This document discusses mind-body medicine and its applications for women's health issues. It begins by defining mind-body medicine and its focus on the interactions between the mind and body. Several women's health issues are then examined, including headaches, urinary incontinence, fibromyalgia, chronic fatigue syndrome, premenstrual dysphoric disorder, mood disorders, and sleep problems. For each issue, the document discusses assessments and mind-body interventions that have evidence for their efficacy, such as relaxation techniques, biofeedback, cognitive-behavioral therapy, and lifestyle changes. It emphasizes taking a biopsychosocial approach and using multimodal therapies tailored to the individual patient.
Introduction to Mindfulness for Stress ReductionPhang Kar
Lecture at Watering the Seed of Mindfulness seminar organized by the Malaysia Association for Mindfulness Practice & Research (MMPR) on 30th September 2018.
Introduction to Mindfulness for Stress ReductionPhang Kar
Lecture at Watering the Seed of Mindfulness seminar organized by the Malaysia Association for Mindfulness Practice & Research (MMPR) on 30th September 2018.
Healing in a holistic sense has faded from medical attention and is rarely discussed in modern (“Western”) medicine especially in therapeutics. However, other disciplines like medical anthropology, sociology, alternate systems of medicine, and medical philosophy have continued an active contemplation of holistic healing. To heal is to achieve or acquire wholeness as a person. The wholeness of personhood involves physical, emotional, intellectual, social, and spiritual aspects of human experience (Egnew, 2005).
It is perhaps difficult to quantify the relative importance of the various factors that contribute to healing. It may vary depending on the kind of illness that is being studied. Of the various factors that contribute to healing of illnesses in a community, only 20% could be ascribed to rational treatment using medicines or surgery. The remaining 80% is divided among three faith-based factors (White, 1988).
i) Placebo effect (faith in drugs or procedural interventions)
ii) Hawthorne effect (faith in a health care system, a facility or a professional)
iii) Factor-X or “spiritual factor” (faith in oneself or in the supernatural)
The relative importance of these faith-based factors in holistic healing may be debatable. However, there is no denying that these factors play an important part in the recovery from illnesses.
Clinical decision making in paedriatic physiotherapyPOOJAMAHASETH1
The Clinical Decision Making Process is the process of establishing an appropriate intervention for a client. Key to this process is the utilization of 1) evidence based practice, 2) a client centred practice approach, 3) the International Classification of Functioning, Disability and Health (ICF), and 4) the development of goals that are Specific, Measurable, Achievable, Realistic, and Timed. This Clinical Decision Making Process was designed to be used at the individual or community/group level and to be applicable in preventative and treatment based approaches. Please refer to attached document for definitions.
Reviewing Cognitive Treatment for Eating Disorders: From Standard CBT Efficac...State of Mind
Reviewing Cognitive Treatment for Eating Disorders: From Standard CBT Efficacy to Worry, Rumination and Control Focused Interventions - EACBT 2015 Jerusalem
Complementary and Alternative Medicine Practices Necola27
As you embark upon your health journey in life, it is important to know all aspects of health and medicine options. As Americans, we are traditional known to practice conventional medicine; however, there are other options to add or supplement to that. Complementary and Alternative Medicine practices are becoming more popular options upon the healthcare world! Learn all about it here!
Presentación de la la Conferència Ciutadana de la Gent Gran de Barcelona sobre la Digitalització de la Societat realizada en el contexto del primer encuentro del Grupo Asesor (30 de noviembre de 2012).
Healing in a holistic sense has faded from medical attention and is rarely discussed in modern (“Western”) medicine especially in therapeutics. However, other disciplines like medical anthropology, sociology, alternate systems of medicine, and medical philosophy have continued an active contemplation of holistic healing. To heal is to achieve or acquire wholeness as a person. The wholeness of personhood involves physical, emotional, intellectual, social, and spiritual aspects of human experience (Egnew, 2005).
It is perhaps difficult to quantify the relative importance of the various factors that contribute to healing. It may vary depending on the kind of illness that is being studied. Of the various factors that contribute to healing of illnesses in a community, only 20% could be ascribed to rational treatment using medicines or surgery. The remaining 80% is divided among three faith-based factors (White, 1988).
i) Placebo effect (faith in drugs or procedural interventions)
ii) Hawthorne effect (faith in a health care system, a facility or a professional)
iii) Factor-X or “spiritual factor” (faith in oneself or in the supernatural)
The relative importance of these faith-based factors in holistic healing may be debatable. However, there is no denying that these factors play an important part in the recovery from illnesses.
Clinical decision making in paedriatic physiotherapyPOOJAMAHASETH1
The Clinical Decision Making Process is the process of establishing an appropriate intervention for a client. Key to this process is the utilization of 1) evidence based practice, 2) a client centred practice approach, 3) the International Classification of Functioning, Disability and Health (ICF), and 4) the development of goals that are Specific, Measurable, Achievable, Realistic, and Timed. This Clinical Decision Making Process was designed to be used at the individual or community/group level and to be applicable in preventative and treatment based approaches. Please refer to attached document for definitions.
Reviewing Cognitive Treatment for Eating Disorders: From Standard CBT Efficac...State of Mind
Reviewing Cognitive Treatment for Eating Disorders: From Standard CBT Efficacy to Worry, Rumination and Control Focused Interventions - EACBT 2015 Jerusalem
Complementary and Alternative Medicine Practices Necola27
As you embark upon your health journey in life, it is important to know all aspects of health and medicine options. As Americans, we are traditional known to practice conventional medicine; however, there are other options to add or supplement to that. Complementary and Alternative Medicine practices are becoming more popular options upon the healthcare world! Learn all about it here!
Presentación de la la Conferència Ciutadana de la Gent Gran de Barcelona sobre la Digitalització de la Societat realizada en el contexto del primer encuentro del Grupo Asesor (30 de noviembre de 2012).
Zamzam water is the purest, healthiest and miraculous water in the world. A small well has provided millions of pilgrims with this water ever since the time of Prophet Ibrahim (Abraham, peace be upon him).
This presentation highlights the superiority of this water, the unique qualities it holds and how modern science has proven its special qualities.
As part of the ‘Islamic Centre Study Circle’ series, held every month at the Islamic Centre (Leicester, UK) and presented by Dr. Hafiz Ather Hussain al-Azhari.
The PDF on the same subject can be found here:
http://www.islamiccentre.org/islamic-information-mainmenu-42/67-study-circle-presentations/1734-zamzam
The video clips can be found here:
https://www.youtube.com/playlist?list=PLUQyyY_YW2QC_BZl_-XcfaovHN5fKurxC
Is free-mixing allowed within cousins?
What does Islam say about working with people of the opposite gender?
What about work socials and group study?
And the big one – where does Islam stand on my relationship with my fiancé?
Allah SWT says in the Qur’an:
"Say to the believing men that they should lower their gaze and guard their modesty: that will make for greater purity for them...
...And say to the believing women that they should lower their gaze and guard their modesty."
[Surah al-Noor: 30-31]
Find out all the answers with your host Sheikh Musleh Khan in this Webinar Presenation where Sheikh Musleh will guide you through the Islamic relationship rules of work, family, friends and fiancés!
Assessment strategies, Neuropsychological Assessment for inpatient and outpatient department, measurement of psychological status, psychological issues faced in rehabilitation settings, and its intervention
RXP International Presents an Overview of Prescribing PsychologistsRXP International
This presentation was developed by Dr. Elaine Levine the first prescribing psychologist in New Mexico. In it, she described the Psychobiosocial Model of care which is a holistic model referenced in The Integration of Psychopharmacology and Psychotherapy in PTSD Treatment Biopsychosocial model of care, In E. Carll Ed., Trauma Psychology: Issues in Violence,
Disaster, Health and Illness. It also includes an overview of the requirements and responsibilities of prescribing psychologists in New Mexico.
How to Improve Quality of Services by Integrating Common Factors into Treatme...Scott Miller
Presentation by Dr. Bruce Wampold about how the outcome and quality of psychotherapy can be improved by adding common factors to the treatment. Wampold documents the lack of difference in outcome between competing treatment methods AND the relatively large contribution made by common factors to outcome.
A synopsis of the book "Collaborative Therapeutic Neuropsychological Assessment". See website http://www.amazon.com/Collaborative-Therapeutic-Neuropsychological-Assessment-Gorske/dp/0387754253
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxjenkinsmandie
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and cognition reactivity, which can be contr.
Similar to Mind Body Medicine and Women's Health (20)
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Mind Body Medicine and Women's Health
1. It’s Not All In Your Head – Mind Body Medicine and Women’s Health
2. Shawn A. Tassone, MD, FACOG
Saybrook University
La Dea Women’s Health
Institute of Women’s Health and Integrative Medicine
July 13, 2012
Portland, OR
4. What is Mind Body Medicine?
• Mind-body Medicine is a revolutionary 21st
–century
approach to health care that includes a wide range of
behavioral and lifestyle interventions on a equal basis
with traditional medical interventions (Moss, 2003, p.3)
• Mind-Body Medicine focuses on the interactions
between mind and body and the powerful ways in which
emotional, mental, social and spiritual factors can
directly affect health. (Center for Mind-Body Medicine,
http://www.cmbm.org)
5. What is Mind-Body Medicine?
• Partnership (physicians, NPs, psychologists,
biofeedback specialists, chiropractors, nutritionists, yoga
instructors, spiritual counselors)
• Behavioral and psychosocial interventions are treated as
first-line interventions.
• Patient education and self-awareness (self-care)
• Active patient – passive practitioner
6. Challenges for Primary Care
• Somatization and emotional distress – emotions become
physical begins at early age and continues for decades
(Quill, 1985)
• 20% of visits to primary care have demonstrable organic
causes (Kroenke & Mangelsdorff, 1989)
• One drug prescribed in at least 66% of all PCP office
visits (Fletcher, 2010, Forbes Online)
• Response stereotypy
– Cardiovascular responders
– Gastrointestinal responders
– Musculoskeletal responders
– Cognitive responders
7. Challenges for Primary Care
• 65% of patients with anxiety seek treatment for a
potential somatic illness (Danton et al, 1994)
• Comorbidities of anxiety and depression in patients with
chronic medical disease is essential in understanding the
cause of the illness an identifying appropriate treatment
(Wayne, Lin & Kronke, 2007)
• Patients with chronic illness account for between 46 and
75% of the costs in healthcare (Moss, 2003, p.7).
• Challenges for the PCP are lifestyle and familial
variables and finding a leverage point into the care of the
patient before emotions become somatic.
8. Evidence Based Mind Body Medicine
• Jonas et al (1999, p.73) – epistemology of EBM
– Patient preferences and meaning
– Mechanisms of action
– Safety and efficacy
– Treatment effect probabilities in the open clinical setting and
from observational and outcomes research
– Precise estimations of effects through systematic summaries
and calculation of confidence intervals when possible
– Demonstration of utility and benefit under normal health service
conditions examining the impact of access, feasibility, and costs.
HOW DO WE MAKE IT WORK??
9. MBM and CAM Therapies
Acupuncture Hypnotherapy
Aromatherapy Manual Therapies
Biofeedback Massage Therapy
Biofeedback Massage
Bioenergetics Nutritional Counseling
Chiropractic Prayer
Exercise Spiritual Healing
Feldenkrais Tai Chi
Herbal Therapy Yoga
10. What Makes The CAM MBM Paradigm
1. Emphasis on holistic practices and unitary view of mind, body, spirit
2. Treating each patient as a unique individual
3. Emphasis on a more personal relationship
4. Attribute and active role to the patient in the healing process
5. Belief in the inherent healing power of the person
6. Prescriptions of lifestyle and habit changes
7. Emphasis on interventions that elicit healing
8. Distrust of invasive treatments that crush the disease but harm the patient
9. Belief in eclecticism and empiricism
10. Readiness to accept unconventional interventions
11. Openness to prayer, meditation and spiritual practices
12. Integration of physical, psychological, and spiritual practices
(Freeman & Lawlis, 2001).
11. MBM and Women’s Health
• Headache
• Urinary Incontinence
• Fibromyalgia and Chronic Fatigue
• Mood disorders
• Sleep and Sleep Disorders
• Premenstrual Dysphoric Disorder (PMDD)
• Temporomandibular and Facial Pain
• Spirituality and Healing
12. Task Force and Levels of Efficacy
• Level 1: Not Empirically Supported
– Supported only by anecdotal reports and/or case studies in nonpeer-
reviewed venues. Not empirically supported.
• Level 2: Possibly Efficacious
– At least one study of sufficient statistical power with well-identified
outcome measures but lacking randomized assignment to a control
condition internal to the study.
• Level 3: Probably Efficacious
– Multiple observational studies, clinical studies, wait-list controlled
studies, and within-subject and intrasubject replication studies that
demonstrate efficacy.
13. Task Force and Levels of Efficacy
• Level 4: Efficacious
a. control utilizing randomized assignment, the investigational treatment is shown to be statistically
significantly superior to the control condition, or the investigational treatment is equivalent to a treatment
of established efficacy in a study with sufficient power to detect moderate differences,
and
b. The studies have been conducted with a population treated for a specific problem, for whom
inclusion criteria are delineated in a reliable, operationally defined manner, and
c. The study used valid and clearly specified outcome measures related to the problem being treated,
and
d. The data are subjected to appropriate data analysis, and
e. The diagnostic and treatment variables and procedures are clearly defined in a manner that
permits replication of the study by independent researchers, and
f. The superiority or equivalence of the investigational treatment has been shown in at least two
independent research settings.
• Level 5: Efficacious and Specific
Evidence for Level 5 efficacy meets all of the criteria for Level 4. In addition, the investigational
treatment has been shown to be statistically superior to credible sham therapy, pill, or alternative bona
fide treatment in at least two independent research settings.
14. Headache and Migraine
• Primary and secondary headache
– Primary headaches have no underlying or medical condition
associated with the pain: migraine and tension
• Biobehavioral approach
– Assessment
– Treatments
– Skills Acquisition
– Combination therapies
15. Biobehavioral Approach to Headache
• Biological – the headache comes from food triggers or
medical problems and can be treated with medications
• Psychobiological - biology changes affect behavior and
conditions of chronic headache involve emotional,
cognitive, and behavioral factors. (Moss et al, 2003,
p.209)
• An example of this is the cause of headache may be
simply stress related causing a migraine but over time
the patient symptoms transform into a daily headache.
Biological and psychological coping change with
chronicity and as such changes must be made – a
reprogramming
16. Assessment of Headache
for the Mind-Body Medicine Practitioner
• In depth clinical interview
– Many patients may feel there is serious cause – r/o with medical
work-up. Some also fear they may be told “it’s all in their head”
– Attempt to avoid categorizing headaches into organic and or
psychogenic as patients may respond to your questions
differently based on your approach
– Medication lists are essential as many patients have been
prescribed opioids and NSAID’s
• 80% of of chronic daily headache patients present because of
analgesic rebound (Rapoport, 1988; Colas et al, 2004) mainly in
women in their 50’s.
– Important to determine the type of headache, triggers, and
treatments used
17. Assessment of Headaches
• Assess if the patient has avoidance behaviors or
secondary gain related to the headaches. Some
patients phobic of the headache may take meds
preemptively as a means to avoid the headache.
• Psychophysiological assessment
– Arousal
– Electrodermal response
– Heart rate and heart rate variability
– Respiratory dynamics
– Skeletal muscle response
– Smooth muscle response
18. Assessment of Headache
Electrodermal Response
• Definition
– a change in the electrical properties of the skin in response to
stress or anxiety; can be measured either by recording the
electrical resistance of the skin or by recording weak currents
generated by the body (Merriman’s Dictionary)
• Clinical Uses
– Polygraph
– Biofeedback devices
– E-meter – Scientology
19. Assessment of Headache
Heart Rate Variability
• Definition
– a measure of the naturally occurring beat-to-beat changes in
heart rate/heart rhythms. It serves as a critical method for
gauging human health and resiliency. www.heartmath.org
23. Assessment of a Headache
Respiratory Dynamics
• RESPeRATE as example
24. Assessment of a Headache
Skeletal and Smooth Muscle Response
• Guarding responses in the muscles of the head and
neck or back
• Tenderness in certain muscle groups
• Twitching
• Trigger points
• Patient history and story
• Combine the location and severity of the pain with the
narrative the patient gives you and look beyond the
obvious.
25. Treatment
• The best approach for headache is usually multi-
dimensional (Moss 2003, p.213)
– Education of triggers
– Cognitive strategies and coping mechanisms (relaxation
response (Blanchard et al)
• MBSR
• Progressive relaxation and body scans
• EMG assisted relaxation
• Thermal control (thermistor)
– Self-regulation with headache diary
– Dietary and behavior change
– Adherence to drug regimens
26. Temporomandibular Disorders
• TMJ disorders cause tenderness and pain in the
temporomandibular joint (TMJ) — the joint on each side
of your head in front of your ears, where your lower
jawbone meets your skull. This joint allows you to talk,
chew and yawn. TMJ disorders can be caused by many
different types of problems — including arthritis, jaw
injury, or muscle fatigue from clenching or grinding your
teeth. In most cases, the pain and discomfort associated
with TMJ disorders can be alleviated with self-managed
care or nonsurgical treatments. Severe TMJ disorders
may need to be treated with dental or surgical
interventions. (Mayo Clinic, 2012)
27. TMJ – Medical History
• Injury
• Dental Work
• Gender and Age
– Women three times more likely than men
• Biopsychosocial approach
– Psychological history
– Social history
– Behavioral issues
28. TMJ – Psych and Behavioral
• Patients more likely to suffer from depression due to
chronic pain (Goto, 2009), and may elicit more anxiety
• Patients may have changed social life to accommodate
the inability to open mouth – soft foods or not going out
to restaurants
• Increased sick days from wok
• TMJ patients reporting myofascial or muscular pain may
also have a concomitant psychological disorder that can
be diagnosed through investigative medical questioning
(Glaros, 2001).
29. TMJ – MBM Interventions
• EMG biofeedback to aid the patient in decrease
functioning where focus is on relaxation of the mouth
and not allowing the teeth to touch
• Ask patient to stop chewing ice, nails, or gum
• Studies have shown that teaching patients generalized
relaxation skills with instructions to help avoid tooth
contact was most successful in reducing pain
• EMG based nocturnal alarms for patients with significant
grinding during sleep
30. Urinary Incontinence
• Determine the type of incontinence
– Stress urinary incontinence
– Overflow Incontinence
– Detrusor instability or Urge Incontinence
– Mixed
– Intrinsic Sphincter Deficiency
31. Urinary Incontinence - Kegels
• Who knows exactly how to do it
• Mostly ineffective if simply described to patients and
more effective when combined with pelvic examination to
show levator ani and pelvic floor musculature.
• 5-10 second contractions followed by similar period of
relaxation
• Primarily effective for stress incontinence and could
worsen urge or detrusor instability
• More efficacious in women with mild symptoms
• Vaginal weights effective for SUI (Herbison, 2009)
32. Pelvic Floor Electrical Stimulation
• Patients treated with a self-help 8 week course and
Kegel-type exercises had improvement but not as
significant as patients enrolled in a similar program in an
incontinence clinic
– Quality of life was improved in both groups but more significantly
in those women undergoing a clinical program with a
biofeedback device
– Timed voiding and habit voiding
33. Fibromyalgia
• American College of Rheumatology diagnosis of 11 out
of 18 tender points
• Sleep disturbances, poor immediate recall
• Poor concentration
• Irritable bowel syndrome
• Headaches
• TMJ
• Predominantly female (80%) between 40-64 (White et al,
1999)
• Myofascial pain and fibromyalgia are comorbid in many
cases
34. Fibromyalgia and Myofascial Pain
Features Fibromyalgia Syndrome Myofascial Pain
Musculoskeletal Pain Widespread Mainly regional
Tender points Multiple Regional
Referred Pain Minimal Follows patterns
Fatigue Dominates Variable
Poor sleep Dominates Variable with pain
Headaches Common Common
Irritable Bowel Common Rare
Pain medications Long term Possible short term
Providers Sometimes multiple Depends
35. Treatments
• Be aware of patients using long term analgesics and
opiates and do not ask them to stop these medications
quickly
• Combination of medications and naturopathic treatments
significantly reduced symptoms (Teitelbaum, 1999)
• Donaldson (2001) explored the effects of long term pain
on the nervous system. The more it is stimulated the
easier it becomes stimulated (neuroplasticity)
• Difficult to treat as Donaldson believes the causes are
neuroplastic, cognitive, and come from childhood
learning processes. Treatments with multi-modalities
like SEMG progressive muscle relaxation are
recommended
36. Fibromyalgia – Other Therapies
• High intensity exercise has improved symptoms for
some and worsened for others
• Feldenkreis – gentle movement of the muscles while
over stimulating the nerves
• TENS units are not recommended
• Muller (2001) reported a combined therapy:
– sEMG and biofeedback
– Massage
– EEG and neurotherapy
– 10% had increased pain
– 25% had a complete resolution of pain
– 65% had reduction of pain in varying degrees
37. Fibromyalgia Thoughts
• Often a frustrating and debilitating process for patients.
• It appears that brain function and learned neroplastic
events contribute to the pain process which then make
other stimuli appear more painful.
• Multiple modalities such as medications, movement,
supplements, MBM, and cognitive therapies have helped
some and worsened others
• Let us remember that first and foremost we are to do no
harm
38. Chronic Fatigue Syndrome
• What patients are using (Neisenbaum 2001)
– Vitamins (79%)
– Exercise (64%)
– Dietary changes (54%)
– Herbal treatments (37%)
39. CFS – Mind Body Therapy
• Acupuncture
– Wang et al (2009) – meta-analysis of 28 studies showed the therapeutic effect of
acupuncture in CFS was superior to control
• Guided Imagery and Hypnosis
– Bernardy (2011) meta-analysis failed to show significant reduction in symptoms
but studies have had poor methodology due to poor follow up
• Biofeedback and progressive relaxation reported as Level 2 – probably efficacious
(EMG being the most common modality utilized)
• Cognitive Behavioral Therapy – somatic symptoms are perpetuated by errant illness
beliefs and maladaptive coping (Moss, 2003, p.340).
– 70% of participants undergoing combination cognitive and behavioral therapies
reported a decrease in symptoms. Difficulties with CBT are finding a qualified
therapist and that treatment is better if one-on-one as group therapies have not
been shown to be effective.
41. PMDD
Nonpharmalogical Treatments
• Change the diet to reduce salt, caffeine and alcohol
– Add magnesium and calcium along with DHA and EPA
– Smaller frequent meals decreased carbohydrates
• Cognitive Therapy (Steiner, 2000)
– Problem-solving
– Reframing or looking at problems from other vantage points
– Stress management
– Interpersonal Competency
– Education about PMS
• Wise Guide Imagery
42. Mood and Sleep Disorders
• Depression
• Dysthymia
• Bipolar
• Depressive Symptoms
• Postpartum Blues and Depression
43. Mood and Sleep Disorders
Future Directions
• EEG Biofeedback or Neurofeedback
45. Sleep Problems in Women
• Hormonal imbalance lends a special issue with women’s
studies and as such most have been done on males
• Women with PMDD have a higher incidence of sleep
disorder (Lee et al, 1990)
• Patients with mood disorders also have a higher
incidence of sleep disorder
• Pregnancy can also be a lengthy time of sleep disorder
due to progesterone
• Menopause also a state of increased sleep disorder
46. Mind-Body Therapies and Sleep
• Yoga and sleep – Khalsa (2004) demonstrated that
individuals practicing yoga each day for eight weeks had
a significant reduction in insomnia
• Manjunath (2005) demonstrated that elderly patients
practicing yoga had a shorter time span falling asleep
and slept longer.
• Irwin (2008) in a small study of 112 individuals
discovered that 25 weeks of Tai Chi practice improved
sleep quality in individuals who had a moderate
complaint profile of falling asleep
47. Spirituality and Healing
• Incorporate ritual and ceremony into the process of
healing.
• Know the spiritual background of your patient
• The Spirit Catches You and You Fall Down – Anne
Fadiman
• Allopathic or Allopathetic?
• Is there a place for spirituality in medicine ?
• Roman Catholic church list spiritual crises and similar
symptoms in their book on exorcisms (Karpel, 1975)
48. Spirituality and Healing
• Applications of Spirituality in Healing (Koenig, 2001,
p.214-219)
– Meaning and purpose in life
– Intrinsic values
– Transcendent belief
– Community relationships
• Individuals with internalized spiritual and religious
dimensions score higher on measures of mental health
(Moss, 2003, 195).
49. Spirituality and Religion
A Piece of the Mind-Body Paradigm
• Individuals who attend religious services once a week
live longer than those who do not compared to similar
controls
• High blood pressure and heart disease are less common
amongst religiously oriented people
• (Koenig, 2001, p.249) demonstrated a link between
spirituality and heart disease in terms of prevention and
decreased treatment procedures.
• If health care providers could participate in spiritual
awareness health care would more closely reflect the
wholeness and integrity of individuals
52. Biofeedback Devices
emWave2 by Heartmath
$229 on Amazon. Comes with computer program and readout
Great for personal and office use, teaches breathing and heart
Rate variability compliance www.heartmathstore.com
55. References
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