16 Mills,24 Partridge,26 Rotstein,27 and Souter29 have advocated a combination of hand splints and rest when the joints are inflamed. During periods of inflammation, the joints are more vulnerable to damage from both internal and external forces. Splinting has been noted to reduce pain and decrease inflammation and muscle spasm, thus reducing stress to the joints and allowing increased motion and function. A study by Zoeckler and Nicholas36 showed that 63 of the patients who responded to their questionnaire found moderate or great relief from pain and morning stiffness by using splints.

The Social Origins of Distress

A key insight of the sociology of mental health is that many people who experience mental distress may be responding normally to stressful life circumstances. Accordingly, research in the sociology of mental health has focused attention on the relationship between life conditions and mental health, demonstrating the negative impact of stressful life events as well as ongoing stressful life conditions. Sociologists have also shown that social roles, such as roles involving subordination to others, may be psychologically stressful and that absence of strong interpersonal ties makes individuals more vulnerable to distress (see Horwitz, 2002, for a brief review of these literatures). Mostly, however, this research has considered the impact of proximate social stressors that differentially affect individuals (e.g., divorce, poverty, unemployment) within particular societies at particular times. In contrast, contemporary social theorists present sweeping statements of the impact of current...

Cultural Immunity from Postnatal Depression

Other psychological theories have depicted women who develop postnatal depression as being emotionally immature, or lacking in social skills, or having anxiety problems that become exacerbated as a result of having a child. Still others have suggested that childbirth is a highly stressful event and that postnatal depression appears in women who are excessively prone to stress and lacking in coping skills. None of these theories entertains the possibility that the woman's culture, rather than she as an individual, might be responsible to a great extent. Yet this is unambiguously the case as one looks at the matter globally and discovers that many cultures have no postnatal depression, nor any equivalent of it. Equally striking is the finding that, as with clinical depression generally, postnatal depression is a psychiatric phenomenon bound largely to Western culture.

Lay Administered Diagnostic Schedules

From the first use of lay-administered schedules in epidemiological studies, questions have been raised about their validity because the resultant prevalence rates were perceived as unrealistically high. This perception was strengthened when the National Comorbidity Survey reported higher overall and diagnostic-specific rates than the other North American studies (Regier et al., 1998). In view of the high rates, it has been suggested that epidemiologic surveys might be identifying normal and transient reactions to stressful life events rather than clinical disorders. If clinicians were to examine the subjects, it was thought that they would be able to differentiate between normal and pathological reactions and would identify smaller numbers of subjects and therefore produce lower prevalence rates.

Psychosocial and Spiritual History

A spiritual history provides information about what gives meaning to the patient's life. Spirituality helps patients cope with serious illnesses, debilitation, and dying. This part of the medical history provides excellent insight into the patient's spiritual needs and belief systems. Meditation and prayer can complement medical care. Spirituality can offer hope to those with chronic disease and may even provide new meaning to their suffering. Several studies have revealed the beneficial effect of spirituality with regard to stress reduction, recovery from illness, mitigation of pain, and faster recovery from surgery. Puchalski and Romer (2000) suggested that a spiritual history might begin with an introductory question such as

Primary Prevention A Focus on Lifestyle

Ten minutes of relaxation, silence, or meditation daily for stress reduction. Consider a fifth lifestyle factor stress reduction or relaxation. intima-media thickness), angina, left ventricular hypertrophy, and overall mortality. A review of controlled trials using Transcendental Meditation (TM) techniques (many of which also compared TM to progressive muscle relaxation and other stress reduction techniques) found the following (Walton et al., 2004) A relaxation or stress reduction variable is added to the basic lifestyle formula for two main reasons (1) the mounting support from clinical research and (2) the epidemiologically well-established correlation of stress to overall morbidity and mortality (Figueredo, 2009). Also, a compelling com-monsense belief among the general public holds that stress is bad for health and can be reduced by various behaviors.

Lateral Epicondylitis

As with other overuse injuries, early treatment goals include reducing stress to the involved muscle groups, identification and adaptation of damaging use patterns, and patient education. Two separate randomized controlled trials (RCT) document wrist immobilization as a statistically significant, effective method for treating lateral epicondylitis. One RCT study found no significant difference between patient groups receiving wrist immobilization splinting and corticosteroid injections,13 and another RTC study found no statistically significant difference between immobilization casting of the wrist and taking a recognized nonsteroidal anti-inflammatory.16 Both studies recommended splinting casting over injection or pharmacological intervention because splinting casting lacks adverse side effects associated with drug-administered therapy.

Cervical Radiculopathy

Treatment relieves pressure on the affected nerve and is mainly conservative, including rest, pain relief, stress reduction, and short-term muscle relaxants. Patients with persistent symptoms may need structured physical therapy and referral for specialist evaluation. Neurologic signs and symptoms and loss of strength are also indications for referral to neurosurgery. A few patients require surgical intervention.

Joanne L Davis Heidi S Resnick and Rachael M Swopes

Our chapter focuses primarily on the use of psychoeducation as a component of secondary intervention approaches in which information is delivered relatively soon after a highly stressful event (e.g., assault) has occurred. In addition, our primary focus is on effects of sexual violence occurring to adult women. It should be noted, however, that psychoeducation content describing possible reactions following a traumatic event, the theories behind development and maintenance of such reactions, and strategies for successful coping and related rationale are also integral components of traditional (e.g., tertiary interventions) treatment for post-traumatic stress disorder (PTSD) and other psychological disorders,5,6 as well as included within multiple-session early interventions that also include additional treatment strategies such as imaginal and in-vivo exposure to trauma-related cues.7,8 Phoenix discussed several key content areas that are often...

Acu Points Concerning Your Burning

Typically, I will use acupuncture and prescribe an herbal formula for their condition and overall health. I have also given them a second herbal prescription if acute symptoms arise. Diet and stress management are quite important for continuous relief. Acupressure and regular exercise are an effective tag team for home care. Common herbs for this condition include Bian Xu, Che Qian Zi, Mu Tong, and Fu Ling. A qualified herbalist will be able to create an individualized approach customized to your needs.

Electromagnetic Therapies

Franz Mesmer, an eighteenth-century Viennese physician, developed a theory of animal magnetism, which he believed to be a basic biophysical force similar to gravity and capable of producing profound neuropsychiatric and physical effects. His first scientific writing on this topic, On the Medicinal Uses of the Magnet, was published in 1775. Although he credited his successful treatment of a woman with numerous complaints to a magnet's ability to realign polarity in her internal organs, it soon became clear that he had discovered hypnotism instead. That is the source of the word mesmerize. Animal magnetism later was shown to be not a biophysical force, but a reaction to the power of suggestion. (For the use of hypnosis in reducing stress, see Chapter 15.)

A biopsychosocial model of response to TBI

One useful way of looking at the evolution of the behavioral and emotional disorders following TBI is to consider them in the context of the diathesis stress model. This model proposes that individuals vary in terms of their sensitivity to stress-induced biological responses, due to their genetic endowment and their exposure to stressful life events (SLE), both in the presence of the injury and during their pre-injury lives. As discussed in chapter 4, stressful experiences may alter endocrine processes to the extent that normal homeostatic processes become compromised and thus psychopathology ensues. A stressful experience may thus exhaust psychological coping by compromising underlying biological and motivational processes. It can be argued that SLEs involve different degrees of controllability, some where life changes, although stressful, are controllable (i.e., deciding to move, taking a new job, terminating a relationship) while others can affect the individual when there is...

Precipitating Factors Stress

Although there is continued interest in the contribution of life events stressors to the onset of mental disorders, their role in increasing the risk of onset of psychotic disorders appears to be weak. With a few exceptions, such as the Chung et al. (1986) finding of an association between life event stressors and first lifetime onset of schizophreniform disorder (Chung et al., 1986), most studies find small and nonsignificant effects of life event stressors (e.g., Dohrenwend and Egri, 1981). At best, it has been suggested that social environmental stressors trigger psychotic episodes in individuals already diagnosed with a psychotic disorder (Bromet et al., 1995). As noted above, Dohrenwend et al. (1992) concluded from their classic study of the social determinants of mental illness in Israel that social selection rather than social causation (e.g., stress) was responsible for the social class differences in schizophrenia.

Dilemma Of Psychiatric Diagnostics Dsms And Beyond

Some mental disorders arise through stressful life circumstances. Others emerge more from constitutional infirmities. Nature-nurture arguments do not help us much in unraveling such intertwined complexities, unless discrete genetic differences can be discovered, as in fragile X and Williams syndrome (Chapter 14). Ultimately psychiatric thought must continue to be guided by a careful appreciation of the evolving stories of selves in action on the stage of life. Neither the brainless psychiatry of the middle of the 20th century, nor the mindless variety of the past 30 years should be taken to represent the most we can achieve. The future should yield a synthesis. However, since we have been unable to unambiguously link most mental functions to brain functions and have only been able to pinpoint biological causes for a few rare genetic disorders, we have been left no other option than to categorize mental disorders on the basis of outward symptoms. Hopefully brain imaging and new...

Spirituality Religion as a Healing Pathway for Survivors of Sexual Violence

Et al. explored positive and negative religious strategies among individuals coping with the Oklahoma City bombing, college students dealing with major life stressors, and patients coping with medical illnesses.34 He found that positive religious coping consisted of religious forgiveness, seeking spiritual support, collaborating with God to solve problems, spiritual connection, searching for purification through religious activities, and religiously viewing the stressor as potentially benevolent. Negative spiritual coping strategies included spiritual discontent, viewing the stressor as a punishment from God because of their sins, dissatisfaction with religious leaders and members, appraising the stressor as the devil's doing, and reappraisal of God's powers. Gall examined the role of spiritual coping in addressing current life stressors for adult survivors of child sexual abuse, and in doing so he distinguished between negative and positive spiritual coping strategies.35 Negative...

Psychological Effects Of Materialism

That they do not act upon these feelings may be related to the therapeutic role that consumption has adopted. Nearly two-thirds of Americans report that they use shopping as a stress reliever. Only television watching and telephone talking rate as more effective in terms of stress reduction. Consumption has also acquired a social dimension that is the source of positive emotion and mutual support, however meager, for many people. Thus life-style simplifications that curtail consumption may represent a perceived threat to coping ability.

Interventions Using Psychosocial Data

Because health outcomes are affected by stressful life events, coping (e.g., stress appraisal), and resources (e.g., personality, social support), addressing any dimension can have a positive effect on functioning. As stress increases relative to available support and coping capacities, disequilibrium results. Increases in stress or decreases in social support tend to destabilize functioning, and various factors can contribute to exacerbating or mitigating stress. For example, a new medical diagnosis is stressful, whereas a loving partnership is a source of support and will tend to ease stress. Some life events, such as the death of a supportive partner, affect several elements in the model, as the bereaved partner confronts a major loss (stress) without the person who had previously offered comfort in such times (decreased support). Accordingly, persons who are grieving are at higher risk for experiencing health problems (Rogers and Reich, 1988). Interventions that should be part of...

Affectrelated traits and creativity The case of trait emotional intelligence and divergent thinking

The literature on links between affect-related traits and creativity is informed mainly by empirical work based on trait emotional intelligence and divergent thinking. The studies conducted so far have generally found no overall correlation between global trait emotional intelligence scores and divergent thinking. However, this null correlation may conceal different relationships between divergent thinking and the separate factors underlying global trait emotional intelligence. In a recent study, Maria Jose Sanchez-Ruiz, Daniel Hernandez-Torrano, Juan Carlos Perez-Gonzalez, and K. V. Petrides found certain trait EI factors such as sociability (i.e., assertiveness, emotion management, and social awareness) to be positively related to divergent thinking, while others such as self-control (i.e., emotion control, impulsiveness, and stress management) were related negatively to it. The latter finding is consistent with positive correlations found elsewhere between divergent thinking...

Coping with Terrorism and Other Traumatic Events

We should expect to experience a full spectrum of strong emotions, ranging from stunned disbelief and shock to anger, grief, fear, numbness, guilt, and or resolve. These feelings are normal. Some might experience post-traumatic stress disorder (PTSD), an understandable response to overwhelmingly dangerous and sudden events. Although PTSD is more likely to occur following stressful events, it is not inevitable.

Alopecia Clinical Summary

It can be classified into scarring (absence of follicles) and nonscarring (presence of follicles) alopecia. Scarring alopecia is commonly caused by discoid lupus erythematosus (erythematous mottled pigmentation and atrophic scalp scarring) and folliculitis decalvans (multiple crops of pustules on the scalp). Occasionally, prolonged bacterial and inflammatory fungal infections (kerion) can induce scarring on the scalp. Nonscarring alopecia results from alopecia areata (annular areas of alopecia on the scalp or beard area), telogen effluvium (diffuse scalp shedding of hair 2 to 3 months after a stressful event, illness, or new medication), anagen effluvium (diffuse scalp shedding after chemotherapy), trichotillomania (constant pulling of the hair), traction alopecia (chronic tension of braided hair causing alopecia), and tinea capitis. Syphilis can cause a patchy, moth-eaten alopecia.

Observation in a controlled environment

One possible issue of concern with the SNAP task is that it places children in a stressful situation. This raises clear ethical concerns that are discussed in the paper. show great excitement in rule-breaking, while Eisenberg, Fabes, Nyman, Bernzweig, and Pinuelas (1994) found that boys became more aroused than girls when watching a film that contained an element of threat. Boys' positive enjoyment of this kind of arousal has been posited as one factor contributing to early gender segregation in peer interactions (Maccoby, 1998), and so it may also be that the SNAP game was not only more exciting for boys, but also more representative of boys' everyday social interactions. This hypothesis is supported by the stronger agreement of SNAP ratings with adult ratings for boys than for girls (although this gender difference was only statistically significant for mother ratings in S2, and may simply reflect the greater variance in boys' ratings). In support of this view, careful naturalistic...

The effect on human health

At the Royal College of Nursing Conference (Frith 2004) showed that women recovering from breast cancer were significantly better at managing their disease if they owned a pet and felt less disfigured following surgery. The psychological benefits of animals to humans are that they are aesthetically pleasing, they instigate a nurturing instinct in man and respond readily to human affection, all of which help to reduce stress and promote feelings of self-worth.

General Treatment Principles

Antidepressant, antimanic and mood stabilizer drugs affect the core brain systems involved in modulating stress. Not surprisingly, the conditions in which antidepres-sant drugs are indicated are exacerbated by stress, suggesting that antidepressants may simply restore function by reversing the adverse effects of stress or buffering the brain from stressful life events. Antidepressants do not cure depression or any other condition (Hyman & Nestler, 1996 Duman et al., 1997, 1999 Stahl, 1998). This is most evident through the high rates of recurrence on discontinuation of successful treatment, even after long periods of medication-induced remission (Keller, 2001).

Quasiexperiments casecontrol studies and cohort studies

To confirm the relationship between severely stressful life experiences and relapse of breast cancer found in a previous case-control study. Overall the researchers found no increased risk of recurrence in women who had one or more severely stressful life experiences in the year before diagnosis compared with women who did not, and of those who had stressful experiences since diagnosis the results demonstrated a lower risk of recurrence, hence confirming that stressful events did not lead to increased risk of recurrence.

Diagnostic Procedures

(which accelerates Cortisol metabolism) (2) the presence of a serious illness or stressful event, chronic diseases (renal failure), or major depressive states (which stimulate the secretion of glucocorticosteroids) and (3) obesity and highestrogen states (estrogen therapy, pregnancy), but in the obese patients the urinary free Cortisol is usually normal. When the results are equivocal, the 2-day test (0.5 mg dexamethasone every 6 hours for 2 days) lowers the plasma Cortisol concentration below 50 nmol L in patients without endogenous Cushing's syndrome.

Provisional hypothesis and rationale for procedures used

When the above case was discussed it was felt that Jane's family would be suitable for family work as there was a high degree of contact between the patient and her parents ( 35 hours) and there appeared to be a certain amount of high expressed emotion. It was agreed that assessment should begin with a view to offering a number of family sessions on completion. Depending on the outcome of the assessment, differing amounts of education, stress management and goal-setting would be negotiated. The aim of the family work would be to lower any distress within the family, offer education to cover any deficits in knowledge and attitude towards

Reported In 70100 ofpatienls and

Increases in intensity as therapy continues Increase aerobic activity, light exercise, improve nutriiion, increase noncaflfeinated fluid intake stress management technique pharmacologic intervention megesterol acetate, methyl phenidaie, to help with either fatigue or anorexia Psychiatric history prior to therapy and reassess every 4 to 6 weeks, antidepressants SSRIs, mood stabilizer, bupropion, psychostimulants

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