SlideShare a Scribd company logo
Mind/Body Approaches to Stress
        and Anxiety
         Jennifer Phelps, MD
    Phelps MD Integrative Medicine
Peace:

It does not mean to be in a place where there is no
   noise, trouble or hard work, it means to be in the
   midst of those things and still be calm in your
   heart.




Author unknown
• Economic burden in 1998 $63.1 Billion
  – Missed work, inc medical morbidity
  – Treatment of panic disorder decreases healthcare
    utilization and costs by 94%
    (Langlieb, 2005)

  – Anxiety has lifetime prevalence 25.1% 13-18 yr
    olds
  – 18% adults in any given year( NIMH,n.d.)
Mind-Body Modalities
•   Biofeedback
•   Autogenic training
•   Guided imagery
•   Hypnosis
•   Yoga
•   Tai Chi
•   Meditation-Mindfulness, PMR, breathwork
Guided imagery

• Deliberate, directed daydreaming
• Imagery is a specific kind of hypnosis, a type
  of meditation
Clinical Hypnosis
• Inner absorption, concentration and focused
  attention
• Like a magnifying glass to focus the rays of the
  sun and make them more powerful
Biofeedback
• Trains people to improve their health by
  controlling certain bodily processes that
  normally happen involuntarily such as heart
  rate, blood pressure, muscle tension and skin
  temperature
• Heart rate variability, EMG, thermal
  biofeedback, and EEG
• Benefits-
  BP, headaches, anxiety, depression, pain
Mindfulness
From a mind-body perspective, mindfulness
  appears to "institute" a left-sided shift in
  frontal electrical activity to support an
  approach state as opposed to a withdrawal
  state.
Mindfulness Meditation
• Shift to left frontal dominance
• Increased thickness of middle prefrontal
  region
• Activation of middle prefrontal areas
• Activation of the Anterior cingulate cortex
Mind body practices
•   Increased coordination of firing
•   Activation of the superior temporal region
•   Emotion regulation
•   Capacity to disengage from top down brain
    processes—caused by enhanced function of
    the middle prefrontal areas of the brain that
    arises from mindfulness practices
Mind
• The human mind is a relational and embodied
  process that regulates the flow of energy and
  information
• Knowing that our minds regulate this flow
  enables us to feel the reality of these two forms
  of mental experience and to act on them instead
  of get lost in them
• We can learn to become more skilled at altering
  our mind and brain by mind body practices.
After one month mind-body training
Neuroplasiticity
Brain Plasticity
• Emerging research in neuroendocrinology
  links stress and anxiety effects on neuronal
  replacement, synapse turnover and dendritic
  remodeling and the detrimental effects of
  untreated anxiety (McEwen, 2012)
• This highlights the importance of effective
  treatment approaches
• As Woody Allen said in the movie
  Manhattan,"You know I can't express
  emotions. I internalize, I grow a tumor."
Freud
neurogenesis
• 5-10K neurons each day average adult done in
  animal models
• Impacts neurogenesis—stress inhibits growth
• Physical exercise enhances growth
Mental exercise
• Short amounts of practice can help
• If stop practicing after 2 weeks affects
Emotion Regulation
• Can be taught and aquired
• Important to manage everyday life
• Resilience maintenance of high levels of well
  being in the face of adversity
• Positive emotions is associated with better
  health
• Brain heart synchronicity in certain kind of
  meditation-compassion meditation a fairly
  dramatic synchronicity not in novices
• Neurons that fire together wire together
Mindful attention
5 Major Diagnostic Groups
•   Generalized anxiety
•   Panic attacks
•   Phobias
•   Obsessive compulsive disorder
•   Post traumatic stress disorder
Conventional treatment
• Psychopharmacology
   -complete list of FDA approved found at NIH
  website
• Antidepressants
  -SSRI/SNRI, tricyclics, MAO, Benzos, B Blockers
• Psychotherapy
  -talk therapy, cognitive behavioral therapy
  -caution with internet based therapy
Integrative Care for Anxiety
• Important to screen for any medical
  conditions that could mimic anxiety
• Examine meds and supplements
• Lifestyle changes
• Mind body or psychotherapy approaches
• Discuss risks and benefits of any therapy
Disease States assoc w anxiety
•   Hypo/hyperthyroidism
•   Vestibular dysfunction
•   CHF/COPD/PE
•   Cardiac arrhythmia
•   Pheochromocytoma
•   Pneumonia
•   Hyperventilation
•   Vit B12 Deficiency
•   Porphyria
•   Neoplasm
•   Encephalitis
•   Hyperadrenalism
•   Substance OD
•   Munchausen's
•   Lead or pesticide toxicity
Exacerbating Factors
•   Sympathomimetics
•   Beta agonists
•   Corticosteroids
•   Thyroid hormone supplement
•   Estrogen therapy
•   ADHD drugs
•   CAFFEINE/energy drinks
•   SAM-e
Lifestyle Factors
• Physical Activity
•   Herring MP, Jacob ML, Suveg C, Dishman RK, O'Connor PJ. Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A
    Randomized Controlled Trial. Psychother Psychosom. 81(1):21-28. Nov 22, 2011
•   Ströaut;hle A, Stoy M, Graetz B, Scheel M, Wittmann A, Gallinat J, Lang UE, Dimeo F, Hellweg R. Acute exercise ameliorates reduced brain-derived neurotrophic factor
    in patients with panic disorder. Psychoneuroendocrinology 35(3):364-8 Apr, 2010Nutrition



    Nutrition
    Cheatham RA, Roberts SB, Das SK, Gilhooly CH, Golden JK, Hyatt R, Lerner D, Saltzman E, Lieberman HR. Long-term effects of provided low
    and high glycemic load low energy diets on mood and cognition. Physiology & behavior 98(3):374-9 Sep, 2009
•   Bercik P, Denou E, Collins J, Jackson W, Lu J, Jury J, Deng Y, Blennerhassett P, Macri J, McCoy KD, Verdu EF, Collins SM. The intestinal
    microbiota affect central levels of brain-derived neurotropic factor and behavior in mice. Gastroenterology.141(2):599-609 2011 Aug


• Sleep
•   van der Helm E, Yao J, Dutt S, Rao V, Saletin JM, Walker MP REM Sleep Depotentiates Amygdala Activity to Previous Emotional Experiences.
    Curr Biol. Nov 22, 2011
•   Gujar N, McDonald SA, Nishida M, Walker MP. A role for REM sleep in recalibrating the sensitivity of the human brain to specific
    emotions. Cereb Cortex. 21(1):115-23. Jan, 2011
Mind-Body Techniques for Anxiety
•   Mindfulness and meditation
•   Yoga
•   Prayer/Spirituality
•   Biofeedback
•   Hypnotherapy
•   Massage
•   Music Therapy
•   Energy Medicine
•   Aromatherapy
Presentation2
Presentation2

More Related Content

What's hot

What Is Neurofeedback And How Can It Help
What Is Neurofeedback And How Can It HelpWhat Is Neurofeedback And How Can It Help
What Is Neurofeedback And How Can It Helpannaemarshall
 
11 depression therapies to get rid of depressive disorder today
11 depression therapies to get rid of depressive disorder today11 depression therapies to get rid of depressive disorder today
11 depression therapies to get rid of depressive disorder today
Booboone, LLC
 
Academic peak performance training via neurofeedback
Academic peak performance training via neurofeedbackAcademic peak performance training via neurofeedback
Academic peak performance training via neurofeedback
ntheva
 
Neurofeedback for Peak Performance, Meditation, Therapy
Neurofeedback for Peak Performance, Meditation, TherapyNeurofeedback for Peak Performance, Meditation, Therapy
Neurofeedback for Peak Performance, Meditation, Therapy
Jonathan Banks
 
Nervous system and yogic application research
Nervous system and yogic application researchNervous system and yogic application research
Nervous system and yogic application research
Dr Shashikant S Kumbar
 
Athletic peak performance training via neurofeedback
Athletic peak performance training via neurofeedbackAthletic peak performance training via neurofeedback
Athletic peak performance training via neurofeedback
ntheva
 
Cancer and Yoga Nidra
Cancer and Yoga NidraCancer and Yoga Nidra
Cancer and Yoga Nidra
Abhishek Ghosh
 
gevirtz, jrv and ptsd
gevirtz, jrv and ptsdgevirtz, jrv and ptsd
gevirtz, jrv and ptsdguestdb8173
 
Hanipsych, oxytocin
Hanipsych, oxytocinHanipsych, oxytocin
Hanipsych, oxytocin
Hani Hamed
 
Guided Imagery to Overcome Anxiety by Dr. Mallika Meinhold
Guided Imagery to Overcome Anxiety by Dr. Mallika MeinholdGuided Imagery to Overcome Anxiety by Dr. Mallika Meinhold
Guided Imagery to Overcome Anxiety by Dr. Mallika Meinholdatocmarketing
 
Combating technostress through yoga
Combating technostress through yogaCombating technostress through yoga
Combating technostress through yoga
Yogacharya AB Bhavanani
 
Nervous system
Nervous systemNervous system
Nervous system
Dr Shashikant S Kumbar
 
J young plenary chronic stress
J young plenary chronic stressJ young plenary chronic stress
J young plenary chronic stress
The Foundation for Medical Excellence
 
Stress management & relaxation techniques - Dr. Shelagh Wright
Stress management & relaxation techniques - Dr. Shelagh WrightStress management & relaxation techniques - Dr. Shelagh Wright
Stress management & relaxation techniques - Dr. Shelagh Wright
Arthritis Ireland
 
Abnormal mental states and behaviours in MS
Abnormal mental states and behaviours in MSAbnormal mental states and behaviours in MS
Abnormal mental states and behaviours in MS
MS Trust
 
Neuropathic pain in MS
Neuropathic pain in MSNeuropathic pain in MS
Neuropathic pain in MS
MS Trust
 
Mus 3
Mus 3Mus 3
Mus 3
alaistair
 
Emd rreferal2016
Emd rreferal2016Emd rreferal2016
Emd rreferal2016
Donald Charnock
 

What's hot (19)

What Is Neurofeedback And How Can It Help
What Is Neurofeedback And How Can It HelpWhat Is Neurofeedback And How Can It Help
What Is Neurofeedback And How Can It Help
 
11 depression therapies to get rid of depressive disorder today
11 depression therapies to get rid of depressive disorder today11 depression therapies to get rid of depressive disorder today
11 depression therapies to get rid of depressive disorder today
 
Academic peak performance training via neurofeedback
Academic peak performance training via neurofeedbackAcademic peak performance training via neurofeedback
Academic peak performance training via neurofeedback
 
Guided Imagery
Guided ImageryGuided Imagery
Guided Imagery
 
Neurofeedback for Peak Performance, Meditation, Therapy
Neurofeedback for Peak Performance, Meditation, TherapyNeurofeedback for Peak Performance, Meditation, Therapy
Neurofeedback for Peak Performance, Meditation, Therapy
 
Nervous system and yogic application research
Nervous system and yogic application researchNervous system and yogic application research
Nervous system and yogic application research
 
Athletic peak performance training via neurofeedback
Athletic peak performance training via neurofeedbackAthletic peak performance training via neurofeedback
Athletic peak performance training via neurofeedback
 
Cancer and Yoga Nidra
Cancer and Yoga NidraCancer and Yoga Nidra
Cancer and Yoga Nidra
 
gevirtz, jrv and ptsd
gevirtz, jrv and ptsdgevirtz, jrv and ptsd
gevirtz, jrv and ptsd
 
Hanipsych, oxytocin
Hanipsych, oxytocinHanipsych, oxytocin
Hanipsych, oxytocin
 
Guided Imagery to Overcome Anxiety by Dr. Mallika Meinhold
Guided Imagery to Overcome Anxiety by Dr. Mallika MeinholdGuided Imagery to Overcome Anxiety by Dr. Mallika Meinhold
Guided Imagery to Overcome Anxiety by Dr. Mallika Meinhold
 
Combating technostress through yoga
Combating technostress through yogaCombating technostress through yoga
Combating technostress through yoga
 
Nervous system
Nervous systemNervous system
Nervous system
 
J young plenary chronic stress
J young plenary chronic stressJ young plenary chronic stress
J young plenary chronic stress
 
Stress management & relaxation techniques - Dr. Shelagh Wright
Stress management & relaxation techniques - Dr. Shelagh WrightStress management & relaxation techniques - Dr. Shelagh Wright
Stress management & relaxation techniques - Dr. Shelagh Wright
 
Abnormal mental states and behaviours in MS
Abnormal mental states and behaviours in MSAbnormal mental states and behaviours in MS
Abnormal mental states and behaviours in MS
 
Neuropathic pain in MS
Neuropathic pain in MSNeuropathic pain in MS
Neuropathic pain in MS
 
Mus 3
Mus 3Mus 3
Mus 3
 
Emd rreferal2016
Emd rreferal2016Emd rreferal2016
Emd rreferal2016
 

Similar to Presentation2

Cancer and meditation
Cancer and meditationCancer and meditation
Cancer and meditation
Abhishek Ghosh
 
Cancer and Meditation
Cancer and MeditationCancer and Meditation
Cancer and Meditation
Yoga for Health Institute
 
Disease and Meditation
Disease and MeditationDisease and Meditation
Disease and MeditationKaivalyaDham
 
Psychiatric nursing review
Psychiatric nursing  reviewPsychiatric nursing  review
Psychiatric nursing reviewgrey clemente
 
Mindfulness, Meditation & Thought Field Therapy (TFT) for Recovery & Relapse ...
Mindfulness, Meditation & Thought Field Therapy (TFT) for Recovery & Relapse ...Mindfulness, Meditation & Thought Field Therapy (TFT) for Recovery & Relapse ...
Mindfulness, Meditation & Thought Field Therapy (TFT) for Recovery & Relapse ...
Dr. Andrea Pennington
 
Hanipsych, biology of psychotherapy
Hanipsych, biology of psychotherapyHanipsych, biology of psychotherapy
Hanipsych, biology of psychotherapy
Hani Hamed
 
Underlying Cause Management ™ Dr Dandes
Underlying Cause Management ™ Dr DandesUnderlying Cause Management ™ Dr Dandes
Underlying Cause Management ™ Dr Dandes
huberin
 
Cancer and Meditation
Cancer and  MeditationCancer and  Meditation
Cancer and MeditationKaivalyaDhama
 
Hanipsych, biology of psychotherap
Hanipsych, biology of psychotherapHanipsych, biology of psychotherap
Hanipsych, biology of psychotherap
Hani Hamed
 
Change your personality
Change your personalityChange your personality
Change your personality
John Bergman
 
Mind body applications in health r
Mind body applications in health rMind body applications in health r
Mind body applications in health r
Yasmine Buraik
 
Mindfulness for trainer's workshop
Mindfulness for trainer's workshopMindfulness for trainer's workshop
Mindfulness for trainer's workshop
stephiejackson
 
Anxiety disorders
Anxiety disorders Anxiety disorders
Anxiety disorders
bhavik chheda
 
Yoga and meditation research in psychiatry
Yoga and meditation research in psychiatryYoga and meditation research in psychiatry
Yoga and meditation research in psychiatry
drnamrata bhati
 
Dynamics of healing in icu
Dynamics of healing in icuDynamics of healing in icu
Dynamics of healing in icu
SUDESHNA BANERJEE
 
Total Pain
Total PainTotal Pain
Total Pain
Mike Aref
 
Mindfulness - a presentation for AJS 2016
Mindfulness - a presentation for AJS 2016 Mindfulness - a presentation for AJS 2016
Mindfulness - a presentation for AJS 2016
Agustin (Gus) Castellanos, M.D.
 
Biofeedback and headaches
Biofeedback and headachesBiofeedback and headaches
Biofeedback and headaches
Norton Healthcare
 
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Norton Healthcare
 

Similar to Presentation2 (20)

Cancer and meditation
Cancer and meditationCancer and meditation
Cancer and meditation
 
Cancer and Meditation
Cancer and MeditationCancer and Meditation
Cancer and Meditation
 
Disease and Meditation
Disease and MeditationDisease and Meditation
Disease and Meditation
 
Psychiatric nursing review
Psychiatric nursing  reviewPsychiatric nursing  review
Psychiatric nursing review
 
Mindfulness, Meditation & Thought Field Therapy (TFT) for Recovery & Relapse ...
Mindfulness, Meditation & Thought Field Therapy (TFT) for Recovery & Relapse ...Mindfulness, Meditation & Thought Field Therapy (TFT) for Recovery & Relapse ...
Mindfulness, Meditation & Thought Field Therapy (TFT) for Recovery & Relapse ...
 
Hanipsych, biology of psychotherapy
Hanipsych, biology of psychotherapyHanipsych, biology of psychotherapy
Hanipsych, biology of psychotherapy
 
Underlying Cause Management ™ Dr Dandes
Underlying Cause Management ™ Dr DandesUnderlying Cause Management ™ Dr Dandes
Underlying Cause Management ™ Dr Dandes
 
Cancer and Meditation
Cancer and  MeditationCancer and  Meditation
Cancer and Meditation
 
Hanipsych, biology of psychotherap
Hanipsych, biology of psychotherapHanipsych, biology of psychotherap
Hanipsych, biology of psychotherap
 
Change your personality
Change your personalityChange your personality
Change your personality
 
Mind body applications in health r
Mind body applications in health rMind body applications in health r
Mind body applications in health r
 
Mindfulness for trainer's workshop
Mindfulness for trainer's workshopMindfulness for trainer's workshop
Mindfulness for trainer's workshop
 
Holistic Case Study Summer 2015
Holistic Case Study Summer 2015Holistic Case Study Summer 2015
Holistic Case Study Summer 2015
 
Anxiety disorders
Anxiety disorders Anxiety disorders
Anxiety disorders
 
Yoga and meditation research in psychiatry
Yoga and meditation research in psychiatryYoga and meditation research in psychiatry
Yoga and meditation research in psychiatry
 
Dynamics of healing in icu
Dynamics of healing in icuDynamics of healing in icu
Dynamics of healing in icu
 
Total Pain
Total PainTotal Pain
Total Pain
 
Mindfulness - a presentation for AJS 2016
Mindfulness - a presentation for AJS 2016 Mindfulness - a presentation for AJS 2016
Mindfulness - a presentation for AJS 2016
 
Biofeedback and headaches
Biofeedback and headachesBiofeedback and headaches
Biofeedback and headaches
 
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
Biofeedback and other Psychophysiological Techniques for Headache - Neuro Exp...
 

Recently uploaded

Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
VarunMahajani
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
MedicoseAcademics
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
Anurag Sharma
 
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdfBENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
DR SETH JOTHAM
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
Swetaba Besh
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Savita Shen $i11
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
sisternakatoto
 
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model SafeSurat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Savita Shen $i11
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
kevinkariuki227
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Prof. Marcus Renato de Carvalho
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
bkling
 
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
GL Anaacs
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
touseefaziz1
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
ACUTE SCROTUM.....pdf. ACUTE SCROTAL CONDITIOND
ACUTE SCROTUM.....pdf. ACUTE SCROTAL CONDITIONDACUTE SCROTUM.....pdf. ACUTE SCROTAL CONDITIOND
ACUTE SCROTUM.....pdf. ACUTE SCROTAL CONDITIOND
DR SETH JOTHAM
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
aljamhori teaching hospital
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
SumeraAhmad5
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
LanceCatedral
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
MedicoseAcademics
 

Recently uploaded (20)

Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
 
micro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdfmicro teaching on communication m.sc nursing.pdf
micro teaching on communication m.sc nursing.pdf
 
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdfBENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
 
263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,263778731218 Abortion Clinic /Pills In Harare ,
263778731218 Abortion Clinic /Pills In Harare ,
 
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model SafeSurat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
 
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeNovas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
 
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
 
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
 
ACUTE SCROTUM.....pdf. ACUTE SCROTAL CONDITIOND
ACUTE SCROTUM.....pdf. ACUTE SCROTAL CONDITIONDACUTE SCROTUM.....pdf. ACUTE SCROTAL CONDITIOND
ACUTE SCROTUM.....pdf. ACUTE SCROTAL CONDITIOND
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
 

Presentation2

  • 1. Mind/Body Approaches to Stress and Anxiety Jennifer Phelps, MD Phelps MD Integrative Medicine
  • 2. Peace: It does not mean to be in a place where there is no noise, trouble or hard work, it means to be in the midst of those things and still be calm in your heart. Author unknown
  • 3. • Economic burden in 1998 $63.1 Billion – Missed work, inc medical morbidity – Treatment of panic disorder decreases healthcare utilization and costs by 94% (Langlieb, 2005) – Anxiety has lifetime prevalence 25.1% 13-18 yr olds – 18% adults in any given year( NIMH,n.d.)
  • 4. Mind-Body Modalities • Biofeedback • Autogenic training • Guided imagery • Hypnosis • Yoga • Tai Chi • Meditation-Mindfulness, PMR, breathwork
  • 5. Guided imagery • Deliberate, directed daydreaming • Imagery is a specific kind of hypnosis, a type of meditation
  • 6. Clinical Hypnosis • Inner absorption, concentration and focused attention • Like a magnifying glass to focus the rays of the sun and make them more powerful
  • 7. Biofeedback • Trains people to improve their health by controlling certain bodily processes that normally happen involuntarily such as heart rate, blood pressure, muscle tension and skin temperature • Heart rate variability, EMG, thermal biofeedback, and EEG • Benefits- BP, headaches, anxiety, depression, pain
  • 8. Mindfulness From a mind-body perspective, mindfulness appears to "institute" a left-sided shift in frontal electrical activity to support an approach state as opposed to a withdrawal state.
  • 9. Mindfulness Meditation • Shift to left frontal dominance • Increased thickness of middle prefrontal region • Activation of middle prefrontal areas • Activation of the Anterior cingulate cortex
  • 10. Mind body practices • Increased coordination of firing • Activation of the superior temporal region • Emotion regulation • Capacity to disengage from top down brain processes—caused by enhanced function of the middle prefrontal areas of the brain that arises from mindfulness practices
  • 11. Mind • The human mind is a relational and embodied process that regulates the flow of energy and information • Knowing that our minds regulate this flow enables us to feel the reality of these two forms of mental experience and to act on them instead of get lost in them • We can learn to become more skilled at altering our mind and brain by mind body practices.
  • 12. After one month mind-body training
  • 14. Brain Plasticity • Emerging research in neuroendocrinology links stress and anxiety effects on neuronal replacement, synapse turnover and dendritic remodeling and the detrimental effects of untreated anxiety (McEwen, 2012) • This highlights the importance of effective treatment approaches
  • 15. • As Woody Allen said in the movie Manhattan,"You know I can't express emotions. I internalize, I grow a tumor."
  • 16. Freud
  • 17. neurogenesis • 5-10K neurons each day average adult done in animal models • Impacts neurogenesis—stress inhibits growth • Physical exercise enhances growth
  • 18. Mental exercise • Short amounts of practice can help • If stop practicing after 2 weeks affects
  • 19. Emotion Regulation • Can be taught and aquired • Important to manage everyday life • Resilience maintenance of high levels of well being in the face of adversity • Positive emotions is associated with better health • Brain heart synchronicity in certain kind of meditation-compassion meditation a fairly dramatic synchronicity not in novices
  • 20. • Neurons that fire together wire together
  • 22.
  • 23. 5 Major Diagnostic Groups • Generalized anxiety • Panic attacks • Phobias • Obsessive compulsive disorder • Post traumatic stress disorder
  • 24. Conventional treatment • Psychopharmacology -complete list of FDA approved found at NIH website • Antidepressants -SSRI/SNRI, tricyclics, MAO, Benzos, B Blockers • Psychotherapy -talk therapy, cognitive behavioral therapy -caution with internet based therapy
  • 25. Integrative Care for Anxiety • Important to screen for any medical conditions that could mimic anxiety • Examine meds and supplements • Lifestyle changes • Mind body or psychotherapy approaches • Discuss risks and benefits of any therapy
  • 26. Disease States assoc w anxiety • Hypo/hyperthyroidism • Vestibular dysfunction • CHF/COPD/PE • Cardiac arrhythmia • Pheochromocytoma • Pneumonia • Hyperventilation • Vit B12 Deficiency • Porphyria • Neoplasm • Encephalitis • Hyperadrenalism • Substance OD • Munchausen's • Lead or pesticide toxicity
  • 27. Exacerbating Factors • Sympathomimetics • Beta agonists • Corticosteroids • Thyroid hormone supplement • Estrogen therapy • ADHD drugs • CAFFEINE/energy drinks • SAM-e
  • 28. Lifestyle Factors • Physical Activity • Herring MP, Jacob ML, Suveg C, Dishman RK, O'Connor PJ. Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A Randomized Controlled Trial. Psychother Psychosom. 81(1):21-28. Nov 22, 2011 • Ströaut;hle A, Stoy M, Graetz B, Scheel M, Wittmann A, Gallinat J, Lang UE, Dimeo F, Hellweg R. Acute exercise ameliorates reduced brain-derived neurotrophic factor in patients with panic disorder. Psychoneuroendocrinology 35(3):364-8 Apr, 2010Nutrition Nutrition Cheatham RA, Roberts SB, Das SK, Gilhooly CH, Golden JK, Hyatt R, Lerner D, Saltzman E, Lieberman HR. Long-term effects of provided low and high glycemic load low energy diets on mood and cognition. Physiology & behavior 98(3):374-9 Sep, 2009 • Bercik P, Denou E, Collins J, Jackson W, Lu J, Jury J, Deng Y, Blennerhassett P, Macri J, McCoy KD, Verdu EF, Collins SM. The intestinal microbiota affect central levels of brain-derived neurotropic factor and behavior in mice. Gastroenterology.141(2):599-609 2011 Aug • Sleep • van der Helm E, Yao J, Dutt S, Rao V, Saletin JM, Walker MP REM Sleep Depotentiates Amygdala Activity to Previous Emotional Experiences. Curr Biol. Nov 22, 2011 • Gujar N, McDonald SA, Nishida M, Walker MP. A role for REM sleep in recalibrating the sensitivity of the human brain to specific emotions. Cereb Cortex. 21(1):115-23. Jan, 2011
  • 29. Mind-Body Techniques for Anxiety • Mindfulness and meditation • Yoga • Prayer/Spirituality • Biofeedback • Hypnotherapy • Massage • Music Therapy • Energy Medicine • Aromatherapy

Editor's Notes

  1. Langlieb AM, Kahn JP. How much does quality mental health care profit employers? J Occup Environ Med. 2005 Nov;47(11):1099-109. National Institute of Mental Health (NIMH). Any Anxiety Disorder Among Children. [Web page]. NIMH Web site. Accessed December 5, 2011.
  2. Subsequent surveys began showing that guided imagery was one of the more frequently used CAM therapies in oncology. Henry Bennett, a behavioral anesthesiologist, published a gold standard, randomized, placebo-controlled, double-blind study with 335 surgery patients and four different audio interventions, showing that the guided imagery alone significantly reduced blood loss, pre- and post-op anxiety and length of hospital stay.study by Blue Shield of California showed that this same guided imagery reduced cost per hysterectomy by an average of $2003.07 per procedure. Hospital-based guided imagery programs for surgery patients became commonplace. Along with the Health Journeys programs, the imagery protocols of Peggy Huddleston and Leslie Davenport became widely used.With MRI's of stroke and rehab patients demonstrating how imagining movement results in the same neurons firing as with actual movement; blood assays showing increased immune activity generated by imagining NK and T-cell proliferation;
  3. (Nakao, 2003), showed that only relaxation-assisted biofeedback significantly decreased both SBP and DBP compared with sham Heartmath, NeurofeedbackCoherence Iswhen HRV waveform oscillates at a frequency of 0.1 Hz, synchronous with respriation Rate. Vagal activity, is increased, baroreceptors are stimulatedLehrer PM, Vaschillo E, Vaschillo B, Lu SE, Eckberg DL, Edelberg R, Shih WJ, Lin Y, Kuusela TA, Tahvanainen KU, Hamer RM. Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic medicine 65(5):796-805 Sept-Oct, 2003
  4. 225 chronic pain (Back pain, HA, neck pain)patients- mean duration of pain 8 yrs. 60-72% moderately to greatly improved. 86% felt they had gotten something of lasting importance from the experience.Kabat-Zinn J, Lipworth L, Burney R, et al. Clin J Pain 2,159-73. 1987Anxiety- 24 patients w panic or generlized anxiety20/22 showed significant improvement on Beck and Hamilton anxiety and depression scale; significant decrease with panic attacks. Gains maintained after 3 years.In another setting, two randomized controlled experimental studies on students (medical, premedical, and behavioral science) with no known medical or psychiatric diagnoses showed improvement in a variety of psychologic parameters (decreased anxiety and depression, increased empathy, sense of control, and measure of spiritual experiences) (Astin, 1997; Shapiro, 1998Similarly a randomized wait-list controlled study of 90 cancer patients showed improvement in depression, anxiety, anger, and confusion and fewer physical symptoms (Speca, 2000
  5. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF. Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine 65(4):564-70 Jul-Aug, 2003Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, McGarvey M, Quinn BT, Dusek JA, Benson H, Rauch SL, Moore CI, Fischl B. Meditation experience is associated with increased cortical thickness. Neuroreport 16(17):1893-7 Nov, 2005Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychological bulletin 132(2):180-211 Mar, 2006
  6. “[A]t this point, we do not have definitive data to suggest how focusing attention in the present moment may harness neural circuits in a particular way, nor why these potential attentional mechanisms would result in such improvements in physiological, psychological, and interpersonal well-being” Dan Seigel
  7. Further, the exertion of willful effort generates a physical force that has the power to change how the brain works and even its physical structure. Dr Schwartz calls this “directed mental force.” In 1986, Sir John Eccles, a Nobel prize-winning Australian physiologist proposed that the probability of NT release depended on quantum mechanical processes, which can be influenced by the intervention of the mind.
  8. Tang YY, Lu Q, Geng X, Stein EA, Yang Y, Posner MI. Short-term meditation induces white matter changes in the anterior cingulate. Proceedings of the National Academy of Sciences of the United States of America 107(35):15649-52 Aug, 2010
  9. McEwen BS, Eiland L, Hunter RG, Miller MM. Stress and anxiety: structural plasticity and epigenetic regulation as a consequence of stress. Neuropharmacology.62(1):3-12. Jan, 2012We can use the power of the mind to change the firing patterns of the brain and thereby alter our feelings, perceptions, and responses.
  10. When Freud listened to his hysterical patients, the patients themselves revealed the deeper layer of their suffering and the underlying currents of their physical symptoms and resultantly, meaningful symbolic connections began to emerge. When patient's minds were encouraged to speak aloud about previously resisted or denied truths about their situation, their bodies no longer had to speak those truths through physical symptoms.Returning to the impact of mind on body, the “body that speaks” narrative explores the impact of the mind on the body and more specifically, the impact of the subconscious mind, and we shall see, mind-body approaches/modalities can have the impact of shifting the interface between the subconscious and the conscious mind. The end result to this shift is that awareness is augmented so that more is in the field of awareness, and one is more aware of choices that are possible in the moment that are supportive to health, balance, and vitality.
  11. Positive emotion assoc with Cortisol diurnalHigher in morning than eveningThose who fail to recover to lower level at night have more health issuesStanford paper mets breast ca cortisol not down at end of day died sooner
  12. Dr. Schwartz had his OCD patients engage in intensive self-directed neuroplasticity through what he called Relabeling, Re-attributing, Refocusing, and Revaluing (the 4 Rs). Patients who undertook this therapy experienced considerable relief from OCD symptoms and their brain scans indicated a lasting realignment of brain-activity patterns. They were able to reorganize their brains by intentionally modifying their thoughts and behaviors. The important point for Schwartz is not simply that modified thoughts and behaviors permanently altered patterns of brain activity, but that such modifications resulted from, as he calls it, “mindful attention”—conscious and purposeful thoughts or actions in which the person adopts the stance of a detached observer (Schwartz, 2002)
  13. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF. Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine 65(4):564-70 Jul-Aug, 2003Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, McGarvey M, Quinn BT, Dusek JA, Benson H, Rauch SL, Moore CI, Fischl B. Meditation experience is associated with increased cortical thickness. Neuroreport 16(17):1893-7 Nov, 2005Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychological bulletin 132(2):180-211 Mar, 2006
  14. 6 wk study 30 women 2x weekly, controls waitlisted: worry symptoms signif reduced in exercise group 60%resistance, 40%aerobicBrain Derived neurotrophic factor BDNF protects neurons and encourages growth and maturation. Low levels implicated in anxiety depression Signig improvement after 30 min exercise.Chronic stressinduces hypothalamus=pituitary-adrenal axis Increased cortisol and exercise improves thisCaffeine/glycemic load46 adults at Tufts showed worsening mood on HG load diet as opposed to LG load dietGut flora studies in mice demonstrate a complex interaction b/t gut flora and BDNF-flora can influence behavior independent of factors ANS, Gastrointestinal neurotransmitters, inflammationStrong association of insomnia with anxiety and mood disorders.Absence of REM is common with anxiety and studies show decreased
  15. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 78(2):169-83. Apr, 2010Vollestad J, Sivertsen B, Nielsen GH. Mindfulness-based stress reduction for patients with anxiety disorders: evaluation in a randomized controlled trial. Behaviour research and therapy 49(4):281-8 Apr, 2011Ospina MB, Bond K, Karkhaneh M, Buscemi N, Dryden DM, Barnes V, Carlson LE, Dusek JA, Shannahoff-Khalsa D. Clinical trials of meditation practices in health care: characteristics and quality. J Altern Complement Med. 14(10):1199-213. Dec, 2008Patients rating higher Gastrointestinal specific anxiety correlate with higher anxiety, inc GI symptoms and inc depression Jerndal P, Ringström G, Agerforz P, Karpefors M, Akkermans LM, Bayati A, Simrén M Gastrointestinal-specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterol Motil. 22(6):646-e179. Jun, 2010