Quality Stress Management Course

8 Minute Meditation for Stress Relief

When you skillfully learn to handle your stress, not only does your stress level go down, but your quality of life goes up. The skills you will learn in the 8 Minute Meditation Stress Reduction Program have a global impact. Just think about it: If you lower your stress, you feel calmer. Your heart rate is normal, your digestive and other systems are working normally, the way they were designed to. Your entire body and mind are in harmony, functioning to give you the most aware, joyful experience you can have. There's nothing in the way. Then, the world may appear totally different. Colors may seem more vivid. Your shoulders seem lighter, like some great burden has been lifted from them. Life is just good again. Read more...

8 Minute Meditation for Stress Relief Summary


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Autogenic Training for Stress Management in Epilepsy

AT was integrated into a stress management program for 12 patients with epilepsy at The Epilepsy Institute in New York. The patients were taught four different methods of relaxation, including diaphragmatic breathing, progressive muscle relaxation, imagery visualization, and AT. The effectiveness of the program was studied during its 1-year duration. The results have not yet been analyzed completely, but preliminary results indicate that some patients who practiced AT experienced a reduction in seizure frequency. More controlled research with a larger sample is needed before definitive conclusions can be made.

Stress Management And Psychiatric Interventions

Stress management techniques such as relaxation training, cognitive restructuring, and coping skills training may reduce negative mood states in HIV-positive persons by lowering physical tension and increasing self-efficacy (Antoni, 2003a). These affective changes are thought to be accompanied by an improved ability to regulate peripheral catecholamines and cortisol via decreases in ANS activation and improved regulation of the HPA axis, respectively. Neuroendocrine regulation may be associated with a partial normalization of immune system functions, providing more efficient surveillance of pathogens such as latent viruses that may increase HIV replication and enhance vulnerability to opportunistic infections or neoplasias. This normalization of stress-associated immune system decrements may ultimately forestall increases in viral load and the manifestation of clinical symptoms over extended periods. A relatively small number of controlled trials have examined the effects of...

Limits of Western Medicine and Research

For children and adults with epilepsy, approaches outside the traditional boundaries may improve seizure control. For example, stress is reported to be a factor that can provoke seizures in a large number of epilepsy patients. Stress can be reduced through a variety of approaches. Many complementary and alternative therapies reviewed in this book specifically address stress reduction. Further, relaxation techniques can provide some sense of control over the disorder. Traditional medicine should consider nonmedical healing and work to identify places where it may be helpful. Although benefits likely extend beyond stress reduction, this is one area that is worthy of further study in the near future.

Effects Of Stress On Visceral Pain

When nervous, one feels butterflies or a pit'' in the stomach. Gut wrenching'' emotions can also evoke profound changes in heart rate, breathing, and all other visceral functions. There is little doubt that the emotional state can alter sensations from and function of the viscera but the reverse situation also appears to be true visceral pain evokes strong emotions, stronger than those evoked by equal intensities of superficial pain. This has been demonstrated in numerous observational studies, but was most definitively demonstrated in the study by Strigo et al. (16) (discussed above), which compared balloon distension of the esophagus with thermal stimulation of the mid-chest skin. Matched intensities of both distending and thermal stimuli were presented and the magnitude of emotional responses was then quantified using several tools designed to dissect out the affective components of clinical pain. Word selection from the McGill Pain Questionnaire suggested a stronger affective...

Relaxation Techniques

A number of strategies can reduce stress and help patients cope, even without psychotherapy. (Some are reviewed in other chapters of this book.) Progressive muscle relaxation frequently credited to Edmund Jacobson, who published his book Progressive Relaxation in 1929 (7) is one of the most well known and widely taught relaxation techniques. Although relaxing sounds simple and is clearly an idea that has been around for many years, being able to relax, especially when feeling stressed or pressured, is a skill. It is possible to become more proficient at relaxation and more aware of specific muscle groups that may be more tense than they should be by progressively tightening and then relaxing specific muscle groups. Relaxation can only be used to maximum advantages if the patient is able to recognize the signs of stress and tension. Psychotherapy, stress management, and relaxation can all help people with epilepsy but should not be expected to cure epilepsy or replace treatment with...

Emotions Coping and Well Being

Some studies have noted that older people tend to cope with stressful events in different ways than do younger adults older people rely more often on emotion-focused forms of coping, as opposed to active, problem-solving approaches. Emotion-focused coping is more passive than confrontational, is more individual than interpersonal, and is oriented toward control of distressing feelings rather than toward alteration of stressful situations. Examples of emotion-focused coping include distancing from the problem, accepting responsibility, and reappraising the problem positively. However, other research has pointed out that the problem situations that older people face are often less changeable than those of younger adults, and when the type of problem is equated across ages, differences in coping styles are reduced or eliminated (Staudinger and Pasupathi 2000). Locus of control is another dimension that affects response to stressful situations. For example, older people who believe that...

Scientific Foundations

From nutrients in the liver, thus providing fuel for cells when the body is under stress. When the stressful situation ends, adrenal hormone production returns to normal. The adrenal glands usually produce about 20 milligrams of Cortisol per day, mostly in the morning, but they can produce five times that much when needed.

Aromatherapy and Hypnosis

Many patients with a genetic predisposition for epilepsy or electrically irritable lesions in the brain never have seizures. Good evidence suggests that first seizures in patients predisposed to epilepsy may occur during periods of stress or during significant life events. Once the epileptic process has been triggered, it may become self-perpetuating or, in some cases, seizures may continue to be induced by stressful circumstances.

Benefits and Precautions

A controlled pilot study of stress management training of elderly patients with congestive heart failure. Prev Cardiol 2002 5(4) 168-172. 18. Roth DL, Goode KT, Williams VL, et al. Physical exercise, stressful life experience, and depression in adults with epilepsy. Epilepsia 1994 35(6) 1248-1255. 27. Panjwani U, Gupta HL, Singh SH, et al. Effect of Sahaja yoga practice on stress management in patients of epilepsy. Indian J Physiol Pharmacol 1995 39(2) 111-116.

The Effect of Physical Illnesses on Fitness for Interview

The presence of any physical illness renders an individual more vulnerable when faced with a stressful situation, such as a custodial interrogation. Features, such as anxiety or depression, affect a person's ability to function during the police interview, and physical illness especially if severe is as likely to cause anxiety and depression as any other form of stress (87). The severity of the emotional response will depend on the nature of the illness itself, the personality of the individual, and social circumstances. Suspects who are already coping with physical illness are more likely to focus on the short-term consequences of their behavior than the long-term outcomes, thus increasing the risk that they might provide a false confession (52).

Behavioral Sensitization In Adult Animals

Antelman et al. (64,65), Robinson et al. (66,67), and Kalivas and Stewart (68) have shown the potential bidirectional cross-sensitization between sensitization induced by psychomotor stimulants and some types of environmental stressors. This is of considerable interest in relation to the high comorbidity of substance abuse and the affective disorders (28,69,70), both of which have been linked to stressful life experiences in their initiation, progression, and in the precipitation of relapse. Thus, cocaine sensitization can be used both as a model for psychomotor stimulant abuse with long-term effects on gene expression and as a potential model of the effects of recurrent stressors on these and related neural systems.

Test or Performance Anxiety

Many children report a greater frequency of pain symptoms prior to a stressful event or competitive activity at school, including athletic events and examinations (4). Such circumscribed anxiety may benefit from the use of positive self-coaching statements, such as, I know I can do it if I just do my best. Negative self-statements, such as What if I fail , should be eliminated. The use of adaptive self-statements is important to enhance coping strategies and diminish distorted negative thoughts when approaching stressful tasks.

Evidence for Altered Psychological State

Certain stressful life events have been associated with both the onset and exacerbation of a number of disorders of the GI tract including FGD (109), PI-IBS (110), and inflammatory bowel disease (111). Anxiety, somatization, neuroticism, hypochondriasis, and preceding adverse life events have all been reported to increase the risk of developing IBS after gastroenteritis (110,112). Both early-life stress in the form of abuse and an acute episode of extreme stress in adult life such as rape have been suggested as important risk factors for the development of FGD (113,114).

Modulation of Brain Responses by Pharmacological Treatments

Morgan et al. studied 22 females with pain-predominant IBS (Rome II positive, 11 with diarrhea, 7 with constipation, and 4 with alternating bowel habit) (75). No patients had significantly elevated symptoms for depression, anxiety, and general psychological distress on the Symptom Check List-90 (SCL-90) instrument. The study was designed as a randomized, placebo-controlled, double-blind crossover trial. Patients initially took 25 mg (one week), and later 50 mg, of amitriptyline at bedtime for three weeks, followed by a three-week washout before switching over to the alternate treatment. Cerebral activation during controlled rectal distension (15, 30, and 50 mmHg distension pressure) was compared between placebo and amitriptyline groups by fMRI. Distensions were performed alternately during auditory stress (babies crying) and relaxing music (stress reduction tape), and a total number of nine distensions in random order were given during each condition. Subjective ratings of rectal pain...

Posttraumatic Effects

A recently emerging literature on stress, threat, and trauma provides a new and different paradigm for examining and understanding emotional responses to life-threatening situations like cancer. Recent conceptualization of cancer as a psychological trauma has furthered our understanding of the long-term psychological effects of cancer and its treatment, with studies assessing the symptoms of posttraumatic stress indicating that anywhere from 10 to 30 meet the criteria for posttraumatic stress disorder, and an additional proportion meet the criteria for at least one trauma symptom 65 . Reporting symptoms of posttraumatic stress appears to be associated with survivors' retrospective subjective appraisal of life threat at the time of treatment and the degree to which the survivor experienced that treatment as hard or scary, as well as with general anxiety, history of other stressful life experiences, less time since end of treatment, female gender, and lack of family or social support.

Modulation of Visceral Pain by Stress

Stress influences the manifestations or the development of visceral pain in IBS patients (Table 1) (5,8,9). For instance, IBS patients exposed to an acute psychological or physical stressor exhibit increased visceral sensitivity to rectal electrostimulation (10). Convergent clinical reports established that stressful life events before or after an acute enteric infection are strong predictors of acquiring postinfectious IBS (26). Childhood trauma by biopsychosocial stressful factors (neglect, abuse, loss of caregiver, or life threatening situation) impact the susceptibility to subsequently develop visceral pain and comorbidity with anxiety, depression, and emotional distress (34-36).

Binary Concept Of Pain And Addiction

For example, stress can increase pain (8). A pain patient who takes inappropriate additional doses of his or her opioid medication after stressful situations to treat anxiety must be educated that this is not the correct response to the situation. Behavior therapy to improve coping skills is indicated. Specific pharmacotherapy with medications that are less likely to be misused, such as the Selective Serotonin Reuptate Inhibitor (SSRI) antidepressants or tiagabine hydrochloride (Gabitril ) also may be indicated to treat the anxiety. This is an appropriate biopsychosocial approach to the problem that can lead to a sustainable solution to the patient's problem.

Companion Animals and Human Health

Studies of Alzheimer's disease patients showed that animal-assisted therapy (especially with dogs) is associated with less aggression, agitation, and wandering, and more social interaction (7-10). Companion animals also have benefits for caregivers (11). Although people with Alzheimer's disease may have seizures as a consequence of the condition, studies of the effect of this therapy present little comment on seizure frequency. Work with people who have spinal cord injury suggests that animal-assisted therapy may provide sensory stimulation, reduce stress, increase self-esteem, and help the patient express feelings (12). At least one report documents the benefits of pet ownership for people living with HIV infection pet ownership is said to promote self-esteem although the evidence for this and for the use in spinal cord injury rehabilitation is mainly anecdotal (13).

Diagnosis of insomnia

In a recent study of a large group of people, representative of seven European countries, about 11 complained of nonrestorative sleep 40 . The complaints concerning nonrestorative sleep are indicative of hyperarousal not allowing relaxation during sleep. Nonrestorative sleep was associated with the presence of anxiety, and stressful life. Furthermore, the prevalence was higher in the United Kingdom (16.1 ), and Germany (15.5 ), than in Spain (2.4 ). By these findings one may conclude that the more society is following the modern western pattern of life, the harder the stress management becomes, and consequently sleep disturbances become more common.

Pharmacological Interventions And Treatment Implications

Methadone, a long-acting opioid medication with effects that last for days, causes dependence, but because of its sustained stimulation of the mu receptors, it alleviates craving and compulsive drug use. In addition, methadone therapy tends to normalize many aspects of the hormonal disruptions found in addicted individuals (Kling et al., 2000 Kreek, 2000 Schluger, Borg, Ho, & Kreek, 2001). For example, it moderates the exaggerated cortisol stress response (discussed earlier) that increases the danger of relapse in stressful situations.

Cognitive Behavioral and Nonpharmacological Treatments

Drug supplies and paraphernalia, breaking off relationships with dealers and drug-using comrades, limiting finances, changing one's telephone number and or geographic location, and structuring one's time during all waking hours. Instead of simply replacing cocaine's central role in one's existence, emphasizing lifestyle changes such as stress reduction, wellness, exercise, and leisure activities is important. This may be more difficult for persons of lower socioeconomic groups and or those with an earlier onset of addiction. These persons lack the knowledge, experience, and resources to make these changes. Such patients may need linkage to other social services and habilitation, in addition to the rehabilitation just discussed. The involvement of significant others in the treatment of cocaine use disorders can have a positive impact. For instance, Higgins, Budney, Bickel, and Badger (1994) recently showed that patients who had family involvement were 20 times more likely to complete...

Adjustment Disorder with Depressive Features

Leserman and colleagues (2002) documented the impact of psychosocial factors such as stressful life events, depressive symptoms, and lack of social support on HIV illness progression, but these studies have not been limited to the diagnosis of adjustment disorder. Therefore, while providing valuable inferential information on the role of adjustment disorder, they are limited to subjects with more profound depressive illness as well as chronic time spans extending beyond the 3-month diagnostic limit (Evans et al., 1997 Leserman et al., 1999, 2000, 2002).

Comonomers the property changers

This monomer (diol) is used to broaden the processing window, increase line speeds, slow the crystallisation rate and reduce stress in biaxially orientated structures. It is used in concentrations ranging from 1 up to about 18 . The higher concentration PET is usually referred to as PETG and is mainly used for extrusion blow moulding and sheet extrusion. Polymers from PTA and CHDM are approved in the US by 21 CFR 177.1315 recently the use of CHDM as comonomer in PTA-EG polymers has been listed in the US FDA regulation for PET (21 CFR 177.1630). Moreover, the use of CHDM has been approved in Europe for plastics intended for food contact applications since the first directive 90 128 EC.

Psychosocial and Supportive Care

Medical professionals caring for the adolescents and young adults may be used to the psychosocial problems more common in either younger children or older adults. Extra effort, including patient and family support groups specifically geared to this age bracket, should be made to uncover and address these needs, to increase compliance, reduce stress, and improve the quality of life during cancer therapy. Established theories of developmental behavior should be used to systematically improve our care of these patients. As Christine Eiser states, only by seeing adolescents with

Youth Smoking Cessation

Reviews of quit-smoking programs for adolescents painted a bleak picture (Burton, 1994 Digiusto, 1994 Sussman, et al., 1999). Retention and recruitment of students were problematic, and end-of-group quit rates were modest. Many studies failed to use appropriate control groups, objective measures of smoking status, and long-term follow-up of graduates (Sussman et al., 1999). Teenage focus groups have provided insight into the nature of smoking cessation programs that appeal to youth (Balch, 1998). Some suggestions were to (1) highlight the seriousness of quitting smoking before becoming an adult (2) include mood control and stress management (3) help teen smokers deal with

Acupuncture and Traditional Chinese Medicine

There are five components of traditional Chinese medicine. In addition to acupuncture, they include traditional Chinese herbs, diet and nutrition, exercise, stress reduction and counseling, and massage. T'ai chi, which is discussed elsewhere in this book, is also a component of traditional Chinese medicine. This chapter discusses acupuncture as well as two types of herbal medicine Asian herbal medicine and Asian proprietary (or patent) medicine.

Treatment of insomnia

Insomnia may be distinguished in two different states. The first is a state of transient insomnia due to an acute event, while the second is the state of chronic insomnia. What is required in the first case is a treatment lasting for a few days only, i.e., for the period of the underlying event that caused insomnia. Such a case requires a medicine able to induce sleep immediately, while its effect quickly diminishes, so that the individual does not experience after effects when awakened. In the case of chronic insomnia, i.e. , when a person cannot relax in order to fall asleep, the therapeutic effort should be aimed at the reduction of chronic stress. The objective is to reduce the level of arousal when going to bed. Thus, the treatment may be more on a psychological basis, employing psychotherapeutic techniques, so that the patient can control the levels of his or her stress. In fact, all psychotherapeutic techniques, ranging from those of a psychoanalytical nature to those of...

Health And Daily Living Form

Purpose To focus on the social resources people use to prevent and adapt to stressful life circumstances Stressful Life Circumstances The nature of individual coping responses to stressful life events was explored in a representative adult community sample. Two approaches to the classification of coping strategies were operationalized. Using these measures, small but significant gender and contextual differences in coping were identified. Mood and symptom levels were related to coping responses and to quantitative and qualitative measures of social resources. Measures of coping and social resources attenuated the relationship between undesirable life events and personal functioning.

Diagnostic Evolution

Has been created in a litigious Western society that seeks to place blame and identify victims and perpetrators. Skeptics argue that PTSD is not found in non-Westernized cultures and contend that normal human reactions to a stressful event only become pathological when diagnoses are applied to them. At their worst, these opponents propose that diagnosing posttraumat-ic reactions has iatrogenic effects on those who are diagnosed.

Stress and Epilepsy

Patients with epilepsy frequently report that stress and stressful life events influence the frequency and severity of their seizures and that epilepsy itself can cause significant stress. Despite the apparent relationship between stress and epilepsy, a relatively poor understanding exists of the specific means by which stress affects the occurrence of seizures. Clinical studies provide strong anecdotal information and evidence of stress-related seizure activity, but these studies are few and inconclusive. Basic scientific research has delineated many of the relevant anatomic pathways of the brain and the potential physiologic mechanisms that could be affected by stress, including how changing concentrations of various hormones and neurotransmitters can affect seizure threshold. Although the information from these studies is intriguing, it remains incomplete and further research is necessary.

Posterior Pituitary

A 74-yr-old male first presented in 1990 for evaluation of recurrent syncope. He had six episodes of syncope since 1979, and these were usually associated with stressful events, recent alcohol intake, or rapid standing. Neurologic evaluation, including electroencephalogram (EEG) and head computed tomography (CT), were unrevealing, and he was diagnosed with vasovagal syncope. Subsequent cardiac evaluation with Holter monitoring and tilt table testing also supported a diagnosis of vasovagal syncope. At his initial presentation in 1990, he was found to have serum sodium 130 mEq L, potassium 4.1 mEq L, blood urea nitrogen 13 mg dL, and serum creatinine 1.1 mg dL. On review of his past medical records, it was apparent that his hyponatremia was longstanding, with serum sodium concentrations ranging from 128-134 mEq L over the past 20 yr. He was on no medications. Further evaluation revealed a random urine osmolality of 717 mOsm kg H2O and a urine sodium of 71 mEq L when his serum sodium was...

Psychologic Stress

Although the psychological and medical literature contains many studies demonstrating that excessive stress and the inability to handle stress are harmful, both physically and mentally, unfortunately, stress is a normal part of life. Given the choice, most of us would not choose a completely stress-free existence, as that life would likely be void of challenges. People react differently to the same stressful situation for many reasons, some outside of their control. Studies of infants suggest that differences in temperament are apparent even at a very young age. Some of these differences seem to persist throughout life. Parents with more than one child point out that almost from birth their children are dramatically different in their ability to tolerate change and stimulation. Patients frequently tell us that being high-strung or nervous runs in their family, and it appears that both genetic (inherited) and environmental factors play a role in an individual's ability to handle...


Some studies estimate that up to 70 of patient visits to a primary care physicians are for stress-related disorders. All chronic illnesses including hypertension, diabetes, and coronary artery disease are adversely affected by excessive stress. It is widely accepted that stressful circumstances exacerbate seizures. Spector and colleagues administered a structured interview to 100 patients with epilepsy in which stress and depression were cited as the most important seizure precipitants (1). Similarly, another study of 149 adults with epilepsy identified psychologic stress as the most important factor in provoking seizures (2). Abnormal structural changes to some brain regions have even been demonstrated in animals exposed to prolonged stress (3). Much of this book is devoted to methods of reducing stress and harmful responses to it. It is clear that there are many ways to achieve the same goal. Whether we use progressive relaxation, neurofeedback, yoga, exercise, or another method,...

Coping with Stress

Most of us would benefit from better stress management. A simple and quick way to deal with psychologic symptoms is to take medication that reduces anxiety and depression however, this may not be the best long-term solution because medications can cause unpleasant side effects, benefits may stop once the medication is discontinued, and medication may mask the underlying problems that will not change by taking a pill. A number of behavioral treatments are as effective as medication in treating depression and anxiety they do not cause unpleasant physical side effects, and they make it less likely that a person will have a relapse of symptoms in the future, even after treatment stops. Although some people clearly require treatment with medication for depression and anxiety, and many benefit from a combination treatment of psychotherapy and medication, alternatives to medication should always be considered.


Despite the relatively little amount of research on stress management and epilepsy, it is clear that better management of stress is a reasonable goal for all patients and their physicians. Recognizing that stress has a negative impact on health and well-being is an important first step. Davis M, McKay M, Eshelman ER. The Relaxation and Stress Reduction Workbook. 5th ed.

Cognitive Appraisals

Individual differences in cognitive appraisals of stressors may moderate the association between stressful life events and health status in HIV-positive persons. Specifically, one research group has demonstrated that positive illusions and unrealistically optimistic appraisals may confer health-protective benefits (Taylor et al., 2000). Results from an investigation of bereaved HIV-positive men indicated that those who engaged in cognitive processing (deliberate, effortful, and long-lasting thinking) about the death of a close friend or partner were more likely to report a major shift in values, priorities, or perspectives (i.e., finding meaning) following the loss (Bower et al., 1998). For those who were classified as finding meaning, positive health effects appeared to follow. Finding meaning predicted slower CD4+ decline and greater longevity over a 2- to 3-year follow-up period (Bower et al., 1998). Decreased cortisol is one plausible mediator of the effects of finding meaning on...

Negative Mood

Negative mood states such as depression and anxiety have been associated with additional functional impairment, mortality, and an approximately 50 increase in medical costs for persons managing a variety of chronic medical conditions (Katon, 2003). Because HIV-positive individuals are at increased risk for developing an affective or adjustment disorder across the disease spectrum (Bing et al., 2001), effectively managing negative mood may be an especially relevant task. In fact, elevated negative mood may result in decrements in immune status, HIV disease progression, and mortality (Leserman, 2003). However, the directionality of this relationship has been hotly debated. Because clinically significant reductions in HIV viral load have been observed to predict decreased distress (Kalichman et al., 2002), longitudinal investigations with repeated measurements of psychosocial and im-munologic data provide the most reliable findings on the temporal associations between negative mood and...


Stress management and psycho-neuroimmunology in HIV infection. CNS Spectrums 8 40-51. Antoni MH (2003b). Stress management effects on psychological, endocrinological and immune function in men with HIV empirical support for a psycho-neuroimmunological model. Stress 6 173-188. Antoni MH, and Schneiderman N (1998). HIV AIDS. In A Bellack and M Hersen (eds.), Comprehensive Clinical Psychology (pp. 237-275). New York Elsevier Science. Antoni M, August S, LaPerriere A, Baggett H.L, Klimas N, Ironson G, et al. (1990). Psychological and neuroendocrine measures related to functional immune changes in anticipation of HIV-1 serostatus notification. Psychosom Med 52 496-510. Antoni MH, Baggett L, Ironson G, August S, LaPerriere A, Klimas N, et al. (1991). Cognitive behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity. J Consult Clin Psychol 59 906-915. Antoni MH, Lutgendorf S, Ironson G,...

Risk Factors

As discussed in earlier sections, chronic illness in general, a few specific illnesses, and exposure to certain substances are clear risk factors for the onset of major depression in the elderly. The role of stressful life events as precipitants of major depression has been studied by several groups, although none has focused on elderly patients per se. Kendler et al. (2003) studied 98,592 person-months in 7,322 male and female twin pairs and found that the baseline risk per month for the onset of an episode of major depression was 0.6 . Of the stressful life events studied (which were categorized as loss, humiliation, entrapment, and danger), only loss and humiliation events were statistically significantly associated with onset of major depression in the month of occurrence. Loss included death, respondent-initiated separation, and other key losses, whereas humiliation included only other-initiated separation. Because old age is a time of loss, less so of other-initiated separation,...

Clinical Studies

Massage therapy is a potentially valuable way for patients with epilepsy to reduce stress, improve emotional well-being, and possibly reduce seizure activity. Dr. Bernhard M ller provides an insightful view of massage for epilepsy based on his extensive personal experience and a thorough review of the available literature. Massage has a natural place in helping people with epilepsy relax, learn to reduce stress, and possibly through self-massage, carry these positive attributes throughout their daily life. Reduced stress can likely help individuals with epilepsy decrease their seizure frequency or intensity. In Chapter 3, Stress and Epilepsy, Drs. Carol J. Schramke and Kevin M. Kelly provide an excellent overview of how stress reduction can improve seizure control. Self-massage offers a way to extend the window of time from a place one has to travel to receive therapy to the patient's hands and the patient's control. It extends the possible improvements temporally so that massage...


Aromatherapy with or without massage is gaining popularity in the medical community and with the public in general. Several small medical studies report benefits of aromatherapy for disorders such as anxiety in patients with brain tumors (1), pain reductions in the terminally ill (2), and even for itching associated with dialysis (3). One small double-blind, placebo-controlled study exists on the use of aromatherapy to reduce agitation in patients with dementia (4). A 35 reduction in agitated behavior was achieved using aromatherapy, while only 11 of the placebo-treated group responded. The common thread in all these studies is the use of aromatherapy to induce calm and help manage stress. Although no well controlled studies exist on the use of aromatherapy in patients with epilepsy, stress reduction is now a well-accepted strategy to reduce seizure frequency (5). Aromatherapy may be one means to accomplish this. Aromatherapy with or without massage is gaining popularity in the...

Yoga and Epilepsy

Yoga has developed in India over the past 5,000 years. It has exploded in popularity as a means to maintain general health, to reduce stress, and to complement standard medical therapy. Yoga literally means to yoke together or to make whole. There are several types of yoga, but the type most applicable to complementary medicine is hatha yoga or versions of it. The main components of hatha yoga are meditation, controlled breathing, and physical postures. Although elements of yoga are found in ancient Hindu spir For several decades, the physiologic and neurophysiologic effects of relaxation and meditation have been studied. Studies document physiologic changes in the muscu-loskeletal, respiratory, metabolic, and cardiovascular systems during yoga (20). These effects benefit patients with high blood pressure (21), asthma (22), and carpal tunnel syndrome (23). Additionally, yoga has measurable effects on the brain. Several studies document increased alpha waves in the EEGs of subjects...

Relaxation Therapy

There are many different types of relaxation techniques which include meditation, mind body interaction, music- or sound-induced relaxation, mental imagery, and biofeedback. Rhythmic, deep, visualized or diaphragmatic breathing may also be used. Most studies of relaxation therapies are of poor quality and provide conflicting results. There is some evidence of short-term benefit in chronic low back pain for combined cognitive therapy and progressive relaxation therapy 28 . Mindfulness based stress reduction, a learned meditation technique that has been applied to many chronic psychological and physical health conditions, appears to be associated with significant and sustained improvements in pain intensity 29 , but has yet to be subjected to adequately sized randomized trials.


We are interested in how people respond when they confront difficult or stressful events in their lives. There are lots of ways to try to deal with stress. This questionnaire asks you to indicate what you generally do and feel, when you experience stressful events. Obviously, different events bring out somewhat different responses, but think about what you usually do when you are under a lot of stress. Then respond to each of the following items by blackening one number on your answer sheet for each, using the response choices listed just below. Please try to respond to each item separately in your mind from each other item. Choose your answers thoughtfully, and make your answers as true FOR YOU as you can. Please answer every item. There are no right or wrong answers, so choose the most accurate answer for YOU--not what you think most people would say or do. Indicate what YOU usually do when YOU experience a stressful event.


A further measurement instrument is the vulnerability scale as well as the questioning about stressful situations (losses), risky behavior (alcohol, nicotine etc.), and various other parameters such as, for example, social adaptation, denial, despair, alienation, and dysphoria (74).


Psychotherapy is an excellent first-line therapy for patients suffering from mild anxiety symptoms or can be used in combination with medication for those in need of more immediate relief or those suffering from more severe symptoms. Psychotherapeutic treatments have been shown to be effective in alleviating the distress of patients suffering from anxiety disorders. A therapeutic modality should be chosen that takes into account a patient's physical and psychological symptomatology, social supports, stressors, prior therapy or medication experience, ability to cope, cultural or religious background, and goals (Zegans et al., 1994). Numerous studies have demonstrated the overall benefits of group therapy as an intervention that ameliorates symptoms ofdepression, anxiety, and distress, and enhances coping in patients suffering from chronic illnesses, including HIV (Mulder et al., 1994 Sherman et al., 2004). Cognitive-behavioral stress management has been shown to result in significant...


Stress management effects on psychological, endocrinological, and immune functioning in men with HIV infection empirical support fora psychoneuroimmunological model. Stress 6(3) 173-188. Antoni MH, Cruess DG, Cruess S, Lutgendorf S, Kumar M, Ironson G, Klimas N, Fletcher MA, and Schnei-derman N (2000). Cognitive-behavioral stress management intervention effects on anxiety, 24-hr urinary norepinephrine output, and T-cytotoxic suppressor cells over time among symptomatic HIV-infected gay men. J Consult Clin Psychol 68(1) 31-45. Cruess DG, Antoni MH, Schneiderman N, Ironson G, McCabe P, Fernandez JB, Cruess SE, Klimas N, and Kumar M (ZOOOb). Cognitive-behavioral stress management increases free testosterone and decreases psychological distress in HIV-seropositive men. Health Psychol 19(1) 12-20. Lutgendorf SK, Antoni MH, Ironson G, Starr K, Costello N, Zuckerman M, Klimas N, Fletcher MA, and Schneiderman N (1998). Changes in cognitive coping skills and social support...

Of Communication

In stressful situations the function of communication is of utmost importance. Information increases the controllability of a threatening situation if the child understands what can be done about the situation, how negative consequences can be avoided or ameliorated by his her own actions. Information thus reduces uncertainty about a threatening situation if it increases the predictability of the situation.

Double Protection

To their children than parents of children with asthma and parents of healthy children. The findings obtained were equivalent for the mothers and the fathers. We believe that, in order to be able to count their child among the lucky ones who will survive the disease, parents create an image of vitality and zest for life. This positive attribution by parents of children with cancer may be a beneficial coping strategy as long as the emotional feelings of children are not underestimated. Caregivers should be aware of this coping strategy, especially if this coping strategy is out of balance or pathological. It can also be possible that children give their parents the impression they are doing fine to protect their parents from the more negative emotions resulting from the stressful situation.

Telephone Systems

Family Help, a research program that we are currently conducting, is an example of the traditional use of telephones (6). As part of the Family Help program, we are delivering a module on pain that is designed to treat headaches (both migraine and tension-type headaches) and recurrent abdominal pain in adolescents. Family Help employs a user-friendly handbook, videotapes, and a nonprofessional coach who speaks to the adolescent patient weekly on the telephone to encourage participation in the program and to problem solve any difficulties. The coach and the participant work their way through a series of chapters on different topics that include education about the pain problem, the teaching of stress management skills, and other aspects of treatment. The coach reviews with the participant the material that the participant has read in the handbook or has seen on the videotapes. A psychologist supervises the coach. In Family Help, all contact during assessment and treatment is over the...

Other Causes

There are many other natural disease processes that could theoretically lead to sudden collapse and death. Among them is asthma, a disease that is usually unlikely to lead to sudden death if adequately treated and supervised but that may, if untreated and unsupervised and in stressful circumstances, result in the individual being found dead in their cell. Other disease processes include the development of hemoptysis, from tuberculosis or pulmonary malignancy, or hematemesis, from peptic ulceration or esophageal varices, which can be life threatening and may, because of the bleeding, be considered to be the result of trauma rather than a natural disease process. These cases should present no problem to an experienced pathologist following a full postmortem examination.


In the pharmaceutical industry of today, you can spend much of your time reading and sending e-mails, informing yourself via the intranet and internet, and going to meetings, seminars, symposia, and courses. As a result, many people feel stressed and frustrated, yet most of these activities are, in themselves, useful and necessary. We cannot blame the surrounding world, but must decide for ourselves how our time should be used. We all know this, but what can we do

Predisposing Factors

Stressful life events in the context of poor social support can heighten suicide risk (Kalichman et al., 2000 Haller and Miles, 2003). Persons with HIV infection can have distorted perceptions of illness. Just as an asymptomatic HIV-positive individual can become suicidal upon learning of his or her HIV serostatus, changes in immune parameters can also trigger a suicidal crisis. Learning that one has an increased viral load or decreased CD4 cell count can precipitate a suicidal crisis, even with reassurance that a change in medical treatment can easily reverse the situation (Alfonso et al., 1994 Haas et al., 1997).

Stress and Fatigue

Often the daily stress of modern lifestyles - a job, financial pressures, deadlines, and family responsibilities - build up to a point where it is difficult to manage. A common complaint of many adults, fatigue is excessive tiredness, inability to concentrate, and lack of energy. Fatigue can be caused by chronic stress, lack of exercise, and poor sleep patterns, often combined with an inadequate and erratic eating pattern. Prolonged fatigue and stress can have serious adverse health effects. Along with adequate rest and regular exercise, a balanced and nutritious diet can help manage stress and prevent fatigue.

Treatment Protocols

The use of music as therapy, and its potential for abating seizure activity, is still a subject for research and clinical investigation. For this reason, no standard exists for what type of music may work or how long the treatments may take. A trained music therapist who is helping an individual build self-help techniques or develop techniques for reducing stress, anxiety, or other emotional triggers that may set off their seizures may schedule weekly sessions until the individual's goals are met.


Existing measures of coping styles can be used in an ACT-consistent fashion. There is a significant relationship between methods of coping and certain forms of symptomatology (Abramsom, Seligman, & Teasdale, 1978 Fondacaro & Moos, 1987), many of which are included in the diagnosis of PTSD. The Ways of Coping Questionnaire (WOC Folkman & Lazarus, 1988), a widely used research instrument for assessing coping strategies, and the Coping Inventory for Stressful Situations (CISS Endler & Parker, 1994) are both useful instruments that tap into emotion-focused or avoidant strategies. They assess a wide range of thoughts and behaviors that individuals use to deal with stressful life experiences. Three dominant means of coping with stressful situations have been identified task-oriented, emotion-oriented (Folkman & Lazarus, 1988), and avoidance-oriented (Endler & Parker, 1994). Task-oriented coping refers to the attainment of problem resolution through conscious efforts to solve or modify the...

Exercise and Yoga

Patients with uncontrolled seizures cite stress as one of the most important seizure precipitants (1). Stress management may be accomplished through aerobic exercise and yoga, and some physicians are interested in these techniques as complementary therapies for patients with uncontrolled seizures (1,2). Unfortunately, many patients with seizures are counseled against exercise because of fear of seizure exacerbation and injury. Moreover, patients with epilepsy are often isolated and participate less in social and physical activities than the average individual (3). This chapter explores the potential benefits and risks of exercise and yoga for epilepsy.

Possible Benefits

Aromatherapy may be useful as a temporary adjunctive measure in people going through a stressful time in their lives, with a consequent increase in seizure frequency. It may also be useful in people with epilepsy who have sleep-related seizures. Finally, aromatherapy promotes more restful sleep. The case histories in the appendix to this chapter illustrate these uses.

Case Study

Clinically, there are many similarities in the diagnosis and the treatment of the MPS and sympathetically maintained pain. An interdisciplinary treatment approach is most effective in patients who have a history of chronic myofascial pain, especially if aspects of sympathetically maintained pain are also found. Physical therapy to break down the myofascial aspects of the pain is necessary, along with exercises to stretch, strengthen, and recondition the musculature and maintain normal joint and muscle mobility. The use of stress-loading activities may also be necessary, particularly if there is significant sympathetically maintained pain. Psychotherapy may be needed, along with stress management, including biofeedback-enhanced neuromuscular re-education and muscle relaxation. Neuropharmacological treatment is obviously also of extreme importance. The use of methodologies to deal with sympathetically maintained pain specifically may be needed to enable MPS to receive the needed therapy.

Treatment Strategies

The negative impact of HIV-related fatigue on quality of life has been emphasized throughout this chapter. Addressing the consequences of fatigue is also crucial to improve the patient's quality of life. Treatment of fatigue should not merely involve the restoration or amelioration of energy, but also the preservation of energy to improve the patient's level of functioning. This may entail appropriate rest, pacing of energy-consuming activities, stress reduction, meditation or relaxation techniques, aerobic exercise (if it is not contraindicated), and participation in pleasurable activities. Counseling and communication can help patients re-prioritize their activities, adjust to their limitations, and restructure their goals and expectations

Diet Allergies

Because a food once caused a sensitivity reaction doesn't mean it will continue to do so. More than three-quarters of children with food allergies grow out of them. Reducing stress can reduce susceptibility to allergies. Nutritional deficiencies may increase vulnerability to food sensitivity reactions, which can gradually clear with proper diet and prudent nutritional supplementation.

Stress Management

Stress Management

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