Quality Stress Management Course
Patients with IBD who had at least one relapse in a 2-year period after entry into the study. A mean of 2.2 exacerbations was seen per subject during the study period. Mood changed concurrently with exacerbations of IBD, but no evidence indicated that stressful life events or depressed mood precipitated exacerbations in this study group 3 . Interestingly, in another investigation carried out on a larger series of 107 IBD patients and 60 controls, patients reported a lower amount of life-event stress than controls but listed more feelings of being under pressure 4 . Greene et al. found that psychosocial stress contributes to the clinical course of IBD 5 and, more recently, Mittermaier et al. reported that psychological factors such as a depressive mood associated with anxiety and impaired quality of life may exert a negative influence on the course of IBD. Therefore, assessment and management of psychological distress should be included in clinical treatment of patients with IBD 6 .
Stress management alone does not significantly alter the course or prognosis of COPD however, as a component of the management program in a rehabilitation setting, it can improve a patient's function, possibly by allowing better coping with their disease (39,40). In a meta-analysis of psychosocial interventions in COPD, the effect of relaxation training was confirmed to be most notable in the areas of subjective dyspnea and psychological well being (41). There was also a trend toward less utilization of hospital services and toward a greater sense of independence in these studies. This is not necessarily surprising, as the patients who can remain calm and are able to relax are less likely to unnecessarily utilize emergency services. The effect of stress relaxation techniques on the utilization of sedative hypnotic medications in COPD has not been studied, but in our clinical experience, the need for these agents does seem to decline with the learning of appropriate relaxation...
In fact, patients are far more apt to present in our offices requesting an hypnotic intervention. We might then think of clients as falling into several categories. There is that group of clients who present with symptoms that are particularly amenable to an hypnotic intervention. Areas of increased use of hypnosis include stress reduction, pain management wellness, and uncovering work in a psychodynamic relationship. Many of these clients are sophisticated in their knowledge of alternative health benefits and ask for information on hypnosis, while others are aware of the benefits of stress reduction techniques such as relaxation exercises, meditation and guided imagery, but are uninformed about their similarity to hypnosis. Still others are uninformed about hypnosis and ignorant of its application to their problem. Those who are actively resistant to the idea of hypnosis pose a particular challenge to clinicians. Resistance may come from several sources. Religious and cultural...
A heterogeneous group of disorders characterized by the acute onset of psychotic symptoms such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption of ordinary behaviour. Acute onset is defined as a crescendo development of a clearly abnormal clinical picture in about two weeks or less. For these disorders there is no evidence of organic causation. Perplexity and puzzlement are often present but disorientation for time, place and person is not persistent or severe enough to justify a diagnosis of organically caused delirium (F05.-). Complete recovery usually occurs within a few months, often within a few weeks or even days. If the disorder persists, a change in classification will be necessary. The disorder may or may not be associated with acute stress, defined as usually stressful events preceding the onset by one to two weeks.
This block contains disorders in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations.
And then breathe deeply and relax to make the craving go away. Repeat until the situation no longer evokes a craving. Generally, this should be done after the 3-day withdrawal from nicotine, d. Recommend using a nonsmoking break for stress management. This is designed to mimic the behavioral stress management components of taking a smoke break, but without a cigaret. There are three steps (1) get away from the stressor, (2) distract oneself with a minor activity, and (3) take several deep breaths to relax.
This category differs from others in that it includes disorders identifiable on the basis of not only symptoms and course but also the existence of one or other of two causative influences an exceptionally stressful life event producing an acute stress reaction, or a significant life change leading to continued unpleasant circumstances that result in an adjustment disorder. Although less severe psychosocial stress ( life events ) may precipitate the onset or contribute to the presentation of a very wide range of disorders classified elsewhere in this chapter, its etiological importance is not always clear and in each case will be found to depend on individual, often idiosyncratic, vulnerability, i.e. the life events are neither necessary nor sufficient to explain the occurrence and form of the disorder. In contrast, the disorders brought together here are thought to arise always as a direct consequence of acute severe stress or continued trauma. The stressful events or the continuing...
Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness, may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence. Typical features include episodes of repeated reliving of the trauma in intrusive memories ( flashbacks ), dreams or nightmares, occurring against the persisting background of a sense of numbness and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and...
States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or a stressful life event. The stressor may have affected the integrity of an individual's social network (bereavement, separation experiences) or the wider system of social supports and values (migration, refugee status), or represented a major developmental transition or crisis (going to school, becoming a parent, failure to attain a cherished personal goal, retirement). Individual predisposition or vulnerability plays an important role in the risk of occurrence and the shaping of the manifestations of adjustment disorders, but it is nevertheless assumed that the condition would not have arisen without the stressor. The manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some...
For most people with stable angina, exercise is not only safe but beneficial. It is generally best to avoid rushing around, and you should try to avoid stressful situations. However, modern treatment of angina is not about wrapping patients up in cotton wool, preventing them from living a full and active life.
The MET system reinforces who and what physiologically constitutes a critically ill patient, and therefore helps to direct attention to those at risk. Along with the ongoing overall hospital education and awareness processes that a MET system entails, this means that the staff becomes more skilled and confident in their initial response to critically ill patients. They also no longer have to deal with these extremely stressful situations and with their potentially adverse outcomes alone. It may be these more intangible benefits that explain the positive attitude of nursing staff toward the MET concept (45).
They did when they were younger, averaging about 50 propositions at the first interview and just over 100 at the second interview. More interesting, stress still had an effect on recall. Children in the highest-stress group recalled less about preparing for the storm than did children in the moderate- or low-stress group but just as much information about the storm itself and its aftermath. But children in the highest-stress group needed more questions and prompts to recall as much information as children in the moderate- and low-stress groups, which suggests that they have more difficulty accessing or talking about this very stressful event.
McDermott, J., Goldberg, A., Park, S., Fivush, R., Bahrick, L., & Parker, J. (1999). Children's long-term memory of a stressful event. Poster presented at the meetings of the Cognitive Development Society, October, Chapel Hill, N.C. Nelson, K. (1988). The ontogeny of memory for real events. In U. Neisser & E. Winograd (Eds.), Remembering reconsidered Ecological and traditional approaches to the study of memory (pp. 244-276). New York Cambridge.
Whether or not it was really fair to expect that of the Unhappy Husband is not clear. True, the psychotherapeutic sessions he had should not, at first glance, be termed treatment , at least not if the label is to be reserved, as we suggested it should be, for attempts to cure illnesses or disorders defined as deviations from species-typical functioning. Rather, what the man showed was a very normal (species-typical) mental reaction to stressful circumstances in his life, which he was unable to escape. So what was done with him looks more like an enhancement of his mental strength that enabled him to cope with those circumstances, and thus improved his well-being. However, seen from another possible perspective - the view that the common goal of medicine is the alleviation of suffering which results from certain physical or mental states - the exclusion of the Unhappy Husband from the basic, macro-level package of medical care seems arbitrary.
Under certain stressful situations, the brain sends impulses to the two small adrenal glands that lie on top of the kidneys. They produce two chemicals called adrenaline and noradrenaline, which affect the body in various ways. These chemicals are released into the bloodstream to help the body react to stressful and potentially dangerous situations. This is often called the fight-and-flight response. The heart rate and blood pressure increase, the breathing gets faster and deeper, sugar is released into the blood from the liver providing energy and fuel for the muscles, and the person feels sweaty and nervous. These chemicals can be measured in the blood. The brain senses, feels, hears, or sees the danger and the adrenal glands produce the chemicals that enable the person to either fight or flee.
Appraisals at work are intended to be a useful, productive, positive, two-way exchange of views between colleagues or employers and employees. This should reduce stress and have very beneficial results in reducing heart disease. There is no doubt that effort reward imbalance is of considerable public health importance.
Can a psychological approach be of any help to the surgeon in the management of patients with IBD To find it out, the surgeon should know whether or not emotional distress plays a causative role in the onset of the disease and whether a stressful event may facilitate an acute attack. Moreover, the surgeon should be aware of the role of psychological support, if any, in the recovery of patients after surgery, especially considering the high recurrence rate of Crohn's disease.
Temperament is also likely to play a part. Stressful life events result in different effects on children as a consequence of individual differences in temperament (Goodyer, 1990). This, in turn, is likely to contribute to their developing personality as well as to the quality of their interactions with adults and peers. For instance, children with ''adverse'' temperamental
Are subjected to sufficient repeated stress 30 . Overt stress fractures similar to those found by West and colleagues have been demonstrated by scanning electron microscopy in our laboratory (Fig. 4) and in a recently reported human patient 31 . A type of'materials failure' of structural elements seems an attractive explanation, in that we found that both reducing stress application frequency (respiratory rate) and stress amplitude (pulmonary artery peak pressure) effectively limited VILI.
The adrenal medulla produces epinephrine and norepinephrine in response to stressful situations, arousing the body to action. As we saw earlier in this chapter, epinephrine increases heart rate and blood pressure and diverts blood flow to active muscles and away from the gut. These fight-or-flight reactions can be stimulated by physically threatening events, such as encounter
NPY is a 36 amino acid neuropeptide that is widely distributed in the brain. In the hypothalamus, it is synthesized in the arcuate nucleus and released in the paraventricular nucleus. It stimulates food intake by binding to Y1 and or Y5 receptor subtypes (12-14). This increase in feeding can be observed upon infusing the peptide intracerebroventricularly (i.c.v.) in normal rats and is accompanied by a rapid, sustained and marked increase in body weight (15,16). Central NPY infusion also stimulates insulin secretion via an activation of the parasym-pathetic nervous system reaching the endocrine pancreas (17). Concomitantly, central NPY administration increases the activity of the hypothalamo-pituitary-adrenal axis, with resulting hypercorticos-teronemia and increased susceptibility to stressful situations (15,17). Finally, central NPY reduces the activity of the efferent sympathetic nerves reaching brown adipose tissue, with resulting decrease in energy dissipation as heat (18,19).
Stress has also been implicated in the causation of IBD. Significant association between acute daily stressful events and bowel symptoms in patients with CD has been shown and these patients have a greater risk of active disease 14,15 . Stress-related IBD was also demonstrated in one study where Bedouin Arabs developed UC when moving from their rural life style into government housing 16 . Smoking has been shown to be associated with an increase susceptibility to CD together with rapid disease progression and immune suppression. In contrast, smoking has been demonstrated to have a protective effect against the development of UC through unknown mechanisms 17 .
I saw patients who started to suffer from ulcerative colitis after the death of the mother, or a divorce or a car accident as well as patients whose colitis disappeared after retirement from a stressful job. It may seem anecdotical, but it is well known that there are very close connections between the central nervous system (CNS), the autonomic nerves and the so-called gut brain , represented by the intrinsic nervous system of the bowel devoted to motility, absorption, secretion, hormonal and immunological response to endogenous and external stimuli. The psycho-neuro-endocrine-immune system (PNEI) is an interactive cybernetic network that regulates activity of abdominopelvic viscera in health and disease 11 . As an example, the role of enterochromaf-fin cells in determining mucosal inflammation has been recently investigated in the large bowel they may be involved in determining both appendicitis and ulcerative colitis 12 .
Coping efforts can be directed toward dealing with the stressful situation itself, managing psychological distress aroused by the situation, or maintaining interpersonal relationships. Most stressful situations evoke all three modes of coping. On learning of their diagnosis, patients may need to minimize the seriousness of their situation or they will be flooded with emotions and not be able to act. Slowly, the patient can acknowledge emotions and deal with the situation in a more adaptive fashion, such as by seeking information to make a treatment decision. Many patients try to normalize or pass as healthy, performing activities that are not advisable.
When an animal is confronted with a stressful situation that requires increased activity fighting or fleeing, in the extreme case neuronal signals from the brain trigger the release of epinephrine and norepinephrine from the adrenal medulla. Both hormones dilate the respiratory passages to facilitate the uptake of O2, increase the rate and strength of the heartbeat, and raise the blood pressure, thereby promoting the flow of O2 and fuels to the tissues (Table 23-6).
Several studies have suggested that psychologically stressful life events, such as the death of a spouse, are potential triggers for myocardial infarction and sudden death (95,96). Other data have shown that periods of general calamity increase the frequency of myocardial infarction. For example, during the 1991 Persian Gulf War, Iraqi missile attacks on Israel nearly doubled the relative frequency of cardiovascular deaths in that country on the day of attack (97) (Fig. 10). Immediately following severe earthquakes in Athens (98), Hyogo, Japan (99), and Los Angeles (100), researchers documented an increase in cardiovascular mortality. In Los Angeles, there were 24 sudden cardiac deaths on the day of the quake, compared to an average of 5 such deaths per day the preceding week. Only 3 of the 24 deaths occurred in relation to unusual physical exertion (100).
OUR 10 STEP METHOD TO REDUCE STRESS Living a healthy life may mean having to make big and difficult changes, and stopping some of the things you enjoy some of these (for example smoking and drinking alcohol) you may believe are helping you to cope with stress. The things that will work, making you feel better, and reducing your stress and your risk of developing coronary heart disease are Exercising, ideally, every day and doing a form of exercise that you enjoy and that you will continue for the long term. Going to the gym is not everyone's idea of fun, but it is not meant to be if you do it properly. Many people join a gym, go once or twice, and then resent having to pay the membership because they don't enjoy it, and don't return. Gym work does not need to be enjoyable, and the best exercise is one where you exert yourself. The idea is to get hot, sweaty, and breathless for at least half an hour, every day. Exercise to this intensity is useful. Useful exercise should be...
Many biomedical examples call for the use of correlation coefficients A physician might want to know whether there is an association between total serum cholesterol values and triglycerides. A medical school admission committee might want to study whether there is a correlation between grade point averages of graduates and MCAT scores at admission. In psychiatry, interval scales are used to measure stress and personality characteristics such as affective states. For example, researchers have studied the correlation between Center for Epidemiologic Studies Depression (CESD) scores (a measure of depressive symptoms) and stressful life events measures.
Hypnosis as a therapeutic approach contributes to all three of these components of stress management. The part hypnosis may play in cognitive attitudinal change, arousal management and in the treatment of the psychological and physical consequences of stress, will be reviewed and the management of anxiety disorders that may result from chronic stress will be outlined. Exercise and the maintenance of physical fitness also reduce the inappropriate arousal responses to stressful life events. The effects are reported immediately after exercise and following a regular exercise programme (Markoff, Ryan & Young, 1982 Ransford, 1982). Both basal and phasic physiological responses are reduced as a result of increased physical fitness. Once more motivation of the patient to maintain this programme is difficult even after the rationale is explained. Where stress is not the result of challenges being turned into threats, stress management may need to consider lifestyle changes. Constant, ongoing...
Dissociative stupor is diagnosed on the basis of a profound diminution or absence of voluntary movement and normal responsiveness to external stimuli such as light, noise, and touch, but examination and investigation reveal no evidence of a physical cause. In addition, there is positive evidence of psychogenic causation in the form of recent stressful events or problems.
The combination of lifestyle changes - being on a low fat diet, stopping smoking, exercising every day, managing and reducing stress, having good-quality, restful sleep and being generally happy, is very effective in relieving angina and reducing the risk of heart attacks.
More examples of this kind of extreme dissociative response to trauma emerged, leading to more systematic examination of the connection between trauma and dissociation. The phenomenology of post-traumatic stress disorder involves, first of all, a traumatically stressful event (APA, 1994). In the DSM-IV there are two components. The first is the actual experience The person experienced, witnessed, or was confronted with an event or events that involved an actual or threatened death or serious injury, or a threat to the physical integrity of self or others (p. 209). The second requirement is 'the person's response involved intense fear, helplessness, or horror' (p. 209). The idea was to make it a stringent requirement. There are problems, however, with this definition in that some peoples' reaction to fear, helplessness or horror may come a long time after the trauma itself.
Shows that connecting people to nature with a view of a Figure 4-17. Space plan, 3495 square feet. Memorial Breast Care Center at Anaheim Memorial Hospital, Anaheim, garden, or a water element like a large fountain, and nat- CA. (Architecture and interior design Taylor & Associates Architects, Newport Beach, CA.) ural light has immediate physiological benefits in terms of reducing stress. Even a simulated view of nature as in Color Plates 9, 25, and 28, Figures 4-20, 5-70, and 7-15, respectively, is effective. Providing options and choice also reduces stress. Patients who visit the Scripps Breast Care Center (Figures 4-19 and 4-21 and Color Plates 10, 11, Figures 4-22, 4-23, and 4-24) have a choice of five options to fill their time while waiting for the procedure. After gowning, they may sip tea from a china tea service and read magazines watch a video on breast self-exam visit the resource library to select a book or video (using wireless headphones) or go on line to research...
Recently, we assisted to an increase of laparoscopic techniques in the field of gastrointestinal surgery, which also involved IPAA, whose laparoscopic practicability was shown with complications and overlapping results to the open approach 35, 36 . There are still some incontrovertible data missing about advantages of the mini-invasive approach in terms of surgical morbility, stress reduction and a faster healing process and more restricted intraabdominal adhesion formation, as data to compare open and laparo-scopic surgery are presently unsuitable 8 . A recent randomised Dutch study 37 showed a comparable life-style between the two groups of patients, but the laparoscopic operation lasts longer, has higher costs and shows no clear advantages about the use of analgesics and duration of hospitalisation. The only real advantage that is presently well documented for the laparoscopic approach is the higher cosmetic effect 36 . Further prospective evaluations are necessary to define the...
Refers to different types of memory disorders. Individuals suffering from anterograde amnesia (ICD-10 R41.1) are severely impaired in their ability to form new lasting memories. While their short-term memory is usually intact, they forget everything they experience shortly afterwards. In contrast, people with retrograde amnesia (ICD-10 R41.2) are unable to recall events which occurred before onset of amnesia. A third type of memory disorder is so-called dissociative amnesia (ICD-10 F44.0) which is characterised by an inability to recall certain episodic or autobiographic memories usually related to traumatic or stressful events. Depending on whether the memory loss is either quite generalised or rather confined to a certain period of time, different subtypes of dissociative amnesia can be distinguished.
To reconfigure gene expression to effectively manage stress conditions. PKR and family members, PKR-like endoplasmic reticulum kinase (PERK), general control non-de-repressible 2 (GCN2) and heme-regulated inhibitor (HRI), share a conserved kinase domain but differ in their flanking regulatory domains. These different flanking domains allow tailored responses to different environmental stresses. Activating ligands for each of the kinases include viral double-stranded (ds) RNA for PKR, uncharged tRNA resulting from amino acid starvation for GCN2, accumulated unfolded proteins for PERK, and low heme concentrations for HRI. There is, however, a degree of redundancy in the response of these four kinases. This is in part due to coordinate induction of multiple signalling pathways, but also to a shared responsiveness of each kinase. The activation of GCN2 by amino acid starvation, for example, has clear application to the detection of intracellular parasites. It could be conjectured that...
This may be accomplished easily by discussing the everyday phenomena of physiologic responses to stressful events. One easily understood example is that of blushing with embarrassment. The clinician can explain that one first experiences something, followed by a feeling reaction of embarrassment, followed often 'instantaneously' by a physical response of blushing which in itself may be embarrassing. When the clinician asks the child if they stay blushed, they usually comment that they can and do act in some way to relieve the feeling of embarrassment, thus curtailing the blushing episode. This brief conversation can provide an everyday example of how a shift in the way a child feels can provide a shift in the physical response (of blushing) without even thinking about it. Graphic representative of changes in autonomic responsivity in response to feeling or 'thinking' changes can be even more dramatically demonstrated to children through computerized biofeedback reflection of EMG...
To assess ego strength, we look for evidence that the patient is oriented in time and place, that thinking is rational and the capacity for judgement is unimpaired either by organic or by psychological problems. The patient's capacity to persist with relationships and occupational or vocational endeavours in the face of challenges provides us with another opportunity to indirectly assess ego strength. This is why it is important to take an educational and occupational history patients who present with histories of dropping out of education, being fired from jobs or flitting from job to job, would raise the question of whether they have a sufficiently well-developed capacity to persevere with stressful situations. Difficulties in this area would not bode well for a course of psychoanalytic therapy, especially of a brief nature.
In some respects, organisms that survive subzero temperatures by avoiding freezing and supercooling are living dangerously. The supercooled state is unstable. Fatal freezing may result from contact with an ice nucleator, exposure to temperatures below their supercooling point or to temperatures below those at which their antifreeze proteins can prevent ice crystal growth. Since the process of freezing may be the most stressful event associated with subzero temperatures, the ability to tolerate freezing (rather than avoiding it) should provide a less risky solution to the problems of living in very cold environments. A
The general term dyssomnia includes a variety of possible disorders that result in excessive sleepiness or difficulty in beginning or maintaining sleep. Simple causes for such disorders include schedule changes or travel to different time zones (jet lag). Insomnia refers to insufficient or nonrestorative sleep despite ample opportunity to sleep. There may be physical causes for insomnia, but often it is related to emotional upset caused by stressful events. Narcolepsy is characterized by brief, uncontrollable attacks of sleep during the day. The disorder is treated with stimulants, regulation of sleep habits, and short daytime naps.
Generally speaking, psychosomatic disorders, i.e. the onset of a disease involving the target organ, in this respect colitis, is the most frequent response to a stressful event or situation, the others being pathological behaviours such as alcoholism or drug dependence, psychosis, anxiety, depression or, the most unlikely, a structured cognitive and sensitive response leading to recovery of bodily and mental health. The aim of the surgeon, aided by the psychologist and or psychiatrist, and, of course, by the gastroenterologist, is to make the patient well aware of his her brain-body global disorder and remove the target organ only when indicated while adequately treating and modifying the related PNEI pattern, if altered. Most IBD patients have alexithymia and do not dream during sleep, or at least they do not remember their dreams, thus showing that the unconscious emotions are not likely to be adequately felt, processed and cleared and therefore might perhaps trigger a pathological...
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